How Amputation Works

Amputation is one of the oldest surgeries and an even older punishment for crime, but it wasn't until the American Civil War and its 50,000 amputations that the procedure began to hit its stride. Learn about amputation and who it attracts in this episode.

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Episode Transcript

Speaker 1 (00:01):
Welcome to you stuff you should know from house Stuff
Works dot com. Hey, and welcome to the podcast. I'm
Josh Clark in the Dynamic duo Chuck Bryant, two Men,
eight lambs. Yeah, that's us. Yeah, I guess so I

(00:23):
hadn't really thought about it. We're fully intact. Yeah, and
I think, Um, I think missing a limb or a
finger or a toe or anything. Sure, um if, I guess,
it's not something you think about until after it happens,
and then it probably becomes one of the central folk
I of your life. Do you know anyone missing a one? Uh? No,

(00:43):
As a matter of fact, I don't, do you. Uh yeah.
I worked with a guy at my last job who
had an accident, biking accident with a truck. Not true,
Not true, Go ahead. I just had to remind myself,
Uh of what. Oh my brother in law's father has
a part of partial finger amputation. Oh yeah, well this

(01:04):
this fan's his arm, the whole arm. Yeah. What happened? Um,
biking on the side of the road and oncoming truck
the side view mirror basically clipped him at the armpit
and did it take it clean off or I don't know.
I'm not sure. I guess if it would have taken
it clean off, they probably would have done a replantation. Yeah,

(01:27):
we talked about Yeah, so this is a I guess
the follow up in a mini suite. I like to
think of it as a part of a larger suite.
We've done broken bones, Yeah, we've done um replantation. I
think it's called your limbs torn off? Now what? Uh?
And then this one how amputation works. Yeah, that's a
good it's a good nice sweet What else can we

(01:50):
possibly add to that? I don't know, because we're gonna
cover uh, sexual fetishes around limb loss and phantom limb pain,
and so I think that's that's all encompassing, sir. I
think this will finish it off, miss hedbird well encompassingly.
Really that was one of his bits. Uh, Chuck, Yes,

(02:15):
have you surely I know that you've heard of Aaron Rollston. Yeah,
we saw the movie and everything. There's a hundred twenty
seven hours, right, um, yeah, I think that's right the
name of the movie. Yeah, I'm doubting it all of
a sudden, the number of hours. Yeah, good movie. Did
you see it? Oh? Yeah, it was great. Yeah, James
Franco is just like, I'm doing so great in the

(02:36):
middle the movie, didn't He look at the camera, He's like,
aren't aw I like that guy? Yeah? I do too,
But he likes himself as well. Yeah. And hey, Danny Boyle,
he makes a great movie. Is that Who directed that? Yeah?
Like he's all over the map, like genre wise, And
I really have appreciation for people that don't make the
same movie over and over, you know, hats off for that.

(02:58):
Um have you seen her? Yeah? I just saw it.
That's a good movie. I was surprised that how good
it was. I thought it was. I loved it. Yeah,
So okay back to hundred twenty seven Hours. That movie
by Danny Boyle is about a real life incident that
happened to a guy named Aaron Ralston in two thousand three.
In May of two thousand three, he was a and

(03:20):
I take it he still is a real like outdoorsy
go getters or can't keep me down kind of guy,
very independent spirit, so much so that he went canyoning
by himself, um, in May of two thousand three, and
while canyoning, there was a uh shift with one of
the boulders that he was leaning on. Or next two

(03:42):
or something, and he slipped down into a crevas so
what it was, and a boulder landed on top, wedging
his arm in there yet Okay, I haven't seen the
movie in a little while. Plus I wasn't there when
it happened. Um, and so he's he's trapped like alone,
no cell service, I firem or correctly. Um, he was
just totally screwed as much as a person could be screwed.

(04:06):
The one saving grace that Aaron Ralston had. The two
saving graces that Aaron Ralston had was a pocket knife
and nerves of steel. Yeah. I'm glad you said that
because I was like, if he doesn't say intestinal fortitude
or something like that, then I have to add a
third thing. Yeah, because I mean there's not I don't

(04:26):
think that that many human beings can pull that off.
So we should say for those of you who haven't
seen the movie, you should see it anyway. But he
cuts his own handoff, He cut a portion of his
arm off. He did what's called a lower extremity amputation.
Oh I thought that'd be an upper upper. Yeah, that's
what I meant. I was thinking lower on the arm

(04:47):
and stupid. But um, Yeah, he without any sedation whatsoever,
after having gone about five days without water, a few
days without water. He was trapped there for five days
with no hope that he was going to be helped
us out in the middle of nowhere. Um, he broke
his arm. And then after he broke his arm, he

(05:09):
cut through the skin and the tendons and the muscles
and all the sinew around, you know, through the break
and the bones, and then cut his his lower arm off. Yeah.
And remember he had dulled his knife from trying to
chip away at the stone for days and I forgot
about that. Yeah, So if he had have done it initially,

(05:29):
it would have been easier. So he had like this
dull blade. Yeah. Yeah. Man, it's a tough scene to
watch for sure, but I think they handled it well
and it's a great story. Yeah. And he is like, oh,
I should say also, we should finish it. He hiked
out six six miles before he finally found somebody to

(05:50):
drive him to the hospital. Yeah, and I think he
even stopped and did a little like splunking along the
way or something like that. No, he went straight to
the hospital. Well, he was probably doing all sorts of
outdoors the activities right afterwards, he's like, I said, one
of those people you can't keep down. But um, in
this article, it's a pretty good article about amputation. UM.

