Moved to a new home on the web...check it out at http://www.prostheticmedic.com

Prosthetic Medic has moved to a new Station!!!!
Come check out the new blog at

www.prostheticmedic.com

www.prostheticmedic.com

Medicine X: You Belong Here

That blur of a weekend in the California sun has came and gone. With it came tons of laughs, learning, and stories of learning to live with life's hurdles. The big theme this year was empathy. A topic I'm honestly not very good at.

You see, while in paramedic school you are taught to disregard your empathetic leanings and act according to the instinct that is drilled into your head for the next two years. Don't get me wrong, empathy has it's place in emergency medicine. I've held the hand of many a patient who were at their worst the very moment they met me. The difference is that in the moments of a true emergency it's easier to treat a disease process or injury than it is to treat a person. Sure, I may be working to save your wife's life, but to me she isn't your wife, she's the head bleed from a car wreck. It may be your grandfather, but to me it was the cardiac arrest and the accompanying rhythm I was treating. It's a harsh way to look at the world, but it allowed me to do my job. Clear the hospital and pick up the next patient in the quickest time, without dwelling on the life that is in my hands. There were times where empathy got in the way. The pediatric patient who happened to be wearing the same shoes I had just bought my son made it impossible to not realize I was working on a child. I was able to resuscitate him, but it interfered with my ability to return to work immediately. In the world of Public Safety that can be construed as a sign of weakness. Yes, in the "Hero" business of saving lives, caring too much can be viewed as weakness. Then came my accident. I traded places with the many patients I have treated over the years. I was now the one lying on the backboard getting a guided tour of the sky and ceiling of the ambulance. I now had first hand experience of the fear of being a patient. Empathy now had a permanent place in my heart. 

Fast forward to this years Medicine X conference. I had just sat down for breakfast in the ePatient lounge and it happened. A pop. Just loud enough for me to hear. I quickly scanned my prosthetic leg and noticed a missing screw. The screw to my rotator had broken, this allows the socket to rotate left and right to be centered to the prosthetic knee. It's a piece that I never think of, because I have rarely had to use it. In fact, I had never heard of anyone having this piece break. And now here I am, struggling to walk, each step I had to fight my prosthetic to keep it remained centered. I had to use my hip and back muscles to constantly, all while keeping an eye on each step to keep from falling. I explained my issues to one of the physicians who helped get me to Medicine X Dr Kadra (sorry Bassam if this is spelled wrong). Immediately, the Medicine X support staff began finding me a prosthetist to get the problem fixed. The difference here is that they all had empathy. No, there were no other amputee's at this conference. Yet, each person there pictured what it would be like to be in the position I had just found myself in. That's the difference empathy can make. They only wanted the best for me, and although they had never experienced my fear, they placed themselves in a position where they understood. They worked tirelessly to find a solution, and thanks to one of the staff, found a prosthetist that was willing to come to me and try to fix the problem. Although we weren't able to find a permanent solution to my broken screw, we managed a temporary fix that would get me through the day. This fix gave way as I stepped on stage to give my Ignite Speech. I was panicked as I delivered my speech. I had planned to walk around the stage, show my advanced prosthetic in action, instead I was left to stand front and center and face a crowd of faces. 

As I looked around, I was shocked to notice so many of my fellow ePatients staring up at me. Wanting nothing but for me to succeed and deliver the message I had prepared. The speech went off without a hitch. I was able to get my point across, although not as I had planned. It was a spiritual experience. That's the only way I can describe it. 

In fact, that's a great way to describe a weekend spent on the Stanford University campus; Spiritual. It's a utopia of sorts, no, you aren't going to get along with everyone. You won't connect with each person, but there will be a group that you do connect with. You will feel at home. You will be welcomed. No matter what is going on with you. If you're a diabetic, have Rheumatoid Arthritis, MS, Cancer, or a disease so rare that you are the only person in the US with a documented case...YOU BELONG HERE! You will be welcomed with open arms. You will be taken care of, no matter what that may mean. They will help you overcome your problems and help mold you into a better version of you. Even if it's only for a weekend. 

