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Monday, March 13, 2017

Choosing to Amputate

"What am I trying to save? Amputation is going to get me a new prosthetic that will have more range of motion than my actual [birth] ankle."
"I just put my leg on and walk, and it is on until I go to bed."
"That's it."
Adam Taylor, New York
Mr. Taylor and his wife, Christa, in Brooklyn. Credit Victor J. Blue for The New York Times
There are over two million Americans who have undergone amputations. In 2014 over four thousand amputations took place in New York City alone. A large proportion of amputations take place resulting from complications of diabetic neuropathy. Another 45 percent are required as a result of trauma; caused by a catastrophic accident of one kind or another, while fewer than 2 percent take place because of the effects of cancer.

Adam Taylor's experience was among that two percent. And his lifetime experience was that of a child, then a man for whom walking was unfailingly difficult. By the time he was a teen, gaping wounds appeared on his feet, the result of a rare skin disease called linear scleroderma. His right ankle was constricted from the buildup of scar tissue. A few years ago, the now-36-year-old was further struck, when a wound on his leg failed to heal.

And there, where the wound had appeared, cancer set in. He underwent surgery, which doctors assured him would destroy the cancer, only to discover post-surgery the cancer was still present. Two options were then presented to him; undergo reconstructive surgery, or opt for amputation of the leg. Before arriving at a decision Mr. Taylor did his own homework.

He came across amputees living positive lives who had learned to be agile in moving about with their prosthetics. He became aware that people no longer look for prostheses resembling a facsimile of their lost limbs, preferring instead the bionic-appearing prosthetic. And he listened to the doctors who  gave him various opinions on how deep into the muscle or bone the procedure to reconstruct his leg would go.

All agreed that recovery would require six months of bed rest before he could begin to learn to walk again. That was a best-case scenario, counting on the surgery succeeding in removing all of the cancer, and that no complications arose post-surgery with infections.

"He has suffered so much for so long -- 25 years -- that we didn't want any more huge surgeries that were maybes", his wife Christa, noted. The matter of choosing which direction to take was not without its own complications. One doctor refused outright to discuss the potential of amputation, while others spoke disparagingly of quality of life after amputation.

He had read a plethora of studies concluding that amputation and reconstruction both give those affected similar functionality and quality of life, though the impression he was left with was that amputation fails to appeal to doctors as a solution because they link it with failure to arrive at more desirable outcomes. An orthopedic oncologist at Memorial Sloan Kettering Cancer Center in New York performed the amputation for Mr. Taylor.

"I think", said Dr. Daniel E. Prince, "it [reluctance to amputate] comes from a little bit of the God complex in medicine. We think we can fix anything." But another complication had convinced Mr. Taylor that he should choose amputation when an M.R.I. confirmed the cancer had spread, and the chance that reconstruction would succeed was immeasurably reduced.

He thought of how difficult it had been for him to get around, walking, propelling himself forward, even before the advent of the cancer that later afflicted him. It had become a difficult challenge for him to walk ten blocks. Regardless of the possible success of the reconstruction surgery and the follow-up therapy, he would be left with the very same dilemma of difficulty in walking.

Nine months have passed since Mr. Taylor underwent the amputation. He wears the bionic-type prosthetic he preferred, and he's back on two feet, walking with far more ease than he had experienced in decades.

Jim Incledon/PA
Oscar and his bionic legs Credit: Jim Incledon/PA

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