Stuff You Should Know - How Amputation Works

Episode Date: February 20, 2014

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. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

On the podcast, Hey Dude, the 90s called, David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses and choker necklaces. We're gonna use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s.

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Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple Podcasts, or wherever you listen to podcasts. Welcome to Stuff You Should Know, from houseforworks.com. Hey, and welcome to the podcast. I'm Josh Clark in the Dynamic Duo, Chuck Bryant. Two men, yeah.

Eight lambs. Yeah, that's us. Yeah, I guess so, I hadn't really thought about it. Yeah, we're fully intact. Yeah, and I think missing a limb, or a finger or a toe or anything like that. I guess it's not something you think about until after it happens,

and then it probably becomes one of the central foci of your life. Do you know anyone missing a limb? No. As a matter of fact, I don't, do you? Yeah, I worked with a guy at my last job who had an accident, a biking accident, with a truck.

Not true, not true, go ahead. I just had to remind myself. Of what? My brother-in-law's father has a partial finger amputation. Oh yeah, well this guy lost his arm. The whole arm, yeah. What happened? Biking on the side of the road, an oncoming truck.

The side view mirror basically clipped him at the armpit. Did it take it clean off, or? I don't know. I'm not sure. Well I guess if it would have taken it clean off, they probably would have done a replantation. Yeah, maybe. Which we talked about.

Yeah, so this is, I guess, a follow up in a mini suite. I like to think of it as part of a larger suite. We've done broken bones. Yeah. We've done replantation. I think it's called your limbs torn off, now what? Right. And then this one, how amputation works.

Yeah. Yeah, it's a good nice suite. Yes it is. What would we possibly add to that? I don't know. Because we're gonna cover sexual fetishes around limb loss and phantom limb pain. And so I think that's all-encompassing, sir.

I think this will finish it off. Yeah, it's a Mitch Hedberg term, all-encompassingly. Really? Yeah. That was one of his bits. Chuck. Yes. Have you, surely, I know that you've heard

of Aaron Ralston. Yeah. Saw the movie and everything. There's 127 hours, right? Yeah, I think that's right. The name of the movie? Yeah, I'm doubting it all of a sudden, the number of hours.

Seems right, though. Yeah. Good movie, did you see it? Oh yeah, it was great. James Franco was just like, oh, I'm doing so great in the middle of the movie. Didn't he look at the camera and he's like, aren't I just too awesome?

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 an appreciation for people that don't make the same movie over and over. Right, you know.

Hats off for that. Have you seen her? Yeah, just saw it. God, that is a good movie. Yeah, very good movie. I was surprised at how good it was. I thought it was, I loved it. Yeah.

So, okay, back to 127 hours. That movie by Danny Boyle is about a real life incident that happened to a guy named Aaron Ralston in 2003, in May of 2003. He was a, and I take it, he still is, a real outdoorsy go-getter, can't keep me down kind of guy, very independent spirit, so much so that he went canyoning by himself in May of 2003.

And while canyoning, there was a shift with one of the boulders that he was leaning on or next to or something, and it- Well, he slipped down into a crevasse. Is that what it was? And a boulder landed on top, wedging his arm, and there he is. Okay, I haven't seen the movie in a little while.

Plus, I wasn't there when it happened. And so, he's trapped, like, alone. No cell service, if I remember correctly. Yeah. He was just totally screwed, as much as a person could be screwed. Yeah. 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. Cause 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 think that that many human beings could 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 hand off. 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. That's what I meant. I was thinking lower on the arm and it was stupid.

But yeah, 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. It's out in the middle of nowhere. He broke his arm. And then after he broke his arm,

he cut through the skin and the tendons and the muscles and all the sinew, around, you know, through the break in the bones and then cut his lower arm off. Yeah, and remember he had dulled his knife from trying to chip away at the stone for days. And... Oh, I forgot about that.

Yeah, so if he had done it initially, it would have been easier. So he had bases like this dull blade. 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.

Yeah, rebelled down, hiked out. Six miles before he finally found somebody to drive him to the hospital. And I think he even stopped and did a little, like, spelunking along the way or something like that. No, he went straight to the hospital. Well, he was probably doing all sorts of outdoorsy activities right afterwards.