Medicine X's tagline is that "This is where technology and medicine intersect" and to a point that is true. More true is that Medicine X is a place where You are more than a sum of your parts, you're more than your disease, and they want to help you celebrate that. Don't believe me? The next round of applications are coming up this winter. Apply, prove me wrong. Last year, Medicine X taught me the power of the Patient Narrative, and how your words can change how medicine is practiced. This year, I was able to learn the power of embracing who you are as a person. How powerful it can be to say My Name is Joe Riffe, I am a Left Above Knee Amputee, and I want to change the world for other Amputees. I am more than my situation. I am more than my physical malady. I AM JOE RIFFE, THE PROSTHETIC MEDIC, AND I AM A HUSBAND, FATHER, SON, BROTHER, FRIEND, AMPUTEE, PARAMEDIC, AND I CAN HELP YOU, BECAUSE I WILL BE EMPATHETIC TO YOU AND WHATEVER YOU BRING TO THE TABLE. I have been on both sides of the stretcher, and can honestly say You are more than the sum of your parts, you are not your disease or injury, or pain...NO, you are You and there are no other you's out there. Celebrate that! I will help you as much as I can along the way; and if I can't...I know someone who can, just let me call on my fellow ePatients. We will welcome you as you are. You Belong Here!

Why Stanford Medicine X is Better than Your Conference

I've had an absolutely terrible day. Honestly, today has been one of the worst days I have had in a very long time. My bad day started last night when I fell in my hotel room. I had taken my leg off, as usual I didn't bring my crutches with me (they're too bulky to travel with), I decided to take my clothes for today into the bathroom so I could just get dressed in there. I hopped my way into the restroom. Here's where the bad day starts, I had forgotten to take my sock off, this resulted in me trying to hop into the bathroom on the tiles with a sock...you can see where this is going. I slid and fell, striking the end of my stump against the hard rim of the toilet, then the ground. You know that feeling you get when the end of your femur pushes down into the muscles that have been stretched over the end of the cut bone? No? Well, it's excruciating. Imagine the worst toothache you've ever had and put it into bone. That's the best way I can describe it.

Now I know what you're thinking, what does this have to do with Med X being awesome? I'll tell you. Last night, @ChronicCurve came to check on me. Just to make sure I was OK. This led to me being checked on by @AfternoonNapper. I convinced them both that I will be fine and called it a night. Honestly, I lied. I wasn't OK. I was in immense pain every time I moved. I pushed through a sleepless night and got ready for the pre-conference course I had signed up for.

Now, here's where things get worse. Kate, my wife, messaged me from Louisville with a health issue. One that could possibly end up with her being hospitalized. This poses a problem. If Kate get's hospitalized then who will take care of the kids? What if a surgery is needed? I'm literally on the other side of the country and feeling quite helpless. I explained to @AfternoonNapper and @HurtBlogger everything that was going on. They were more than helpful; offering to move my presentation so that I could leave if need me and still complete my requirements of the ePatient Program. Kate refused me leaving early. She's a trooper and knows how important this conference is to me. All was going well, Kate had gotten in touch with her mother and worked out that if something happened she would come down to take care of the kids until I got back Monday. Once again, things seemed to be looking up. With all the stress I suppose my PTSD triggers were just waiting for the slightest reminder to go off...that reminder came in the peaceful (for most) form of a clear blue sky, a slight breeze, and the sounds of water crashing against rock. Instantly, panic set in. I had one of the worst panic attacks of my life. It ranks up there with the first one I ever had inside an MRI machine with a fixator attached to my leg. I was in a tailspin. The leg pain coupled with the issues at home that are beyond my control had sent me into a PTSD anxiety attack that had no mercy. @AfternoonNapper and @HurtBlogger went out of their way to make sure I was ok. Hooked me up with a set of headphones, a quiet place to gather myself, and even went as far as bringing my lunch to me, away from the crowds where I could attempt to regain some form of composure.

