A nice article in the paper - I thought you would enjoy

Here is a nice reprint of an article from the T&G in Worcester.
Dr. Pelto

Lancaster amputee helps others handle the challenge


LANCASTER — Rose-Marie Bissonnette should have been preparing for retirement in the fall of 1996, but instead she was contemplating life as an amputee.

On the eve of her ninth wedding anniversary, on Oct. 19, 1996, the car Mrs. Bissonnette was driving collided with a truck on Route 13 in Brookline, New Hampshire. The car was crushed under the truck, with her inside. Practically every bone in the left side of her body was broken. She wasn't expected to survive.

"I was so badly crushed, I was literally bleeding out from all of my broken bones. I had a broken pelvis, broken ribs, a severed right ankle, broken arm, broken wrist," Mrs. Bissonnette recalled. "I had multiple, multiple injuries and they tried to save my left leg. I had either years of reconstructive surgery ahead of me with no guarantee that I would walk again, or amputation."

As she considered her options, she asked to speak with someone about what life is like as amputee. To her surprise, there were no resources available.

But Mrs. Bissonnette, 69, whose left leg was amputated below the knee, has changed that. In 2004, she founded what is known today as the New England Amputee Association, a nonprofit organization that is a resource for amputees and caregivers looking for support and information.

To date, the New England Amputee Association, which was originally called Central Mass Limb Loss Support Group, has 250 on its rolls, and receives requests for information from families, patients, doctors and hospitals across the region. Mrs. Bissonnette has met with Boston Marathon survivors to help them as they deal with limb loss.

Mrs. Bissonnette fields the phone calls herself from her Lancaster home, and most requests usually fall into two categories: a spouse or child who is looking for help because they've noticed a change in their loved one's personality after an amputation; or a new amputee who is having trouble adjusting physically or emotionally.

The New England Amputee Association just started a new branch at Kent Hospital in Rhode Island and is working to have at least one branch in every New England state.

The impetus for Mrs. Bissonnette to start the association was not just her accident, but the tragedy that followed three months after her amputation — the unexpected death of her husband from undiagnosed cancer.

"I wanted to give back," Mrs. Bissonnette said. "I was having difficulty dealing with how I had lost my husband, but I lived through this accident. He took care of me for the last six months of his life, and I had a lot of guilt."

Mrs. Bissonnette attended the Amputee Coalition's annual conference in Boston in 2003, and registered to be a peer visitor. As a peer visitor, she had to go to a local support group, but there weren't any. She began working with the Lancaster Commission on Disability, Clinton Hospital and prosthetists in the area.

The hospital allowed her to use a conference room the second Tuesday of every month at 6 p.m. There are speakers or themes each month. Mrs. Bissonnette wants the association to be there not only as a resource, but a reminder that there is still fun in life. For instance, the association has held a pizza and prosthetic party, announcing "We supply the pizza, you bring the prosthetic." There are dances and barbecues and fundraisers, including one in the works to raise money to send a child with an amputation to Camp No Limits, a camp in Maine for children and families dealing with limb loss.

Charles Milewski a former Douglas resident who now lives in Dayville, Connecticut, had his right leg amputated in May 2010.

"I had a diabetic problem that caused me to end up in the hospital with the choice of dying or having my right leg cut off. I chose to live," said Mr. Milewski, 70. "Every morning I wake up, I look at my prosthetic and say, 'Some assembly required.' "

As he recovered, his podiatrist, Dr. Donald Pelto of Central Mass Podiatry in Worcester, suggested he connect with Mrs. Bissonnette and the New England Amputee Association. He served as treasurer of the organization for two years before stepping down so he could move to Connecticut.

"The people who come to us for the first time may be in a wheelchair and they don't know what's down the road," Mr. Milewski said, adding that his limb loss has not prevented him from enjoying life with his family. He still plays with his grandkids, he shovels snow, he travels, he even had a scene as an extra in the HBO show "Boardwalk Empire." "We offer a lot of life experience, and we are here to help."

Mrs. Bissonnette has stepped down as president of the organization and is now focusing on working with doctors and other medical professionals on what happens after amputees are discharged from the hospital.

"The health care community is very good at what they do," Mrs. Bissonnette said. "But once a patient leaves their care, that patient is now facing real life. It is not unusual for depression to set in. You don't get a new limb and have a fairy tale ending when you leave the hospital."