He's, like I said, one of those people you can't keep down. But in this article, it's a pretty good article about amputation. Agreed. The author makes the point that Aaron Ralston is a great example of amputation in that. It's a blast resort, typically. Like, you don't just go, let's try amputation

and then we'll go from there. Yeah, exactly. It's like, if we don't amputate, you're going to die usually. Yeah. So it also, he also provides the point that your 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 a suck thing to happen, I imagine. But when you do have limbs amputated, your life isn't over, basically. And we'll talk about that, too. But you want to get into amputation? Want to talk about the history of this stuff?

Yeah, man. History is like all old medical history involving surgery. It's pretty grisly. It dates all the way back to ancient times. They found archeological proof that they performed the procedure many, many, many years ago. About 7,000 years ago, they found a grave

of a man who had had his lower arm amputated and had healed. Yeah, what they found the difference is 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. And there wasn't any blood flowing to it. No blood. No. And then, of course, in Rome and Greece, they were smart and they advanced the process. And actually, we're the first to tie off these blood vessels. Is that called legating?

Yeah, like ligature marks? Yeah, yeah, yeah. And that would stop the blood flow. And they did a good job with that, but it seems that people forgot about that. And they didn't do that for another few hundred years afterward. No, and not only did they forget about that,

the Romans and the Greeks both used wine and vinegar as antiseptics during surgery, too. And people just lost that, too. I wonder if that worked. I think probably is better than nothing, I would guess, yeah. So like I said, they forgot for a couple hundred years or a few hundred and then started cauterizing wounds instead, which, as we all know, is burning a blood vessel shut.

Or dipping it in boiling oil. That's one way, yeah. Or just the old hot poker treatment. Yeah, just awful. Yeah, it's like, say goodbye to your leg and then say hello 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 in Rainbow Three, when he gets shot in the side and he cauterizes his wound by pouring some gasoline in and lighting it on fire?

I don't remember that. Oh, man. Did he did that? Yeah. Wow. This like blue flame shoots through his abdomen and he goes, ah, it's the best acting salons ever done.

Wow. I don't know that I agree with that, but it's impressive. But you should watch it, see what you think. Okay. Okay. I put first blood on my list, but I haven't heard any chiding yet. On your list of hundred greatest movies of all time?

That's right. 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 Mujahideen? I was at the Middle East.

Those 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. That's a good one. All right, so amputation advanced, of course, over the years after the cauterization debacle. And in wartime or after wartime, with no surprise,

is when they made a lot of these advances, especially in France, with a military surgeon named Ambroise Perret. I don't know if he's related to Michael or not. But he, of course, with gunpowder and bullets and cannonballs and things, we saw injuries like we'd never seen before. Yeah, we can thank those things

for advancement of amputation. Totally. Successful amputation. Right. So that was one of the big reasons that Perret was effective. And he was basically the first guy to bring back the legating.

Yeah, sounds weird to me. He rediscovered it. Yeah, in 1529. Which is said that it took that long. From ancient Rome to 1529. Yeah, for somebody to be like, oh, what if we just, like, tied these things shut? Now burn it.

Right. We've got the hot oil ready already. It's too late for your advancement. And that is how fondue was born. You're like, we've 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 it was talking about,

like body parts? Yeah. No, no, no. I'm not a monster. Then. I thought it was funnier when you were a monster. Then the tourniquet was invented in 1674, which kind of surprises me that,

because that seems more rudimentary than any of this stuff. It's another bonehead invention. Yeah. It's like, why don't you, you come up with this stuff before you cut people's limbs off. That'd be nice.

And then anesthetic, of course, in the 1840s with anesthetic gas, went a long way toward performing these surgeries, you know, without a lot of pain. Yeah. And here in the Western world, the American Civil War was a huge- Dude.

It was a big board to understanding amputation techniques. They might as well call it the amputation war. Right. Just from sheer volume of amputations, a lot of doctors who got their nicknamed saw bones from amputating, sawing through bones and all that. Just the number of amputations that they performed formed this body of knowledge

that carried on after the war. Yeah, 50,000, more than 50,000 amputations in the Civil War. And 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 eight and a surgeon. 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 gown. I did eight amputations today. Right, beat that. Yeah, exactly. Pepper John. They would douse them with a chloroform soaked rag,

put on the tourniquet, and slice through everything. And then like you said, get out the old saw bone saw. Yeah. And take care of business, basically. And then they would just toss the limb onto a pile, which grew pretty quickly. And there's plenty of old photographs of limb piles

from the Civil War. Yeah, one out of four patients died in those days after an amputation and that doubled if it didn't happen in the first 24 hours. Right, but a lot of people's lives were saved from battlefield amputations. Yeah, and most of those, I think, were probably bacterial due to infection

and not necessarily like just bleeding out 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 that's creating dead tissue. And that site of dead tissue is a really great place for bacterial infections to take root and take hold.

