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How Amputation Works · Stuff You Should Know

0:01
Speaker 1: Welcome to you stuff you should know from house Stuff
0:04
Speaker 1: Works dot com. Hey, and welcome to the podcast. I'm
0:12
Speaker 1: Josh Clark in the Dynamic duo Chuck Bryant, two Men,
0:19
Speaker 1: eight lambs. Yeah, that's us. Yeah, I guess so I
0:23
Speaker 1: hadn't really thought about it. We're fully intact. Yeah, and
0:26
Speaker 1: I think, Um, I think missing a limb or a
0:30
Speaker 1: finger or a toe or anything. Sure, um if, I guess,
0:34
Speaker 1: it's not something you think about until after it happens,
0:36
Speaker 1: and then it probably becomes one of the central folk
0:38
Speaker 1: I of your life. Do you know anyone missing a one? Uh? No,
0:43
Speaker 1: As a matter of fact, I don't, do you. Uh yeah.
0:45
Speaker 1: I worked with a guy at my last job who
0:47
Speaker 1: had an accident, biking accident with a truck. Not true,
0:53
Speaker 1: Not true, Go ahead. I just had to remind myself,
0:56
Speaker 1: Uh of what. Oh my brother in law's father has
1:00
Speaker 1: a part of partial finger amputation. Oh yeah, well this
1:04
Speaker 1: this fan's his arm, the whole arm. Yeah. What happened? Um,
1:08
Speaker 1: biking on the side of the road and oncoming truck
1:12
Speaker 1: the side view mirror basically clipped him at the armpit
1:18
Speaker 1: and did it take it clean off or I don't know.
1:22
Speaker 1: I'm not sure. I guess if it would have taken
1:23
Speaker 1: it clean off, they probably would have done a replantation. Yeah,
1:27
Speaker 1: we talked about Yeah, so this is a I guess
1:30
Speaker 1: the follow up in a mini suite. I like to
1:33
Speaker 1: think of it as a part of a larger suite.
1:35
Speaker 1: We've done broken bones, Yeah, we've done um replantation. I
1:41
Speaker 1: think it's called your limbs torn off? Now what? Uh?
1:44
Speaker 1: And then this one how amputation works. Yeah, that's a
1:47
Speaker 1: good it's a good nice sweet What else can we
1:50
Speaker 1: possibly add to that? I don't know, because we're gonna
1:53
Speaker 1: cover uh, sexual fetishes around limb loss and phantom limb pain,
2:00
Speaker 1: and so I think that's that's all encompassing, sir. I
2:04
Speaker 1: think this will finish it off, miss hedbird well encompassingly.
2:09
Speaker 1: Really that was one of his bits. Uh, Chuck, Yes,
2:15
Speaker 1: have you surely I know that you've heard of Aaron Rollston. Yeah,
2:20
Speaker 1: we saw the movie and everything. There's a hundred twenty
2:22
Speaker 1: seven hours, right, um, yeah, I think that's right the
2:26
Speaker 1: name of the movie. Yeah, I'm doubting it all of
2:28
Speaker 1: a sudden, the number of hours. Yeah, good movie. Did
2:31
Speaker 1: you see it? Oh? Yeah, it was great. Yeah, James
2:33
Speaker 1: Franco is just like, I'm doing so great in the
2:36
Speaker 1: middle the movie, didn't He look at the camera, He's like,
2:39
Speaker 1: aren't aw I like that guy? Yeah? I do too,
2:42
Speaker 1: But he likes himself as well. Yeah. And hey, Danny Boyle,
2:46
Speaker 1: he makes a great movie. Is that Who directed that? Yeah?
2:49
Speaker 1: Like he's all over the map, like genre wise, And
2:52
Speaker 1: I really have appreciation for people that don't make the
2:54
Speaker 1: same movie over and over, you know, hats off for that.
2:58
Speaker 1: Um have you seen her? Yeah? I just saw it.
3:01
Speaker 1: That's a good movie. I was surprised that how good
3:04
Speaker 1: it was. I thought it was. I loved it. Yeah,
3:07
Speaker 1: So okay back to hundred twenty seven Hours. That movie
3:10
Speaker 1: by Danny Boyle is about a real life incident that
3:13
Speaker 1: happened to a guy named Aaron Ralston in two thousand three.
3:16
Speaker 1: In May of two thousand three, he was a and
3:20
Speaker 1: I take it he still is a real like outdoorsy
3:23
Speaker 1: go getters or can't keep me down kind of guy,
3:26
Speaker 1: very independent spirit, so much so that he went canyoning
3:30
Speaker 1: by himself, um, in May of two thousand three, and
3:34
Speaker 1: while canyoning, there was a uh shift with one of
3:39
Speaker 1: the boulders that he was leaning on. Or next two
3:42
Speaker 1: or something, and he slipped down into a crevas so
3:46
Speaker 1: what it was, and a boulder landed on top, wedging
3:49
Speaker 1: his arm in there yet Okay, I haven't seen the
3:51
Speaker 1: movie in a little while. Plus I wasn't there when
3:53
Speaker 1: it happened. Um, and so he's he's trapped like alone,
3:58
Speaker 1: no cell service, I firem or correctly. Um, he was
4:02
Speaker 1: just totally screwed as much as a person could be screwed.
4:06
Speaker 1: The one saving grace that Aaron Ralston had. The two
4:09
Speaker 1: saving graces that Aaron Ralston had was a pocket knife
4:14
Speaker 1: and nerves of steel. Yeah. I'm glad you said that
4:18
Speaker 1: because I was like, if he doesn't say intestinal fortitude
4:20
Speaker 1: or something like that, then I have to add a
4:22
Speaker 1: third thing. Yeah, because I mean there's not I don't
4:26
Speaker 1: think that that many human beings can pull that off.
4:30
Speaker 1: So we should say for those of you who haven't
4:32
Speaker 1: seen the movie, you should see it anyway. But he
4:35
Speaker 1: cuts his own handoff, He cut a portion of his
4:38
Speaker 1: arm off. He did what's called a lower extremity amputation.
4:42
Speaker 1: Oh I thought that'd be an upper upper. Yeah, that's
4:45
Speaker 1: what I meant. I was thinking lower on the arm
4:47
Speaker 1: and stupid. But um, Yeah, he without any sedation whatsoever,
4:54
Speaker 1: after having gone about five days without water, a few
4:56
Speaker 1: days without water. He was trapped there for five days
4:59
Speaker 1: with no hope that he was going to be helped
5:01
Speaker 1: us out in the middle of nowhere. Um, he broke
5:04
Speaker 1: his arm. And then after he broke his arm, he
5:09
Speaker 1: cut through the skin and the tendons and the muscles
5:12
Speaker 1: and all the sinew around, you know, through the break
5:16
Speaker 1: and the bones, and then cut his his lower arm off. Yeah.
5:20
Speaker 1: And remember he had dulled his knife from trying to
5:24
Speaker 1: chip away at the stone for days and I forgot
5:27
Speaker 1: about that. Yeah, So if he had have done it initially,
5:29
Speaker 1: it would have been easier. So he had like this
5:32
Speaker 1: dull blade. Yeah. Yeah. Man, it's a tough scene to
5:35
Speaker 1: watch for sure, but I think they handled it well
5:37
Speaker 1: and it's a great story. Yeah. And he is like, oh,
5:41
Speaker 1: I should say also, we should finish it. He hiked
5:44
Speaker 1: out six six miles before he finally found somebody to
5:50
Speaker 1: drive him to the hospital. Yeah, and I think he
5:52
Speaker 1: even stopped and did a little like splunking along the
5:55
Speaker 1: way or something like that. No, he went straight to
5:57
Speaker 1: the hospital. Well, he was probably doing all sorts of
6:00
Speaker 1: outdoors the activities right afterwards, he's like, I said, one
6:03
Speaker 1: of those people you can't keep down. But um, in
6:06
Speaker 1: this article, it's a pretty good article about amputation. UM.
6:11
Speaker 1: The author makes the point that Aaron Ralston's is a
6:14
Speaker 1: great example of amputation in that UM it's a blast
6:19
Speaker 1: resort typically, like you don't just go this, try amputation
6:23
Speaker 1: and then we'll go from there. It's like if we
6:26
Speaker 1: don't amputate, you're going to die usually. So it also
6:30
Speaker 1: he also provides the um the point that your your
6:35
Speaker 1: life doesn't end when you undergo an amputation. That's right,
6:38
Speaker 1: Like there's all sorts of things that kind of get
6:40
Speaker 1: you back on track, and it's a lot of work
6:41
Speaker 1: and it's the suck thing to happen, I imagine. But
6:44
Speaker 1: when you do have UM limbs amputated, your life isn't
6:49
Speaker 1: over basically. And well we'll talk about that too, But UM,
6:53
Speaker 1: you want to get into amputation. I want to talk
6:54
Speaker 1: about the history of this stuff. Uh yeah, man, it's
6:57
Speaker 1: UM history is like all old medical history involving surgery.
