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Complex challenges lie ahead for Marathon bombing amputees

Some of the patients who lost limbs in Monday’s Marathon bombings woke up hungry for news about the horrific event, while others have barely been able to acknowledge what happened to them.

“We have some people who don’t want to know and haven’t asked any questions,” said Jennifer Lawrence, a social worker at Boston Medical Center, where five of the 14 patients who underwent amputations following the attack are hospitalized.

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Three days after the bombings, people who lost limbs may differ in their emotional responses, but all are beginning a daunting journey that will force them to relearn many of the most basic activities of daily life. The challenges ahead range from brushing their teeth standing on one leg to pulling pants over their new prosthesis, specialists and amputees say.

One person well aware of the difficulties — both physical and mental is Posie Mansfield, who has been tapped to help provide peer support to some of the Marathon patients whose limbs were blown off. Mansfield’s left leg was amputated above the knee two years ago.

Her soul-testing odyssey began the week after surgery, as she got up in the middle of the night to use the bathroom and forgot she was missing a leg. She fell to the floor, where she lay sobbing.

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“Your brain remembers there was a limb there; it doesn’t feel like it’s gone,” Mansfield said. “That stays for a long time.”

One of the toughest challenges for the former skier in the months-long rehabilitation that followed her surgery was learning how to maneuver in her own kitchen.

‘You can say I am going to give up and sit in a wheelchair the rest of my life, or you can choose to go on.’

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“I was afraid to use the stove because I was afraid I would lose my balance and get burned,” Mansfield said. “The fear of falling is the biggest fear an amputee has, I don’t care how long you have been an amputee.”

Initially “angry at God” about having her leg amputated, the 64-year-old Wenham resident has since mentored many new amputees.

Most of the Marathon amputees apparently lost legs. They will encounter multiple teams of specialists in the days and weeks after surgery, to help rebuild body and soul.

At Boston Medical Center, social workers meet with a patient’s family and friends two to three days after surgery to learn the best way to broach the loss, particularly if the patient is waking up after a traumatic event unaware of what transpired.

“Their families know them better and may know how much information is enough or too much to help them process this,” Lawrence said.

The wound where a limb has been amputated usually heals within 10 to 14 days, if there are no complications. The end of the limb is then wrapped tightly with an elastic bandage or sock for several weeks, to compress it into a cylindrical or cone shape that better fits the socket of a prosthesis.

“Sometimes they can be ready for a prosthesis in five or six weeks, but I have seen patients not ready for up to a year because they had complications with wound infections or problems with insurance,” said Dr. David Crandell, director of the amputee program at Spaulding Rehabilitation Hospital. The socket usually has to be adjusted multiple times to get the right fit.

It was like “sitting on a barbed wire fence,” Mansfield said of her early fittings. “When they first put it on you, you feel like you will never walk again.”

Patients are typically moved to a rehabilitation hospital before going home. Inpatient rehab usually lasts about three grueling weeks, with patients working with therapists to strengthen their good leg and their upper bodies, while also relearning simple tasks of daily living, such as getting into and out of a shower and dressing themselves.

Once they are discharged, outpatient rehab can last months. Mansfield needed a year at Spaulding, with twice-weekly sessions to strengthen the hip on her amputated side and the knee on her good leg.

“They got me walking again with a prosthesis and encouragement and pushing,” she said. “They didn’t make it easy. They didn’t let up for a minute.”

Patients’ road to recovery will probably include bouts of “phantom limb,” sensations of pain or itchiness in the limb that is no longer there.

“It feels like your toes itch, your foot tingles, or you have a cramp,” said Mansfield, who was taught to massage her good leg to help ease the sensations, in addition to taking medications.

“You can say I am going to give up and sit in a wheelchair the rest of my life, or you can choose to go on,” said Mansfield, who has returned to skiing, kayaking, and even surfing since her amputation. “There are lots and lots of people out there to help and wonderful science and technology to give you the best possible life you can have.”

That’s the message Steve Chamberland brings to new amputees. He lost his right leg in a motorcycle accident in Lowell in 1999, and said it can help patients early in their recovery to meet someone like him, burly — he had pursued a career with World Wrestling Entertainment, as a one-legged wrestler — with a full life.

“If I wore jeans, you’d never know I had a prosthetic leg,” the 41-year-old said.

Chamberland, who runs a nonprofit called 50 Legs that helps amputees buy prosthetics, received a call from an old friend earlier this week. Dale Maybury of Westford had just learned his nephew, Jeff Bauman, lost both legs in the Marathon blasts.

Maybury told Chamberland that Bauman, a 27-year-old who worked at Costco, had plans to go back to school, and had no health insurance. Chamberland responded: “Don’t worry. I’ll buy his legs.”

“I’m a pretty rugged guy,” Maybury said Wednesday by phone, but he cried when he received Chamberland’s message.

“I was just so overwhelmed.”

Kay Lazar can be reached at klazar@globe.com. Follow her on Twitter @GlobeKayLazar.
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