Otto Bock Genium Knee Product Profile

Hey Guys! Finally getting back into the swing of posting. There have been lots of really exciting things going on lately at work, and my first climbing trip of the Fall season is this weekend to Northwest Georgia to go explore the boulder fields of Rocktown and Zahnd.

One of our patients at POA, Karen Hughes, got the opportunity to try the Genium Knee and made a nice write up. Check it out along with video below!

POA has begun fitting the new Genium knee on patients and their feedback has been very informative. In an effort to share those helpful first impressions with the rest of the amputee community, I will begin posting patient feedback via written words, photos, and videos on this blog, starting with my own….
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Karen Hughes, age 52, above-knee amputee
since age 13 due to osteosarcoma (bone cancer)

I was recently given an opportunity to try the new Genium knee by Otto Bock. I’d been following its evolution over the past five years, and looked forward to testing it myself. But at the same time I was trying to curb my enthusiasm for it a bit since I knew my insurance company would not likely pay for one. While I truly believe that this technology will be the standard for the future, I am concerned about its affordability and availability for all amputees. Incredibly, many of the private sector insurance companies are still denying microprocessor knees which have been on the market for 12 years because they consider them “experimental?!” Not much chance they’d cover this new and more expensive technology.

So with that in mind, I took my first few steps with the Genium knee. It was unlike my past experience with another Otto Bock knee, the C-Leg, which I found to be very controlling and robotic. The movement of the Genium knee was smooth and responsive in a way I have never experienced before.

Set-up was quick and easy, based on information provided by the knee which allowed the practitioners to fine tune the settings to my personal requirements. In less than 5 minutes I was ready to go!

The first thing I tried was going from a standing position to a seated one. The knee sensed my movement and released the knee instantly with just enough support; I didn’t have to push down with my foot to initiate it! Then I began to walk. Because I don’t choose to fully utilize the stance flexion feature of my current microprocessor knee (it inhibits my ability to control the prosthesis myself), I was worried that I would have difficulty adapting to the Genium. That was not an issue. I was amazed at how quickly I just relaxed into it! The motion was smooth and natural in a way that is different from other microprocessor knees. It seemed to respond faster and I was able to change direction and/or walking speed without even thinking about it. The knee intuitively knew what to do. I felt like I was walking on my two natural legs again! The Genium didn’t require me to initiate anything other than a normal walking motion – it was effortless.

Then I tried it on the stairs. I always use a handrail for support when walking down stairs foot over foot. I’ve never trusted the hydraulics in my knees enough to “ride them down.” This time I walked down without gripping the handrail; in fact, I barely touched it! The knee supported and released without hesitation or effort no matter where my foot was placed. Ascending the stairs required a backwards sweeping motion to activate the function, which I found awkward. However, I’m sure I’d be able to master it, with time and practice. That same motion is used to signal the knee to step over an obstacle. I tried using it to step over a curb and kept reverting back to my usual method - swinging it around and bringing the foot down heel first. Again, that is something I could easily learn to do if I desired.

I was also able to walk up and down a steep ramp without a thought. From what I have read, that was because gyros and sensors were making adjustments in heel rise as I moved. All I know is that it was very easy and required no extra effort.

Would I recommend the Genium to other above-knee amputees? In a heartbeat! There is nothing else like it on the market today. Although not everyone will utilize every single one of the knee’s features, its ability to sense where it is in space is HUGE, and something that would be beneficial for us all. I have seen ads and videos featuring young, athletic men using the Genium knee to help them do things faster, smoother and easier than they were able to before. While that in itself is exciting and definitely life-enhancing, I think Otto Bock is targeting too small a group. The people I believe it will impact most are “average” amputees of all ages and physical condition. The optimized performance of the Genium could give them the confidence to try things they never had the courage or stamina to try before! It could be life-changing.

All that being said, I also have had very good experience with my Plie’ microprocessor knee for the past 5 years. It allows me to do most things I want to do and is safe enough without being controlling during most activities. But the Genium is definitely more cutting edge and responsive, in a different class than all other microprocessor knees.

Overall, I was very impressed with the Genium knee, and I hope that this type of technology will soon be the standard for all prosthetic knees. Its important that we advocate for ourselves as a community to change the way insurance companies determine coverage of prosthetic devices. We need to push lawmakers to require insurance companies to cover prosthetic care on par with other essential medical care.

Last Residency Column for the O&P Edge Magazine

“Fifteen hundred years ago, everybody knew the Earth was the center of the universe. Five hundred years ago, everybody knew the earth was flat, and 15 minutes ago, you knew that humans were alone on this planet. Imagine what you’ll know tomorrow.”
-Agent K, Men in Black (1997)

My residency experience has flown by. It is difficult to sit down and reflect on the experiences of the past year while still caught up in the whirlwind of the present. Workflow is a fickle thing in this field; it is hard to strike a perfect balance between not busy and swamped. While things have calmed down this month, the whole month previous was my biggest learning experience to date. Managing multiple patients every day allowed me to pull together all the skills I have acquired and implement my own clinical decisions with little assistance. It feels good to see all the pieces of knowledge I have gained over the past year come together.

