Case Study: Riverside Premier Rehabilitation & Healing Center (September 2019)

Patients Age: 67

Admitted From: Mount Sinai St. Lukes

Discharged To: Home

Length of Stay: 157 days 

Reason for Stay: Short-term rehabilitation

How did this patient hear about the Riverside? Previously a resident

Mr. Sanders was admitted to The Riverside on October 23, 2017. As stated in the previous case study, he was admitted for right transmetatarsal amputation from Mount Sinai West Medical Center. Poor circulation in the right to lead to further amputation of the right foot. Several months later, poor granulation tissue on the foot leads to a complete below the knee amputation.

Mr. Sander’s journey continues one step at a time.
As of March 1st, 2018 Mr. Sanders, alongside his team of therapists, got to work. His therapist, Jennifer Cohen, instructed Mr. Sanders on wearing a shrinker sock prior to obtaining his prosthesis. The purpose of the shrinker sock is to control swelling on the amputated leg, promote healing, and assist with shaping the amputated leg. This sock would create a consistent shape on the stump, allowing the prosthesis to fit directly on the stump. Next, his therapist taught him to conduct skin checks along the amputated site using a long-handled mirror. The mirror would be used to check areas along with the stump that cannot be visually seen without assistance. His stump needed to be checked regularly to ensure the surgical site is closed and wound free. As soon as Mr. Sander’s doctor checked the surgical site, and deemed it healed he progressed into learning the steps of how to put on the prosthesis. The order became automatic after practicing several times. He was educated on waiting to listen for the clicks in order to assure that the prosthesis was secured properly. Following a strict order of how to put on the prosthesis is necessary to properly wear the prosthetic and to ambulate safely.

Once the prosthesis was put on correctly the next challenge was walking. Mr. Sanders learned to walk with the least restrictive assistive devices. First, the walker followed by the quad cane, then finally the single point cane. With a tremendous amount of support from Dennis and Todd, they coached him on walking without a cane. It took time to gain his first full stride, but with Dennis and Todd at his side, strong encouragement from his therapist, Mr. Sanders took his first steps. As he took his first steps with staff, residents watched in awe. Dennis and Todd walked to Mr. Sanders embracing his magnificent accomplishment. Mr.Sanders was beaming with pride at what had just happened and looked towards his team of the therapist with a big smile. He could not stop thanking his therapists for sticking with him through his recovery.

As he continued to practice every day Mr. Sanders was walking everywhere he could. Part of the Amputee Walking Schools program involved coaching other amputees in the building through emotional support. Meetings took place on the 15th-floor Hotel Lobby after the Urban Zen class. Mr. Sanders would joke that the first order of business is to take part in the Urban Zen class before members of the Amputee Walking School met. He met regularly with two other members of the class. Each member spoke as if they were long lost friends. They discussed how they became amputees, and what they are looking forward to after completing their stay at the Riverside Rehab. They each provided one another with emotional support, even after the meetings were held. For Mr. Sanders, his goal was to return to work at the theater. As well he was gearing up for the warmer temperatures, which would involve walking around the city he loves. Taking different paths and exploring different streets, and watching boats sail across the Hudson River.

On Mr. Sander’s last day at The Riverside, he was invited to speak to the staff about his stay. Mr. Sanders rolled his wheelchair out of his room, stopped short of the staff. The staff eagerly waiting to hear from him, he locked the brakes of his wheelchair, and finally stood up without any assistance. It was truly a momentous occasion for him as well as the staff. His first interaction with them he could not even lift his body out of bed. Now he is walking towards them with a giant smile on his face. The staff as well residents on his floor started clapping for Mr. Sanders as if he was a Big Broadway Actor finishing a grandiose theatrical performance. As Mr. Sanders expressed his thanks to each staff member by name there was a deep emotional connection that can be seen, and felt. Staff members said their goodbyes to him as he walked out of the building into a Yellow Taxi waiting for him. We at The Riverside applaud Mr. Sanders for his hard work and dedication. May he continue to take One Step at a Time, always looking forward to a bigger and brighter future.

The Journey Continues
Returning home for Mr. Sanders was everything he could imagine. Within a short period of time, Mr. Sanders was able to return to work full time in his beloved theater. As his friends and cast members greeted him, he could only mention his love and affection towards the incredible staff at the Riverside. Every day he would take, “the scenic route to and from work.” 2 months after being home Mr. Sanders had a follow-up appointment with his Vascular Surgeon on 6/5/2018 for a minor debridement on his ankle. While waiting for the doctor to see him, he went into septic shock. “I should have played the lotto that day because the moment I went into shock the doctor literally walked in.” He was able to return home the next day with instructions to take it easy. Over the next few days, Mr. Sanders was beginning to feel discomfort, his legs began to swell, and he was having difficulty walking. Out of concern for his change in the condition, he went to Mount Sinai St. Luke’s emergency room for medical attention. Medical staff diagnosed him with aggressive diuresis. The fluid retention explained why his legs were swelling, and with a history of Afib medical staff admitted him. With multiple combinations of medications, and IV treatment swelling began to decrease. Medical staff informed Mr.Sanders he would need to continue IV treatment, as well as take part in Occupational Therapy, and Physical Therapy. With a giant smile on his face, he said there is only one place for me and that is The Riverside.

In a matter of days, Mr. Sanders was back at The Riverside with complete celebrity status. While entering the facility, staff members began to high fiving him and asking how he is doing. Smiling as always with a quick, rye joke, he said to familiar staff members, “you know I had some vacation time, and I just thought why not spend a few weeks at The Riverside?” Department Managers from different disciplines arrived to welcome him back and wished him a speedy recovery. Medical staff closely monitored his health while updating the private doctors of his progress. Mr. Sanders had difficulty for the 1st few weeks because of the swelling in his amputated area. Therapy focused on a modified cardio exercise while trying to educate him on using the bathroom with assistance. While he was recuperating at the Riverside, Mr. Sanders had undergone ocular nerve surgery. His vision was impaired due to an accident sustaining while living at home. The combination of a history of diabetes, foot ulcer, IV medication, and fluid retention posed difficulty for a potential discharge. Over the course of several months, his vision returned substantially. Fluid retention was minimized with a combination of medication, compression stockings, and consistent dialog with his private vascular medical staff. With his sight returning and the swelling completely gone, the rehab department was prepared to work their magic. As the months continued to pass Mr. Sanders began to surpass his very own expectations. In the coming weeks, he was informed by multiple departments he will be safe to discharge home.

As all great shows must end, our celebrity Mr. Sanders was preparing to end his time at the Riverside. With all the necessary supports put into place, in order to make sure he would succeed in the community, he still felt nervous about returning home. The desire to return to regular life, and being independent pulled at his heart more than anything. On the other hand, he has the security, and comfort of being at the Riverside. With the encouragement of staff and friends, Mr.Sanders discharged from the Riverside on 9/20/2019 home. Riverside’s favorite celebrity returned home, not by stretcher, not by wheelchair, but by walking out with no assistance.