Lives & Limbs – Soldiers

Robert Heinlein once wrote that the most noble fate a man can endure is to place his own mortal body between his loved home and the war’s desolation. The line is based on the fourth stanza of our national anthem, which no one ever seems to sing at sports games for some reason.

As my series inspired by Nicole Ver Kuilen continues, I’d like to take the opportunity to remind you all that there are a hell of a lot of women who put their bodies on the line as well, and a lot of them leave pieces behind when they come home.

Marine Turned Mountaineer

#11 - Kirstie Ennis Final

I was spending yet another layover at Chicago O’Hare on my way home from a business trip last month when I caught sight of a provocative painting on the wall. You don’t see a lot of pictures of beautiful, powerful-looking amputees in their underwear hanging around in airports, so I got curious and stopped to read the plaque underneath it. It turned out that I was looking at U.S. Marine Corps Sergeant Kirstie Ennis, who lost her leg in a chopper crash back in 2012.

That’s putting her injuries lightly, actually. The crash also tore her rotator cuff, damaged her spine, shattered her jaw, lacerated her face, and left her with a case of brain damage and PTSD. Her recovery took three years and required over 40 surgeries. That she was able to recover at all is a testament to the power of modern medicine. What she’s done since her brush with death on the battlefield is a testament to the power of the human spirit. Kirstie is a United States Marine, and Marines don’t quit.

As a life-long athlete, Kirstie turned to sports to get her back into fighting shape during her recovery. The same year that her leg was amputated, she participated in a 1,000 mile hike across England called Walking with the Wounded. She went on to compete in rowing, swimming, and cycling during the 2016 Invictus Games, and joined the U.S. Snowboarding Team for the 2018 Paralympics after that. Her current passion is rock-climbing. She’s the first woman with an above-the-knee amputation to reach the top of Mount Kilimanjaro, and she eventually plans to stand on top of each of the world’s Seven Summits.

Pilot Turned Politician

Back in the early Nineties, there weren’t a lot of combat roles for women in the United States Armed Forces. That’s why Tammy Duckworth, who comes from a long line of fighters going all the way back to the Revolutionary War, chose to train as a helicopter pilot after joining U.S. Army Reserve back in 1992. In 2004, Tammy’s unit was deployed to Iraq during the War on Terror, where her Blackhawk helicopter was struck by an RPG while on patrol. Tammy tried to land her damaged chopper, but had some trouble reaching the pedals because she’d lost both of her legs in the explosion. Fortunately, her co-pilot got the job done and pulled her from the wreckage.

Tammy recovered from her injuries at Walter Reed Army Medical Center, where OPGA’s Dennis Clark saw to her prosthetic care and rehabilitation. Unable to return to active combat duty, Tammy needed a new way to serve her country. She found it in politics. Returning to Illinois, Duckworth became the Director of the Illinois Department of Veteran’s Affairs. Her efforts got her noticed at the national level, and she was nominated by President Barak Obama to serve as Assistant Secretary of Public and Intergovernmental Affairs for the United States Department of Veterans Affairs in 2009.

She resigned her position in 2011 so that she could run for an open seat in the House of Representatives in 2012. Her election to that office made her the first disabled woman to serve in Congress. She was elected to the U.S. Senate in 2016, where her service continues today. Since her time at the VA, Senator Duckworth’s government service has been characterized by her common sense, fighting spirit, and dogged determination to do what’s best for her constituents. She’s been particularly active as an advocate for veterans, the disabled, women, and minorities.

Lives & Limbs – Science Fiction

Welcome back. Whether you’re a licensed O&P practitioner, an amputee fortunate enough to have a state-of-the-art prosthesis, or even just an industry outsider who’s amazed at the level of technological innovation that goes into creating today’s prosthetic devices, it’s hard not to be amazed by the sophisticated solutions available to amputees. As my series inspired by Nicole Ver Kuilen‘s visit continues, I’d like to keep the sci-fi theme that I started on Friday rolling just a bit longer. Enjoy.