The problem with the bacterial infection is that it tends to spread toward the rest of your body. Sure. So the point of amputation almost across the board is to prevent the spread of infection in the rascist 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 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 with the infections and a British surgeon named Joseph Lister

was known as kind of the father of antiseptic surgery. Yeah, Listerine. Oh yeah? Is that where it comes from? No way. Of course it is. Yeah. 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 Listerine.

Probably is. They used it back then to prevent wood rot and to treat sewage. So I guess they just knew it was good for stopping bacteria. I'll bet that cauterizes wounds too. And he would spray it on surgical tools and incisions and dressings and even people

in the surgery room. He would spray them with it. Stand still. And then he was the first to stress hand washing and clean gloves and things like that. So hats off to you, 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. True. So amputation, it's been around for a while. And that's just surgical amputation. There's evidence of amputation for religious self-sacrifice as far back as like 30,000, 40,000 years ago. It was very, for a long time, it was a punishment

that word amputatio, or amputatio, is a Roman for, well, it's a punishment. It's synonymous with punishment. And it meant like you had your hands chopped off. Yeah, like if you steal something, then symbolically they would cut off your hand. Yeah. And then amputation was even inscribed as a punishment

in the first written law, the Code of Hammurabi. If you were a doctor and you lost a patient, 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. Right. You're worried about tort law. Think about how good you have it now. Yeah. So like you said, the reason, there are a couple of reasons you would get an amputation. One is disease, and the other is injury,

like my friend with the truck. Yeah. Some kind of catastrophic injury, 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 is dying beyond the point where it can be rescued, essentially.

And it might be a truck, it might be a bullet wound, 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 flowing, you're gonna lose an arm if it stops flowing.

Sure. 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, there are plenty of diseases that see a lessening of blood flow, like arteriosclerosis. Sure. So it's plaque buildup on blood vessels.

Yeah. When it builds up enough and enough, those blood vessels harden and the amount of blood flow through those vessels diminishes so much that the tissue that those blood vessels feed dies. There's something called peripheral artery disease, which is the result of a lack of blood flow

leading to dead tissue. Yeah, it's big in diabetics. Yeah, you join that with diabetes, which has the tendency to also kill nerve endings, neuropathy, and then all of a sudden you can't feel. So when you cut yourself, say you cut your foot or something like that, 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 gangrenous and threatens your entire life. Yeah, and the US 90% of amputations are as a result of this disease scenario. Yeah.

Whereas if you're under 50, traumatic injury is the leading cause. Of amputations. Yeah, so you're out riding your bike on a mountain road for your Aaron Ralston in your mountaineering in Utah. Yeah, I would call that a traumatic injury. Can your hand pinned under a boulder?

For sure. Man, could 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, he tried for a while. Let me get out of this mess. Or trying to move the boulder is like nothing.

And then all of a sudden you think, I might die of starvation. Yeah. And then your eye just goes over to the knife like, man. I wish I hadn't adulted. So then there's cancer, which we haven't mentioned. There are a couple of ways that it could lead to amputation, obviously just damage to your body tissue.

But also, like you said, to keep a malignant tumor from spreading around, sometimes they will just lop it off. Yeah. And apparently those amputations from cancer have diminished tremendously over the last decade or two. But unfortunately, those from disease have increased. Yeah, 50%, it's dropped by 50% over the past 20 years.

Amputations overall? No, just from cancer. Traumatic injury and cancer. I got you. So I don't know if people are being safer in their recreation, if that has something to do with it or not. Or if they're just getting better. Yeah, we might have better trauma.

Yeah, or better reattaching too. Yeah. But yes, you were right. It has increased because of, at least in the United States, largely due to obesity. So much so that this article was from, maybe 2006, something like that. And it says that one out of every 200 Americans

is an amputee. That's not right anymore. No, it's actually even more. One out of, from what I could find, 176 Americans. So it's 1.7 million people. One out of 100, that seems like a lot of people. Yeah. But that counts digits and things that you don't think about.