Simply put, I love my profession. It is inspiring to see people of all walks of life overcome obstacles and adversity and be a part of that process. Doing the job right takes work, but there has never been a time where the extra effort spent on a patient wasn’t worth it. There is no amount of hours spent or check sockets fabricated that could diminish the feeling I get when a satisfied patient walks out the door with a smile on his or her face.

I have come a long way in the past year as both a practitioner and an individual, but I still have a long way to go on a journey that never really ends. I look at my boss, Stan Patterson, CP, who has been in this profession for approximately 20 years and never stops learning. Although he’s the owner of a successful P&O practice, he is constantly trying to better our day-to-day practices. I have come to appreciate the benefits of actively trying new techniques in order to make myself a better practitioner, even with the possibility of failure. I have come to believe that resisting new techniques and new technology can be damaging to the progression of the field, and it can also negatively impact the level of care available for patients. Prosthetics is a dynamic and changing field, and I know that if I don’t stay on top of my game for even one day, I could easily be at the bottom the next day.

Stan has always told me, “It takes five years until you really start to know what you are doing,” and I do not doubt that for one second. It takes time for everything to soak in. My whole process of fitting individuals with transfemoral amputations, for example, has changed drastically in the past three to four months, and I imagine that my approach will continue to evolve as I develop my skills. I am sure that a year from today I will not even recognize the practitioner that I am as I complete my residency. I know I have always tried my best, but looking back I already see times when I could have done better. While I cannot go back and fix what I did yesterday, I can change what I do tomorrow. I will embrace the experiences that come my way—both positive and negative—continue to learn every day, and actively work on making myself better so that I can directly influence the quality of people’s lives to the best of my ability and in the positive fashion I know I am capable of.

Thank you for letting me relate my experiences over the past year. It has been personally rewarding to share my thoughts with readers. These columns have allowed me to reflect in a way that I otherwise would not have taken the time to enjoy.

Ronald Dickson is a graduate of the bachelor of science in orthotics and prosthetics program at St. Petersburg College, Florida. He is a resident at Prosthetic and Orthotic Associates, Orlando, Florida, and has been sharing his experiences as he completes his residency.

C-leg post update!

Last week I posted about how Otto Bock Healthcare was optioning not to cover the extended warranty on my C-Leg because of “corrosion.” The letter made a splash on the internet and made it back to Otto Bock corporate. They immediately made this of notice with my local sales representative, who made a point to stop by our facility and have a chat with me immediately. He was understandably upset that I had not contacted him first in this situation, and given him the opportunity to take care of these charges. There are several reasons why I chose to handle the situation through the internet first, most notably because Otto Bock has a reputation for being “sticklers”. They are a company that gives no freebies, no matter how small, and handles every situation straight by the book and it has never been any different in all of my dealings with them in the past.

The representatives from Otto Bock informed me that the US portion of the company is undergoing a personality change that puts the customer first. This is coming from direction under their new American CEO that is hoping to change courses from their German roots. They hope to be able to address all needs quickly and efficiently, and provide superior care to their customers. You biggest advocate at the company will be your sales representative, but they assured that the customers voice will be heard through nearly any channel in the company.

I personally think this is a great step in the right direction for Otto Bock, and will look forward to seeing how their dealings with customers manifest themselves in the future. It is one thing to talk the talk, and another to walk the walk. Only time will tell.

I also received news that they were going to repair my C-leg at no cost. I was happy about this news, but also hope that had this been any other patient they would have received the same treatment. My name has started to carry a certain amount of clout with it, as an amputee athlete, active user, and prosthetist, but I hope this was not a primary reason that they chose to honor their warranty concerning my C-leg. I will give them the benefit of the doubt.

So here is the 411.  The C-leg warranty stands now at $5,700. I had extensive damage on mine, and that clocked in right at $2,162. It is very unlikely that any patient will accrue $5,700 worth of damage on their C-leg, and most likely if that is the case it will not be covered because its usage would be out of the terms of the warranty which does not protect against corrosion of any kind, however natural it may be. It is most likely in the user’s benefit to pocket the money, store it in their own private account and pay to get the leg fixed when need be. The C-leg already comes with a two year warranty. At the two year mark it will get serviced on the company’s tab. This in itself should keep the knee functioning reasonably for many years.

It is also in the user’s best benefit to not purchase the warranty of the C-leg if they believe they will do anything to violate the terms of the warranty. That way they can guarantee coverage (coming from their own pocket) that the knee will be fixed. Let me also point out that the C-leg warranty is void if another manufacturer’s foot is used such as a Freedom Innovations or Ossur foot. Otto Bock has notoriously had stiff and unresponsive feet in the past (there are some new models out now, which I have not had the opportunity to try so I will hold judgment), hence leading many to use another manufacturer’s feet on their C-legs. This VOIDS the warranty and extended warranty. If you feel you need to use another manufacturer’s feet you are best going with the Freedom Innovations Plie 2.0.