World War I & The Rise of the Bionic Men

The thing that made WWI so incredibly unique was the sheer scale of it. When the guns fell silent and the soldiers started returning home in 1919, the world’s most powerful nations found themselves facing a new crisis on the home front. They had millions of newly disabled veterans to care for, and they were going to have to do it while their economies were in complete shambles. To make matters worse, the war had taken millions of able-bodied young men out of the workforce, and many feared that this would make the process of rebuilding slow and painful due to a massive loss in productivity. No matter which side of the war they’d been on, each of the belligerents came to the same conclusion:

If they were going to avoid going broke, they needed to find a way to return their veteran amputees to the workforce. Fast.

Fortunately, these brave men and women were extraordinarily willing to put their shoulders to the wheel…even if those shoulders were no longer always made of flesh and bone. Douglas C. McMurtrie of the American Red Cross, French engineer Jules Amar, and German innovator Georg Schlesinger were at the forefront of a revolution in prosthetic design where form was cast aside entirely in favor of functionality. Their innovative thinking ultimately made prosthetic limbs cheap and easy to mass-produce while also providing maximum utility to the amputees that would be expected to use them.

Schlesinger was especially excited about the potential of prosthetics, and went so far as to advocate for the idea that well-designed prosthetic devices could enhance the abilities of an amputee and give them a powerful advantage in the workplace. This idea got a lot of people talking about whether science could (or should) be used to create race of bionic “super men.” We never quite got around to turning everyone into cyborgs after the war, but we did see an enormous shift in the prosthetics industry from cosmetic limbs meant to fill space and hide “deformity” to the mass production of practical, functional limbs.

This change allowed millions of injured soldiers to return to work and, in many cases, completely shatter expectations for what they could do. No longer looked upon as cripples in need of government protection and assistance, amputees equipped with prosthetic devices were seen as being more than capable of contributing to society. This new, elevated status for amputees combined with their sheer numbers after the war went a long way toward reducing and even eliminating the social stigma that came with missing a limb.

Scotty’s Missing Middle Finger

Space: The Final Frontier…

Gene Roddenberry captured the imagination of millions of Americans when he brought Star Trek to the airwaves in 1966. Captain James T. Kirk had command of the Enterpise, but it was his loyal Chief Engineer, Montgomery Scott, that kept the ship flying through all of its crazy adventures. Being the Chief Engineer on a starship wasn’t easy. Scotty had to perform delicate repairs on extremely complex machinery under enormous pressure, often while the ship was being shot at by the villains of the week. One can only imagine that he had to have the kind of manual dexterity that would make a bomb-squad technician jealous…a quality he prided himself on despite the fact that he was missing the middle finger on his right hand.

You see, prior to being cast as Scotty, Canadian actor James Doohan served with the 14th Field Artillery Regiment of the 3rd Canadian Infantry Division during the Second World War. After storming the beaches of Normandy with his unit, he ended up being shot by friendly fire while moving between command posts the night after the battle. Doohan took four in the leg, one in the chest, and one through his middle finger, which had to be amputated. This may seem like a relatively small injury compared to some of the others that I’ve talked about in this series, but you have to remember that Hollywood is a pretty superficial place today. It was even worse in the 1960s. There weren’t a lot of casting calls going out in Tinsel Town for people who were missing body parts.

Obviously, Star Trek was an enormous success. My great grandchildren will probably be watching some version of it long after I’m dead. James Doohan’s part on the show helped open the door for other amputees to try their hand at acting…no pun intended…and also inspired a generation of kids to go into engineering. His character was cited by so many engineering students as their reason for choosing the profession that he was given an honorary doctorate in the subject to go with his star on the Hollywood Walk of Fame. Doohan passed away in 2005, but his legacy of inspiring young amputees, engineers, and astronauts will live on forever.

Lives & Limbs – Musicians

It’s Friday. Let’s all put down our history books and pick up our headphones. As my series inspired by Nicole Ver Kuilen‘s visit continues, I’d like to put the spotlight on an impressive pair of musicians who continue to play the music that they love despite having suffered what many would consider to be career-ending setbacks.

The Thunder God’s Missing Arm

 

Rick Allen has been drumming for Def Leppard since 1978, and is widely acknowledged as being one of the best drummers in the world. His legendary skill has earned him the fan nickname “The Thunder God,” and millions still come to Def Leppard concerts to hear him play. If your only experience with Def Leppard has been listening to their music on the radio, you may have missed the fact that Allen plays his custom-made drum set with only one arm.