(06:11):
The author makes the point that Aaron Ralston's is a
great example of amputation in that UM it's a blast
resort typically, like you don't just go this, try amputation
and then we'll go from there. It's like if we
don't amputate, you're going to die usually. So it also
he also provides the um the point that your your

(06:35):
life doesn't end when you undergo an amputation. That's right,
Like there's all sorts of things that kind of get
you back on track, and it's a lot of work
and it's the suck thing to happen, I imagine. But
when you do have UM limbs amputated, your life isn't
over basically. And well we'll talk about that too, But UM,
you want to get into amputation. I want to talk
about the history of this stuff. Uh yeah, man, it's

(06:57):
UM history is like all old medical history involving surgery.
It's pretty grizzly. UM. It dates all the way back
to ancient times. They found archaeological proof that they performed
their procedure many many many years ago, about seven thousand
years ago, they found a grave really who had had
his lower arm amputated, head healed. Yeah. What they found

(07:21):
the differences though, back then they were moving dead tissue,
tissue that was already dead because they didn't know how
to stop bleeding at the time, so they obviously couldn't
cut any healthy blood flow, any arteries or blood vessels, right,
so they had to cut off tissue that was just
like you said, already dead. There wasn't any blood flowing

(07:41):
to it, no blood. Uh. And then of course in
Rome in Greece they were smart and they advanced the
process and actually, uh were the first to tie off
these blood vessels. Is that called legating? Yeah, okay, like
ligature marks, yeah yeah yeah um. And that would stop
the blood flow, and they did a good job with that.

(08:03):
But it seems that people forgot about that and they
didn't do that for another few hundred years afterwards. And
not only did they forget about that, the Romans and
the Greeks both used um wine and vinegars an aseptics
during surgery too, and just lost that too. I wonder
if that worked. I think probably better is better than

(08:24):
nothing other than um so, like I said, they forgot
for a couple hundred years or a few hundred and
then and started cauterizing wounds instead, which, as we all know,
is burning a blood vessel shut, dipping it and boiling oil.
It's one way, or just the old hot poker treatment.
Um yeah, just awful, It's like and then say hello

(08:49):
to this hot boiling oil. Wow. I wonder how well
it worked, though, I mean, at least as far as
keeping the person alive and staving off infection. I mean
I think that I don't know about the infection part,
but back then, I think they just wanted to keep
someone alive. Do you remember Rainbow three when he gets
shot in the side and he cauterizes his wound by
pouring some gasoline in and lighting and I don't remember

(09:11):
that he did that. Yeah, this like blue flame like
shoots through his abdomen and he goes it's the best
acting still one's ever done. Wow. I don't know that
I agree with that, but it's impressive. You should watch it.
See what you think. Okay, okay, I put first blood
on my I saw that in my list, But I
haven't heard any chiding yet. On your list of hundred

(09:32):
greatest movies of all time. That's right, um, but Rainbow
three was not on there. It was still pretty good, Okay,
I'll check it out. Remember he was fighting with the Taliban.
The mujah Hadeen was at the middle. There are the
freedom fighters that he was helping fight the Russians. I
actually don't know if I saw Rainbow three now that
I think about it. Um, all right, So amputation advanced,

(09:53):
of course over the years after the cauterization um debacle
and in wartime or after wartime with no surprise is
when they made a lot of these advances, especially in
France with a surgeon name, a military surgeon name Ambroyce Parae.
I don't know if he's related to Michael or not,

(10:15):
but um he uh. Of course, with gunpowder and bullets
and cannonballs and things we saw like injuries like we've
never seen before. Yeah, we can. We can thank those
things for advancement of amputation. Totally successful amputation. Um. So
that was one of the big reasons that Parae was effective.

(10:38):
And he was basically the first guy to bring back
the legating he rediscovered it. Yeah, in which is said
that it took that long from ancient Rome to somebody
be like, oh, what if we just like tied these
things shut? Now, burn it right, really got the hot

(11:00):
oil already already, it's too late for your advancement. And
that is how fond was born. Like, we got the
hot oil ready, he said, we don't need it. Put
some meat on a stick and have at it. Oh no,
you thought I was talking about like body parts. No, no, no,
I'm not a monster. Um. Then I thought it was
funnier when you were a monster. Then the tourniquet was

(11:23):
invented in sixteen seventy four, which kind of surprises me
that because that seems more rudimentary than any of this
another bonehead invention. Yeah, like, why don't you know, you
you come up with this stuff before you cut people's
limbs off, it would be nice. And then anesthetic of course, uh,
in the forties with anesthetic gas went a long way
towards performing these surgeries, you know, with that lot of pain. Yeah.

(11:46):
And here in the Western world, the American Civil War
was a huge, dude springboard to um understanding amputation amputation techniques.
They might as well call it the amputation War just
from sheer volume of amputations. A lot of doctors who
got their nickname sawbones from amputating, sawing through bones and
all that. Um, just the number of amputations that they performed,

(12:11):
formed this body of knowledge that carried on after the war. Yeah,
fifty thousand, more than fifty tho amputations in the Civil War.
And this this is also hard to believe, but I
guess it's hard to go back in time and realize
if they just didn't know something, they didn't know it yet.
It seems like a no brainer now that keeping a
surgical environment clean should just be an eate and a surgeon.