If you are having issues with warranty coverage on your C-leg contact your Otto Bock sales representative. They are your number one point of contact. If the complaint or issue is within reason (e.g. you did not fall into a pool with your C-legs) they have the power to handle it. Make your voice heard if they do not handle your claim within a timely manner. Contact others in the company, or let others know of your experience at your prosthetist’s office or through the internet. We as patients and users in the field have a voice if we choose to use it! 

Used Prosthetic Knees and Feet - We need help!

My time here at Prosthetic and Orthotic Associates has really been eye opening. I have been in the position as a prosthetist where we are financially lucky enough to not have to turn any amputee away. We will treat patients without insurance or with financial needs for free because it is the right thing to do. They are treated exactly the same as our patients with insurance, with carbon fiber feet and hydraulic knees as well.

The cost of the socket is the part that is easy for us to do, but high activity prosthetic feet and knees can go in between $2,000 to $6,000. We have been using old and donated components for the past year, and have sucessfully fit over 20 "free" patients. Unfortunately our stockpile we had amassed has run dry.

                    Our stockpile of ancient or broken knees from over ten years of being in practice.

Our patients have been a huge part in making this happen, as they receive new components, they have generously donated their old components. In today's harder times, more and more amputees are without insurance, so our pro bono work has skyrocketed. 

If you yourself or anybody you know has any old prosthetic components lying around in their closets we desperately need the help. Please pass this note along to anybody who might be able to help.  There are lots of persons with amputations who could use your help, and I promise that we will fufill our end of the bargain and get them up and walking again in a kick ass socket from Prosthetic and Orthotic Associates.

One of the our patients we were able to help out recently, Tanya (AK/BK) celbrating her 21st birthday with the team!

Ronnie Dickson, Board Eligible Prosthetist

Prosthetic and Orthotic Associates

3160 Southgate Commerce Blvd #34

Orlando, FL 32806

863-651-6844

Otto Bock's C-leg warranty lies!

Hi, my name is Ronnie Dickson. I have been an above the knee amputee for six years now. I have been using a second generation Otto Bock C-Leg for four and a half of those years. The C-leg was a big investment for both me and my family. We are an average, modest, middle class family that is by no means swimming in money.  I was eighteen at the time of purchase, so my family played a big role in helping me purchase the knee. The C-leg bills out for a hefty $25,000. Insurance only covered 80% of the cost, so we paid the rest of the cost out of pocket ($5,000). Having made such a substantial investment into my healthcare we decided to take the option for the extended warranty that would change the coverage from two years to five years. This was an extra $5,000. We believed that this extra cost would help us protect our investment so that I could enjoy and use it for many years to come. We were wrong.

I will start out by saying that the C-leg has been a wonderful addition to my life. It has helped me go about life without even thinking about it and has kept up with me no matter what the activity. I have used it actively, and have been able to live the way I always imagined. I started having trouble with my usually reliable C-Leg about four years after purchase. My plug did not always charge, my battery was not holding the same life it used to, and knee did not feel as smooth as it previously did. I understand this is normal wear and tear, but I also knew that I had attempted to keep my investment running smoothly by purchasing the extended warranty. This wear and tear directly affects my quality of life. Walking around occasionally, because my battery did not hold charge, with a “locked knee” hurts my back. I also feel more fatigued on a daily basis because the hydraulics are not workings properly.  I sent the knee back only to find out that they refuse to cover any of the repairs. They claim that the knee is “corroded” and to restore the knee back to its previous functionality according to manufacturer’s recommendations it was going to cost $2126.52. I would like to note here that there were many other things wrong with the knee aside from “corrosion”. Many of the main parts including the kneeball, kneeball axis, and lower cylinder axis all had scoring. They did not fix anything because of the “corrosion” which I expect was the minor issue in all of this.

Although Otto Bock refuses to acknowledge it, corrosion is part of the natural wear process. I have been a resident of Florida my whole life, and anybody who has ever been to the state knows it is a steaming sauna with humidity of 100% almost all of the time. Who is to say that over 1000 days of exposure to humidity did not cause the corrosion? Water is a daily factor in all of our lives. Last I checked it rains in all 50 states. It is highly unlikely that a C-leg user will never get a drop of water on the knee. Most of them are too busy living their lives to avoid it. Otto Bock’s slogan is “quality for life” but last I checked their policies completely contradict this. They want the amputees to sacrifice the quality of their lives to protect the product. Lame.

So my point here is completely irrelevant to whether or not my C-leg actually came in contact with water, for the purpose of this discussion I will exercise my privilege to withhold those details. We paid Otto Bock $5000 to keep my C-leg functioning for five years and they did not come through with their end of the bargain. I feel cheated in every sense of the word; they may as well have stolen the money straight out of my pocket.

I currently work as a prosthetist in Orlando, Fl at Prosthetic and Orthotic Associates. I am not the only one in the profession that thinks that there is a lot wrong with these tactics.

I did take economics in high school, and even if they did fix all the “DAMAGE” on my C-leg they would still come out on top of the whole deal by over $2,000. Instead they chose to take money from a population group that is going to be burdened with healthcare costs for the rest of their lives.

