Bouldering in Joshua Tree

Bouldering in Joshua Tree
Ronnie 15 feet off deck on the classic White Rastafarian.

Friday, August 19, 2011

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! 

Monday, August 15, 2011

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

Tuesday, August 2, 2011

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.

Monday, August 1, 2011

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