This is where MedX outshines all other conferences. It's OK to not be OK. It's OK to be a patient, to take off that mask of wellness we all wear everyday. You know what I mean, we all do it from time to time. Convincing everyone you're fine when on the inside you know it's not true. Be it a psychological issue like I had today, or as simple as working through a bad headache. Here those masks aren't necessary, you're surrounded by patient and providers alike. They understand that sometimes life happens and it's beyond your control. I've never seen another place like this. Not just a medical conference, but in general. It's a nearly Utopian ideal. Be who you are; sick, stressed, healthy, or a mixture of them all. It doesn't matter...That's why this conference is better than yours...It's not just a place where the patients finally have a voice. It's a place where the patients can finally drop their guard and be themselves and allow others help them cope; and with this environment the providers can finally see what patient life is really like and leave changed by the power of the patient life and narrative.

Introducing the Medicine X Global Access Program

As most of you know, I will be returning to speak at Stanford University's Medicine X conference this year. What if I told you that you can watch my speech and the entire conference for free!?! That's right, you can get all the education and information that those in attendance receive from the comfort of your own home. It doesn't get any better than that now does it? Learn all about the emerging technologies on the healthcare front...all while kicking back on your couch, lounging in your pajamas.

Think you're too busy, going to be on the go and can't sit around looking at your computer for hours, even though you want to get all this awesome education....this year Stanford Medicine has brought back the Global Access Program. All you have to do is register for the site and you can enjoy a live stream of the conference, photos of the speakers and guests, and best of all its Free!!!

Medicine X Global Access Program

From the Medicine X website

The Global Access team is led by Emmy-award winning television producer Bita Nikravesh Ryan and 2013 Stanford-NBC Global Health Media fellow Hayley Goldbach. Our photography team includes Academy Award-winning documentary filmmaker Theo Rigby, speaker portrait photographer Christopher Kern, and our special venues photographer Yuto Wantanabe. 

Medicine X is an amazing conference, not only for the in depth look at the emerging technologies that fuel healthcare and healthcare innovation, but because it's a conference that truly does put the Patients First! This is ground zero of the ePatient movement. I highly recommend you sign up for the Global Access Program and see what I'm talking about. Last year, the Medicine X conference was a life changing event for those in attendance. I'm so happy that now you can watch and learn from the amazing presenters and ePatients from anywhere you have an internet connection (4g counts).

So what are you waiting for? Go own...get registered and get your learn on! Remember to watch your very own Prosthetic Medic speaking on September 6th at 4:20pm PST (7:20pm EST)

Grief Mops

I realized a sad truth very early into my career in EMS. It can best be summed up by a quote from the movie "Bringing Out the Dead." Nicholas Cage's character is describing his role as a paramedic

" I realized that my training was useful in less than ten percent of the calls, and saving lives was rarer than that. After a while, I grew to understand that my role was less about saving lives than about bearing witness. I was a grief mop. It was enough that I simply turned up."

Bringing Out the Dead is a perfect example of a paramedic who is "burnt out" in public safety terms, in medical terms Frank Pierce (Nic Cage's character) is a classic, albeit highly dramatized for the film, case of PTSD. He had ran too many calls, had tried to wring out that grief mop one too many times. The years of hiding his feelings coupled with the lack of that adrenaline rush that comes with a save to give his life meaning, he is left to battle his demons. His particular demon was named "Rose," an asthmatic he was unable to save, becomes the standard barer for all those perceived losses he is unable to mourn. We call it being "Burnt Out," the inability to have any empathy. It's not that we don't care about our patients, we just simply cannot take any more, our mop is soaked and there is no way to wring it out.

The role of Public Safety falls into this category all too many times. The combined amount of human suffering and tragedy that we are exposed to is only compounded by the perceived machismo of the position. Showing emotion is often viewed as a sign of weakness and is preyed upon by the collective group. As always, there are exceptions, most often pediatrics. It seems to be the only time when emotion is not weakness, but expected. The same isn't true for the countless other tragedies, for those you are expected to "suck it up and move on."

For years, I followed this formula. Pushing all the fear and guilt of the "lost" saves into a dark recess of my mind. I would find outlets where I could, dark humor and nightmares were my two normal weapons to combat the feelings when they crept up. Insomnia became constant, only to be quelled by medication (both self and prescribed).