I would still purchase a C-Leg in the future, but I would not pay for the lie that they call the extended warranty. Instead I would just put the money in the bank, and fix the knee when needed. That way I could keep the promise that Otto Bock refused to honor.

The Gods are in the details

It is hard to describe the residency experience in its entirety. It could best be summed up as one massive learning experience. Now at the three-quarters mark, I am hitting the home stretch. Some days I feel like I have been doing this forever, combining my limited experience with the right patient to produce a positive outcome. More often than not, I am reminded of how far I have to go as I face the multitude of challenges that present themselves daily.

The one thing that I know with certainty is that to get the best result, the details that go into every prosthetic device must be perfect.

The most important part of any building is its foundation. If the foundation is shoddy, the structure's integrity will be compromised. A patient's residual limb takes many different shapes and sizes; no two are alike. Invaginations, scarring, burns, and heterotopic ossification, to name a few, all present a difficult foundation upon which to build a socket. We level the playing field by customizing about 90 percent of our silicone liners. This allows us to achieve the full contour of the limb, reduce shear forces, provide cushioning, and achieve a more even surface to serve as the foundation for each socket. We choose to use silicone instead of TPE because it is more hygienic, does not pack out over time, and provides improved protection against impact forces. We almost always default to vacuum as our suspension method because of the intimate connection it offers the limb.

All of the facilities that I have visited do clear, static check sockets to evaluate the fit. Only a few are doing dynamic check sockets. While a static fit provides valuable information, there is only so much you can tell from standing up into a socket. It does not replicate in any way the forces that will be put on a limb while ambulating, particularly after an extended period of time. I believe that a dynamic check socket is crucial to an optimal outcome, not only for fitting but also for alignment purposes. We mount our sockets onto an oversized mounting plate with Bondo®, then reinforce it with fiberglass wrap. The large mounting plate gives us adjustability in our components' M-L and A-P placement, as well as the ability to initially set the flexion, adduction, etc. during the mount.

It is almost impossible to see everything that happens during gait with the human eye. Is the pylon really vertical at mid-stance? I would venture to say that it probably is not. There are many alignment devices and tools available on the market, such as the Otto Bock HealthCare, Duderstadt, Germany, L.A.S.A.R. Posture, (which only does static alignment), and Orthocare Innovations', Oklahoma City, Oklahoma, Compas™ computerized prosthesis alignment system. These products are expensive and can be time-consuming to implement. A much simpler solution is to use a digital camera with a video function. Record your patient from the coronal and sagittal views, upload the video to your computer, and analyze the film using basic video software. We are able to slow down the video frame by frame and optimize the alignment accordingly on our alignment plate. Sometimes the changes are drastic, such as making a slide change. Other times an adjustment is as simple as putting in an extra turn of flexion to make sure the pylon is truly vertical at mid-stance, instead of having the sound side trail or lead by one or two frames.

Check sockets are easy and less costly to adjust than laminated sockets. When a patient's residual limb is put into suction/vacuum suspension, it tends to shrink quickly. Keeping a patient in a check socket for one to two weeks allows us to accommodate for any volume changes as needed. It is unfortunate when you have to reduce a brand new laminated socket a week later because the patient's residual limb shrank drastically.

These procedures ensure that we deliver the highest-quality product to our patient. It usually takes more than the two check sockets we can bill for, and extra time picking things apart, but it is always worth it in the end. My residency has taught me that the pieces of the puzzle all work together; if you take any one of them away, the outcome, while still potentially favorable, is not the same.

As published in the July 2011 issue of the O&P Edge

Back to blogging, Colorado trip

Things have been absolutely wild lately. About two months ago I got slammed at work for an extended period of time, and between that and training lost sight of a few different things I have been working on. On the verge of a burnout I decided I just needed to take a break and do the essential things in my daily life but put blogging and video making on the back burner.

 So what have I been up to? Well this summer has been great so far. I went out to Colorado to go to the No Barriers Summit. That was an adaptive sports festival for people with disabilites to introduce them not only to outdoor activities but also to various adaptive technologies from prosthetics, mountain bikes adapted for paraplegics and quadraplegics, eye implants for the blind, and just about everything in between. It was a really great event and I was glad to be a part of it. My main reason for being out there was to learn how to use the Wellman Rig. Essentially it is an ascending system I can use in the future at my adaptive clinics so that paraplegics and people with more severe disabilities can make it up the wall as well.

Mark Wellman was super cool to work with and I am looking forward to getting my own adaptive equipment in the future. Mark Wellman was the first paraplegic to do El Capitan among his many other accomplishments in the disabled community.

I also took the time while in Colorado to hang with a bunch of good friends from Challenged Athletes Foundation, Adaptive Action Sports, and Louder Than 11. 

Evan Strong, me, Jill Prichard, Amy Purdy, Carlos Moleda, Oscar Martinez and Jeff Erenstone

Colorado is known for its Alpine Bouldering and I got the opportunity to make it out to Mt. Evans Area A for a couple of days and send an old project The Dali (Stand V6).

