Amputation Prevention: Why Second Opinions Can Save Lives

Dr. Bill Releford
April 11, 2022

Approximately 2.1 million people in the United States are currently living with limb loss with this number expected to double by 2050. Also, about 50% of this population will undergo lower extremity amputation without any prior testing or seeking a second opinion. Every patient has a right to a second opinion as it helps narrow down all the alternative modes of treatment before parting with a limb.

What Causes Amputation?

While there are several causes for limb loss, the most prevalent one is Peripheral Artery Disease (PAD). PAD is a complication of diabetes that causes narrowing of the arteries and ultimately, reduced blood flow to the limbs. Statistics show that an estimated 8.5 million Americans suffer from PAD with nearly 15% of them being above 70 years.

If left untreated, PAD can lead to limb loss, and for many PAD patients facing amputation, this is a scary time whereby they often don’t know where to turn to. Other common causes for amputations include foot ulcers, traumatic injuries, and cancer-related symptoms.

The Downside of Amputation

Approximately 185,000 amputations are carried out each year – that’s a shocking 300 to 500 amputations per day. Many patients who consider amputation are usually not aware that other options are available.

Amputation causes loss of independence, increased levels of depression, and shorter survival rates. The financial burden is also great on amputees. In 2017, the healthcare costs for amputations were about $509,275 compared to $361, 200 for patients who didn’t lose a limb.

Blacks have for a long time faced many disparities and health care is one of them. Amputations can lead to even more disparities. According to the U.S Department of Health and Human Services Offices of Minority Health, Blacks are at a higher risk of having heart disease and diabetes, both of which are linked to lower extremity amputation. 

Further, most of the patients either don’t understand the disease or lack transportation to get to healthcare centers.

A majority of the Black patients who undergo amputations are lower-income earners and risk losing their jobs after an amputation. Also, rehabilitation for people who have lost limbs can be expensive. 

All these results in a person being less healthy and less financially stable than a patient who has undergone limb salvage.

The Importance of a Second Opinion in Amputation Prevention

Patients tend to believe the doctor’s treatment option as final and approve the amputation without considering a second opinion. A second opinion helps you understand the range of treatment options. 

Take it upon yourself to learn all the alternative treatments available because the earlier the diagnosis and treatment, the less likely you are to advance to the later stages of the disease.

It’s estimated that about half of amputees who had their lower limb cut because of a vascular disease die within 5 years. Further, a study shows that up to 55% of people who have undergone a lower extremity amputation will need their other leg amputated within 2-3 years. 

For these reasons and more, it’s important to exhaust all other options before settling on an amputation.

A Different Approach

There’s no one-size-fits-all solution to amputation prevention. However, many doctors resort to doing away with the limb majorly due to the complex nature of PAD, chronic wounds, and traumatic injuries. Such cases require years of expertise and experience to best treat the underlying conditions.

Many risk factors for limb loss such as PAD can be treated using minimally invasive surgeries on an outpatient basis. Amputation is final, but other options could help you avoid it. 

After a diagnostic appointment with a specialist, the doctor may suggest improving your condition with exercise, dietary changes, medication, or quitting smoking.

If there’s little improvement even after following the above recommendation then you may be required to go through a surgical procedure such as angioplasty whereby a long thin catheter is put into a blood vessel and guided to the blocked artery with the help of an x-ray. 

A balloon is then inflated to press the plaque or blood clot against the side of the artery and thus widening the artery allowing for increased blood flow.

Advanced cases may require a surgical bypass or atherectomy to improve circulation. In bypass surgery, a vein or synthetic graft is attached above or below the blockage to reroute blood flow thus increasing circulation to the legs and feet. 

Atherectomy involves grinding or cutting away the plaque causing the blockage. A combination of open surgical techniques may be used in some cases.

All these alternatives go to show that amputation is never really the only option. Each patient should have their anatomy, symptoms, and risks analyzed carefully for a customized treatment plan.

Bottom Line

Amputation prevention involves taking early and aggressive steps to heal and preserve your legs, feet, and toes. A big part of it involves seeking a second opinion to rule out the possibility of limb loss. Not all health care professionals are PAD specialists, so if your doctor is not, you may want to get a second opinion. Only settle for lower extremity amputation as the last resort when all else fails.