Search Engine Grab Bag: Stump Shrinkers and the Odd Scrap of Hilarity

(Odd scraps of search engine hilarity will be listed at the end of this post.  You can skip to them directly by clicking here.)

Awhile back, some people came to this site via the following queries, which I have translated from search language to English:

• When is the right time to start using stump shrinkers?

• I need help.  I am an amputee above the left knee.  What kind of shrinkers are there out there?

I got another query recently which happens to be kind of related:

• leg stump massage

Hey, I can take a hint!  So let's talk about this a little.

First, you should know that I have very limited experience with this, strictly my own.  Your prosthetist and/or physiatrist can tell you more, as can a physical therapist with lots of experience with amputees.  Your surgeon may know less than I do.  Though a very good surgeon indeed, mine knew less the last time I saw him than I know now, and didn't interact with me long enough or often enough after my surgery to give him any opportunity to learn more.  So, as usual, I am happy to share what I've learned, but you should not view mine as the last word on the subject, okay?  There is much, much more to know.

Second, on the off-chance that anyone reading this doesn't know what a stump shrinker is or why anyone would want one, let's review briefly.

Upon amputation of a limb, even therapeutic, planned amputation (as opposed to traumatic amputation through misadventure such as war or a car accident), the body goes a little nuts.  Any residual limb, which is a fancy term for "stump," will begin to swell like crazy.  Though this is a natural defense process of the body, past a certain point it's not actually helpful.  Unchecked inflammation can cause damage all by itself, as well as discomfort, both of which can complicate healing, and new stumps don't really have a lot of power to drain themselves.

On top of that, the process of shaping the stump begins immediately.  This can be an active or passive process; it will happen whether anyone steps in to guide it or not.  It's far better that an amputee and his/her medical team should approach it as proactively as possible, as soon as possible.  This way, once the wound has healed, the amputee has a better chance of ending up with a stump which is comfortable, not prone to irritation or infection, fully alive (as opposed to dying and rotting from the inside) and well circulated.  The amputee likely also will desire a stump which will be able to fit well into a prosthesis.  For example, a stump with "dog ears" (little flaps that used to be the corners of a seam of sutures) will be prone to irritations and infections and will not seat comfortably within a prosthetic socket.  A smoothly rounded stump is far less likely to experience these problems.

Accordingly, proactive shaping via compression and shrinkage all begin with the initial bandaging after surgery.  The bandages are wrapped as tightly around the body of the stump as possible to prevent the fluids which are inflammation from accumulating in the stump in the first place.  Swelling happens anyway, of course, but this first bandaging moderates the process.  Still, the stump will usually swell so much immediately after amputation even within a tight dressing that friction of the skin against the bandages as the skin expands will be sufficient to cause major blistering.  (I pretty much had one giant blister encompassing my entire sutured seam.  Individual blisters ranged in size from dime to quarter.  It was truly gross, and when my surgeon popped and debrided them during my first office visit after leaving the hospital, I found it far more painful than the amputation itself.)

Every time the dressing is changed, the compression must continue.  Once the wound has healed well externally, more aggressive steps can and should be taken to promote further healthy shaping.

The two methods I used to control and eliminate inflammation through compression were stump wrapping using ace bandages and stump shrinkers.  You can follow the method of stump wrapping I followed by visiting this very useful illustrated tutorial:

"Fitting the Prosthesis," a chapter from A Manual for Above-Knee Amputees, by Alvin L. Muilenburg and A. Bennett Wilson, Jr.

Instructions for transtibial (below-knee) amputees can be found here:

"Preparation for Fitting the Prosthesis," a chapter from A Manual for Below-Knee Amputees, by Alvin L. Muilenburg and A. Bennett Wilson, Jr.

(I regret that I have never seen comparable instructions online for upper extremity amputees, but perhaps the people who run the site UpperEx.com can help you find something, if that's what you need.)

As the surgical wound heals, this type of compression is better at first than a stump shrinker because donning a stump shrinker can involve manhandling the end of your stump a little bit to a lot.  It's like putting on a very tough, very tight, very thick support stocking.  You can't really get one on well if you still have stitches, seepage, blisters, etc.