The hike out to Mt. Evan's Area A

The Dali Boulder

 The first day was frustrating as we got hailed out almost immediately after arriving to the boulder (after an hour and a half of hiking). Thankfully I managed to get free another day and make it back. It was good to go and clean it up from my trip two years ago. The scenery was breathtaking and it was cool to hike the three miles out to the boulders and just enjoy the day.

Colorado summer alpine flowers

 On the last day of the trip I made it back out to Rocky Mountain National Park. Unfortunately most of the boulders in Lower Chaos Canyon, including several projects, were completely buried under snow. 

Lake Haiyaha and Upper Chaos Canyon in the distance completely buried in snow

Thankfully the boulders at Emerald Lake were clear and I did one of the best V5's I think I will ever do in my life, The Kind. It had some stellar movement and looking at Long's Peak from the top was a nice reward. 

Satisfaction

Jeff on top of the Kind

In hindsight we could have gotten some sick video done, but I was just happy to go hang out with friends, do some rock climbing, and enjoy life. I am reinvigorated and ready for whatever is next. Thanks to Jordan and Jon for letting me crash at their place in Boulder, and thanks to Jeff Erenstone for dragging me all around the state of Colorado. 

Future Practioner Profile - Becky Curls

Prosthetics is a very small field. Even if you do not know somebody personally somebody you know has a connection with that person.

The most asked question I have heard over the years is "how did you get into prosthetics?"

Some people have really simple answers like mine, "because I wear one", and others have different ties into the field.

I met Becky Curls at Camp No Limits Florida 2010. She was coming to volunteer and had shadowed a few different times and decided she liked the field. She came and spent a couple of days with us at prosthetic and orthotic associates and ended up doing a 10 week internship with us.

Here is a short video on her. She has been really impressive in these past 10 weeks and no doubt she will be an important addition to the field. She might even be one of our residents going into the future.

Check it out!

Amputee Profile - Justin Gaertner

A few weeks ago I participated in the first annual Winter's Beachfest 5k in Clearwater, Fl. I had a really good race and took second place in my age group! Aside from running myself I got to meet a guy by the name of Justin Gaertner. Justin was serving our country over in Iraq and was injured, causing him to lose both of his legs above the knee. His injury happened just before Thanksgiving, and after six months of rehab he got his prosthetic legs. He had only had his legs for a little over a month, and was just released to his home in New Port Ritchey, Fl but although having never walked anything close to the distance, he felt up to walking his first mile on his new prosthetic legs. It was one of the most inspiring things I have seen in a long time. I wish Justin the best and no doubt he will go on to accomplish anything he puts his mind to. Check out the video!

Breaking feet

So earlier I saying that I use a wood foot to wakeboard, but I broke it.  Well I just tried out a foot that had a plastic core tonight... and busted it.  I found that definitely shouldn't wakeboard with one of these plastic feet, and you're probably best off not walking on one either.  

Tips on pursuing rock climbing as an amputee

1. You can locate an indoor climbing wall near your home by visiting www.indoorclimbing.com. You will find that most staff at your local climbing wall is very friendly and can further assist helping you pursue the sport or just participate on a recreational basis.

2. Below the knee amputees can climb with their prosthesis. They can put a rock climbing shoe right over their prosthetic foot to help them climb recreationally.

3. I recommend that above the knee amputees climb without their prosthesis or set up in a "stubby" style with the foot right under the socket. Manuevering a full prosthetic leg can be cumbersome and take away from the effectiveness and enjoyability of climbing.

4. There are two companies that make special prosthetic climbing feet. The first is TRS Prosthetics, which creates the Eldo Axis Z prosthetic climbing foot. The second is Jeff Erenstone, who creates another similar prosthetic climbing foot. Both feet share the similar properties of being shorter and stiffer than your average prosthetic foot and are covered in climbing rubber. I highly recommend either of these feet if you plan on making climbing a routine activity or just something you do from time to time.

Jeff Erenstone - erenstone@gmail.com

Bob Radocy - TRS Prosthetics - bob-trs@att.net

5. Climbing can be difficult, but as with anything it gets easier and more natural over time. If you think it might be something you would enjoy, don't give up on it right away. Tenacity is the key to doing anything well, especially as an amputee.

6. Climbing is about journey and adventure. It has a really neat community of people that will embrace you with open arms. It gives back what you put into it. It can be as simple as a recreational activity or it can become a lifestyle. It has given me so much that I have wanted nothing more than to be able to pass it onto others. If you ever have questions about climbing, other sports, or just being an amputee in general feel free to contact me any time. Thanks again!