7:03
Speaker 1: It's pretty grizzly. UM. It dates all the way back
7:07
Speaker 1: to ancient times. They found archaeological proof that they performed
7:10
Speaker 1: their procedure many many many years ago, about seven thousand
7:14
Speaker 1: years ago, they found a grave really who had had
7:17
Speaker 1: his lower arm amputated, head healed. Yeah. What they found
7:21
Speaker 1: the differences though, back then they were moving dead tissue,
7:25
Speaker 1: tissue that was already dead because they didn't know how
7:28
Speaker 1: to stop bleeding at the time, so they obviously couldn't
7:33
Speaker 1: cut any healthy blood flow, any arteries or blood vessels, right,
7:37
Speaker 1: so they had to cut off tissue that was just
7:39
Speaker 1: like you said, already dead. There wasn't any blood flowing
7:41
Speaker 1: to it, no blood. Uh. And then of course in
7:45
Speaker 1: Rome in Greece they were smart and they advanced the
7:49
Speaker 1: process and actually, uh were the first to tie off
7:53
Speaker 1: these blood vessels. Is that called legating? Yeah, okay, like
7:57
Speaker 1: ligature marks, yeah yeah yeah um. And that would stop
8:01
Speaker 1: the blood flow, and they did a good job with that.
8:03
Speaker 1: But it seems that people forgot about that and they
8:06
Speaker 1: didn't do that for another few hundred years afterwards. And
8:09
Speaker 1: not only did they forget about that, the Romans and
8:13
Speaker 1: the Greeks both used um wine and vinegars an aseptics
8:17
Speaker 1: during surgery too, and just lost that too. I wonder
8:21
Speaker 1: if that worked. I think probably better is better than
8:24
Speaker 1: nothing other than um so, like I said, they forgot
8:27
Speaker 1: for a couple hundred years or a few hundred and
8:29
Speaker 1: then and started cauterizing wounds instead, which, as we all know,
8:34
Speaker 1: is burning a blood vessel shut, dipping it and boiling oil.
8:38
Speaker 1: It's one way, or just the old hot poker treatment.
8:43
Speaker 1: Um yeah, just awful, It's like and then say hello
8:49
Speaker 1: to this hot boiling oil. Wow. I wonder how well
8:54
Speaker 1: it worked, though, I mean, at least as far as
8:56
Speaker 1: keeping the person alive and staving off infection. I mean
8:59
Speaker 1: I think that I don't know about the infection part,
9:01
Speaker 1: but back then, I think they just wanted to keep
9:03
Speaker 1: someone alive. Do you remember Rainbow three when he gets
9:05
Speaker 1: shot in the side and he cauterizes his wound by
9:08
Speaker 1: pouring some gasoline in and lighting and I don't remember
9:11
Speaker 1: that he did that. Yeah, this like blue flame like
9:15
Speaker 1: shoots through his abdomen and he goes it's the best
9:19
Speaker 1: acting still one's ever done. Wow. I don't know that
9:21
Speaker 1: I agree with that, but it's impressive. You should watch it.
9:24
Speaker 1: See what you think. Okay, okay, I put first blood
9:28
Speaker 1: on my I saw that in my list, But I
9:30
Speaker 1: haven't heard any chiding yet. On your list of hundred
9:32
Speaker 1: greatest movies of all time. That's right, um, but Rainbow
9:36
Speaker 1: three was not on there. It was still pretty good, Okay,
9:39
Speaker 1: I'll check it out. Remember he was fighting with the Taliban.
9:42
Speaker 1: The mujah Hadeen was at the middle. There are the
9:44
Speaker 1: freedom fighters that he was helping fight the Russians. I
9:47
Speaker 1: actually don't know if I saw Rainbow three now that
9:49
Speaker 1: I think about it. Um, all right, So amputation advanced,
9:53
Speaker 1: of course over the years after the cauterization um debacle
9:58
Speaker 1: and in wartime or after wartime with no surprise is
10:04
Speaker 1: when they made a lot of these advances, especially in
10:06
Speaker 1: France with a surgeon name, a military surgeon name Ambroyce Parae.
10:12
Speaker 1: I don't know if he's related to Michael or not,
10:15
Speaker 1: but um he uh. Of course, with gunpowder and bullets
10:20
Speaker 1: and cannonballs and things we saw like injuries like we've
10:23
Speaker 1: never seen before. Yeah, we can. We can thank those
10:26
Speaker 1: things for advancement of amputation. Totally successful amputation. Um. So
10:34
Speaker 1: that was one of the big reasons that Parae was effective.
10:38
Speaker 1: And he was basically the first guy to bring back
10:43
Speaker 1: the legating he rediscovered it. Yeah, in which is said
10:51
Speaker 1: that it took that long from ancient Rome to somebody
10:54
Speaker 1: be like, oh, what if we just like tied these
10:57
Speaker 1: things shut? Now, burn it right, really got the hot
11:00
Speaker 1: oil already already, it's too late for your advancement. And
11:04
Speaker 1: that is how fond was born. Like, we got the
11:07
Speaker 1: hot oil ready, he said, we don't need it. Put
11:10
Speaker 1: some meat on a stick and have at it. Oh no,
11:12
Speaker 1: you thought I was talking about like body parts. No, no, no,
11:16
Speaker 1: I'm not a monster. Um. Then I thought it was
11:20
Speaker 1: funnier when you were a monster. Then the tourniquet was
11:23
Speaker 1: invented in sixteen seventy four, which kind of surprises me
11:26
Speaker 1: that because that seems more rudimentary than any of this
11:29
Speaker 1: another bonehead invention. Yeah, like, why don't you know, you
11:32
Speaker 1: you come up with this stuff before you cut people's
11:34
Speaker 1: limbs off, it would be nice. And then anesthetic of course, uh,
11:38
Speaker 1: in the forties with anesthetic gas went a long way
11:42
Speaker 1: towards performing these surgeries, you know, with that lot of pain. Yeah.
11:46
Speaker 1: And here in the Western world, the American Civil War
11:49
Speaker 1: was a huge, dude springboard to um understanding amputation amputation techniques.
11:56
Speaker 1: They might as well call it the amputation War just
11:58
Speaker 1: from sheer volume of amputations. A lot of doctors who
12:01
Speaker 1: got their nickname sawbones from amputating, sawing through bones and
12:06
Speaker 1: all that. Um, just the number of amputations that they performed,
12:11
Speaker 1: formed this body of knowledge that carried on after the war. Yeah,
12:16
Speaker 1: fifty thousand, more than fifty tho amputations in the Civil War.
12:20
Speaker 1: And this this is also hard to believe, but I
12:23
Speaker 1: guess it's hard to go back in time and realize
12:25
Speaker 1: if they just didn't know something, they didn't know it yet.
12:27
Speaker 1: It seems like a no brainer now that keeping a
12:30
Speaker 1: surgical environment clean should just be an eate and a surgeon.