(12:34):
But back then they didn't know that. They didn't understand
bacteria like they do now. They didn't know germs. Yeah,
and so it was like a stamp of experience to
have a bloody surgical gown. So surgeons would like purposefully
not change their clothes and things because they were like, hey,
look at my bloody gownd eight amputations today beat that, yeah, exact,

(12:56):
pepper John. Um. They would doll some the chloroform soaked rag,
put on the tourniquet and slice through everything and then
like you said, get out the old saw bones all
and uh, take care of business. Basically, and then we
just toss the limb onto a pile, which grew pretty quickly. Yeah,
and there's plenty of old photographs of limb piles from

(13:18):
the Civil War. Yeah. One out of four patients died
uh in those days after an amputation, and that doubled
if it didn't happen in the first twenty four hours. Right,
But a lot of people's lives were saved battlefield amputations. Yeah,
and most of those I think we're probably um bacterial
due to infection and not necessarily like just bleeding outer

(13:41):
or a mistake or something, right, which we should say
at this point. The whole reason to amputate is because
you often have a wound or a diseased part of
your body UM that's creating dead tissue, and that site
of dead tissue is a really great place for becked
a real infections to take root and take hold. The

(14:03):
problem with the bacterial infection is that it tends to
spread towards the rest of your body. So the point
of amputation almost across the board is to prevent the
spread of infection in the rashest way possible, which is
why amputations typically are just the last resort. You're trying
to stop this infection from spreading. And if you literally

(14:25):
separate it from the rest of the healthy body, that
should do the trick, and it frequently does. Yeah, and
I think the final advancement, well not final advancement, of course,
it's still advancing. But the last big advancement was was
with the infections and a British surgeon named Joseph lister
Um was known as kind of the father of antiseptic surgery.

(14:50):
Oh yeah, no, way, of course it is. I never
put those two together. Boom. Did he make any money
off that? Like, was it actually his company or did
they just I don't know. Interesting, So he was the
first guy. He used something called carbolic acid, which is listering.
Probably is. They used it back then to prevent wood

(15:11):
rot and to treat sewage, so I guess they just
knew it was good for for stopping bacteria. I'll be
that caught aizes wounds. Yeah, and uh he would spray
it on surgical tools and incisions and dressings and even people,
uh in the surgery room. He would spray them with
it and then he would he was the first distress

(15:31):
handwashing and clean gloves and things like that. So hats
off to you, Mr Lister. Dr Lister, Well, he was
one of those people who like made up a handful
of human beings who have saved billions of people's lives
just from their innovations and their insights. Um. So amputation,

(15:53):
it's been around for a while, and that's just surgically amputation.
There's evidence of amputation for um religious self sacrifice as
far back as like thirty thousand, forty thousand years ago. Um,
it was very for a long time. It was a punishment.
That um word amputatio or amputasho is a Roman for well,

(16:14):
it's a punishment. It's synonymous with punishment, and it meant
like you had your hands chopped off, Like if you
steal something you then symbolically they would cut off your hand. Yeah,
and then it was even amputation is even inscribed as
a punishment in the first written law, the Code of Hammurabi.
If you were a doctor and you lost the patient,

(16:35):
well you should lose one of your hands. That was
the code. That just makes this so counter to trying
to make doctors better. You know, yeah, we want you
to be a better doctor, so we're gonna remove one
of your hands. You're worried about tort law. Think about
how good you have it now. Um. So, like you said,
the reason, Um, there are a couple of reasons you

(16:55):
would get an amputation. Uh. One is disease and the
other is um injury like my friend with the truck,
like some kind of catastrophic injury. UH damages It doesn't
necessarily always like rip your arm off, but it damages
it to the point where there's no blood flowing there
and the tissue was dying beyond the point where it

(17:17):
can be rescued, essentially. And it might be a truck,
it might be a bullet wound, Um, it could be well. Basically,
any traumatic injury, a fire, a burn, a severe burn
is considered a traumatic injury. Yeah. Blood flow is big.
If it's not flowing, then problems happen. You're gonna have
a stroke. If it stops blowing, you're gonna lose an arm.

(17:38):
And it stops slowing. So if your blood flow is
cut off for too long, then you're in big trouble. Right,
And it's not just a traumatic injury disease. UM, there's
plenty of diseases that see a lessening of blood flow,
like um arterio, sclerosis because plaque build up and blood vessels.
When it builds up enough and enough, those blood vessels hardened,

(18:01):
and the amount of blood flow through those vessels diminishes
so much that the tissue that those blood vessels feed
Uh dies. Um. There's something called peripheral artery disease, which
is the result of a lack of blood flow leading
to dead tissue. Uman. Diabetics. Yeah, you you join that

(18:22):
with diabetes, which has the tendency to also kill nerve
endings neuropathy. Uh. And then all of a sudden, you
can't feel so when you cut yourself, so you cut
your foot or something like that, Um, you don't feel it,
So you're more prone to cuts, and it takes longer
to heal because of the lack of circulation, And all
of a sudden, you have an infection that possibly turns

(18:42):
gangrenous and threatens your entire life. Yeah. And in the US,
ninety percent of amputations are as a result of this
disease scenario. Um. Whereas if you're under fifty, UM, traumatic
injury is a leading cause of amputations. Yeah. So like
you know, you're out rudding your bike, I'm on a
mountain road, or your Aaron Ralston in Your Mountaineering and Utah.

(19:06):
You know, I would call that a traumatic injury getting
your hampined under a boulder for sure, man, can you imagine?
And they did a good job in the movie. But
as it sets in, like what the deal is because
at first he was like, oh man, yeah, like let
me get out of this, or trying to move the
boulder was like nothing, and then all of a sudden,
you think I might die of starvation. Yeah, and then

(19:30):
you it just goes over to the knife, like, man,
I wish I hadn't adulled it. So then there's cancer,
which we haven't mentioned. Um. There are a couple of
ways that it could lead to amputation. Obviously just damage
to your body tissue. Um. But also like you said,
to keep a malignant tumor from spreading around, sometimes they
will just lop it off. And apparently those amputations from

(19:55):
cancer have diminished tremendously over sure that gator two. Um.
But unfortunately those from disease have increased. Yeah, it's dropped
by over the past twenty years amputations overall. No, just
from for answer, traumatic injury and cancer. UM. So I