Time to catch up

Hey how's it going??  So I've been doing a lot of catching up in my life and this is just another area I need to take care of.  I've been wakeboarding and fishing a lot lately, it's been an awesome summer so far.  I usually get asked a lot of questions about the prosthetic I use for wakeboarding, questions like is it waterproof, is your wakeboard all set up for your prosthetic, or how much does it hurt your stump.  Well the prosthetic I use for wakeboarding is actually my regular walking leg.  It takes a lot of abuse.  It is waterproof because it's an airtight vacuum socket but my screws rust out because I'm too lazy to grab some stainless steal screws... someday.  The pain isn't so bad.  Sometimes I will bruise the back of my leg on impact but it's relative to the beating the rest of my body takes.  I learned early on that I couldn't use my carbon fiber renegade walking foot because it can't take the high impact and torque I put into it while riding.  Also super expensive to replace!  So I switched to a wooden foot and I can't tell a difference.  I have managed to break one of these too... I fell hard and ripped straight out of my binding.  Check it out-  It's amazing how much force you can put into your ankle.

Traveling with a prosthesis

Airports have become an adventure in awkwardness ever since 9/11. Longer lines and requirements insisting removal of just about everything into a bin except your pants and shirt have been in place ever since. Things also got wilder traveling with a prosthetic leg as well. Last summer alone I traveled through Costa Rica, Spain, and over twenty of the states after graduating college with my degree in prosthetics. I got to see the good, the bad, and the ugly of airport security around the US.

Most airports have a special line for people with disabilities. This works out nicely because these lines are usually staffed appropriately and have male and female assists waiting to assist with the screening process. Sometimes this line can be a disaster when it is combined with the “family with kids” section and then you have all of the strollers and screaming toddlers to deal with as well.

After removing all of the contents of your pockets, belts, and jewelry you will be asked to go through the metal detector despite the fact that you will set it off every time! I think they just want to “make sure” that your leg is really fake and made of metal instead of possibly being real by some amazing congenital anomaly. You have the right to keep your shoes on for this process, because they are going to screen you heavily anyways and taking off shoes is cumbersome and could cause you to walk unevenly or different. I personally always wear shorts to the airport so that all staff knows I am an amputee and can act accordingly. I also always carry on my bags (I don’t trust checking my climbing or running legs) and by wearing shorts the person screening the bag can usually get the hint that there are prosthetic components in the bag, instead of glancing at the screen with a confused look and then asking me to open my bag.

The screening process can be simple at some airports and difficultly involved at others. In a best case scenario somebody is available right away to pat you down and swab your socket, leg, and shoe for traces of explosives. If you get lucky this is all the airport staff will do.

In a worst case scenario they will not have an assistant on hand, or that person will be on break, at which point you will stand around and be shifted from place to place aimlessly until somebody who is competent can assist you. They will proceed to do the above screening procedure along with asking to X-ray your leg. They will escort you to a private screening room to which they never have the key readily available, and after another twenty minutes your nightmare will be over.

You should not be required to take off your leg under any circumstances. The best thing to do while traveling is to just expect the worst and give yourself enough time to catch you plane so that during your 10-45 minute security process you can stay calm and relaxed to just go with the flow.

In Europe they are much less stringent, often times not even bothering to check out the leg (unless you are flying back to the US).

I do have a favorite airport story. I was helping campers get to their plane from ACA Youth Camp last summer and got paired up with a little boy who was about eight. He was really sassy that morning (and always) to say the least and while going through security said “What the hell do you think? That I have a bomb in there?” followed by “You are lucky that I am not carrying my pocket knife with me today” among other things. He then proceeded to take off his leg without prompting and throw it through the X-ray machine.

Anyways those are some of my experiences, what are some of your best stories? Any thoughts on traveling? Leave some comments!

I am at the ACA conference, check back for some updates soon!

Amputee Profile - Maggi Pivovar

How is it going? New video up. This one is of our patient at Prosthetic and Orthotic Associates Maggi. She lost her legs below the knee to bacterial meningitis a few years ago but has not let any of that get in her way. She does phenomenal on her legs. Check out the video!

Things have been wild here, just keeping the ball rolling on a few different projects and getting ready for ACA National Conference coming up next week in Kansas City.

Take it easy!

Amputee Profiles - Mabio Costa

One of the coolest things about my job working as a prosthetic resident and being involved in the field has been the stories that people have to tell. I am always impressed by the challenges people have overcome and how anything is possible when you throw away all your excuses and just go for it. I am going to start sharing those stories with everybody via youtube and vimeo. Our first amputee profile is of Mabio Costa. He was the 2004 World Triathlon Champion in the PC division. He is a below the knee amputee of many years. Check it out!

CAF Gait Clinic

Hey guys! So psyched! I am starting to do video posts on all of the events that I am a part of. Here is a clip that I filmed with Drew, and my buddy Ian Wald put it together. The Challenged Athletes Foundation hosts mobility clinics to learn how to run all across the country with Bob Gailey. I have been lucky enough to not only learn from these clinics but to be one of the instructors as well now. I highly recommend checking one of these out when you get a chance, it will do wonders for your running!

1st Annual Adaptive Climbing Clinic presented by Sanuk & Evolv

First video is up from the Joshua Tree Clinic. Sanuk recently added me as one of their athletes. They were also one of the sponsors of the clinic. I am really excited to collaborate with them on future projects. Check out their shoes as well, they make some killer stuff!