12:34
Speaker 1: But back then they didn't know that. They didn't understand
12:36
Speaker 1: bacteria like they do now. They didn't know germs. Yeah,
12:39
Speaker 1: and so it was like a stamp of experience to
12:44
Speaker 1: have a bloody surgical gown. So surgeons would like purposefully
12:48
Speaker 1: not change their clothes and things because they were like, hey,
12:51
Speaker 1: look at my bloody gownd eight amputations today beat that, yeah, exact,
12:56
Speaker 1: pepper John. Um. They would doll some the chloroform soaked rag,
13:01
Speaker 1: put on the tourniquet and slice through everything and then
13:05
Speaker 1: like you said, get out the old saw bones all
13:08
Speaker 1: and uh, take care of business. Basically, and then we
13:11
Speaker 1: just toss the limb onto a pile, which grew pretty quickly. Yeah,
13:15
Speaker 1: and there's plenty of old photographs of limb piles from
13:18
Speaker 1: the Civil War. Yeah. One out of four patients died
13:22
Speaker 1: uh in those days after an amputation, and that doubled
13:26
Speaker 1: if it didn't happen in the first twenty four hours. Right,
13:28
Speaker 1: But a lot of people's lives were saved battlefield amputations. Yeah,
13:33
Speaker 1: and most of those I think we're probably um bacterial
13:37
Speaker 1: due to infection and not necessarily like just bleeding outer
13:41
Speaker 1: or a mistake or something, right, which we should say
13:43
Speaker 1: at this point. The whole reason to amputate is because
13:47
Speaker 1: you often have a wound or a diseased part of
13:50
Speaker 1: your body UM that's creating dead tissue, and that site
13:55
Speaker 1: of dead tissue is a really great place for becked
14:00
Speaker 1: a real infections to take root and take hold. The
14:03
Speaker 1: problem with the bacterial infection is that it tends to
14:06
Speaker 1: spread towards the rest of your body. So the point
14:09
Speaker 1: of amputation almost across the board is to prevent the
14:13
Speaker 1: spread of infection in the rashest way possible, which is
14:18
Speaker 1: why amputations typically are just the last resort. You're trying
14:22
Speaker 1: to stop this infection from spreading. And if you literally
14:25
Speaker 1: separate it from the rest of the healthy body, that
14:27
Speaker 1: should do the trick, and it frequently does. Yeah, and
14:32
Speaker 1: I think the final advancement, well not final advancement, of course,
14:35
Speaker 1: it's still advancing. But the last big advancement was was
14:38
Speaker 1: with the infections and a British surgeon named Joseph lister
14:43
Speaker 1: Um was known as kind of the father of antiseptic surgery.
14:50
Speaker 1: Oh yeah, no, way, of course it is. I never
14:54
Speaker 1: put those two together. Boom. Did he make any money
14:58
Speaker 1: off that? Like, was it actually his company or did
15:00
Speaker 1: they just I don't know. Interesting, So he was the
15:03
Speaker 1: first guy. He used something called carbolic acid, which is listering.
15:08
Speaker 1: Probably is. They used it back then to prevent wood
15:11
Speaker 1: rot and to treat sewage, so I guess they just
15:13
Speaker 1: knew it was good for for stopping bacteria. I'll be
15:16
Speaker 1: that caught aizes wounds. Yeah, and uh he would spray
15:20
Speaker 1: it on surgical tools and incisions and dressings and even people,
15:25
Speaker 1: uh in the surgery room. He would spray them with
15:27
Speaker 1: it and then he would he was the first distress
15:31
Speaker 1: handwashing and clean gloves and things like that. So hats
15:36
Speaker 1: off to you, Mr Lister. Dr Lister, Well, he was
15:39
Speaker 1: one of those people who like made up a handful
15:42
Speaker 1: of human beings who have saved billions of people's lives
15:48
Speaker 1: just from their innovations and their insights. Um. So amputation,
15:53
Speaker 1: it's been around for a while, and that's just surgically amputation.
15:56
Speaker 1: There's evidence of amputation for um religious self sacrifice as
16:02
Speaker 1: far back as like thirty thousand, forty thousand years ago. Um,
16:06
Speaker 1: it was very for a long time. It was a punishment.
16:08
Speaker 1: That um word amputatio or amputasho is a Roman for well,
16:14
Speaker 1: it's a punishment. It's synonymous with punishment, and it meant
16:17
Speaker 1: like you had your hands chopped off, Like if you
16:20
Speaker 1: steal something you then symbolically they would cut off your hand. Yeah,
16:24
Speaker 1: and then it was even amputation is even inscribed as
16:27
Speaker 1: a punishment in the first written law, the Code of Hammurabi.
16:32
Speaker 1: If you were a doctor and you lost the patient,
16:35
Speaker 1: well you should lose one of your hands. That was
16:37
Speaker 1: the code. That just makes this so counter to trying
16:41
Speaker 1: to make doctors better. You know, yeah, we want you
16:44
Speaker 1: to be a better doctor, so we're gonna remove one
16:45
Speaker 1: of your hands. You're worried about tort law. Think about
16:48
Speaker 1: how good you have it now. Um. So, like you said,
16:53
Speaker 1: the reason, Um, there are a couple of reasons you
16:55
Speaker 1: would get an amputation. Uh. One is disease and the
16:59
Speaker 1: other is um injury like my friend with the truck,
17:03
Speaker 1: like some kind of catastrophic injury. UH damages It doesn't
17:09
Speaker 1: necessarily always like rip your arm off, but it damages
17:12
Speaker 1: it to the point where there's no blood flowing there
17:15
Speaker 1: and the tissue was dying beyond the point where it
17:17
Speaker 1: can be rescued, essentially. And it might be a truck,
17:20
Speaker 1: it might be a bullet wound, Um, it could be well. Basically,
17:25
Speaker 1: any traumatic injury, a fire, a burn, a severe burn
17:28
Speaker 1: is considered a traumatic injury. Yeah. Blood flow is big.
17:32
Speaker 1: If it's not flowing, then problems happen. You're gonna have
17:35
Speaker 1: a stroke. If it stops blowing, you're gonna lose an arm.
17:38
Speaker 1: And it stops slowing. So if your blood flow is
17:42
Speaker 1: cut off for too long, then you're in big trouble. Right,
17:44
Speaker 1: And it's not just a traumatic injury disease. UM, there's
17:48
Speaker 1: plenty of diseases that see a lessening of blood flow,
17:52
Speaker 1: like um arterio, sclerosis because plaque build up and blood vessels.
17:58
Speaker 1: When it builds up enough and enough, those blood vessels hardened,
18:01
Speaker 1: and the amount of blood flow through those vessels diminishes
18:05
Speaker 1: so much that the tissue that those blood vessels feed
18:09
Speaker 1: Uh dies. Um. There's something called peripheral artery disease, which
18:14
Speaker 1: is the result of a lack of blood flow leading
18:17
Speaker 1: to dead tissue. Uman. Diabetics. Yeah, you you join that
18:22
Speaker 1: with diabetes, which has the tendency to also kill nerve
18:26
Speaker 1: endings neuropathy. Uh. And then all of a sudden, you
18:28
Speaker 1: can't feel so when you cut yourself, so you cut
18:31
Speaker 1: your foot or something like that, Um, you don't feel it,
18:34
Speaker 1: So you're more prone to cuts, and it takes longer
18:37
Speaker 1: to heal because of the lack of circulation, And all
18:39
Speaker 1: of a sudden, you have an infection that possibly turns
18:42
Speaker 1: gangrenous and threatens your entire life. Yeah. And in the US,
18:46
Speaker 1: ninety percent of amputations are as a result of this
18:49
Speaker 1: disease scenario. Um. Whereas if you're under fifty, UM, traumatic
18:56
Speaker 1: injury is a leading cause of amputations. Yeah. So like
18:59
Speaker 1: you know, you're out rudding your bike, I'm on a
19:02
Speaker 1: mountain road, or your Aaron Ralston in Your Mountaineering and Utah.
19:06
Speaker 1: You know, I would call that a traumatic injury getting
19:09
Speaker 1: your hampined under a boulder for sure, man, can you imagine?
19:13
Speaker 1: And they did a good job in the movie. But
19:15
Speaker 1: as it sets in, like what the deal is because
19:17
Speaker 1: at first he was like, oh man, yeah, like let
19:21
Speaker 1: me get out of this, or trying to move the
19:23
Speaker 1: boulder was like nothing, and then all of a sudden,
19:26
Speaker 1: you think I might die of starvation. Yeah, and then
19:30
Speaker 1: you it just goes over to the knife, like, man,
19:33
Speaker 1: I wish I hadn't adulled it. So then there's cancer,
19:36
Speaker 1: which we haven't mentioned. Um. There are a couple of
19:39
Speaker 1: ways that it could lead to amputation. Obviously just damage
19:42
Speaker 1: to your body tissue. Um. But also like you said,
19:44
Speaker 1: to keep a malignant tumor from spreading around, sometimes they
19:50
Speaker 1: will just lop it off. And apparently those amputations from
19:55
Speaker 1: cancer have diminished tremendously over sure that gator two. Um.