"I think a lot of new amputees think life is over," Mr. Milewski said. "Your life is not over. Your whole body and living is controlled from the neck up, not if you lose an arm or a leg. It's how you mentally figure it out."

For information on the New England Amputee Association, go to www.newenglandamputeeassociation.com/ 

Pain to base of nail

I had a visit from a patient today that has a common problem at the base of his mail. You can see that the nail is very large and that can filled with a fungal infection or another dermatological infection and what happens when he tries to trim the nail or wears shoes and hurts the base of the nail. This is because as he hits the front of the nail it causes kind of like a teeter totter reaction and lifts up at the base of the nail. Therefore if you have a very loose nails thisay be a reason for pain at the base of the nail. 

Frostbite questions

This is Dr. Pelto here after I put up that post yesterday about frostbite I had a patient come in and he had a few questions that I want to go over.

Does my skin need to be exposed to the cold to get frostbite?

Many patients think they can only get frostbite on their nose or ears that are exposed to the cold weather. This makes the frostbite worse but even if it's in a boot even with a couple pairs of socks in your expose for a long period time you can have the beginnings of frostbite.

Does frostbite have to be painful?

Many patients think that frostbite is very painful and if it's very severe it can be painful but for many people they feel a tingling or only pain when they have pressure on different areas of the frostbite. For example this patient with the picture above he had pain mostly on those red areas when they were touched by his shoe or by his hand.

How long will it take to get better?

Typically frostbite takes a couple of weeks to a couple of months to get better but you have to be aware that you are going to be susceptible to cold so it's important to keep your feet warm during this snow season in the following seasons. 

So my best advice is for people to stay out of the cold for long periods of time. Instead of shoveling for two hours try to do it for 15 minutes and then come back in and once warm go out again. 

Frost Bite in Worcester

If you live in or around Worcester we been getting a lot of snow this year and here you can see it on this patient's fourth toe there is some swelling and redness. She thought it was frostbite but it ended up being something similar called pernio. If you have this type of a condition there's not much you can do except keep your feet very warm in one of the ways is to use a heating pad in your shoes or even there are some socks that I have some electricity to keep them warm. Usually multiple pairs of socks aren't enough. So if you live in or around Worcester it's best to keep your feet warm in if you have any signs of frostbite come to the clinic.

Frost bite

Here’s an example of a patient in the wintertime, and they had developed this little red spot on the tip of the toe. I actually see a lot of people that come in with this in the wintertime. It’s a type of frost bite where there’s this little redness there and it tends to go away over time, but it sometimes can get purplish and it can be very, very painful.  Sometimes there are some other names you give this like pernio and this can go away over time.  It is especially painful in the winter when you’re outside working. If you have any problems with frost bite or another condition called Raynaud’s, you should probably stay out of the cold as much as possible and have somebody else do the shoveling for you.

To Your Health,
Dr. Donald Pelto

Big bunion and curved toes.

Here’s an example of patient, you can see the x-ray there, with a very large bunion and you can see just by the L where it signifies the left foot, there is a big bump. That is a bunion and there is a big space between the first and second big bones.  You see those two little circles underneath the big bone, those are called sesmoid bones.  Those two circles are actually where that bone that shifted over is supposed to be.  So the whole goal of bunion surgery is to shift that over, but you also notice that there is some curving of the bone and that curving needs to be corrected. You need to move that whole head of that bone back over on top of those two little circles, and so that requires a pretty aggressive bunion surgery to take care of this patient.

To Your Health,
Dr. Donald Pelto

Nail spicule can happen after permanent nail removal (matrixectomy)

This is a picture of a patient that previously had the whole nail removed permanently using a procedure called a matrixectomy. That’s where you kill the root of the nail. As you can see, there’s a little piece of nail that comes back. This is called a nail spicule. This happens because when you put the medication in the base of the nail, it’s kind of inexact because you just rub it around both edges and along the base of the nail, and hopefully it doesn't come back. Occasionally there is a little spicule that can grow back and you can either trim this down on your own or if needed, you can retreat this so it doesn't come back again.  There is always a risk of having it come back, but usually the second or third time is a charm.  

To Your Health,
Dr. Donald Pelto