Back in 1984, at the height of his band’s success, Allen was thrown from his car during an accident and lost his left arm in the process. Doctors initially re-attached it, but a nasty infection caused them to re-amputate it shortly thereafter. As you might imagine, Allen was devastated. It isn’t easy to make it big as a musician, and his career looked to be over just when it had finally taken off. Fortunately for his fans, Rick’s love of drumming was too great to walk away just because he could no longer hold both sticks.

It may seem to run counter to the theme of my series, but Allen was never fit with a prosthesis for his arm. Prosthetics aren’t just for replacing limbs and filling space, after all. In order to restore maximum function, Rick had his drums modified with a series of cables and foot pedals that allowed him to play the drums on the left side of his set with his feet. Through his use of this adaptive technology, Rick’s story and example have inspired countless amputees to adapt to their new circumstances and continue doing what they love.

The Force is Strong with This One

 

It’s easy to forget that Luke Skywalker was an amputee. A long time ago in a galaxy far, far away, his dad severed his right arm in one of the coolest sword fights ever captured on film. Things turned out all right for him though. By the end of the film, he got a prosthetic replacement that looked and worked just like the orginal. Back in 1983, Luke’s cybernetic arm was just as much of a fantasy as lightsabers or landspeeders, but recent developments have brought it a step closer to reality.

Jason Barnes was cleaning the exhaust vents on a restaurant roof in McDonough, Georgia when he was electrocuted by over 22,000 volts of electricity that arced to him from a nearby power line. Doctors managed to save his life, but not his right arm. Jason was devastated, as he believed that his chances of getting accepted to the Atlanta Institute of Music had been lost right along with it.

His hope was restored by researchers at Georgia Tech’s College of Design, who created a replacement hand and forearm for Jason that was inspired by Luke Skywalker. Jason’s prosthesis uses a combination of electromyogram (EMG) sensors, an ultrasound probe, and machine learning that allows it to read the movements of the muscles in Barnes’ residual limb while it adapts and learns to move as a natural hand would.

Barnes’ new hand has allowed him to play the piano, and another custom prosthesis provided by Georgia Tech has also restored his ability to play the drums. He was eventually accepted to the AIM, and his career is really starting to take off. He toured with Rick Allen during the summer of 2014, and continues to hone his skills and play in various venues to this day.

Lives & Limbs – Ancient History

My series of articles inspired by Nicole Ver Kuilen‘s visit continues.

I noticed over Thanksgiving that a lot of TV channels seemed to be embracing “Throwback Thursday” by airing old but awesome episodes of their most popular shows. I’m a few days late to the party, but I thought that this would be a good opportunity to highlight a couple of fascinating figures from our distant past.

The Original “Iron Man”

Iron artificial arm, 1560-1600.

We have evidence of prosthetics being used by the ancient Egyptians, but the first documented example of a prosthesis being worn to restore function to an amputee was a metal arm worn into battle by the Roman General Marcus Sergius Silas, who lost his right arm while fighting in the Second Punic War, which took place from 218 to 201 B.C.E. We don’t know how it came about, but Sergius managed to obtain an immobile prosthetic arm made of iron, which he attached to his residual limb with leather straps. His prosthesis allowed him to wear his shield again, so he returned to active duty, where he served with valor and distinction in many battles.

He was wounded almost thirty times over the course of his career. At the time, the mortality rate for soldiers wounded once in battle was north of 80%. Sergius not only survived, but he quickly returned to the front lines each and every time. His iron limb and incredible durability made him famous, and people eventually gave him the nickname Ferrous, which is Latin for “made of iron.”

Sorry, Tony Stark. Marcus Sergius was the original Iron Man.

Sergius’ reputation for dedicated military service eventually earned him a place in public politics, where he served as a Roman Praetor. He faced a certain amount of adversity while in office because of his amputation, with several of his colleagues attempting to bar him from taking part in public ceremonies because of his perceived “deformity.” Sergius was apparently quite successful in defending himself against his detractors, which probably makes him the world’s first advocate for the rights and dignity of amputees.