(20:17):
don't know people are being safer and their recreation if
that has something to do with it or not, or
they're yeah, we might have better trauma or better reattaching
to UM. But yes, you're right. It has increased because
of at least in the the United States, largely due to obesity,
so much so that this article was from UM maybe

(20:38):
two two thousand and six something like that, and it
says that one out of every two hundred Americans is
an amputee. That's not right anymore. No, it's actually even
more one out of from what I could find, a
hundred and seventy six Americans, so it's one point seven
million people, one out of hundreds. That seems like a
lot of people. Yeah, but that counts digits and things

(21:02):
that you don't think about, you know, like someone lost
a thumb, because I hear that, and I'm like, why
don't I see that more on a daily basis. You
don't work in the industrial arts. Yeah, that's true. I
don't work in a factory with lots of saws and chains,
and yeah, that's good point. You got Alaska about every
like third person has a limb that's missing. You don't

(21:23):
see a lot of the podcasting field. UM, so we're
gonna prepare you for surgery. Dr Clark right for this message. Break. Wait,
I'm doing the surgery right always. Okay. So preparing for
amputation surgery is like every surgery. Initially, you're gonna have

(21:47):
a lot of meetings because they want you to be prepared,
and you're gonna have everything very explained very well, and
what you can expect before, during, and after, just like
with all surgery. How what kind of anesthesia they're going
to use? Um, Yeah, it's not always general anesthesia. I
knew this would stand out to you too. Yeah, I
would not want to be awake. No, knock me out,

(22:10):
cut my toe off, I don't care. Yeah, I'd better
be out. Well, actually, I take that back. If it
was like a just a digit, I could stomach that.
Not me. I don't know. If I'd watch it. At
the very least, I wouldn't would be boring. I think
it'd be fascinating. Well, I mean you couldn't see anything.
You'd just be sitting there like these guys are cutting
my finger off right now. I think it'd arrange a
mirror or something. I used to get that at the dentist.

(22:33):
I used to request a mirror, so I could look
at what they were doing. I think, just because it
fascinated me and to keep an eye on Yeah, exactly.
So Yeah, they say sometimes you just local anesthetic to
to carry out a amputation. That's nutty. Um, if it's
a limb, I don't think they would do that. No,
that's got to be generalized. Yeah, because I think like

(22:55):
if you weren't under your blood pressure would advise to
dangerous levels. This good point. Yeah. Uh, if you're gonna
get a prosthetic device, you might meet beforehand with your prosthetics, uh,
to measure you out and kind of talk about what
you're looking for post surgery, and um, then you're gonna
you know, then it's go time. I guess it is

(23:18):
kind of go time. The well, the surgeon is gonna
want to figure out exactly where to cut ahead of time.
It's not like how about here they actually measure blood
flow to the area, um, to see what tissues still
receiving you know, circular, a healthy amount of circulation. Yeah,
they don't want to leave any bad tissue behind. No,
but they want to get as much of the bad

(23:40):
tissue as they can, which is what you just said.
But they also want to leave intact as much healthy
tissue as possible, which is why they measure and they
try to find that line of demarcation where they should cut. Yeah,
they said, especially around the joints. Uh. They want to
preserve all the healthy stuff they can because, uh, if
your joint is working, then that's gonna help you out

(24:03):
with your prosthetic limbits. Oh yeah, if they if they
can do anything to save a joint, they're gonna leave
it intact um. So they figure out where to cut.
They try to leave a joint as intact as possible.
And this is all the non emergency variety exactly. Yeah,
like all of this planning and everything, it goes out

(24:23):
the window when you come in with a shotgun blast
your lower leg exactly. Um, they're gonna be like, we
need to amputate. We have to do this quick. And
they do. And you don't have to meet with anybody.
That's the plus side meetings. Um. Some of the techniques

(24:44):
they use it are actually let's just go ahead and
walk you through the process, all right, so everyone please.
The article points out that the first thing they cut
through is the skin, right, They cut through the imaginary
barrier and the air above the skin. First, technically, of
course you're going to cut through the skin and you
want it to heal quick. And they said leave an

(25:06):
appropriate scar, which doesn't mean for cosmetics, like don't you
don't leave your your initials as a scar or something.
You know. What they mean is they don't want to
leave a scar where it might rub up against the
prosthetic or something and cost problems. Yeah, that can't be good. Um.
So they cut through the skin and pretty soon after

(25:27):
that they meet muscle. Mr muscle, and this makes up
the bulk of what they're cutting through. And I only
like within the last year so realized that muscle is
what steak is. Did I tell you this? Yeah? You
told me. It's just crazy to me. Like I I
used to be like, okay, so you got muscle, you
have the skin, you have the what's the steak? And

(25:48):
then I realized, like, oh, muscles the steak. Yeah. I
was like, I'd make a good steak. Now you'd be sinewy,
so I'd make a good steak. So with with muscle
there there, they want to they have to cut through it,
but they want to save a little bit of length
of it as much as possible. Yeah, Um, that's your

(26:10):
padding basically, Yeah, they're gonna fit it around the bone
at the bottom. It is, it's the padding on the bottom,
the exposed part of the the residual limb, which is
what the stump is called. You shouldn't call people's residual
limb stumps, is that true? Yeah? Well why do they
use it? Fifty times in this article? They finally get
to the point where they're like the residual limb, which

(26:32):
is the preferred term. I think my friend called his stump.
Oh yeah, I mean, if you have an amputated limb,
you can call it whatever you want. Right. It's like
you can't pick on my brother, Well, only I can
pick up my brother. Okay, it's along the same line.
So we've cut through the skin the muscle. No, you've

(26:52):
got your nerves. Oh man, I know it sends a
chill up my spine thinking about it. Um, you have
to cut through the nerves out of slee and then
what they want to do, you're gonna have you know,
where you cut the nerve is going to be a
nerve stump. Now that's okay to call it a stumps.
The nerves exactly, Um, and they still carry signals of

(27:16):
pain sometimes even, and so they do their best to
minimize what we're gonna talk about next, which is phantom
limp pain, by sewing nerving things into the tissue around
it and even cutting it off, cutting the nerves off
higher up than the amputation site to try and prevent that. Um.