Ronnie

Challenged Athletes Mobility Clinic featuring Bob Gailey

The Florida Chapter of the Challenged Athletes Foundation was started about four years ago and is based out of Tarpon Springs. Meeting them back at the Gasparilla in 2007, I was one of the first athletes in the area they came in contact with. It has been really cool to see how much the organization has grown in the four years that I have known them.

Giving a talk at the end of the clinic

One of CAF California’s biggest events every year is the San Diego Triathlon Challenge, which is the event around which the national organization started. Challenged athletes fly in from all over the country to participate in this triathlon weekend that also features several adaptive clinics, including one held by Bob Gailey every year focused on teaching amputees how to run and increasing mobility. These clinics are one of a kind and have an amazing impact on the people that are able to attend. Every year amputees come in just barely able to walk and with the proper training and motivation leave not only running but with an increased self confidence as well.

Kids stopping to pose for a photo at the SDTC

Exchanging the chip as part of a relay team

These clinics were held once a year in San Diego, but recently have expanded to Chicago, Durham, New York City, and right in our backyard here in St. Petersburg, Florida as part of our St. Anthony’s Triathlon weekend.

Photo from St. Anthony's two years ago

Bob Gailey has been a big inspiration of mine and I have been lucky to call him a mentor as well. He is a mad scientist when working with people and leaves every clinic almost losing his voice. He is able to bring out the best in everybody that works around him and I hope to be able to do the same in the future as well. I have been really fortunate to have assisted in five of his clinics now to date.

The man himself

This year was the second year that the event has been held here. The first year blew all expectations out of the water, with huge attendance from the local community totaling to right around 20 amputees. The clinic held this year set the bar even higher and doubled in size. People came from all over the state of Florida and our furthest came from South Carolina. It was amazing to see not only small kids learn how to run better for the first time but also people in their seventies as well! One man I came in touch with had not run since his amputation in 1997. Here, 14 years later, he ran for the first time as a below the knee amputee.

Running can be such a daunting task as an amputee, with the challenges being both mental and physical. Sometimes it is just gaining that extra trust in the prosthesis, and other times it is learning to physically push past your comfort zone. Even the most minor tweaks like working on the rotation of your hips, pulling back into the socket, and swinging your arms can make drastic differences. The biggest thing that people are able to overcome is their fear of the unknown and of falling.

The group was very diverse, with some aspiring to become accomplished athletes, while others just wanted to be able to run around with their kids or just do the local 5k on Thanksgiving.  The mobility clinic caters to people of all ability levels, from kids, to people who need to work on the basics, to the advanced athletes looking to perfect their form. The best thing is the energy that is carried through the whole day. It is absolutely infectious and everybody leaves with a smile on their face riding the new high of their accomplishments. There is nothing like seeing everybody around you running and having an instructor believe you can run as well. Personal doubt soon turns into an “I can do this” attitude that can take people to new heights.

There has always been a really strong amputee community here in the Tampa Bay area and things seem to have come together perfectly with the addition of CAF Florida. I did my first Triathlon two years ago with only one other amputee doing the race as well. This year while doing the run I came across eight other people with disabilities competing as well. It is all because of the opportunities offered by the Challenged Athletes Foundation and other organizations that have given people with disabilities the possibility and encouragement to go out there and compete.

Me and Maria Katz after St. Anthony's 2008

Haiti: In Search of Solid Ground

Some of the video footage I took in Haiti was used by a Nature Coast Technical High School for a class project. I make a small appearance in the video when taking a break from filming. The video is a general piece on Haiti and its people.

Look for a more prosthetics specific piece coming soon!

Ronnie

Prosthetics of Hope - Haiti January 2011

In my March column, I mentioned that I had gone on a prosthetics mission to Haiti recently, which was organized by one of our patients, Kevin Valentine, a pastor at a local church. I was chosen to go along with my colleague, Michael Littles, CP, to make the week-long trip. We had no idea what we were getting ourselves into.

We arrived on Saturday, settled in on Sunday, and began seeing patients first thing on Monday. We worked 12-hour days, arriving at Prosthetics of Hope promptly at 8 a.m., breaking one hour for dinner at 5 or 6 p.m., and then coming back to complete our work until about 9 p.m.

Challenges

Mike and I did not realize that our stay would coincide with the one-year anniversary of the earthquake. The media frenzy was tough to handle at times, disrupting our workflow the day before and the day of the anniversary.

The weather was another challenging factor. Living in Florida, I enjoy the comfort of air-conditioned indoor environments—I didn't realize just how much I took that for granted until spending a week in Haiti. It is hard to describe how oppressive the heat feels not only after working in it all day, but sleeping drenched in sweat all night. When I woke up in the morning, I never felt like I had gotten truly restorative sleep.

As a patient who, until about six months ago, was constantly going through volume fluctuations, I always felt like it was a matter of time before I would need a new socket. This has taken on new meaning in my short time as a practitioner. I have learned that there is no such thing as a finished patient. I like to think of their prostheses as works in progress—some are just more complete than others. People outgrow sockets, and some sockets just flat out don't fit anymore. This was the case when we arrived in Haiti.