You know, like someone lost a thumb. Right. Cause 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 pulleys.

That's a good point. You go to Alaska, I bet every third person has a limb that's missing. You don't see it a lot in the podcast field. Yeah. So we're going to prepare you for surgery. Dr. Clark, right for this message break. Wait, I'm doing the surgery, right?

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Okay, so, preparing for amputation surgery is like every surgery, initially. You're gonna have a lot of meetings. Always with the meetings. I know, 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 surgeries,

what kind of anesthesia they're gonna use. Yeah, it's not always general anesthesia. I knew this would stand out to you too. Yeah, I would not wanna be awake. No, knock me out, cut my toe off, I don't care. Yeah. I'd better be out. Well, actually, I'll take that back.

If it was 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, it'd be boring. Oh, 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. Yeah. I used to get that at the dentist. 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 them. Yeah, exactly.

So yeah, they sometimes use just local anesthetic to carry out a amputation. That's nutty. If it's a limb. I don't think they would do that. No, that's gotta be general anesthesia. Yeah, because I think if you weren't under, your blood pressure would rise to dangerous levels.

That's a good point. Yeah. If you're gonna get a prosthetic device, you might meet beforehand with your prosthetist to measure you out and kind of talk about what you're looking for, post-surgery. Yeah. And then you're gonna, you know, then it's go time.

I guess it is kind of go time. Well, the surgeon's gonna wanna figure out exactly where to cut ahead of time. It's not like, how about here? They actually measure blood flow to the area to see what tissue is still receiving, you know, a healthy amount of circulation. Yeah, they don't wanna leave any bad tissue behind.

No, but they want to get as much of the bad tissue as they can, which is what you just said. But they also wanna 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, they wanna preserve all the healthy stuff they can

because if your joint is working, then that's gonna help you out with your prosthetic limb. Oh yeah, if they can do anything to save a joint, they're gonna leave it intact. Yeah. So they figure out where to cut, they try to leave a joint as intact as possible. Yeah, and this is all the non-emergency varieties,

by the way. Exactly, yeah. Like all of this planning and everything, that goes out the window when you come in with a shotgun blast to your lower leg. Exactly. 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, no meetings. Some of the techniques they use, or actually, let's just go ahead and walk you through the process. All right, so everyone, please. I love how this 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 gonna cut through the skin, and you want it to heal quick. And they said leave an appropriate scar, which doesn't mean for cosmetics. Like don't leave your initials as a scar or something. Now what they mean is they don't wanna leave a scar

where it might rub up against your prosthetic or something and cause problems. Yeah, that can be good. No. So they cut through the skin, and pretty soon after 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 this. It's just crazy to me, like I used to be like, okay, so you got muscle, you have the skin, you have the bones. But what's the beef? Like what's the steak?

And then I realized like, oh, muscle's the steak. I was like, I'd make a good steak. Now you'd be sinewy. I'd make a good steak. So with the muscle, they have to cut through it, but they wanna save a little bit of length of it as much as possible. Yeah, that's your 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 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 50 times in this article?

They finally get to the point where they're like, which is the residual limb, which is the preferred term. I think my friend called his a 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 on my brother. Sure.

Okay. It's along the same lines. Gotcha. So we've cut through the skin. The muscle. Yep. Now what? You've got your nerves.

Oh man. I know. It's the worst part. It just sends a chill up my spine thinking about it. You have to cut through the nerves, obviously. And then what they want to do, you're gonna have, you know, where you cut the nerve is gonna be a nerve stump.

Now that's okay to call it a stump. Yeah, sure. It's just the nerve, you know? Exactly. And they still carry signals of pain sometimes even. And so they do their best to minimize what we're gonna talk about next, which is phantom limb pain,

by sewing nerve endings 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. 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, I think it's like not a given necessarily, but I think that it's very common. Should we go ahead and cover it now? Yeah, let's. And then finish up with the surgery?

Yeah, so like you said, when you cut through. Gats them up, right? We'll be back. Right, you just sit still. When you cut a nerve fiber. Sure. It's still, even though there's a stump, and it's not connected to anything anymore down there,

it can still transmit 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

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. Well, 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,

and that's by sending a painful sensation from the leg to the brain to you to experience it. Yeah. And when that leg's not there, and your brain thinks it still is and 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.