(27:36):
But thanks to you in that article you sent me,
we learned that phantom limb pain actually occurs in the
majority of patients who lose their limbs. I didn't know
that it sounded like a rarity to me. No, I
think it's like, um, I think it's like not a
given necessarily, but I think that it's very common. Should

(27:58):
we go ahead and cover it now? And then yeah,
finish up with the surgery. Yeah. So, like you said,
when you when you cut fanstom up right right, still um,
when you cut a nerve um fiber um, you're it's
still even though there's a stump and there's it's not
connected to anything anymore down there, it can still transmit

(28:20):
information to the brain and it still does. And your
brain has been it's developed this certain kind of arrangement
of neurons. Say that have to do with your lower leg.
Your lower left leg is in this one region of
your brain. And the thing is, when you amputate your
lower left leg, your brain doesn't really get the news

(28:42):
that it's not there anymore, or at least at the
very least, it confuses it. It does and it makes
the brain think that you have a lower left leg still,
but you're just not using it. Or your brain has
this technique for telling you when it's like you need
to use your limbs or get up or move around
or do something UM. And that's by sending a painful

(29:05):
sensation from the leg to the brain to you to
experience it. And when that leg is not there and
your brain thinks it still isn't you're not using it,
then what you have is something called phantom pain. Yeah,
and that can be. It's not just like, oh it
hurts a little bit, UM, it hurts a lot apparently
UM burning aching sensations as if the hand is being

(29:26):
crushed in the ice. So say some And here's the
bad news is that it is UM chronic and once
it happens and persist, it's there like it's tough to
get rid of UM. In fact, I think they only
I think this article they said they only UM these
other post surgeries to limit that are only effective for

(29:48):
a few months and it usually returns, and so they
usually don't even do those surgeries unless you're terminal. Yeah,
and apparently chuck jugs don't necessarily do a lot like
a paint. Yeah, like it can't help. I think you
get used to it and it's still not really helping
very much. So they have some pretty interesting radical treatments
that apparently work. And one of the best ones is

(30:11):
a mirror box. So you like have a box that
you put your hand into and then your residual limb
into in the same box, and the mirror the mirrors
inside basically make it look like you have two limbs,
both intact facing the correct way, and then you move
the intact one and it looks like your residual limb

(30:35):
is now moving, and you basically your eyes sends the
signal to the brain exactly, and you trick your brain
into thinking like, Okay, I'm moving my limb. You can
stop sending me the pain signals now. And it works
for a lot of people. Yeah, And even more amazing
is they don't even know if they need a mirror box.
They think simply um imagining using that limb could work

(30:59):
like golfing. Yeah, Like, so just imagine you're you're swinging
a golf club with your phantom with your limb that's
not there anymore, and they think they can actually work. Yeah. Um.
They're also trying to figure out how to uh, re
plastic size the brain so that it can, um, it
can rearrange itself to basically be aware that there's no
limb there any longer, and it says it can ignore

(31:21):
sensory signals from that area. What they're doing is is
they're working on the brain now instead of the site
of the amputation, like the physical site. They thought it
was the psychosis for a little while. Um that that
it was basically just like people had such a deep
lamentation of the loss of their limb that they were
suffering this this form of psychosomatic experience. But now they're like, no,

(31:46):
this is real. We have seen it. Um. There's also
stimulation of the nerves around the area, um, which kind
of confused the pain signals so they don't make it
to the brain. It's pretty amazing, Yeah, but it's it's
a real thing, and apparently it's awful. Yeah, it's it's
way more common than I thought that was like my
biggest surprise in all this. I thought it was like, oh,

(32:07):
that's super rare, But apparently it's kind of rare if
you don't experience phantom in pain. So back to the
operating room, we should probably get back in there. He's looking,
he looks fine. Do you have any junior mint on you?
That's okay, I'm very nice. Uh So, now you've cut
through the skin, you've cut through the muscle, You've cut
through the nerves and done all your work to try
and make sure that the nerves are not going to

(32:28):
cause fandom pain as much as you can much as
you can. Now you have to cut the blood vessels. Yeah, right,
and you want to legate them or cauterize, right, probably
legate them if you don't want to, although I'm sure
there's cauterization too as well. And I think if you're
trapped in the woods or something, there might be no
but I think like they even have like a um,

(32:50):
little tools to cauterize blood vessels, wood burning set kind
of yeah. Yeah. Um. And either way, you're gonna stop
the flow of blood out the open end of these
blood vessels now, because that's not good. Um, I mean,
you tie this off and you want to avoid as
many blood vessels as you possibly can. Um that don't
need to be amputated because they still bring blood to

(33:12):
the healthy tissue, and blood's chuck full of nutreats, which
is how these things just tissue keeps alive. It's right.
And then there's only one thing left, my friend, man,
that's the old bone. So they get out the old
bone saw and um, when you cut the bone, like
you said, you you're gonna wrap the muscle around it.
So you want a nice smooth surface. You don't want

(33:33):
any kind of jagged edges. So they're gonna smooth it out.
I don't know what they use. Probably some kind of sander.
They sand it down. Remember start start low with your
sand paper number and work your way up. Oh is
there more grit in the lower numbers? More grit? Like
an eighty sand papers super rough, and like a two