The World’s First Prosthetist Was a Barber

#2 - Pare Prosthetics

If you were unfortunate enough to need surgery in Europe during the Middle Ages, you wouldn’t have gone to see a doctor. Doctors at the time considered surgery to be barbaric practice that was beneath the dignity of their profession. If you needed surgery done, your local barber had the sharpest blades and the surest hands in town and was often trained to use them for medicine as well as shaving. Ambroise Paré, a barber who served in the French military during the mid to late 1500s, is widely considered to be a founding father in the fields of surgery and prosthetic care.

Paré is particularly celebrated in prosthetics circles for his ground-breaking work in the field of amputation surgery. He popularized the use of ligatures to repair severed arteries and developed an ointment that promoted healing in wounds, both of which greatly improved the survival rate of veteran amputees. Unfortunately, Paré’s brilliant new treatment methods weren’t enough to save all of his patients. Many of the soldiers that he had worked so hard to save on the battlefield later chose to take their own lives rather than live without their amputated limbs.

Horrified and saddened, Paré decided that it wasn’t enough to simply heal an amputee’s wounds or fill the space left empty by their missing arms and legs. If he truly wanted to save lives, he needed to restore a sense of wholeness and function to his patients. With this in mind, he was the first to take a holistic approach to managing prosthetic care. He also created the first artificial leg with a working knee joint as well as the first artificial hand with articulated fingers. Many of his designs are actually still in use today.

I don’t necessarily recommend that you let your barber perform your next surgery, but I would invite you to recognize and celebrate the achievements of this one barber in particular. As a surgeon, a scientist, and a humanitarian, Ambroise Paré was a cut above the rest.

Lives & Limbs – Athletes

Last week, I announced a series of posts inspired by a visit with Nicole Ver Kuilen. Since Nicole has chosen to use running as the vehicle for her advocacy on behalf of her fellow amputees, I’d like to start with a couple of impressive amputee athletes.

The Blade Runner

#9 - Aimee Magazine Covers

Oscar Pistorius got a lot of attention for being the first amputee to make the transition into the regular Olympics, and that’s probably appropriate. He didn’t run particularly well though, and he stirred up a bit of controversy over his poor sportsmanship. He’s also serving a 13-year prison sentence for killing his girlfriend. Not the most inspiring stuff. Everyone seems to forget that Aimee Mullins was also at the 2012 Olympic Games, and that the Flex-Foot Cheetahs provided to Pistorius by OPGA partner Össur out of Iceland were originally designed for her.

Mullins wasn’t in London to run. She was too busy serving as the Chef de Mission for the United States. That’s the highest honor the U.S. Olympic Committee gives out, and Mullins earned it after a lifetime of barrier-breaking athletic achievement that was accomplished without the use of her legs.

Aimee was born without fibula bones, leading her parents to make the difficult choice to amputate both of her legs below the knee when she was only a year old. Had she kept them, she would have been wheelchair bound for the rest of her life. The amputation allowed her to learn to walk using prosthetics, but Aimee wasn’t satisfied with walking. By the time she got to high school, she’d learned to run. Fast. Mullins participated in high school track and field events while wearing a pair of clunky wooden legs. As she did so, she set records.

Aimee went to college at Georgetown University, where she became the first amputee to compete in standard NCAA Division 1 track and field events. She became a Paralympic phenomenon, setting world records for the 100-meter dash, 200-meter dash, and the long jump while competing at the 1996 games in Atlanta. She was named the USA Track & Field Disabled Woman of the Year in 1997, and her athletic prowess brought her world-wide fame.

Her stunning good looks and competitive spirit were an inspiration to legendary fashion designer Alexander McQueen, who invited Mullins to be the first down the runway at one of his fashion shows in 1999. She’s been challenging our standards of beauty ever since as a model and Hollywood actress, often posing proudly in her running blades.

The Rock Climber Turned Biophysicist

#8 - Hugh Herr (Cropped)

Hugh Herr was born the youngest of five siblings to a Mennonite Family in Lancaster, Pennsylvania. I’ve read that being the lastborn in a family can have a big effect on your personality as you grow up. Being the youngest means that you’re always surrounded by people who are older, bigger, faster, and smarter than you are, which means that you’ve got to try pretty hard to differentiate yourself. Some kids do it by being rebellious. Hugh Herr did it by being amazing. By the time he was eight years old, he’d climbed almost 12,000 feet to the top of Mount Temple in the Canadian Rockies. By the time he was set to graduate high school, he was considered one of the best climbers in the U.S.

