Double Amputation Rebound

Of all the amputations every year in the U.S., just 11% are of both legs, above the knee. Albert Hepler is one of them.

Last fall, doctors at Lehigh Valley Health Network (LVHN) had to amputate the 69-year-old Allentown man’s legs above the knees because of life-threatening problems in both limbs that developed following his hospitalization after cardiac arrest last April.

Part of Hepler’s cardiac treatment included him being temporarily placed on a heart-lung machine to help his heart rest and heal. Later, circulation and muscular problems worsened. Wounds were not healing.

“It’s amazing that he’s alive and amazing that he’s on this journey to be more functional again,” says vascular surgeon Eric Shang, MD, who amputated Hepler’s limbs. “Both of those are somewhat miraculous.”

Dr. Shang says it was matter of life over limb for Hepler, whose health problems include peripheral artery disease. “Leg problems can develop when you are in cardiogenic shock. You don’t get a lot of blood flow to your extremities,” Dr. Shang says, adding that Hepler would not have survived numerous future operations. “He needed to be done [with surgery].”

Soon after his three-hour amputation surgery, Hepler began his journey back to increased mobility, in rehabilitation at the Inpatient Rehabilitation Center at Lehigh Valley Hospital–Cedar Crest.

The goal during his 2½ weeks there was to work on general conditioning and get him to the point where he could get back home and live there safely. Things such as getting from bed to a wheelchair and using the wheelchair around his home were among the goals. There was a home evaluation by two LVHN therapists and discussions with Hepler and his family, which includes his three adult children.

People who undergo amputation above the knee require significantly more energy to move around, says LVHN physical therapy assistant Courtney Miller.

One prosthetics website noted someone with double above-the-knee amputations uses 300-500% more energy just to walk across a flat surface using prosthetic legs. Hepler is only starting his prosthetics journey.

While in inpatient rehabilitation, Hepler began using very short prosthetics with training feet, informally known as “shorties” or “stubbies” that put him just a few inches off the ground. As he begins outpatient therapy, the goal is to increase the height of those prosthetics and eventually get him to the point of getting a prosthetic leg with a knee joint.

“I want to get up in the air,” Hepler says. “I was 6 feet tall before. Now I’m nothing. It’s hard. There are a lot of things I can’t do right now. I’m sort of home bound.”

He’s intent on reaching his goals. “I’m very positive. I have to be. I need to walk again. It’s very important to me to walk. I’ve seen people do it and I know I can do this. I just need to get it in gear and walk.”

The sweet spot, Miller says, is for Hepler to be able to function around the house, be able to access what he needs and go about daily activities, without overburdening his balance. The taller the prosthetic, the bigger the balance challenge.

Hepler’s positive attitude and determination are drawing praise from his caregivers. “Al’s mindset has carried him through everything so far,” Miller says. “He was so positive. He was uplifting to other amputee patients in the rehabilitation unit, and he was willing to try anything. His confidence was awesome.”

“He’s been through a lot in a relatively short period of time,” says LVHN physical therapist Devan Rimmer. “His perseverance is incredible.”

Hepler says everyone at LVHN, to a person, was supportive and helpful. “I didn’t meet one bad person,” he says. “Everyone there was welcoming, friendly and easy to talk to. They knew what muscles to work and how to get me ready to be back home while decreasing my risk for falling.”

Hepler says self-confidence is half the battle. “You just have to have a good outlook on life and what you want to do,” he says. “I know I need to think positively and move forward if I want to walk.”

Dr. Shang says in his experience, patients such as Hepler are normally wheelchair- or bed-bound and Hepler is bucking the odds. “I’m impressed with him,” he says.

Lehigh Valley Amputee Support Group was formed in 2003 to help amputees with everything associated with their condition, from lifestyle transitions to potential help for those in financial difficulty. The group meets on the third Monday of each month, from 5-7 p.m., in ECC Room 6 at the Kasych Family Pavilion at Lehigh Valley Hospital–Cedar Crest.

For more information, contact support group coordinator Kim Bartman at 610-402-7130 or via email below.

Email Kimberly Bartman