It hurts a lot, apparently. Burning aching sensations as if the hand is being crushed in the vice. So say some. And here's the bad news, is that it is chronic, and once it happens and persists, it's there. Like it's tough to get rid of. Yeah.

And in fact, I think they only, I think in this article, they said they only, these other post surgeries to limit that are only effective for a few months, and it usually returns. And so they usually don't even do those surgeries unless you're terminal. Yeah, and apparently chug drugs

don't necessarily do a lot. Oh, like pain drugs? Yeah, like it can 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 a mirror box.

Yeah, this is so cool. So you 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 is now moving.

And you basically- It's your eyes sends a 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 imagining using that limb could work. Like golfing? Yeah, like so, just imagine you're swinging a golf club with your phantom limb that's not there anymore. And they think it can actually work. Yeah.

They're also trying to figure out how to replasticize the brain so that it can it can rearrange itself to basically be aware that there's no limb there any longer, and it can ignore 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. Right, they thought it was a psychosis for a little while. That it was basically just like, people had such a deep lamentation of the loss of their limb that they were suffering this form of psychosomatic experience. But now they're like, no, this is real. We have seen it.

There's also stimulation of the nerves around the area, which kind of confuse the pain signals so they don't make it to the brain. It's pretty amazing. Yeah, but it's a real thing, and apparently it's awful. Yeah, it's way more common than I thought. That was like my biggest surprise in all this.

I thought it was like, oh, that's super rare. But apparently it's kind of rare if you don't experience phantom limb pain. Yeah. On the podcast, Hey Dude, the 90s called David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses

and choker necklaces. We're gonna use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s. We lived it, and now we're calling on all of our friends to come back and relive it. It's a podcast packed with interviews, co-stars, friends, and non-stop references

to the best decade ever. Do you remember going to Blockbuster? Do you remember Nintendo 64? Do you remember getting Frosted Tips? Was that a cereal? No, it was hair. Do you remember AOL Instant Messenger and the dial-up sound like poltergeist?

So leave a code on your best friend's beeper because you'll want to be there when the nostalgia starts flowing. Each episode will rival the feeling of taking out the cartridge from your Game Boy, blowing on it and popping it back in as we take you back to the 90s. Listen to Hey Dude, the 90s called

on the iHeart radio app, Apple Podcasts, or wherever you get your podcasts. I'm Mangesh Atikular, and to be honest, I don't believe in astrology, but from the moment I was born, it's been a part of my life. In India, it's like smoking. You might not smoke,

but you're gonna get second-hand astrology. And lately, I've been wondering if the universe has been trying to tell me to stop running and pay attention, because maybe there is magic in the stars if you're willing to look for it. So I rounded up some friends and we dove in, and let me tell you, it got weird fast.

Tantric curses, Major League Baseball teams, canceled marriages, K-pop. But just when I thought I had a handle on this sweet and curious show about astrology, my whole world came crashing down. Situation doesn't look good. There is risk to father. And my whole view on astrology, it changed.

Whether you're a skeptic or a believer, I think your ideas are gonna change too. Listen to Skyline Drive and the iHeart Radio app, Apple Podcast, or wherever you get your podcasts. So back to the operating room. We should probably get back in there. He's looking, he looks fine. You have any junior mints on you?

No, that's okay. Oh, very nice. 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 cause pain and pain. As much as you can.

As much as you can. Now you have to cut the blood vessels. Yeah, right. And you wanna 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 little tools to cauterize blood vessels. Like a wood burning set. Kind of, yeah. Yeah, and either way you're gonna stop the flow of blood out the open end of these blood vessels now because it's not good.

When you tie those off and you wanna avoid as many blood vessels as you possibly can. That don't need to be amputated because they still bring blood to the healthy tissue. And blood's chock full of nutrients which is how these things, just tissue keeps alive. That's right. And then there's only one thing left my friend.

No man. That's the old bone. So they get out the old bone saw. And when you cut the bone, like you said, you're gonna wrap the muscle around it so you want a nice smooth surface. You don't want any kind of jagged edges. So they're gonna smooth it out.

I don't know what they use. Probably some kind of sander. Sure. They sand it down. Remember start low with your sandpaper number and work your way up. Oh, is there more grit in the lower numbers? More grit.