My "Rose" came in the form of a 10 year old boy. He happened to be wearing the same shoes I had just bought my son. Prior to this run, I had been comfortable as seeing my patients as their respective conditions. I could trick my brain into seeing a broken bone, a stroke, a heart attack as just that, the person who had suffered these ailments didn't exist. That wasn't your father, that was a full arrest who needed to be intubated and medicated. I followed my protocols and treated each problem in order of it's severity and life threat...until this child. I jumped into my normal role, he was a cardiac arrest that was more than likely caused  by a respiratory problem. I needed to get him intubate and oxygenated...I inserted my laryngoscope blade and looked up to get my tube, that's when those Thomas the Tank Engine shoes came into view...I continued on my mission. I had been successful and had a return of circulation. I was walking on air...I had a save. One who had an actual chance of walking out of the hospital. Yet, his shoes stuck in my mind, I would relive this run over and over again, every night he would meet me in my sleep. I thought if I went to see him, to see that he was getting better it would help quell this temporary problem. I met his mother, I saw him on the ventilator with my tube still in his trachea, providing that all important oxygen. Yet, this only worsened the nightmares. It all came to a head when I heard the news of him dying. He was to be released, and suddenly took a turn for the worse. His death marked my first experience with that flood of emotion breaking loose from the dam I had built. Years upon years of tragedy I had held in broke loose with a force I had never experienced.

I took more and more ambien, trying to knock myself out and patch this hole...and it worked for a little while. The problem is, self medication never works. We need to change this broken dynamic. We need to realize that in our field there are no walls, we are alone in a sea of human suffering. We have been called to be islands of refuge in this storm, and we need to let their be strength in showing emotion.

I'll end this diatribe with this thought. We all have a calling. For those of us who chose to run towards the chaos instead of away from it, we have to realize that it comes with a price, more often that price is our own piece of mind. So take on that grief, be the mop, but before you become saturated, turn to your friends, your coworkers, and show that their is untold strength in empathy and emotion.

Update on Life...Glad to be back

Well, after a long hiatus I'm finally back online. We have been having some issues with our internet connection, so after several phone calls AT&T finally got the issue handled. I just wanted to stop in and give you an update on things around the Prosthetic Medic household.

First things first, I'm very excited to say that the schedule for 2014's Stanford Medicine X conference is out, and I will be speaking Saturday Sept 6th. I'm still working out the speech and trying to decide between the two topics I've been writing on. I've got a few more days before my initial outline has to be turned in, so I've got to make a decision soon.

Next up, Kate has taken a job with Bullitt County EMS and couldn't be happier. She loves working in a 911 system and I'm very excited for her to finally find a service that feels like home to her.

Lastly, I have taken a job with Amazon in Sheperdsville, Kentucky. I am so excited to move to my next step in this crazy experiment of life. I will be working there as an Onsite Medical Representative. Basically, I'll be providing basic medical care and helping to manage their  cases. I'm very excited to be joining the Amazon team and try my hand at Industrial Medicine. It will be quite the change from working on the ambulance, but after proving that I can still do that job, I think working in this setting will be better for me physically. I will probably try to find a part time job on a truck somewhere, just to keep my skills up, but I'm ready for the change.

I'll be back in a night or two to write about something with some more substance, so for now, that's all thats going on in our little corner of the internet.

Later,

PM

I'll give you a hand....just need an XBOX Kinect and a 3d Printer

While mindlessly browsing Facebook today I came across a very interesting article. For the low price of $45 we are now capable of printing a mechanical 3d hand that is, according to many users, better than any mech hand on the market made by the major prosthetic companies.

This got me thinking...With the push in 3D printing technology, the ever strengthening materials, and the constant battle to obtain a prosthetic from insurance companies...Why aren't the big prosthetic companies making a huge push for Insurance Fairness for Amputees? With the lack of access to reliable and high performance prosthetic equipment, mankind is doing what it has always done when faced with a problem...We are adapting. Now with the Open Hand Project, and countless others, hand amputees have more options than ever.

To add to the dilemma, 3D printed sockets are now available for upper extremity and below knee amputees, how long till every class of amp is included. With very little knowledge in the AutoCAD program and a Microsoft Kinect camera from an XBOX, you can now 3d scan in your own limb, design a socket to fit, and soon, attach this socket to your own home printed limb....It boils down to this. The Apathy of the manufacturers is going to put them out of business. They are too blinded by their own success to look down and see the patients on whom their limbs reside, and rely on. Why would I jump through the hoops and red tape for a prosthetic, when I can design one just for what I want it to do from the comfort of my own living room? Unless this lack of response is reversed and pressure placed on the correct sources (ie Congress, not the people designing the limbs they couldn't receive through traditional means) then they are going to put themselves out of business.