20:02
Speaker 1: But unfortunately those from disease have increased. Yeah, it's dropped
20:08
Speaker 1: by over the past twenty years amputations overall. No, just
20:12
Speaker 1: from for answer, traumatic injury and cancer. UM. So I
20:17
Speaker 1: don't know people are being safer and their recreation if
20:19
Speaker 1: that has something to do with it or not, or
20:21
Speaker 1: they're yeah, we might have better trauma or better reattaching
20:25
Speaker 1: to UM. But yes, you're right. It has increased because
20:31
Speaker 1: of at least in the the United States, largely due to obesity,
20:34
Speaker 1: so much so that this article was from UM maybe
20:38
Speaker 1: two two thousand and six something like that, and it
20:43
Speaker 1: says that one out of every two hundred Americans is
20:45
Speaker 1: an amputee. That's not right anymore. No, it's actually even
20:49
Speaker 1: more one out of from what I could find, a
20:51
Speaker 1: hundred and seventy six Americans, so it's one point seven
20:55
Speaker 1: million people, one out of hundreds. That seems like a
20:58
Speaker 1: lot of people. Yeah, but that counts digits and things
21:02
Speaker 1: that you don't think about, you know, like someone lost
21:04
Speaker 1: a thumb, because I hear that, and I'm like, why
21:07
Speaker 1: don't I see that more on a daily basis. You
21:10
Speaker 1: don't work in the industrial arts. Yeah, that's true. I
21:13
Speaker 1: don't work in a factory with lots of saws and chains,
21:17
Speaker 1: and yeah, that's good point. You got Alaska about every
21:20
Speaker 1: like third person has a limb that's missing. You don't
21:23
Speaker 1: see a lot of the podcasting field. UM, so we're
21:28
Speaker 1: gonna prepare you for surgery. Dr Clark right for this message. Break. Wait,
21:33
Speaker 1: I'm doing the surgery right always. Okay. So preparing for
21:43
Speaker 1: amputation surgery is like every surgery. Initially, you're gonna have
21:47
Speaker 1: a lot of meetings because they want you to be prepared,
21:52
Speaker 1: and you're gonna have everything very explained very well, and
21:56
Speaker 1: what you can expect before, during, and after, just like
21:59
Speaker 1: with all surgery. How what kind of anesthesia they're going
22:01
Speaker 1: to use? Um, Yeah, it's not always general anesthesia. I
22:05
Speaker 1: knew this would stand out to you too. Yeah, I
22:07
Speaker 1: would not want to be awake. No, knock me out,
22:10
Speaker 1: cut my toe off, I don't care. Yeah, I'd better
22:13
Speaker 1: be out. Well, actually, I take that back. If it
22:16
Speaker 1: was like a just a digit, I could stomach that.
22:18
Speaker 1: Not me. I don't know. If I'd watch it. At
22:20
Speaker 1: the very least, I wouldn't would be boring. I think
22:24
Speaker 1: it'd be fascinating. Well, I mean you couldn't see anything.
22:26
Speaker 1: You'd just be sitting there like these guys are cutting
22:28
Speaker 1: my finger off right now. I think it'd arrange a
22:30
Speaker 1: mirror or something. I used to get that at the dentist.
22:33
Speaker 1: I used to request a mirror, so I could look
22:34
Speaker 1: at what they were doing. I think, just because it
22:36
Speaker 1: fascinated me and to keep an eye on Yeah, exactly.
22:41
Speaker 1: So Yeah, they say sometimes you just local anesthetic to
22:44
Speaker 1: to carry out a amputation. That's nutty. Um, if it's
22:50
Speaker 1: a limb, I don't think they would do that. No,
22:53
Speaker 1: that's got to be generalized. Yeah, because I think like
22:55
Speaker 1: if you weren't under your blood pressure would advise to
22:59
Speaker 1: dangerous levels. This good point. Yeah. Uh, if you're gonna
23:01
Speaker 1: get a prosthetic device, you might meet beforehand with your prosthetics, uh,
23:06
Speaker 1: to measure you out and kind of talk about what
23:08
Speaker 1: you're looking for post surgery, and um, then you're gonna
23:15
Speaker 1: you know, then it's go time. I guess it is
23:18
Speaker 1: kind of go time. The well, the surgeon is gonna
23:21
Speaker 1: want to figure out exactly where to cut ahead of time.
23:25
Speaker 1: It's not like how about here they actually measure blood
23:28
Speaker 1: flow to the area, um, to see what tissues still
23:32
Speaker 1: receiving you know, circular, a healthy amount of circulation. Yeah,
23:36
Speaker 1: they don't want to leave any bad tissue behind. No,
23:38
Speaker 1: but they want to get as much of the bad
23:40
Speaker 1: tissue as they can, which is what you just said.
23:44
Speaker 1: But they also want to leave intact as much healthy
23:46
Speaker 1: tissue as possible, which is why they measure and they
23:49
Speaker 1: try to find that line of demarcation where they should cut. Yeah,
23:53
Speaker 1: they said, especially around the joints. Uh. They want to
23:55
Speaker 1: preserve all the healthy stuff they can because, uh, if
24:00
Speaker 1: your joint is working, then that's gonna help you out
24:03
Speaker 1: with your prosthetic limbits. Oh yeah, if they if they
24:05
Speaker 1: can do anything to save a joint, they're gonna leave
24:08
Speaker 1: it intact um. So they figure out where to cut.
24:13
Speaker 1: They try to leave a joint as intact as possible.
24:17
Speaker 1: And this is all the non emergency variety exactly. Yeah,
24:21
Speaker 1: like all of this planning and everything, it goes out
24:23
Speaker 1: the window when you come in with a shotgun blast
24:27
Speaker 1: your lower leg exactly. Um, they're gonna be like, we
24:31
Speaker 1: need to amputate. We have to do this quick. And
24:34
Speaker 1: they do. And you don't have to meet with anybody.
24:39
Speaker 1: That's the plus side meetings. Um. Some of the techniques
24:44
Speaker 1: they use it are actually let's just go ahead and
24:46
Speaker 1: walk you through the process, all right, so everyone please.
24:51
Speaker 1: The article points out that the first thing they cut
24:53
Speaker 1: through is the skin, right, They cut through the imaginary
24:57
Speaker 1: barrier and the air above the skin. First, technically, of
25:01
Speaker 1: course you're going to cut through the skin and you
25:03
Speaker 1: want it to heal quick. And they said leave an
25:06
Speaker 1: appropriate scar, which doesn't mean for cosmetics, like don't you
25:11
Speaker 1: don't leave your your initials as a scar or something.
25:14
Speaker 1: You know. What they mean is they don't want to
25:15
Speaker 1: leave a scar where it might rub up against the
25:18
Speaker 1: prosthetic or something and cost problems. Yeah, that can't be good. Um.
25:22
Speaker 1: So they cut through the skin and pretty soon after
25:27
Speaker 1: that they meet muscle. Mr muscle, and this makes up
25:31
Speaker 1: the bulk of what they're cutting through. And I only
25:34
Speaker 1: like within the last year so realized that muscle is
25:37
Speaker 1: what steak is. Did I tell you this? Yeah? You
25:39
Speaker 1: told me. It's just crazy to me. Like I I
25:42
Speaker 1: used to be like, okay, so you got muscle, you
25:44
Speaker 1: have the skin, you have the what's the steak? And
25:48
Speaker 1: then I realized, like, oh, muscles the steak. Yeah. I
25:51
Speaker 1: was like, I'd make a good steak. Now you'd be sinewy,
25:57
Speaker 1: so I'd make a good steak. So with with muscle
26:00
Speaker 1: there there, they want to they have to cut through it,
26:03
Speaker 1: but they want to save a little bit of length
26:06
Speaker 1: of it as much as possible. Yeah, Um, that's your
26:10
Speaker 1: padding basically, Yeah, they're gonna fit it around the bone
26:13
Speaker 1: at the bottom. It is, it's the padding on the bottom,
26:16
Speaker 1: the exposed part of the the residual limb, which is
26:20
Speaker 1: what the stump is called. You shouldn't call people's residual
26:23
Speaker 1: limb stumps, is that true? Yeah? Well why do they
26:26
Speaker 1: use it? Fifty times in this article? They finally get
26:29
Speaker 1: to the point where they're like the residual limb, which
26:32
Speaker 1: is the preferred term. I think my friend called his stump.
26:36
Speaker 1: Oh yeah, I mean, if you have an amputated limb,
26:39
Speaker 1: you can call it whatever you want. Right. It's like
26:42
Speaker 1: you can't pick on my brother, Well, only I can
26:44
Speaker 1: pick up my brother. Okay, it's along the same line.
26:47
Speaker 1: So we've cut through the skin the muscle. No, you've
26:52
Speaker 1: got your nerves. Oh man, I know it sends a
26:56
Speaker 1: chill up my spine thinking about it. Um, you have
26:59
Speaker 1: to cut through the nerves out of slee and then
27:01
Speaker 1: what they want to do, you're gonna have you know,
27:06
Speaker 1: where you cut the nerve is going to be a
27:07
Speaker 1: nerve stump. Now that's okay to call it a stumps.