Like an 80 sandpaper is super rough and like a 200 is. Super fine. Super fine. I think that's right. Sure. If I got this wrong, I'm gonna. I think you're right. Okay.

It makes sense. Yeah. But yeah, you really wanna smooth out that bone because it's going to keep the amputation site from healing. If it's a jagged edge just rubbing up against muscle and nerves and blood vessels and all that, it'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. Yeah. And frequently if they think that there's a high risk of infection, they'll just kind of temporarily close the skin. Yeah. Leaving a tube to drain the almost inevitable liquids that build up.

Sure. And then if they watch it and like no infection comes along then they'll permanently sew it up. Yeah. And of course for the next several weeks, you're gonna be closely monitored for infection. Yeah. They're not gonna leave you alone.

They're gonna bother you every single day probably. Yeah. Checking on your, what was the word? Not stump. Residual limb. Residual limb. Your, your resident. Occasionally they will take off the wrong limb.

Should we go and talk about this? Yeah. Just in October of 2013 in Brazil, guy got it, the wrong leg removed. And the daughter said, hey, you removed the wrong leg. So they said, you're right. And they removed his other leg. And now you own this hospital.

And now he has no legs. That is crazy. And it said the family plans to sue. I'm sure. Yeah. My dad got a knee replaced and I went and visited him before the operation and he had like no written on his, on the kneecap that he does.

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 2010. And this is in Colorado alone. This is not nationwide or anything. Over six and a half years in Colorado alone,

they operated on the wrong patient at least 25 times and on the wrong body part 107 times. Wow. And that's a six and a half year period. They studied close to 30,000 medical records. And 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. And a lot of times it's not even the surgeon. We should point out it's the support staff or other doctors that make this mistake. Oh, you throw them under the bus. But so there's a thing now,

the American Academy of Orthopedic Surgeons is an initiative called sign your site, which is exactly what you're talking about. Yeah. Well, sort of the surgeon actually initials the surgical site for you to see 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 it? And then the joint commission is a nonprofit group and they have a protocol now called a timeout, a pre-surgery timeout, which is where literally everyone just pauses and goes, okay, this is what we're doing, right?

This is correct, right? That's smart. Yeah. I'm surprised it wasn't a 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. Yeah, they gotta hit the golf course.

Yeah. Get drunk. Listen to us. So, okay. So it does happen. And so you can write it on your own leg or you can ask for the timeout or whatever. Sure.

Well, I think they should give you the timeout either way. It's not as rare as you think. All right. So, let's say that they've successfully amputated the correct leg. There's a recovery period as well. Sure. You know, the little white bandage

that's like a cap, like an inverted cap? No. Well, it's called a compression bandage. Oh, yeah, sure. It's like athletes wear them now. Like a compression sleeve. Right. This one doesn't have a hole on one side.

Sure. You know what I mean? Yeah, I do. And the compression raises, it increases the blood pressure around the site. Yeah. Which helps prevent infection. Yeah.

It reduces swelling, of course. Yeah. Which is a big deal. Yeah. And then also 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 necessarily your leg.

I just always think of a leg amputation. Really? Yeah. I always think of arm. Probably because of my friend. Oh, yeah. So, once you get home, you're gonna start meeting with the therapist.

Yeah. 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 that are gonna have to kind of step in a little bit to make up for that shortfall. Yeah, and apparently aside from just strength training, they do real world training like,

you know, you gotta get out of bed and dress yourself now without your left leg. So, let's see you do it. Do it. And I don't think we mentioned either. You might meet with a brain therapist before and after as well. A psychiatrist?

Yeah, to help you along because it's a weird thing to not have a limb anymore. Yeah, I'm sure there's almost mandatory counseling for something like that. Yeah, probably so. 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 aplomb and just go get them spirit of people like Aaron Ralston or the girl from Georgia who had necrotizing fasciitis who like just managed to like keep her spirits up. I think it's probably very easy to sink into a post-surgery depression. And that would need to have an eye kept on it.

Sure. If you go through all this physical therapy and you go through your psychiatry therapy and you're doing great. Would you say a brain therapist? Yeah, brain therapist. I like that better. You will be, you may have to work with your prosthetist

if you want a prosthetic limb. In these days, they're not one size fits all, like the old days. Yeah. Like here, you know, here's this wood leg. A little longer than you might want, but that's okay. Yeah, timber toe. Exactly.