In January of 1982, Herr was climbing with a friend in New Hampshire when a blizzard stranded them for three days in temperatures well below freezing. Both men were eventually rescued, but not before they had suffered severe frostbite. Both became amputees, with Herr losing both of his legs below the knee. Herr’s doctors told him that he would never climb again. He proved them wrong in a matter of months, designing and building an ingenious pair of prosthetic legs that allowed him to firmly stand on even the narrowest and most slippery of surfaces.

Herr’s new legs gave him the distinction of being the first professional athlete that could actually perform better at their sport than a non-amputee, and his success at rebuilding himself after his brush with death gave him a new interest in biomechanics. He earned a bachelor’s degree in physics, a master’s in engineering, and finally a Ph.D. from Harvard in biophysics. Armed with his new knowledge, he secured himself a position at MIT, where he serves as the head of their biomechatronics program. His work there has led him to boldly and controversially declare that the end of disability as we know it is close at hand.

Lives & Limbs: A Celebration of Prosthetic Advancement and Amputee Achievement
1a - Nicole Running (Cropped)
1a - Nicole in Washington (Cropped)

I recently had the pleasure of being visited in my office by an impressive young woman by the name of Nicole Ver Kuilen. Nicole has been named as the inaugural Health Policy & Advocacy Fellow at the National Association for the Advancement of Orthotics & Prosthetics (NAAOP), having lost her left leg to cancer at the age of ten. As she grew older, Nicole’s desire to be an athlete brought her new challenges. Obtaining a prosthesis that could meet her needs was difficult, as was navigating the financial complexities that often come with seeking prosthetic care in our country.

Nicole found herself asking a lot of questions during her sixteen years as an amputee: Why is prosthetic care so time consuming and expensive?  Why are all but the most basic of prosthetic devices often deemed “cosmetic” or “convenience” items by insurance providers? Why are people who lose their limbs under certain circumstances afforded better access to care than amputees like her who lose limbs to things like cancer? Nicole’s quest for answers led her to take a 1,500 mile jog down the west coast to raise public awareness of the issues facing American amputees. Her journey has been recorded in a documentary called 1,500 Miles, which she has used to take her message to our elected leaders in Washington and demand change.

Nicole’s story, thought leadership, drive, and sprawling list of accomplishments were a great reminder that amputees are often some of the most determined, hard-working, and impressive people around. The history of prosthetic care is packed with fascinating accounts of people like Nicole who overcame tremendous odds to make important and impactful contributions to society. Those contributions were made possible by others who saw the dignity and worth of amputees and developed the technologies and medical procedures necessary for them to live their lives to the fullest.

Inspired by Nicole’s visit, I’ll be presenting a list of people (in no particular order) who have  changed the way we look at amputees and the prosthetic care that they rely on. I’ll introduce you to a couple of people every few days until I make it through my material, so check back often!

 

 

Opportunities in HME

building blocks

CMS’s Office of the Actuary has published their National Health Statistics for 2016 (they always run about a year behind.)  A few interesting statistics in there about HME:

  • The annual growth rate across all HME categories will average about 6% a year for the next several years.
  • Unit growth and demand will result in total HME spend five years from now (2022) being nearly 30% greater than the HME spend in 2017.
  • The increase in HME spend in 2018 over 2017 – in terms of total dollars spent – will be a greater increase than in any year in the past decade.
  • Looking at 5 years ago vs 5 years from now, to gain perspective, shows Medicaid as the payer source that will have grown the most, by a fair margin. Private health insurance grows proportionately as well.  Medicare shrinks in proportion.  Said another way, Medicaid and private health insurance become more important to HME providers than they have been in the past.

Yes, those serving the HME space face many daunting challenges, there isn’t much argument over that.  But we do so in a market that is growing in dollars and growing much faster than almost every other segment of our economy.  Shifting sands are requiring us to change, to do things differently, to re-prioritize and to focus.   But opportunities abound.