27:10
Speaker 1: The nerves exactly, Um, and they still carry signals of
27:16
Speaker 1: pain sometimes even, and so they do their best to
27:20
Speaker 1: minimize what we're gonna talk about next, which is phantom
27:22
Speaker 1: limp pain, by sewing nerving things into the tissue around
27:27
Speaker 1: it and even cutting it off, cutting the nerves off
27:31
Speaker 1: higher up than the amputation site to try and prevent that. Um.
27:36
Speaker 1: But thanks to you in that article you sent me,
27:40
Speaker 1: we learned that phantom limb pain actually occurs in the
27:44
Speaker 1: majority of patients who lose their limbs. I didn't know
27:47
Speaker 1: that it sounded like a rarity to me. No, I
27:50
Speaker 1: think it's like, um, I think it's like not a
27:54
Speaker 1: given necessarily, but I think that it's very common. Should
27:58
Speaker 1: we go ahead and cover it now? And then yeah,
28:00
Speaker 1: finish up with the surgery. Yeah. So, like you said,
28:02
Speaker 1: when you when you cut fanstom up right right, still um,
28:07
Speaker 1: when you cut a nerve um fiber um, you're it's
28:14
Speaker 1: still even though there's a stump and there's it's not
28:17
Speaker 1: connected to anything anymore down there, it can still transmit
28:20
Speaker 1: information to the brain and it still does. And your
28:23
Speaker 1: brain has been it's developed this certain kind of arrangement
28:29
Speaker 1: of neurons. Say that have to do with your lower leg.
28:32
Speaker 1: Your lower left leg is in this one region of
28:35
Speaker 1: your brain. And the thing is, when you amputate your
28:38
Speaker 1: lower left leg, your brain doesn't really get the news
28:42
Speaker 1: that it's not there anymore, or at least at the
28:45
Speaker 1: very least, it confuses it. It does and it makes
28:49
Speaker 1: the brain think that you have a lower left leg still,
28:53
Speaker 1: but you're just not using it. Or your brain has
28:56
Speaker 1: this technique for telling you when it's like you need
28:59
Speaker 1: to use your limbs or get up or move around
29:01
Speaker 1: or do something UM. And that's by sending a painful
29:05
Speaker 1: sensation from the leg to the brain to you to
29:09
Speaker 1: experience it. And when that leg is not there and
29:12
Speaker 1: your brain thinks it still isn't you're not using it,
29:14
Speaker 1: then what you have is something called phantom pain. Yeah,
29:17
Speaker 1: and that can be. It's not just like, oh it
29:20
Speaker 1: hurts a little bit, UM, it hurts a lot apparently
29:23
Speaker 1: UM burning aching sensations as if the hand is being
29:26
Speaker 1: crushed in the ice. So say some And here's the
29:30
Speaker 1: bad news is that it is UM chronic and once
29:35
Speaker 1: it happens and persist, it's there like it's tough to
29:39
Speaker 1: get rid of UM. In fact, I think they only
29:42
Speaker 1: I think this article they said they only UM these
29:45
Speaker 1: other post surgeries to limit that are only effective for
29:48
Speaker 1: a few months and it usually returns, and so they
29:51
Speaker 1: usually don't even do those surgeries unless you're terminal. Yeah,
29:54
Speaker 1: and apparently chuck jugs don't necessarily do a lot like
29:58
Speaker 1: a paint. Yeah, like it can't help. I think you
30:02
Speaker 1: get used to it and it's still not really helping
30:05
Speaker 1: very much. So they have some pretty interesting radical treatments
30:08
Speaker 1: that apparently work. And one of the best ones is
30:11
Speaker 1: a mirror box. So you like have a box that
30:15
Speaker 1: you put your hand into and then your residual limb
30:18
Speaker 1: into in the same box, and the mirror the mirrors
30:22
Speaker 1: inside basically make it look like you have two limbs,
30:26
Speaker 1: both intact facing the correct way, and then you move
30:31
Speaker 1: the intact one and it looks like your residual limb
30:35
Speaker 1: is now moving, and you basically your eyes sends the
30:38
Speaker 1: signal to the brain exactly, and you trick your brain
30:41
Speaker 1: into thinking like, Okay, I'm moving my limb. You can
30:44
Speaker 1: stop sending me the pain signals now. And it works
30:47
Speaker 1: for a lot of people. Yeah, And even more amazing
30:50
Speaker 1: is they don't even know if they need a mirror box.
30:53
Speaker 1: They think simply um imagining using that limb could work
30:59
Speaker 1: like golfing. Yeah, Like, so just imagine you're you're swinging
31:03
Speaker 1: a golf club with your phantom with your limb that's
31:05
Speaker 1: not there anymore, and they think they can actually work. Yeah. Um.
31:09
Speaker 1: They're also trying to figure out how to uh, re
31:12
Speaker 1: plastic size the brain so that it can, um, it
31:16
Speaker 1: can rearrange itself to basically be aware that there's no
31:19
Speaker 1: limb there any longer, and it says it can ignore
31:21
Speaker 1: sensory signals from that area. What they're doing is is
31:25
Speaker 1: they're working on the brain now instead of the site
31:27
Speaker 1: of the amputation, like the physical site. They thought it
31:30
Speaker 1: was the psychosis for a little while. Um that that
31:33
Speaker 1: it was basically just like people had such a deep
31:37
Speaker 1: lamentation of the loss of their limb that they were
31:40
Speaker 1: suffering this this form of psychosomatic experience. But now they're like, no,
31:46
Speaker 1: this is real. We have seen it. Um. There's also
31:49
Speaker 1: stimulation of the nerves around the area, um, which kind
31:53
Speaker 1: of confused the pain signals so they don't make it
31:56
Speaker 1: to the brain. It's pretty amazing, Yeah, but it's it's
31:59
Speaker 1: a real thing, and apparently it's awful. Yeah, it's it's
32:02
Speaker 1: way more common than I thought that was like my
32:04
Speaker 1: biggest surprise in all this. I thought it was like, oh,
32:07
Speaker 1: that's super rare, But apparently it's kind of rare if
32:10
Speaker 1: you don't experience phantom in pain. So back to the
32:13
Speaker 1: operating room, we should probably get back in there. He's looking,
32:16
Speaker 1: he looks fine. Do you have any junior mint on you?
32:18
Speaker 1: That's okay, I'm very nice. Uh So, now you've cut
32:22
Speaker 1: through the skin, you've cut through the muscle, You've cut
32:24
Speaker 1: through the nerves and done all your work to try
32:26
Speaker 1: and make sure that the nerves are not going to
32:28
Speaker 1: cause fandom pain as much as you can much as
32:31
Speaker 1: you can. Now you have to cut the blood vessels. Yeah, right,
32:35
Speaker 1: and you want to legate them or cauterize, right, probably
32:40
Speaker 1: legate them if you don't want to, although I'm sure
32:42
Speaker 1: there's cauterization too as well. And I think if you're
32:46
Speaker 1: trapped in the woods or something, there might be no
32:47
Speaker 1: but I think like they even have like a um,
32:50
Speaker 1: little tools to cauterize blood vessels, wood burning set kind
32:54
Speaker 1: of yeah. Yeah. Um. And either way, you're gonna stop
32:58
Speaker 1: the flow of blood out the open end of these
33:00
Speaker 1: blood vessels now, because that's not good. Um, I mean,
33:03
Speaker 1: you tie this off and you want to avoid as
33:06
Speaker 1: many blood vessels as you possibly can. Um that don't
33:09
Speaker 1: need to be amputated because they still bring blood to
33:12
Speaker 1: the healthy tissue, and blood's chuck full of nutreats, which
33:16
Speaker 1: is how these things just tissue keeps alive. It's right.
33:19
Speaker 1: And then there's only one thing left, my friend, man,
33:22
Speaker 1: that's the old bone. So they get out the old
33:24
Speaker 1: bone saw and um, when you cut the bone, like
33:28
Speaker 1: you said, you you're gonna wrap the muscle around it.
33:30
Speaker 1: So you want a nice smooth surface. You don't want
33:33
Speaker 1: any kind of jagged edges. So they're gonna smooth it out.
33:35
Speaker 1: I don't know what they use. Probably some kind of sander.