(33:54):
is super fine, super fine. I think that's right. Sure
I got this wrong. I'm gonna I think you're right. Okay,
it makes sense yea um, but yeah, you really want
to smooth out that bone because it's it's going to
keep um the amputation site from healing. If it's a
jagged edge just rubbing up against muscle and nerves and

(34:16):
blood vessels and all, that's not good. So you have
it nice and sanded, You arrange the muscles around it,
and then you tie the skin off. When you close
the skin um and frequently if they think that there
there's a high risk of infection, they'll just kind of
temporarily close the skin. Were leaving a tube to drain

(34:38):
the um almost inevitable liquids that build up um. And
then if if they watch it and you're like, no
infection comes along, then they'll permanently sew it up. And
of course for the next several weeks you're gonna be
closely monitored for infection. Uh. They're not gonna leave you alone.
They're gonna bother you every single day, probably checking on

(34:59):
your uh what was the word, not stomp, residual limb,
residual limb, your your reside. Occasionally they will take off
the wrong limb. Should we go ahead and talk about this. Yeah,
just in October of two thousand thirteen in Brazil, guy
got it the wrong leg removed and the daughter said, hey,

(35:21):
you removed the wrong leg. So they said, you're right
and they removed this other leg and now you own
this hospital and now he has no legs. That's crazy.
And it said the family plans to sue. I'm sure. Um,
my dad got a knee replaced, and I went and
visited him before the operation, and he had um, like
no written on his on the kneecap that he is

(35:42):
supposed to remain intact. No. I think one of the
nurses did for him or something. I think it's kind
of typical. Well, it's one of the things they do.
I read this article from two thousand ten, UM. And
this is in Colorado alone. This is not nationwide or
anything over six and a half years. UM. In Colorado alone,
they operate it on the wrong patient at least twenty

(36:02):
five times and on the wrong body part hundred and
seven times. And um, that's a six and a half
year period. They studied close to thirty thousand medical records,
and UM. All the mistakes, of course, are traced back
to miscommunication. It's never apparently anything but that, right. It's
never the doctor was super drunk. No. Uh. And a

(36:25):
lot of times it's not even the surgeon. We should
point out, Um, it's a support staff for other doctors
that make this mistake throw them under the buff. But
so there's a thing now the American Academy of Orthopedic
Surgeons is an initiative called Sign your Site, which exactly
what you're talking about, UM, well sort of it. The
surgeon actually initials the surgical site UM for you to

(36:47):
see and and say, yes, this is the bad leg. Yeah,
and you can be like, you're the one who told
me that I have to lose my leg, isn't uh.
And then the Joint Commission is nonprofit group UM, and
they have a protocol now called a time out. A
presurgery time out is where literally everyone just pauses and goes, okay,

(37:09):
this is what we're doing, right, this is right correct, right,
that's smart. Yeah. I'm surprised it wasn't the protocol anyway,
but I'm glad it is now. Well, you know, doctors
are all go go go with their jargon and their
white coats and all that they got to hit the
golf course, get drunk, listen to us. So so it
does happen, and so you can you can write it

(37:31):
on your own leg, or you can ask for the
time out or whatever. Well I think they should give
you the time out either way, it's not as rare
as you think. All right, So, um, let's say that
they've successfully amputated the correct leg. Uh, there's a recovery
period as well. Um. You know the little white bandage

(37:51):
that's like a like a cap, like an inverted cap. No, well,
let's call the compression bandage. Oh yeah, sure, it's like
athletes wear him now like a compression sleeve. Right, this
one doesn't have a hole on one side. Sure, you
know what I mean. Um, And the compression raises it
increases the blood pressure around the site, um, which helps

(38:15):
bring infection. It reduces swelling of course, yeah, um, which
is a big deal. And then also you, um, you
will be moved about quite a bit while you're in
the hospital recovering because they want to keep your leg circulating,
your blood circulating, and not not necessarily your leg. I
just always think of a leg amputation. Really yeah, that's
a good arm, probably because my friend, oh yeah yeah. Um.

(38:39):
So once you get home, you're gonna start meeting with
the therapist, because physical therapy is a big deal. And
it's not just maintaining motion in your residual limb, but
also bulking up the other parts of your body. They're
gonna have to kind of step in a little bit
to make up for that, um, that shortfall. Yeah, and
apparently aside from just strength training, they do real world training,

(39:03):
Like you know, you gotta get out of and dress
yourself without your left leg, so let's see you do it.
Um do it. And I don't think we mentioned either
there's you might meet with a a brain therapist before
and after as well a psychiatrist, yeah, to help you
along because it's a it's a weird thing to not
have a limb anymore. Yeah, I'm sure there's almost mandatory

(39:25):
counseling for something like that. Yea, probably because I'm sure
also like even if you go into it like all right,
I can do this, I'm good with this. I think
very few people come out of it with the kind
of a plalm and and just go get them spirit
of people like Aaron Ralston or the girl from Georgia
who had um necrotizing fasciitis who like just managed to

(39:48):
keep her spirits up. I think it's probably very easy
to sink into a post surgery depression and that would
need to be have an eye kept on it. Um,
if you go through all this physical therapy and you
go through your psychiatry therapy and you're doing great. It's

(40:08):
actually a brain therapist. Brain therapist. I like that better. Um,
you will be. Uh. You may have to work with
your prosthetics if you want a prosthetic limb. And these
days they're not one size fits all like the old days.
Like here, you know, here's this wood leg longer than
you might want, but that's okay exactly. These days are

(40:32):
gonna fit it very much for you, longer than you
might want it. Uh, they're gonna fit it for you.
It's very much tailor made. They've come. Like the advancements
in prosthetics is just unbelievable. We might could do a
show on that alone. Oh, they'd make the sweet beautiful. Um.
There was also another treatment for phantom pain that had

(40:54):
to do with prosthetics, and it was there's prosthetics that
basically jack into your nerves, nerves and so like you
still use the same nerves that used to make your
lower leg move, but now it makes your prosthetic move
and apparently your brain is fine with that. Yeah. I
mean we covered some of this and um uh human augmentation.