Most people putting their prosthetic designs on the internet for 3D printing aren't doing so to make a quick dollar, no, they are doing so because they can see the insanity of denying a person a limb that could give them back a quality of life that is similar, if not better, than they had prior to their amputation. We need to join forces, there are 2 million of us in the United States, not to mention the tens of thousands of employees that are working for the big name prosthetic makers.

If you are reading this, please send this to your prosthetist, your doctors, your prosthetic company, whomever you think may benefit from prosthetic parity. The time is now...

Stanford Speech and Steampunk Prosthetics

If you missed it, above is the link to my Ignite Speech and QA at Stanford Medicine X's School for Design Course. David Ruthven and I had the opportunity to speak about Designing for the Physical Environment. I focused my ignite speech on Prosthetic design. The biggest problem is lack of Patient Centered Designs. For a refresher:

Patient Centered Designs are generally customizable and retain some patient individuality. In the Prosthetic world you need to look no further than the Socket. The patient interface that connects to the prosthesis itself. These are designed for each patient, molded to fit their limb, and often some form of individual design added to make it feel like "mine." As an example:

      

 This is my first socket. Notice the "Jackass Jolly Roger" a great way to individualize a socket

In Contrast, the prosthetic itself is a cookie cutter design that is the same for each patient. No options on colors or exterior design. Otto Bock has helped with making the individual settings customizable to speed up or slow down, add resistance or take it away, or preset settings for specific sports and activities. However, for appearance you, have no options. 

Until Now...I was forced to eat my words by the guys at Digital EFX Wraps 

( http://www.digitalefxwraps.com ) 

They have taken the idea of wrapping a car with a vinyl design and applied to prosthetics. I am the second person to have the opportunity to have my prosthetic customized to a design I chose. I went for an Industrial/Steampunk look. It fits my personality...the great part is they can do anything. I've already been dreaming up my next cover, probably a mixture of anatomy and machine.

I'm so excited at what this will do for amputees and bringing amputation to the forefront of peoples minds. I love that my prosthetic is a piece of art. Let me know what you think. If you want one...message me and I'll get you in contact with Dallas at Digital EFX. Lets get this viral...spread the word!!!

Dancing with the Amputee Star...

I've avoided watching Dancing with the Stars. I have successfully avoided watching not only this season, but most seasons. Sure, I've seen an episode here and there, but for the most part, I'm simply not interested. That being said, tonight there's not much to watch and I found myself watching Amy Purdy's dance. She was amazing, for those who aren't familiar. Amy Purdy is a Paraolympian Snow Boarder who happens to be a bilateral below knee amputee. What struck me the most was the buildup to her dancing, and her decision to perform the quick-step with her "blades." Blades are the running legs most people are familiar with seeing, and for some reason the image most people associate with prosthetics.

Amy Purdy on "Cheetah" running blades



What I noticed is that she had several other pairs of prosthetic feet to choose from, in addition to the running blades. I realize that she is a gold medal winning Olympian and has several sponsors who are willing to pay for these prosthesis. I found myself getting upset. No, not upset, down right mad. Not at Amy Purdy, mind you, at the fact that in order to receive the prosthesis you need to live you have to either 1.)Be independently wealthy, 2.) Be extraordinary and have sponsors who want you to wear their prosthesis, 3.) Fight tooth and nail with insurance companies to "maybe" get a prosthetic...not the best one to let you live life again, no just a prosthetic.

I nearly found myself in the 3rd category, but thanks to those of you who read this blog, and, as I was described by Dr Larry Chu at Stanford Medicine X, being persistently disruptive for a positive change in the amputee community, I was able to pressure an insurance company into covering a prosthetic they deemed "Experimental." By the way, Experimental is an insurance term for prosthetic technology that has been around since the 1990's, being the microprocessor controlled prosthesis. There are nearly 2 million people with some sort of limb loss currently, not everyone of these amputees would benefit from this technology, but for those that would, it is a life changing prosthetic.