33:39
Speaker 1: They sand it down. Remember start start low with your
33:43
Speaker 1: sand paper number and work your way up. Oh is
33:46
Speaker 1: there more grit in the lower numbers? More grit? Like
33:50
Speaker 1: an eighty sand papers super rough, and like a two
33:54
Speaker 1: is super fine, super fine. I think that's right. Sure
33:57
Speaker 1: I got this wrong. I'm gonna I think you're right. Okay,
34:00
Speaker 1: it makes sense yea um, but yeah, you really want
34:04
Speaker 1: to smooth out that bone because it's it's going to
34:07
Speaker 1: keep um the amputation site from healing. If it's a
34:12
Speaker 1: jagged edge just rubbing up against muscle and nerves and
34:16
Speaker 1: blood vessels and all, that's not good. So you have
34:20
Speaker 1: it nice and sanded, You arrange the muscles around it,
34:24
Speaker 1: and then you tie the skin off. When you close
34:27
Speaker 1: the skin um and frequently if they think that there
34:32
Speaker 1: there's a high risk of infection, they'll just kind of
34:34
Speaker 1: temporarily close the skin. Were leaving a tube to drain
34:38
Speaker 1: the um almost inevitable liquids that build up um. And
34:44
Speaker 1: then if if they watch it and you're like, no
34:46
Speaker 1: infection comes along, then they'll permanently sew it up. And
34:50
Speaker 1: of course for the next several weeks you're gonna be
34:51
Speaker 1: closely monitored for infection. Uh. They're not gonna leave you alone.
34:56
Speaker 1: They're gonna bother you every single day, probably checking on
34:59
Speaker 1: your uh what was the word, not stomp, residual limb,
35:04
Speaker 1: residual limb, your your reside. Occasionally they will take off
35:10
Speaker 1: the wrong limb. Should we go ahead and talk about this. Yeah,
35:14
Speaker 1: just in October of two thousand thirteen in Brazil, guy
35:18
Speaker 1: got it the wrong leg removed and the daughter said, hey,
35:21
Speaker 1: you removed the wrong leg. So they said, you're right
35:23
Speaker 1: and they removed this other leg and now you own
35:25
Speaker 1: this hospital and now he has no legs. That's crazy.
35:28
Speaker 1: And it said the family plans to sue. I'm sure. Um,
35:31
Speaker 1: my dad got a knee replaced, and I went and
35:34
Speaker 1: visited him before the operation, and he had um, like
35:38
Speaker 1: no written on his on the kneecap that he is
35:42
Speaker 1: supposed to remain intact. No. I think one of the
35:44
Speaker 1: nurses did for him or something. I think it's kind
35:46
Speaker 1: of typical. Well, it's one of the things they do.
35:49
Speaker 1: I read this article from two thousand ten, UM. And
35:52
Speaker 1: this is in Colorado alone. This is not nationwide or
35:54
Speaker 1: anything over six and a half years. UM. In Colorado alone,
35:59
Speaker 1: they operate it on the wrong patient at least twenty
36:02
Speaker 1: five times and on the wrong body part hundred and
36:06
Speaker 1: seven times. And um, that's a six and a half
36:10
Speaker 1: year period. They studied close to thirty thousand medical records,
36:14
Speaker 1: and UM. All the mistakes, of course, are traced back
36:17
Speaker 1: to miscommunication. It's never apparently anything but that, right. It's
36:21
Speaker 1: never the doctor was super drunk. No. Uh. And a
36:25
Speaker 1: lot of times it's not even the surgeon. We should
36:27
Speaker 1: point out, Um, it's a support staff for other doctors
36:30
Speaker 1: that make this mistake throw them under the buff. But
36:34
Speaker 1: so there's a thing now the American Academy of Orthopedic
36:36
Speaker 1: Surgeons is an initiative called Sign your Site, which exactly
36:40
Speaker 1: what you're talking about, UM, well sort of it. The
36:43
Speaker 1: surgeon actually initials the surgical site UM for you to
36:47
Speaker 1: see and and say, yes, this is the bad leg. Yeah,
36:52
Speaker 1: and you can be like, you're the one who told
36:55
Speaker 1: me that I have to lose my leg, isn't uh.
36:58
Speaker 1: And then the Joint Commission is nonprofit group UM, and
37:02
Speaker 1: they have a protocol now called a time out. A
37:04
Speaker 1: presurgery time out is where literally everyone just pauses and goes, okay,
37:09
Speaker 1: this is what we're doing, right, this is right correct, right,
37:12
Speaker 1: that's smart. Yeah. I'm surprised it wasn't the protocol anyway,
37:15
Speaker 1: but I'm glad it is now. Well, you know, doctors
37:18
Speaker 1: are all go go go with their jargon and their
37:20
Speaker 1: white coats and all that they got to hit the
37:22
Speaker 1: golf course, get drunk, listen to us. So so it
37:29
Speaker 1: does happen, and so you can you can write it
37:31
Speaker 1: on your own leg, or you can ask for the
37:33
Speaker 1: time out or whatever. Well I think they should give
37:36
Speaker 1: you the time out either way, it's not as rare
37:37
Speaker 1: as you think. All right, So, um, let's say that
37:42
Speaker 1: they've successfully amputated the correct leg. Uh, there's a recovery
37:47
Speaker 1: period as well. Um. You know the little white bandage
37:51
Speaker 1: that's like a like a cap, like an inverted cap. No, well,
37:58
Speaker 1: let's call the compression bandage. Oh yeah, sure, it's like
38:00
Speaker 1: athletes wear him now like a compression sleeve. Right, this
38:04
Speaker 1: one doesn't have a hole on one side. Sure, you
38:07
Speaker 1: know what I mean. Um, And the compression raises it
38:11
Speaker 1: increases the blood pressure around the site, um, which helps
38:15
Speaker 1: bring infection. It reduces swelling of course, yeah, um, which
38:19
Speaker 1: is a big deal. And then also you, um, you
38:21
Speaker 1: will be moved about quite a bit while you're in
38:24
Speaker 1: the hospital recovering because they want to keep your leg circulating,
38:28
Speaker 1: your blood circulating, and not not necessarily your leg. I
38:31
Speaker 1: just always think of a leg amputation. Really yeah, that's
38:34
Speaker 1: a good arm, probably because my friend, oh yeah yeah. Um.
38:39
Speaker 1: So once you get home, you're gonna start meeting with
38:42
Speaker 1: the therapist, because physical therapy is a big deal. And
38:44
Speaker 1: it's not just maintaining motion in your residual limb, but
38:50
Speaker 1: also bulking up the other parts of your body. They're
38:52
Speaker 1: gonna have to kind of step in a little bit
38:55
Speaker 1: to make up for that, um, that shortfall. Yeah, and
38:58
Speaker 1: apparently aside from just strength training, they do real world training,
39:03
Speaker 1: Like you know, you gotta get out of and dress
39:04
Speaker 1: yourself without your left leg, so let's see you do it.
39:09
Speaker 1: Um do it. And I don't think we mentioned either
39:12
Speaker 1: there's you might meet with a a brain therapist before
39:16
Speaker 1: and after as well a psychiatrist, yeah, to help you
39:19
Speaker 1: along because it's a it's a weird thing to not
39:22
Speaker 1: have a limb anymore. Yeah, I'm sure there's almost mandatory
39:25
Speaker 1: counseling for something like that. Yea, probably because I'm sure
39:29
Speaker 1: also like even if you go into it like all right,
39:31
Speaker 1: I can do this, I'm good with this. I think
39:33
Speaker 1: very few people come out of it with the kind
39:36
Speaker 1: of a plalm and and just go get them spirit
39:40
Speaker 1: of people like Aaron Ralston or the girl from Georgia
39:43
Speaker 1: who had um necrotizing fasciitis who like just managed to
39:48
Speaker 1: keep her spirits up. I think it's probably very easy
39:51
Speaker 1: to sink into a post surgery depression and that would
39:56
Speaker 1: need to be have an eye kept on it. Um,
40:00
Speaker 1: if you go through all this physical therapy and you
40:03
Speaker 1: go through your psychiatry therapy and you're doing great. It's
40:08
Speaker 1: actually a brain therapist. Brain therapist. I like that better. Um,
40:13
Speaker 1: you will be. Uh. You may have to work with
40:16
Speaker 1: your prosthetics if you want a prosthetic limb. And these
40:19
Speaker 1: days they're not one size fits all like the old days.
40:23
Speaker 1: Like here, you know, here's this wood leg longer than
40:27
Speaker 1: you might want, but that's okay exactly. These days are
40:32
Speaker 1: gonna fit it very much for you, longer than you
40:36
Speaker 1: might want it. Uh, they're gonna fit it for you.
40:39
Speaker 1: It's very much tailor made. They've come. Like the advancements
40:43
Speaker 1: in prosthetics is just unbelievable. We might could do a
40:46
Speaker 1: show on that alone. Oh, they'd make the sweet beautiful. Um.
