External Hemipelvectomy in the Acute Care Setting - a brief insight of an Eval
This past tuesday I evaluated a 23 year old after a chest surgery who also had a hemipelvectomy (Janurary 2014) for a recurrent osteosarcoma.
He had a very complex social history (father in jail, mother passed away, homeless at one point - now living with uncle, opiod/alcohol/benzodiazepine abuse, etc.) with multiple wound infections and follow up surgeries for the amputation.
It was a unique case, one I felt moderately confident going into even though I have no experience working with someone that high of an amputation.
My biggest findings were he had low back and bilateral upper arm pain (from uses crutches all the time, we lowered the height of them in his session to decrease that pressure and practiced the most efficient sit to stand transfer and proper sitting posture), decreased activity tolerance (he walked about 20 feet before feeling slightly dizzy and pain from his recent surgery in which he needed to continuously be cued to slow down, take a break and focus on deep breathing), and a high risk for recurrent falls (he had two falls just within the last few months at home where he was taking the steps to enter his house).
I recommended Acute Rehab on my assessment - which he is interested in but concerned about finances (I told him someone from social work would discuss this further and his insurance coverage, etc.). He may or may not get a prosthetic - but to increase his endurannce, balance and safety it would be well worth the stay since he is so young and was independent prior.