Once your wound has sealed itself, you will be encouraged by a good physical therapist to start unbinding and massaging your stump vigorously, several times a day.  You want to do this.  Your circulation has been rerouted.  This is one of the reasons edema (swelling) cannot subside easily on its own.  Massage will help.  Massage will:

• encourage healthy circulation of bodily fluids through the stump, thereby encouraging tissue to heal itself, remain healthy, and stop swelling up;
• help you integrate the new shape of your limb both sensorily and psychologically;
• help you combat phantom limb sensation;
• help you toughen up your stump so that it can become strong and able, which will be necessary whether or not you plan to employ a prosthesis because you don't know what else life is going to throw at you, but will be especially important for your success if/when you do wear a prosthesis.

Naturally, you have to start sort of gently, but a good physical therapist will show you the technique and let you know when to amp it up at the appropriate times in your rehab.  If you cannot reach and manipulate your own stump well enough, the physical therapists will do it for you and will also happily show other people in your personal recovery team -- your spouse or significant other, for example -- how to carry on with it at home.  Massage may include not just manual manipulation but also, once the wound has healed sufficiently, tapping on the end of your stump with a spoon wrapped in washcloths held on by rubber bands or some other object similar to a soft mallet.  Again, the point of all this is not to torture you but to help you heal, it doesn't always feel bad, it starts to feel rather good after a certain point, and it usually works.

Your physical therapist will take regular measurements of your stump.  When your wound has healed sufficiently, and when your swelling has reduced sufficiently, your prosthetist will try to fit you with a stump shrinker.  If no complications arise, this, I am told, usually happens within a month of surgery.  I can't remember now how many weeks after my surgery I got my first shrinker, but it was after my wound had completely healed externally.  My blisters were mere scars.  My stitches had been absorbed into my body.  There was no seepage from anything.  Also, as it turned out, most of my swelling had gone away.  There were still a couple of inches to go before I would achieve my "permanent" shape (though, honestly, there is no such thing as a truly permanent shape).  It was felt by my team, as it is apparently normally felt by most teams at this stage of recovery, that a shrinker would help me get to a stable, healthy shape more quickly than just continuing with the ace wrap.

The brand of shrinker with which I was presented was a Juzo.  I do not know if there are other brands.  I imagine there must be, but I have never seen any or researched this.  The type with which I was presented looked like the "Varin Soft-in" model.  (Obviously, it looked a little different on me than it does on the gentleman modeling it at the Juzo site.)

Because the office of the prosthetist I chose was located very far away from my home, could only be reached after a long drive, and no one was available to take me there at the drop of a hat, when it came time for me to start using a stump shrinker, my physical therapist so advised my surgeon in writing, my surgeon checked my scar, then my surgeon gave me written approval for my prosthetist's file, and then I called in the measurements my physical therapist had taken to my prosthetist's office.  After that, my prosthetist mailed me my first shrinker.  On my physical therapist's advice, I took the shrinker with me to my next visit with my surgeon, which I believe was actually my last visit.  I attempted to don it in front of him after he checked my scar one last time.

My surgeon was puzzled as to why I wanted to try my putting on my shrinker in front of him, but said, "Uh, okay," when I proposed it.  He had no useful input to give.  I struggled to get the garment on.  I grunted, huffed and puffed, and flushed.  It was very tight and very firm, and I was very afraid of hurting myself while donning it.  I didn't know how it was supposed to fit.  He didn't know how it was supposed to fit, either, which shocked the heck out of my physical therapist when I told her later, and though we were both kind of embarrassed, he seemed to think this might all be perfectly normal, as was my assumption.

Now, I am an American woman, and therefore I have been wearing constrictive, uncomfortable, elastic garments on various parts of my body since my early teens, at least.  I wouldn't know if something like this was unhealthily tight without being able to see my flesh turning blue or having my breathing so impaired that I got dizzy.  Juzo stump shrinkers are nearly opaque, so you can't see the color of your stump's skin while you wear one.  Also, who breathes through a stump?  The only clue I had that this shrinker was too small was when I removed the shrinker and my physical therapist saw the red marks it left around the top of my thigh.  It turns out I had been sent a size 2 when what I really needed was a size 4 or 5.  The external package had been incorrectly matched to the contents.  However, because of the way I was fit, by mail and without meaningful supervision until I'd been wearing the thing a few days, no one caught the error.

I am told that most people, most men anyway, can feel when these things are too tight because they cause discomfort, including throbbing.  I was already uncomfortable, having just had my leg amputated a month before, and never experienced throbbing.