40:50
Speaker 1: There was also another treatment for phantom pain that had
40:54
Speaker 1: to do with prosthetics, and it was there's prosthetics that
40:58
Speaker 1: basically jack into your nerves, nerves and so like you
41:02
Speaker 1: still use the same nerves that used to make your
41:04
Speaker 1: lower leg move, but now it makes your prosthetic move
41:09
Speaker 1: and apparently your brain is fine with that. Yeah. I
41:12
Speaker 1: mean we covered some of this and um uh human augmentation.
41:18
Speaker 1: Oh yeah, remember a while ago, like these prosthetic limbs
41:20
Speaker 1: now that are hardwired. Did we do that? Is I
41:23
Speaker 1: don't remember that episode? No, not not the podcast when
41:26
Speaker 1: you or a live speaking thing with you know these
41:30
Speaker 1: prosthetic limbs that are hardwired into your brain so that
41:33
Speaker 1: you can think pick up apple and it picks up
41:35
Speaker 1: an apple. Right, that's right? Yeah remember that. Yeah, so
41:38
Speaker 1: when when you're like, lower leg is moving, your brain
41:41
Speaker 1: apparently doesn't care whether it's flesh and blood leg or
41:44
Speaker 1: prosthetic leg, as long as it's moving, then that can
41:46
Speaker 1: help treat phantom pain as well. Yeah. So, Chuck, you
41:50
Speaker 1: imagine you're a single guy and you you lose the
41:56
Speaker 1: lamb you're okay, I'm just saying a mansion, you are,
42:00
Speaker 1: you lose a lamp that every day you have a
42:04
Speaker 1: wonderful wife, I know, I'm just kidding. And you you
42:06
Speaker 1: lose your left leg, you think that your chances of
42:11
Speaker 1: ever getting a date probably just go up in smoke, right,
42:15
Speaker 1: Some people might think that that will cut that down.
42:18
Speaker 1: It's not necessarily true. Yeah, there's just a lot of
42:21
Speaker 1: people out there there like that. Yeah, you may become
42:23
Speaker 1: a lot more attractive to certain people, specifically people who have.
42:29
Speaker 1: Do you want to say this one? Which one? Is
42:32
Speaker 1: it appo or acro acro acro tomophilia. Yeah, that's an
42:41
Speaker 1: actual There is appo tim nophilia, which is uh, we've
42:47
Speaker 1: talked about this before with body integrity identity disorder, when
42:51
Speaker 1: you want to remove a limb from your own body. Yeah,
42:55
Speaker 1: that is app no appo tim nephelia. Like I just
43:00
Speaker 1: feel like incomplete with all my four limbs and I uh,
43:05
Speaker 1: I want a limerod moved and their doctors that will
43:07
Speaker 1: do that. Yeah. And there's a lot of um, a
43:10
Speaker 1: lot of controversy lumping that into a paraphilia because the
43:15
Speaker 1: if someone is attracted to the idea of living without
43:19
Speaker 1: a limb, it's very rarely sexually. Most of the time
43:22
Speaker 1: it's a form of hero worship, or they want to
43:24
Speaker 1: be challenged more in life, or they have like you
43:27
Speaker 1: just said, a real identity disorder that where they've always
43:31
Speaker 1: envisioned themselves paralyzed, where they've always envisioned themselves as a
43:35
Speaker 1: double double amputee and they feel less than whole by
43:38
Speaker 1: being whole. Yeah, it's not any different than a transsexual
43:42
Speaker 1: saying they were born in the wrong body. Yeah, they
43:45
Speaker 1: bear a striking resemblance. Yeah, so the B I I
43:49
Speaker 1: D and uh what was theophilia? Yeah, are are one
43:54
Speaker 1: and the same. But it really shouldn't be a paraphilia. Now,
43:56
Speaker 1: the other ophelia acrotomophilia, that should be a paraphilely because
44:01
Speaker 1: that is a sexual attraction to people who are who
44:04
Speaker 1: um amputees or who are paralyzed. Yeah. If you haven't
44:08
Speaker 1: seen that David Cronenberg movie Crash, I have not. You
44:13
Speaker 1: haven't seen. No, Well that's what it's about, boxing Helena.
44:17
Speaker 1: Oh yeah, boy, that was awful. I haven't seen it.
44:20
Speaker 1: It was bad. I just know about it. It's like
44:21
Speaker 1: notoriously bad. I've got to see it. Then. Um, yeah,
44:26
Speaker 1: there's so. I mean, there is some reference to this
44:30
Speaker 1: in popular culture, but it was only I think five
44:33
Speaker 1: and the first case of that was put Forth. Yeah. Um,
44:38
Speaker 1: so it's a relatively new and then going to great
44:42
Speaker 1: links to amputate your your own limb is even newer
44:48
Speaker 1: than that. Um. There was a Scottish doctor in two
44:51
Speaker 1: thousand who very famously amputated the healthy legs of two
44:56
Speaker 1: men and when he caught a huge contract Percy. Yeah,
45:00
Speaker 1: he stood by it, though he did he said he
45:03
Speaker 1: thought about it for eighteen months, and when he finally
45:05
Speaker 1: did it, he had decided that it was by far
45:07
Speaker 1: the most humane thing he could possibly do in this situation,
45:10
Speaker 1: because these men were suffering by having their intact legs. Yeah,
45:14
Speaker 1: and they say, I don't know if it's true, but
45:17
Speaker 1: some of them contend that no amount of mental of
45:20
Speaker 1: brain therapy can help. It's like they've got to get
45:23
Speaker 1: rid of that limb right or paralyze themselves. And a
45:27
Speaker 1: lot of people do take it on themselves. There was
45:29
Speaker 1: a man who went down to Mexico in the nineties
45:31
Speaker 1: I think he was seventy three UM to have an
45:35
Speaker 1: amputation surgery in a hotel and died of gang green
45:39
Speaker 1: as a result. Another guy successfully amputated his own leg
45:42
Speaker 1: with a log splitter. People will will go to great
45:46
Speaker 1: lenks and do what we would consider self harm, whereas
45:49
Speaker 1: they're really like fulfilling their identity. So it raises that question, like,
45:54
Speaker 1: in that specific situation, is medicine harming people by carrying
46:00
Speaker 1: out these amputations cleanly and professionally or are you just
46:07
Speaker 1: giving into somebody's delusions and and really making things worse. Yeah,
46:11
Speaker 1: supposedly the evidence is after surgery. These people feel good,
46:15
Speaker 1: they feel great, they feel the way that they're supposed
46:17
Speaker 1: to feel supposedly, so it's hard to argue that you're
46:21
Speaker 1: doing them harm by carrying out the surgery. Yeah, and
46:23
Speaker 1: again those are two very different things. The wanting to
46:28
Speaker 1: remove your own limb to feel like a complete person
46:30
Speaker 1: is not in the same as the sexualization and attraction
46:35
Speaker 1: to um. Like in Penthouse magazine. Remember in this article.
46:40
Speaker 1: What article was this? By the way, it was an
46:41
Speaker 1: Atlantic article from two thousand, Yeah, called The True Self.
46:45
Speaker 1: It's really good. Oh was it? I don't I thought
46:47
Speaker 1: it was something else, but yeah, or no, maybe that
46:49
Speaker 1: was a subheading, but it was. It was a great article. Um.
46:53
Speaker 1: And it's nothing new the sexual side of things. Um.