All seven patients we worked with in Haiti were earthquake victims. Six of them had previously been fitted with a prosthesis; the seventh we fit from start to finish. There was no official patient list, but more like a running tab of who needed a replacement socket the most. We hit the ground running on our first day, casting four of the seven patients we would tend to that week. There were countless others who needed follow-up care, but in one week, seven is all that we could get to.

We used an infrared PDQ oven much like the one I used in school, but this one was a little quirkier. On our first transtibial patient we attempted to do a check socket, but several hours and failed sheets of plastic later, we realized that this would take more time than it was worth, and time was what we had the least of. The oven and the plastic seemed to have minds of their own. The oven heated slowly and unevenly, making the PETG bubble, so Mike and I left the plastic pulling to the two Haitian technicians, David and Nonue, who seemed to have learned the nuances through a lot of trial and error. David and Nonue worked their tails off while we were there but were still rough around the edges with their fabrication skills. It is hard for them to grow their skills consistently when they work only when a visiting practitioner is at the clinic. When there isn't a practitioner at the clinic, they work only on minor adjustments, as needed, with existing patients. They are waiting for the prosthetics school to open in Haiti and aspire to be two of its first students.

Learning to Simplify

After the first day, we decided we needed to simplify our processes. Patients with transtibial amputations were casted and after modifications the casts were turned straight into definitive sockets—brown polypro-copoly blend plastic with a pelite liner and neoprene sleeve. Each patient with a transfemoral amputation got a test socket, which was then mounted onto a plate with plaster and wrapped in fiberglass to get the alignment. We then did a second modification and made the final socket with the brown plastic, a distal end cap, and TES belt suspension. All sockets were fabricated with grace plates.

On one of my last days, I decided I needed to get some fresh air and went out for a five-minute walk. One of our older patients, Mary, was being carried to our facility piggy-back style by her son because she was unable to navigate the rough and rocky terrain. They both had huge smiles on their faces. Although she had lost her leg, she still had her son, her family. So many others have lost so much more.

Tent city 10 miles outside the city

Getting water inside the city

There is always hope

Beautiful sunset to close out the trip

Ronald Dickson is a graduate of the bachelor of science in orthotics and prosthetics program at St. Petersburg College, Florida. He is a resident at Prosthetic and Orthotic Associates, Orlando, Florida, and will be sharing his experiences as he completes his residency.

March Southeast Climbing Trip

Drew Johnson has been a friend of mine for a little over a year now. He is one of those guys that just likes to stay active and aside from his passion wakeboarding tries a lot of other sports on the side. He had been climbing with me a few different times, and finally I think the bug stuck and he got a gym membership to the climbing gym in Gainesville and started climbing a couple of times a week. When I heard this I told him that on my next outdoor climbing trip he had to come along.

The southeast can be really unpredictable in the spring time, and it is always best to have a couple of different weekends to work with because you might get rained out of your whole entire trip. The forecast was looking favorable at the beginning of the week, but dramatically changed by the middle of it. It was the only weekend we both had to work with so we just decided to go with it.

 The weather we did not get on Saturday.

We left after work on Friday and about seven hours into the drive to Horse Pens in Gadsden, Alabama we decided to just get a cheap hotel for the night at two a.m. and finish the drive in the morning since we were going to get rained out anyways.

Saturday was a complete washout! We managed to set up camp before the rain came it, but once it started it did not stop for about twenty hours straight. Thankfully it was the weekend of Horse Pens 40 rocks and there were some other people there to hang out with. It was still fairly miserable either way.

The rain stopped at about 4am and with the heavy wind all of the rock was dry and ready for the Sunday morning session. I am sure Drew hated me by this point because he slept in the car with the engine running because he almost froze to death in the tent (he neglected to bring a down sleeping bag).  Not having spent much time at Horse Pens, I used the day to get on some harder climbs and find some things that I was psyched on. Drew did a few of his first rock climbs, including a fun little V0 on the side of the Bumboy Boulder. My consolation prize for the day was a flash of Cuts like a knife (V5).

Scoping out all of the wet rock the day before.

We decided to move onto Chattanooga for the last day of our trip. I had unfinished business there that I could not wait to get back to and I know the area much better. My last trip in December I came agonizingly close to sending The Wave (V6). It is one of those climbs I thought I would never be able to do, but was really surprised when I was able to put it all together in one day. The hard part for me is spreading my body weight between both of my legs, compressing, and getting both hands on the arête. It is a move that never gets any easier and you just have to try really hard. It really made me use my prosthetic leg in ways that I never have before. After about twenty go’s I manage to link the move and make it on top! It really all just came down to executing and believing in myself. Drew had a good time climbing around and even did his first outdoor V3, Toucan Sam on the slice and dice boulder.

My hope this works/trying really hard face on the crux of The Wave.

Greenlife parking lot grabbing food on our way home.

We left the boulder field at 5pm on Monday and managed to get back into Orlando by 3 am. Work the next day was a blast! It is always worth it for climbing! It was really cool to get a chance to go climbing with Drew and he made this little video of our trip. Check it out!