No harm was done.  I received a replacement at no additional charge to my insurance company.  Now the difficulty was getting the right fit.  Size 4 was too short.  Size 5 was too loose.  And I may be misremembering; it may have been that I tried sizes 3 and 4, not sizes 4 and 5, but it doesn't matter.  The point is, every stump is unique, a perfect fit may not be had by everyone, and I certainly never experienced a perfect fit although I ended up using three different sizes of shrinker.

Since the goal is to eliminate all edema from the stump for its health and also so that the stump can be well fit with its first prosthesis, the patient must wear the tightest shrinker s/he safely can.  Circulation to all parts of the stump of healthy bodily fluids (e.g., blood, lymph) must not be impeded.

Now, the way it's supposed to go, the way it goes for "normal" amputees, that is, men with no complications, is that the amputee is given progressively smaller sizes of shrinker over a period of weeks or months, as the stump shrinks in a smooth progression.  This is not how it went for me.

As a woman, as I have noted elsewhere on many occasions, I have completely separate issues with water in my body, and I am a different size and shape every single day of the month.  Sometimes the smaller size shrinker was intolerable for me; sometimes the larger size was ridiculously large to the point of uselessness; sometimes the only shrinker which felt both comfortable and effective was the teeny-tiny one I'd been initially sent by accident.

Possibly because I'm a woman, or more likely because every stump is unique and not a perfect stock size, not only did I never achieve a perfect fit, I was also never perfectly comfortable in any shrinker.  The Velcro waist strap that held the shrinker on was too long and scratched me, even after I cut it down.  On the larger sizes, the top hem of the garment would not stay in place at my crotch but kept riding down creating a little blub of flesh out the top.  (That blub issue isn't just a woman thing, either.  You can see such a thing happening on the model in the picture at the Juzo website linked above.)  The garment would chafe around that blub. Also, my skin does not tolerate synthetic fibers well, so I got a rash from the shrinker if I wore it too long, even though I kept them all and my skin very clean.

I found that I preferred to continue the ace wrap except when I left the house.  The ace wrap continued to work well at home.  Not only could I customize the fit more closely to my personal dimensions, but the ace bandages allowed my skin to breathe a little better.  Also, my prosthetist felt the bandages were better for me to sleep in than the shrinkers.

The bandages were very expensive and not covered by insurance, though, whereas the shrinkers were about $40 apiece and totally covered.  Also, the bandages lost elasticity with every washing, which made it progressively harder to get a tight enough bind to be effective, and we were too broke to buy more.

I found the shrinkers stayed taut through many washings even after several developed runs, like nylons.  Also, I found shrinkers better for leaving the house for one reason more than any other:  you do not want to be fussing with bandages and clip fasteners in a public restroom on one leg.  You don't.  Take my word for it.

A shrinker such as the type I wore is sufficiently unobtrusive in its design that you probably won't have to take it off or move it around very much to toilet yourself without getting anything nasty on it, whereas bandages can come undone and trail into places such as a toilet bowl.  And then what do you do with it, right?  Bandages can come undone when you're not on the toilet, too.  Those little prongy clips are not exactly high endurance fasteners, and no matter how tightly you bind yourself, all those strips of elastic strap can move in an assortment of directions as you move through your day.  You don't want to be digging around in your pants adjusting your bandages while you're crutching or wheeling around a bookstore, right?

So for leaving home, a shrinker is a tremendous convenience.  It's one, neat piece that mostly stays where it should, most of the time.  You can keep constant pressure on your stump, keeping up the edema fighting every minute, and not have straps and hooks ready to fling themselves away from you at the slightest bump.

Once you are fit with a prosthetic, the socket will provide pressure on your stump, and your stump will continue to shrink partly from continued lessening of edema but also from loss of tissue as it atrophies.  It may be suggested to you, as it was to me, that you should continue to wear a stump shrinker when you are not wearing your new prosthesis to help speed along this process and to prevent swelling from reoccurring.  Because it was so uncomfortable, and because I stopped seeing any benefit, I chose to discontinue my use of both shrinkers and bandages about four or five months after amputation.  Your rehab team will make recommendations to suit your individual case, and you will have to make choices based on your own experience.

