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It's a lot like a bereavement... then you adjust

When you lose a limb you go through a period of bereavement and grieving before you are ready to adjust to your new body. This is a situation that Michael McWilliam is familiar with, having had an above-knee amputation 15 years ago due to a vascular problem.

"Ireland and the HSE are not obliged to keep statistics on amputations," says Michael, who set up the website amputee.ie, "however we estimate that there are 4,000 amputees in the Republic."

The large majority of these cases are due to medical reasons.

"That includes diabetes, vascular, cancer tumours and meningitis. The rest are made up of congenital and trauma -- for example, motorcycle accidents and farm machinery accidents."

Prosthetics can be an expensive business. In Ireland, traditionally you get your first prosthetic limb, which can last for up to a year, for free.

"If you have a medical card, the State would pay for further prostheses. Ireland is the only country in Europe where the state doesn't pay for everyone," he says.

"In the UK, amputees get a free limb every three to five years and they also have a back-up limb in the cupboard that they can use if they're stuck!"

According to Michael, 30pc of amputees in Ireland don't have a medical card.

"If I want to replace my above-knee prosthetic limb, it will cost me €10,000. Luckily, I'm entitled to a medical card on my next birthday," says Michael.

A prosthesis is an artificial limb, made from different types of materials and different types of sockets. Before or after an amputation, the hospital should refer the patient to a prosthetist.

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Jan Ottosson is general manager with Independent Disablement Services (IDS) Limited, a private company based in Cappagh Hospital, Dublin, that makes and fits prosthetic limbs and orthotics.

"Thirty per cent of our client group are female," says Jan. "Sixteen per cent are under 18, and 24pc are upper-limb (hands and arms). The average age of our client is 46 years, although this would usually be probably around 60 plus or so in a more typical service, without the high numbers of children.

"I don't consider age to be an issue," says Jan, who is originally from Sweden. "It's about suitability and how likely the person is to benefit from it. They just need to be able to use it. They may not need to walk a great distance, but a prosthetic leg, for example, may help a person to go to the toilet independently or reach for something out of a kitchen press."

Jan worked as a prosthetist in Sweden for 10 years before coming to Ireland two years ago to join IDS.

"There are currently no courses in Ireland for students who would like to train as prosthetists. An Irish student would have to go to the University of Strathclyde in Glasgow or Salford University in the UK.

"Clients come in for a couple of visits during the manufacturing of the prosthetic limb," says Jan. "We assess them and see what they are in need of. We discuss what they expect and what we expect them to do -- we find a common goal. We then take a mould and they come for a fitting. If the operation is planned in advance, we can meet clients beforehand.

"This can help them to understand the process and will make them a little less vulnerable afterwards. Some of their questions can be answered in advance," Jan says.

Patients receive physiotherapy training pre- and post-operation. They also work with the physiotherapy team in the hospital when they receive their limb.

Eddie Laycock (50), from Rathfarnham, Dublin, is at the early stages of his prosthetic journey. His prosthetic leg weighs 3.5kg and still feels quite heavy and bulky. This is normal.

Using it also requires extra energy, which can leave him feeling quite tired. He is also more aware of safety, although he has fallen and even broken a few ribs since it was fitted last July.

Eddie has a high-speed background, winning the Isle of Man TT Races back in 1987 and 1989. However, it wasn't a motorcycle accident which caused Eddie to lose his left leg and hip but three cancerous tumours, which first appeared in 2006.

After four years of chemotherapy and radiation, gangrene set in around his left knee.

"I was told by three doctors in December 2010 that I needed to have my left leg and hip amputated or I would be dead by the following May. It was an easy decision for me."

Eddie had attended the Sloan Kettering Cancer Centre in New York, but there was nothing the doctors there could do to save his leg. They recommended tumour consultant and specialist surgeon Dr Gary O'Toole in St Vincent's Hospital, Dublin, to carry out the amputation.

"It really didn't sink in until I woke up afterwards," says Eddie. "I didn't know what to expect. I'll be in a wheelchair, I thought, but I'm alive. I was always very active -- painting the house and doing the garden, and always on a motorcycle."

It took a long time initially for the wound to heal. Eddie still attends Dr O'Toole every three months to ensure that there are no more tumours. So far, so good. Those visits may be pushed out to every six months soon. Dr O'Toole referred Eddie to Donna Fischer, lead prosthetist at IDS in Cappagh, who fitted him with a hip and knee joint.

"The main problem is that there is no feeling, as the hip is gone too," he says.

"I can use the leg now. I can go around the house in small steps without the crutch. It's like learning to walk all over again," says Eddie.

Eddie had private health insurance which covered his surgery, but it didn't cover anything to do with the prosthetics. The HSE covered the cost of the socket and hip, but it didn't cover the cost of the knee joint.

Otto Bock is the company that manufactures the Helix Joint and C-Leg micro-processor knee that Eddie needed. It is specifically designed for above-knee amputations and 40,000 people use it worldwide.

"My family and friends organised a fundraiser in Citywest Hotel, which raised the €26,500 for the knee joint. It's a bionic one and has to be plugged in every night like a phone."


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