These days they're gonna fit it very much for you. It's a little longer than you might want it. They're gonna fit it for you. It's very much tailor made. They've come, like the advancements in prosthetics is just unbelievable. Oh, sure. We might could do a show on that alone.

Oh, they'd make this sweet, beautiful. There was also another treatment for phantom pain that had to do with prosthetics. And it was, there's prosthetics that basically jack into your nerves. Yeah. 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's fine with that. Yeah. I mean, we covered some of this in human augmentation. Oh, yeah. Remember a while ago, like these prosthetic limbs now that are hardwired. Did we do that?

I don't remember that episode. No, not the podcast. Oh, yeah, yeah. Our live speaking thing. Sure. With, you know, these prosthetic limbs that are hardwired into your brain so that you can pick up Apple and it picks up an Apple.

Right, that's right. Yeah. Remember that? When your 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.

Wow. Yeah. So Chuck, you imagine that you're a single guy and you lose a limb. Not me, you're okay. I'm just saying a mansion you are. Okay. And you lose a limb.

I do that every day. That's terrible. I know. You have a wonderful wife. I know, I'm just kidding. And 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. That's not necessarily true. Yeah, there's a lot of people out there that 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? Apo or Acro?

Acro. Acrotomophilia. Yeah. That's an actual, there is Apo Timnophilia, which is, we've talked about this before with body integrity identity disorder when you want to remove a limb from your own body. Yeah.

That is Apo Timnophilia. Right. Like I just feel like incomplete with all my four limbs and I want a limb removed and there are doctors that will do that. Yeah. And there's a lot of controversy lumping that into a paraffilia.

Yeah. Because 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 where they've always envisioned themselves paralyzed

where they've always envisioned themselves as a 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. Yeah. So the B-I-I-D and what was the? Apo Timnophilia. Yeah. One in the same, but it really shouldn't be a paraffilia. Now the other philia. Acrotomophilia.

That should be a paraffilia because that is a sexual attraction to people who are amputees or who are paralyzed. Yeah. If you haven't seen the David Cronenberg movie Crash. Yeah. I have not to. Oh, you haven't seen it?

No. Oh, well, that's what it's about. Boxing Helena. Oh yeah. Boy, that was awful. I haven't seen it. It was bad. I just know about it.

It's like notoriously bad. Oh, I've got to see it then. Yeah. So, I mean, there is some reference to this in popular culture, but it was only, I think, 1975 when the first case of that was put forth. Oh, yeah. Yeah.

So it's relatively new. And then going to great lengths to amputate your own limb is even newer than that. There was a Scottish doctor in 2000 who very famously amputated the healthy legs of two men. Yeah. And when he caused a huge controversy. Yeah, he stood by it, though.

He did. He said he thought about it for 18 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 brain

therapy can help. Right. It's like they've got to get rid of that limb. Right, or paralyze themselves. Yeah. And a lot of people do take it on themselves. There was a man who went down to Mexico in the 90s. I think he was 73 to have an amputation surgery in a hotel

and died of gangrene as a result. Another guy successfully amputated his own leg with a log splitter. People will go to great lengths 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 giving into somebody's delusions 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.

Yeah. 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 remove your own limb to feel like a complete person is not the same as the sexualization and attraction to, like in Penthouse Magazine.

Remember in this article? What article was this, by the way? It was an Atlantic article from 2000. Yeah, called The True Self. Really good. Oh, was it? I thought it was something else, but yeah. Or no, maybe that was a subheading.

But it was a great article. And it's nothing new, the sexual side of things. Going back to this dude, Richard Von Kraft Ebbing, he was a researcher of sexual pathology. And he started categorizing and cataloging in 1886. And I don't know if it was a book or just a medical journal called Psychopathia Sexualis. And of course, everything from bestiality to necrophilia

is in there. But to strabismus, apparently Descartes had a thing for women with crossed eyes. Yeah. I didn't know that. I didn't know that either. But there are sexual things all the way back then. This 128-year-old engineer was excited by the sight

of a woman's disfigured feet. And another guy pretended to be crippled. Or lame is what they called it back then. Yeah, and apparently that's still a thing. If you go on to the web and start looking up acrotomophilia, you're going to find there are pretenders, people who use wheelchairs and leg braces and crutches even though they don't need them.