(41:18):
Oh yeah, remember a while ago, like these prosthetic limbs
now that are hardwired. Did we do that? Is I
don't remember that episode? No, not not the podcast when
you or a live speaking thing with you know these
prosthetic limbs that are hardwired into your brain so that
you can think pick up apple and it picks up
an apple. Right, that's right? Yeah remember that. Yeah, so

(41:38):
when when you're like, lower leg is moving, your brain
apparently doesn't care whether it's flesh and blood leg or
prosthetic leg, as long as it's moving, then that can
help treat phantom pain as well. Yeah. So, Chuck, you
imagine you're a single guy and you you lose the
lamb you're okay, I'm just saying a mansion, you are,

(42:00):
you lose a lamp that every day you have a
wonderful wife, I know, I'm just kidding. And you you
lose your left leg, you think that your chances of
ever getting a date probably just go up in smoke, right,
Some people might think that that will cut that down.
It's not necessarily true. Yeah, there's just a lot of

(42:21):
people out there there like that. Yeah, you may become
a lot more attractive to certain people, specifically people who have.
Do you want to say this one? Which one? Is
it appo or acro acro acro tomophilia. Yeah, that's an
actual There is appo tim nophilia, which is uh, we've

(42:47):
talked about this before with body integrity identity disorder, when
you want to remove a limb from your own body. Yeah,
that is app no appo tim nephelia. Like I just
feel like incomplete with all my four limbs and I uh,
I want a limerod moved and their doctors that will
do that. Yeah. And there's a lot of um, a

(43:10):
lot of controversy lumping that into a paraphilia because the
if someone is attracted to the idea of living without
a limb, it's very rarely sexually. Most of the time
it's a form of hero worship, or they want to
be challenged more in life, or they have like you
just said, a real identity disorder that where they've always

(43:31):
envisioned themselves paralyzed, where they've always envisioned themselves as a
double double amputee and they feel less than whole by
being whole. Yeah, it's not any different than a transsexual
saying they were born in the wrong body. Yeah, they
bear a striking resemblance. Yeah, so the B I I
D and uh what was theophilia? Yeah, are are one

(43:54):
and the same. But it really shouldn't be a paraphilia. Now,
the other ophelia acrotomophilia, that should be a paraphilely because
that is a sexual attraction to people who are who
um amputees or who are paralyzed. Yeah. If you haven't
seen that David Cronenberg movie Crash, I have not. You
haven't seen. No, Well that's what it's about, boxing Helena.

(44:17):
Oh yeah, boy, that was awful. I haven't seen it.
It was bad. I just know about it. It's like
notoriously bad. I've got to see it. Then. Um, yeah,
there's so. I mean, there is some reference to this
in popular culture, but it was only I think five
and the first case of that was put Forth. Yeah. Um,

(44:38):
so it's a relatively new and then going to great
links to amputate your your own limb is even newer
than that. Um. There was a Scottish doctor in two
thousand who very famously amputated the healthy legs of two
men and when he caught a huge contract Percy. Yeah,

(45:00):
he stood by it, though he did he said he
thought about it for eighteen months, and when he finally
did it, he had decided that it was by far
the most humane thing he could possibly do in this situation,
because these men were suffering by having their intact legs. Yeah,
and they say, I don't know if it's true, but
some of them contend that no amount of mental of
brain therapy can help. It's like they've got to get

(45:23):
rid of that limb right or paralyze themselves. And a
lot of people do take it on themselves. There was
a man who went down to Mexico in the nineties
I think he was seventy three UM to have an
amputation surgery in a hotel and died of gang green
as a result. Another guy successfully amputated his own leg
with a log splitter. People will will go to great

(45:46):
lenks and do what we would consider self harm, whereas
they're really like fulfilling their identity. So it raises that question, like,
in that specific situation, is medicine harming people by carrying
out these amputations cleanly and professionally or are you just

(46:07):
giving into somebody's delusions and and really making things worse. Yeah,
supposedly the evidence is after surgery. These people feel good,
they feel great, they feel the way that they're supposed
to feel supposedly, so it's hard to argue that you're
doing them harm by carrying out the surgery. Yeah, and
again those are two very different things. The wanting to

(46:28):
remove your own limb to feel like a complete person
is not in the same as the sexualization and attraction
to um. Like in Penthouse magazine. Remember in this article.
What article was this? By the way, it was an
Atlantic article from two thousand, Yeah, called The True Self.
It's really good. Oh was it? I don't I thought
it was something else, but yeah, or no, maybe that

(46:49):
was a subheading, but it was. It was a great article. Um.
And it's nothing new the sexual side of things. Um.
Going back to this dude, Richard von Kraft Ebbing, he
was a researcher of UH sexual pathology and he started
categorizing and cataloging six and UM, I don't know if

(47:12):
it was a book or just a medical journal called
Psychopathia Sexualist and of course everything from bestiality and necrophilias
in there. But to Stravi SMI's Apparently des Cartes had
a thing for um. Women with crossed eyes that I
didn't know that. I didn't know that either, But there
are sexual things all the way back then, Um, this

(47:34):
year old engineer was excited by the sight of a
woman's disfigured feat. Um, and another guy pretended to be
crippled or lame is what they called it back then. Yeah,
and apparently that's still a thing. Like if you go
onto the web and start looking up across acrotomophilia, you're
gonna find there are pretenders, people who use wheelchairs and