Imagine this...for an insurance premium of around 5 cents per person, microprocessor controlled prosthesis would be covered for those who meet the standard. That would be possibly hundreds of thousands of people able to return to a more active lifestyle and many of them would return to work.

Now for contrast, lets apply insurance companies logic to other areas of healthcare. Could you imagine an insurance company denying a pacemaker that a cardiologist wants to implant? How about denying the hardware for a hip replacement? Yes, these happen in rare occasions, but under normal circumstance these devices are implanted and covered. Now, realize that these are also prosthetics. A pacemaker is a prosthetic that assumes the function that the heart has lost the ability to perform, a hip replacement places a prosthetic ball and socket joint that resumes function of a joint that lost it's ability to perform the normal function. Now, why does implantation inside the body make these more important than a hand, knee, ankle, or other prosthetic device? I wish I had an answer...that's why we need Insurance Fairness for Amputees.

Oh well,

I will step down off of my soap box for tonight and hope this has given you something to consider.


Until Next Time ...PM

Happy Anniversary!!!!

Yesterday was the 3 year anniversary of my life changing fall. This week has seen a spike in my anxiety, while it has been rough, it was not unexpected. I have experienced the same problems for the past 2 years, so the increase in symptoms this year, while unexpected, were not preventable. The amazing part was that, on the actual day of the fall, I had a wonderful day. This is due to Kate and I celebrating our 1 year wedding anniversary. We made the decision to change the outlook of that terrible day into a very positive one, and I must say...it worked.

On to the updates,

I had the wonderful opportunity to speak to the Moving Forward Limb Loss support group a few weeks ago. It was a wonderful experience and I look forward to further meetings with those wonderful people. You can watch the speech here Moving Forward Speech

I spoke about one of my least favorite cliches..."Playing the hand you're dealt." We all have heard this euphemism before. A negative event happens, and inevitably you're met with at least one person telling you to play the hand you're dealt. I happen to disagree strongly with this though process. Playing the hand your dealt, leaves you in the situation. I say, instead of playing the hand you're dealt, why not change your cards. Life is not a poker game, No, life is more a game of Go Fish. You can ask your neighbor for help, and luckily, you can help your neighbor as well. Playing the hand you're dealt would have left me with a fused knee and ankle, and miserable.

In a few weeks, I will be travelling to Stanford University to speak to the School of Medicine. I will be giving an Ignite! style speech with a power point to back up my points. I will be posting a video of this once it's available.

I am happy to say that, while I'm not where I want to be in life, I am finally optimistic again. It has taken 3 years, but I feel like I'm finally getting back to who I am. I have finally mourned my loss of both my leg and previous identity. I have came out on the other side with a determination I wasn't aware I was capable of...I now understand the battles I have been through will be platform I stand on to help others either get through their battles or avoid them completely.

I'll be updating again soon,

Until next time.

PM

Louisville Metro and Open Doors

On Tuesday I attempted to take the Louisville Metro EMS physical agility test. For an overview here is what the test consists of...

100' Serpentine Carry: Carry an approximately 80 pound hose bundle 100 feet

zigzagging through cones spaced 5 feet apart

you have 1min 10sec to complete

Enter through the window of a standard size car window and then exit 

through the same window

The following tasks are performed continuously, you have 5min 30 sec to

complete these tasks

Enter the driver side of the ambulance, touch the radio, emergency

equipment, gas and brake pedals then exit

Open the rear compartment and remove the stretcher with 2 med bags placed

on the bed. Move the stretcher next to the fire tower

Carry the med bags (approx 33 pounds) to the 3rd floor (although their paperwork

says 3rd floor they made me go to the 4th)

Once on the 4th floor put the bags down and pick up the 80 pound hose bundle and

carry back to the stretcher.

Put the stretcher with hose bundle back in the ambulance

Return to the 4th floor, retrieve the med bags and place them on the floor of the

ambulance (end of test)

As stated above, I had 5 min and 30 sec to finish this task. I completed the skill in 5 min and 57 seconds. 27 seconds over my allotted time. I had asked prior to testing for another minute or 2 to complete the tasks as an accommodation under the Americans with Disabilities Act. I was denied this accommodation and therefore failed the exam. To say I was bummed was an understatement. I was crushed. Thankfully, I have a very supportive group of friends and family, who helped me realize that considering I climbed effectively 8 stories in under 6 minutes as an amputee. That's not to shabby. 