46:57
Speaker 1: Going back to this dude, Richard von Kraft Ebbing, he
47:01
Speaker 1: was a researcher of UH sexual pathology and he started
47:07
Speaker 1: categorizing and cataloging six and UM, I don't know if
47:12
Speaker 1: it was a book or just a medical journal called
47:14
Speaker 1: Psychopathia Sexualist and of course everything from bestiality and necrophilias
47:19
Speaker 1: in there. But to Stravi SMI's Apparently des Cartes had
47:23
Speaker 1: a thing for um. Women with crossed eyes that I
47:28
Speaker 1: didn't know that. I didn't know that either, But there
47:30
Speaker 1: are sexual things all the way back then, Um, this
47:34
Speaker 1: year old engineer was excited by the sight of a
47:37
Speaker 1: woman's disfigured feat. Um, and another guy pretended to be
47:42
Speaker 1: crippled or lame is what they called it back then. Yeah,
47:45
Speaker 1: and apparently that's still a thing. Like if you go
47:47
Speaker 1: onto the web and start looking up across acrotomophilia, you're
47:52
Speaker 1: gonna find there are pretenders, people who use wheelchairs and
47:56
Speaker 1: leg braces and crutches even though they don't need them. Yeah. Um,
47:59
Speaker 1: and there are frequently people who are also deemed wannabes
48:03
Speaker 1: who are I guess pre event amputees. Yeah, they're still
48:08
Speaker 1: in tect that they don't want to be. And then
48:10
Speaker 1: there's devoteeshia. Yeah, those are the sexual the ones who
48:16
Speaker 1: want to be with amputees because it's sexually aroused by
48:19
Speaker 1: them exactly. Yeah, and it's big on the internet. Yeah,
48:23
Speaker 1: it's um, this article points out, and there's probably been
48:26
Speaker 1: more medical research on it since then. But he points
48:29
Speaker 1: out that in legit medical circles there's not a lot
48:32
Speaker 1: of information, but if you get on the internet, there
48:34
Speaker 1: are all kinds of chat rooms in places where you
48:37
Speaker 1: can find amputee porn. Yeah, if that's what your thing is. Hey,
48:44
Speaker 1: that's such a thing is I can't really see anything
48:47
Speaker 1: wrong with it. I was surprised though, by the one
48:52
Speaker 1: how the people that it's not sexual but they just
48:56
Speaker 1: want to be challenged more. It's pretty interesting. Yeah, I
49:00
Speaker 1: wonder if that kind of falls into a um the
49:03
Speaker 1: category of munch housands where they want they want the
49:09
Speaker 1: sympathy or at it, attention or something like that that
49:12
Speaker 1: comes with being paralyzed or being being an amputee. I
49:16
Speaker 1: think pretenders for sure. Yeah, like if you're walking around
49:19
Speaker 1: on crutches and you're just fine, you're you're looking for attention.
49:22
Speaker 1: But yeah, like you said, there are some people out
49:24
Speaker 1: there who report wanting to lose the body part because
49:27
Speaker 1: they want to be more physically challenged. Alright, we should
49:34
Speaker 1: do one on paraphilias sometimes. I've always wanted to. Is
49:38
Speaker 1: that just any kind of sexual fetish everything? That's everything?
49:42
Speaker 1: And there's a lot of them out there. Yes, basically,
49:45
Speaker 1: any weird thing you can come up with, there's a
49:47
Speaker 1: paraphilia for it. Yeah, but you're right, Yeah, like I
49:52
Speaker 1: liked never mind, I think it's a good way to
49:56
Speaker 1: end this one. If you want to learn more about amputations,
49:59
Speaker 1: you can type that word into the search part how
50:01
Speaker 1: stuff works dot com. And uh, let's see. Since I
50:04
Speaker 1: said search part, that means it's time for a listener mail. Ah. Yeah,
50:08
Speaker 1: this is kind of long, but it's appropriate. Um, I'm
50:11
Speaker 1: gonna call it h one testicle down? Was there an amputation?
50:17
Speaker 1: Not so much? Let's see is from Rich Uh. This
50:20
Speaker 1: came off the Castration podcast and he says, Guys, when
50:23
Speaker 1: I was about twelve years old, I got kicked in
50:25
Speaker 1: the grapes but particularly violent classmate appearance. Took me to
50:28
Speaker 1: the hospital and after a bunch of tests, determined I
50:31
Speaker 1: had testicular torsion. It's when uh, male's testicles twist around
50:35
Speaker 1: inside the scrotum, essentially twisting the wires that connected to
50:39
Speaker 1: your inner workings, and it cuts off the blood supply.
50:42
Speaker 1: Like we said, it's not any good. You don't want
50:45
Speaker 1: to cut off the blood supply. Um tissue does That's right. Uh.
50:50
Speaker 1: It was too late to save his injured testicles, so
50:52
Speaker 1: they set a date for surgery to remove it, but
50:55
Speaker 1: it wasn't until the end of August, apparently because there
50:57
Speaker 1: was no rush because it didn't like make any worse. Oh,
51:00
Speaker 1: there'd be a rush if it happened to me, I'd
51:03
Speaker 1: be like, look, just get this over with. Oh I know. Ah.
51:08
Speaker 1: So he said he was stuck in bed for an
51:09
Speaker 1: entire summer, and his family didn't have working air conditioning
51:12
Speaker 1: yet either, and his scrotum was the size of a grapefruit. Walking, moving, laughing,
51:18
Speaker 1: or even breathing heavily caused some of the worst pain
51:20
Speaker 1: of experienced. Uh. So he had the surgery, and it
51:23
Speaker 1: said I had two purposes, one to remove the injured
51:26
Speaker 1: and now useless testicle, and too to affix the remaining
51:29
Speaker 1: healthy testicle the inside of the scrotum to prevent the
51:32
Speaker 1: possibility of future torsion. So he felt a lot better
51:36
Speaker 1: physically after the surgery, but it was very hard to
51:38
Speaker 1: cope mentally and socially. I think I only told my
51:42
Speaker 1: closest friends what had happened. I told the rest of
51:44
Speaker 1: my school that I had knee surgery or something. I
51:47
Speaker 1: felt incredibly embarrassed. Um and remember I was at the
51:50
Speaker 1: most awkward, puberty ridden age for something like this to
51:53
Speaker 1: happen to my private parts, I know. Uh. Then two
51:57
Speaker 1: things happened. The first thing was acceptance. I don't remember
51:59
Speaker 1: if anything in particular brought it on, but I distinctly
52:01
Speaker 1: remember the day where I finally thought to myself, you
52:04
Speaker 1: know what, who cares? And at that moment, testical grew
52:08
Speaker 1: back twice the size is before. Uh. Then I did
52:13
Speaker 1: something that still surprises me now that I think about it.
52:15
Speaker 1: I opened an a o LL instant messenger, Um this
52:19
Speaker 1: is back in the day, of course, uh and picked
52:22
Speaker 1: out one of my high school friends at random and
52:24
Speaker 1: told them before I could chicken out. As soon as
52:26
Speaker 1: I told this random person, I felt a huge weight
52:28
Speaker 1: lift off my chest. And then the second thing was surgical.
52:32
Speaker 1: I opted for elective surgery to put in a fake ball,
52:35
Speaker 1: a neudical, a noudical, a human nudical, human utical, or
52:41
Speaker 1: a prosthesis made of silicon silicone. It was mainly for
52:45
Speaker 1: cosmetic purposes, and I was happy to that I did it.
52:49
Speaker 1: Even now, you can't really tell a difference unless you
52:51
Speaker 1: touched them and want somebody's in that situation where they
52:54
Speaker 1: could feel the difference. It really doesn't make a difference anyway,
52:56
Speaker 1: wink wink. So he says, now he is very proud
53:01
Speaker 1: to have one real testical and one fake one. And
53:04
Speaker 1: he went on and to write about how like to
53:08
Speaker 1: tell the kids out there, Hey, if something like happens
53:10
Speaker 1: to you, then you know it's not the biggest deal
53:12
Speaker 1: and you're still a complete person. And he wonders if
53:14
Speaker 1: he would have even gotten the nuticle if he would
53:16
Speaker 1: have been older, you know, and not been at that
53:19
Speaker 1: awkward age. Yeah, he says, he probably didn't think like
53:22
Speaker 1: he would happen. He doesn't regret it, right, Uh, he
53:24
Speaker 1: doesn't regret it. He says, I'm really proud of it.
53:27
Speaker 1: And Uh, I wonder how many of your listeners only
53:30
Speaker 1: have one testical for a little crown on it every
53:34
Speaker 1: once in a while. That is Rich and Rich. Thank
53:37
Speaker 1: you for your courage and trying to tell people, especially kids. Yeah,
53:41
Speaker 1: way to go, Rich, you know something into the world.
53:44
Speaker 1: I mean, that is a rough thing to go through. Yeah. Man, well,
53:47
Speaker 1: hats off to you, Rich, crowns off. Uh, if you
53:51
Speaker 1: want to be brave like Rich, you can tell us
53:53
Speaker 1: about something that you overcame in your life. We love
53:57
Speaker 1: hearing about stuff like that. Um, you can twee to
54:00
Speaker 1: us at s Y s K podcast. If it's a
54:02
Speaker 1: very short story, You can join us on Facebook dot com,
54:05
Speaker 1: slash stuff you Should Know, You can send us an
54:07
Speaker 1: email to stuff Podcasts at Discovery dot com, and you
54:10
Speaker 1: can join us at our home on the web, stuff
54:12
Speaker 1: you Should Know dot com. For more on this and
54:20
Speaker 1: thousands of other topics, visit how stuff works dot com
54:30
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54:32
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