(47:56):
leg braces and crutches even though they don't need them. Yeah. Um,
and there are frequently people who are also deemed wannabes
who are I guess pre event amputees. Yeah, they're still
in tect that they don't want to be. And then
there's devoteeshia. Yeah, those are the sexual the ones who
want to be with amputees because it's sexually aroused by

(48:19):
them exactly. Yeah, and it's big on the internet. Yeah,
it's um, this article points out, and there's probably been
more medical research on it since then. But he points
out that in legit medical circles there's not a lot
of information, but if you get on the internet, there
are all kinds of chat rooms in places where you
can find amputee porn. Yeah, if that's what your thing is. Hey,

(48:44):
that's such a thing is I can't really see anything
wrong with it. I was surprised though, by the one
how the people that it's not sexual but they just
want to be challenged more. It's pretty interesting. Yeah, I
wonder if that kind of falls into a um the
category of munch housands where they want they want the

(49:09):
sympathy or at it, attention or something like that that
comes with being paralyzed or being being an amputee. I
think pretenders for sure. Yeah, like if you're walking around
on crutches and you're just fine, you're you're looking for attention.
But yeah, like you said, there are some people out
there who report wanting to lose the body part because
they want to be more physically challenged. Alright, we should

(49:34):
do one on paraphilias sometimes. I've always wanted to. Is
that just any kind of sexual fetish everything? That's everything?
And there's a lot of them out there. Yes, basically,
any weird thing you can come up with, there's a
paraphilia for it. Yeah, but you're right, Yeah, like I
liked never mind, I think it's a good way to

(49:56):
end this one. If you want to learn more about amputations,
you can type that word into the search part how
stuff works dot com. And uh, let's see. Since I
said search part, that means it's time for a listener mail. Ah. Yeah,
this is kind of long, but it's appropriate. Um, I'm
gonna call it h one testicle down? Was there an amputation?

(50:17):
Not so much? Let's see is from Rich Uh. This
came off the Castration podcast and he says, Guys, when
I was about twelve years old, I got kicked in
the grapes but particularly violent classmate appearance. Took me to
the hospital and after a bunch of tests, determined I
had testicular torsion. It's when uh, male's testicles twist around
inside the scrotum, essentially twisting the wires that connected to

(50:39):
your inner workings, and it cuts off the blood supply.
Like we said, it's not any good. You don't want
to cut off the blood supply. Um tissue does That's right. Uh.
It was too late to save his injured testicles, so
they set a date for surgery to remove it, but
it wasn't until the end of August, apparently because there
was no rush because it didn't like make any worse. Oh,

(51:00):
there'd be a rush if it happened to me, I'd
be like, look, just get this over with. Oh I know. Ah.
So he said he was stuck in bed for an
entire summer, and his family didn't have working air conditioning
yet either, and his scrotum was the size of a grapefruit. Walking, moving, laughing,
or even breathing heavily caused some of the worst pain
of experienced. Uh. So he had the surgery, and it

(51:23):
said I had two purposes, one to remove the injured
and now useless testicle, and too to affix the remaining
healthy testicle the inside of the scrotum to prevent the
possibility of future torsion. So he felt a lot better
physically after the surgery, but it was very hard to
cope mentally and socially. I think I only told my
closest friends what had happened. I told the rest of

(51:44):
my school that I had knee surgery or something. I
felt incredibly embarrassed. Um and remember I was at the
most awkward, puberty ridden age for something like this to
happen to my private parts, I know. Uh. Then two
things happened. The first thing was acceptance. I don't remember
if anything in particular brought it on, but I distinctly
remember the day where I finally thought to myself, you
know what, who cares? And at that moment, testical grew

(52:08):
back twice the size is before. Uh. Then I did
something that still surprises me now that I think about it.
I opened an a o LL instant messenger, Um this
is back in the day, of course, uh and picked
out one of my high school friends at random and
told them before I could chicken out. As soon as
I told this random person, I felt a huge weight
lift off my chest. And then the second thing was surgical.

(52:32):
I opted for elective surgery to put in a fake ball,
a neudical, a noudical, a human nudical, human utical, or
a prosthesis made of silicon silicone. It was mainly for
cosmetic purposes, and I was happy to that I did it.
Even now, you can't really tell a difference unless you
touched them and want somebody's in that situation where they

(52:54):
could feel the difference. It really doesn't make a difference anyway,
wink wink. So he says, now he is very proud
to have one real testical and one fake one. And
he went on and to write about how like to
tell the kids out there, Hey, if something like happens
to you, then you know it's not the biggest deal
and you're still a complete person. And he wonders if

(53:14):
he would have even gotten the nuticle if he would
have been older, you know, and not been at that
awkward age. Yeah, he says, he probably didn't think like
he would happen. He doesn't regret it, right, Uh, he
doesn't regret it. He says, I'm really proud of it.
And Uh, I wonder how many of your listeners only
have one testical for a little crown on it every
once in a while. That is Rich and Rich. Thank

(53:37):
you for your courage and trying to tell people, especially kids. Yeah,
way to go, Rich, you know something into the world.
I mean, that is a rough thing to go through. Yeah. Man, well,
hats off to you, Rich, crowns off. Uh, if you
want to be brave like Rich, you can tell us
about something that you overcame in your life. We love
hearing about stuff like that. Um, you can twee to

(54:00):
us at s Y s K podcast. If it's a
very short story, You can join us on Facebook dot com,
slash stuff you Should Know, You can send us an
email to stuff Podcasts at Discovery dot com, and you
can join us at our home on the web, stuff
you Should Know dot com. For more on this and

(54:20):
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(54:42):
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