After you have a working prosthetic, you will continue to lose muscle mass in your stump as you use the various cut and reattached muscles in different ways than you used to, if at all.  This is natural.  This is part of why you will probably go through several prosthetic sockets in your first year post-amputation.  Throughout your life, your stump will change shape, too, just like your face and your torso, just like any person's body changes with age.  Things shift with time and gravity.  That's life.  So there will be no truly permanent shape to your stump, ever.  The most dramatic shaping usually happens in the first year after amputation, however, and part of it is in your hands, which is why you will use massage, ace wrapping and/or stump shrinkers as your team advises, beginning immediately after amputation.

Okay, now, as promised, for the Odd Scrap of Hilarity, four to be precise:

In the last few months, I have been visited by guests arriving here through the following search queries (translated into English):

• Who made Gene Wilder's purple Wonka coat?

I have no idea, but IMDb.com lists the costumer of that film as one Helen Colvig.  It doesn't say whether she actually manufactured the garment with her own hands, but my, didn't he look fine in it?  Mmmmm-mmmm.  And don't I want one just like it but in my size to this very day?  Oh, yes.  Yes, I do.

Next query:

• sexy prosthetic feet

Yeah, good luck with that, and no, I don't want to hear about it.

And next:

• the woman who paints with her boobs

Not me; that's all I know.  Not enough control, you know?

Finally, I received this gem:

• [JANE DOE] IS A BITCH!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Wow!  That's not a search query, is it?  That's a publicity statement.  "Jane Doe," of course, is not the name of the person this "searcher" purported to seek.  The "searcher" was brought to this site through this "query" because the actual name of "Jane Doe" appears in one of my posts.  I will not say which one or who it is, because I do not know the woman personally and refuse to perpetuate any assertion about her character or personality without knowing whether it's true.  I was, however, vastly amused by the ingenuity of using a search engine to spread dirt about somebody.  So clever, and yet so juvenile.  And yet, really, so clever.  'Cause now I've got to wonder if this person really is a bitch.  Sorry; I can't help it.

Incidentally, the "searcher" did in fact use exactly that number of exclamation points.  Honestly.  In case the chain of them gets cut off by my margins, I count 104.  That's a lot of exclamation.

Okay, that's it for this edition of Search Engine Grab Bag.  One way or another, I hope everyone who reads it finds it, uh, enlightening.  Yeah, enlightening.  Sure.

Comments

[Neil]

This is what is great about the internet. Whatever you are looking for, you can probably find. My father was a physical therapist and things would have been so much easier for him if he was able to connect people online to learn about new therapies, etc. Things always make so much more sense when someone has had actual experience using a product or received a treatment himself.

Now, for that woman that paints with her boobs...

[Sara]

If Art Center or Otis Parsons had offered a course in painting with boobs back in the day, I must confess I probably would have been tempted to take it because I was that frivolous, but I never did see it on the curriculum of either, and anyway, I couldn't have afforded it. We should thank the groves of academe for small favors.

I have heard of men using women as paint brushes, you know, having them roll around in paint and then roll their painted bodies all over big sheets of paper and/or canvas, but I can't remember if that was real or a scene from some ridiculous movie from the '60s. I wouldn't be at all surprised to discover it had happened though, even if what I remember about it isn't journalism.

Interestingly, I have never heard of women using men's bodies the same way.

And yes, Neil, the internet is wonderfully rich with human experience -- and scary, because even though we may not be able to see exactly who is searching for what, being able to see all these diverse search strings, and then click to the full responses generated by each search engine, exposes facets of our fellow humans we might never have dreamed existed -- and might possibly have preferred never to discover! There are many, many search strings I will never dignify with repetition here, because they're just too weird and gross, demeaning and objectifying. Sometimes, though, I send them to my friend Melissa for one of her "Monday morning Google smackdowns." She is very skilled at these.

Hilarity aside, though, as weird as things are on the internet as elsewhere, yes, it is the pooling of knowledge and experience -- and the sharing of real tragedy and real joy -- that makes this whole thing such an enormous gift. Every day, this thing helps people go through disaster, prepare for it, heal from it, get and give help, and also have trivial conversations that just bring us all closer. It is delicious.

[Kay]

I learned two things here: All about stumps (thanks), and that Sara cannot paint with her boobs. Always good to know, I guess.

[Sara]

heh heh

It's not that I can't; it's that I've never tried. It simply doesn't seem likely to yield results I'd like well enough for the amount of bother it would entail. However, not knowing what life holds in store, one never likes to rule anything out categorically. ;)