And those are frequently people who are also deemed wannabes, who are, I guess, pre-event amputees. They're still intact, but they don't want to be. And then there's devotees who are acrotomophiliacs. Yeah, those are the sexual. The ones who want to be with amputees, because it's sexually aroused by them. Exactly.

Yeah. And it's big on the internet. Yeah. It's 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. That's what your thing is. Hey, that's what your 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.

Yeah. It's pretty interesting. Yeah, I wonder if that kind of falls into the category of munchausens, where they want the sympathy or added attention or something like that that comes with being paralyzed or having it being an amputee. I think pretenders, for sure. Yeah.

Like if you're walking around on crutches and you're just fine, you're looking for attention. But yeah, like you said, there are some people out there who report wanting to lose a body part because they want to be more physically challenged. Yeah. All righty. We should do one on paraphernalia sometime.

I've always wanted to. Yeah, is that just any kind of sexual fetish? Yeah, 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 paraphernalia for it.

Yeah. I bet you're right. Yeah. Like I liked it. Well, never mind. I think it's a good way to end this one. Yeah. If you want to learn more about amputations,

you can type that word into the search bar at howstuffworks.com. And let's see, since I said search bar, that means it's time for listener mail. Yeah, this is kind of long, but it's appropriate. I'm going to call it one testicle down. Was there an amputation? Not so much.

We'll see. This is from Rich. This came off the castration podcast. And he says, guys, when I was about 12 years old, I got kicked in the grapes by a particularly violent classmate. My parents took me to the hospital and after a bunch of tests, determined I had testicular torsion.

That's when a male's testicles twist around inside the scrotum, essentially twisting the wires that connect it to 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. No, it's where tissue dies. That's right. It was too late to save his injured testicle,

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 make anything worse. Oh, there'd be a rush if it happened to me. I'd be like, look, let's just get this over with. Oh, I know. 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. Oh, my god. Walking, moving, laughing, or even breathing heavily caused some of the worst pain I've experienced. So he had the surgery and said it had two purposes. One, to remove the injured and now useless testicle.

And two, to affix the remaining healthy testicle to 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 my school that I had knee surgery or something.

I felt incredibly embarrassed. And remember, I was at the most awkward puberty-ridden age for something like this to happen to my private parts. Poor kid. I know. But 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, his testicle grew back. Twice the size as before. Then I did something that still surprises me now that I think about it. I opened an AOL Instant Messenger. This is back in the day, of course.

Sure. 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. Nice. And then the second thing was surgical. I opted for elective surgery to put in a fake ball.

Aneutical. Aneutical. Yeah. A human-neutical. A human-neutical. Sure. Or a prosthesis made of silicone. Silicone.

It was mainly for cosmetic purposes. And I was happy that I did it. Even now, you can't really tell a difference unless you touch them. And once somebody's in that situation where they could feel the difference, it really doesn't make a difference anyway, wink-wink. Yeah.

So he says now he is very proud to have one real testicle and one fake one. And he went on to write about how to tell the kids out there, hey, if something like this happens to you, then it's not the biggest deal. And you're still a complete person. And he wonders if he would have even gotten the nautical if he would have been older and not been at that awkward age.

Oh, yeah. He says he probably didn't think like he would have. Yeah, he doesn't regret it, right? He doesn't regret it. No. He says I'm really proud of it. And I wonder how many of your listeners only have one testicle. I'll put a little crown on it every once in a while.

So that is Rich. And Rich, thank you for your courage in trying to tell people, especially kids, is something like that. Yeah, way to go, Rich. It's not the end of the world. I mean, that is a rough thing to go through. Heck yeah.

Man. Well, hats off to you, Rich. Crowns off. 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. You can tweet to us at S-Y-S-K podcast if it's a very short story.

You can join us on facebook.com, slash stuff you should know. You can send us an email to stuffpodcastsatdiscovery.com, and you can join us at our home on the web, stuffyoushouldknow.com. For more on this and thousands of other topics, visit howstuffworks.com. To get a free audio book download of your choice when you sign up today. And to, hey dude, the 90s called on the iHeart radio app, apple podcasts, or wherever you get your podcasts. Listen to Frosted Tips with Lance Bass on the iHeart radio app, apple podcast, or wherever

you listen to podcasts.