I did email the HR rep for LMEMS and brought to his attention that although their departmental paperwork said we would be tested by going to the 3rd floor, we were instructed on test day to go to the 4th. Had I went to the 3rd floor as on the paper they gave us I very well may have passed. The rep responded that since I didn't say anything before my test then I forfeited all rights to complain. So, that's it. My future with LMEMS is over. I can retest in 6 months if I chose too, but I think this ship has sailed. That leaves me with a decision to make. Do I continue on in EMS or do I try a new path? I think I've made that decision. I may take a part time job on the ambulance, just because I really do enjoy patient care, and I am good as a medic, but in the long run EMS is just too hard on our bodies. Most people in this field end their career with a back injury. The days of making it 20 or 25 years are quickly coming to an end. An ever expanding population of bariatric (obese) patients is increasing the rate of injury on duty, and ending careers almost quicker than we can replace those left by the wayside. 

I have decided that I will continue in some function in medicine. I may teach paramedics, I may go back to nursing school, who knows where my path will lead. One thing is for sure. I am turning my focus. For the next few years my focus will be on helping Kate go to school and continue to push for Insurance Fairness for Amputees. I am going to try to focus on a national level instead of state level. My number one priority will be Kate. She has supported me throughout this insane journey we have been on. Up till now, the focus has been squarely on me, it's her turn for center stage. I will continue to write, do the occasional speaking engagement, and always mentor others (amputees and EMS). 

So, with that said, please continue to follow along. I have decided to stop trying to open this closed door and search for a door that is open. 

Until next time, 

PM

The Six Million Dollar Man and PTSD Breaks

Yesterday I did an AMA (ask me anything) on Reddit. It was a great experience. It reminded me of the power of the internet. I was able to reach out to thousands of people with a simple  post. More importantly, I was able to connect with a person who is facing an amputation and after reading and participating in my AMA felt much better about the prospect of amputation. It amazes me that it's 2014 and still amputation is looked upon as a life ending prospect.

Link to Reddit AMA

What comes to mind when you hear the word amputee? Do you still get flashes in your head of peg legs and wheelchairs? Do you see a person who is downtrodden and broken? These are the common perceptions of the amputee. I hope to change that. No, when I hear the word amputee I see a fighter. I see strength. I see a future where man and machine are joined to not only replace, but enhance our abilities. Yes. I am a bionic man (play the six million dollar man theme here). It is an exciting time to be an amputee. No longer are we going to be forced to sit idly by and watch the world pass. We are out on the front lines of the blurring of flesh and bone limbs being replaced and augmented by gears and neural interfaces.

After such a high of course, I came crashing down. I was quickly reminded that while I am happy with my decision to have an amputation, and about where the future of prosthesis are headed. I still have my demons that I must deal with. As I lay down last night to try to sleep, the PTSD demon reared his ugly head in full force. It was different than any attack I had ever had. Not only did I feel like I was reliving the moments after my fall. I was there. My background noise of what ever show I was half watching was replaced with the sounds of birds chirping and water splashing down against rocks. For most it would be a serene scene, for me it was Hell envisioned. The walls lit by the television light were replaced with the sights of trees passing overhead as I was carried up the mountainside by Fort Knox Fire and Rescue. This was the first time that I had a full on hallucination of my fall. I WAS THERE! I felt like my bones were trying to crawl out of my skin, my phantom pains added to the delusion by recreating the burning sensation of an open ankle dislocation. Yes it was truly terrible. Yet, today...I'm still here. I'm alive. No demon; PTSD or otherwise, will stop me on my quest. I am thankful today that I was reminded in vivid detail of why I'm here. I'm not saying I'm thankful that I have PTSD. On the contrary I loathe this disease with all my being. I am thankful that I have a place to go talk about it and it can be seen by anyone who wants to read it. I hope this message reaches you. I know your in Public Safety and being affected by the atrocities you see is perceived as a weakness somehow. I want you to know you are not alone. I realized now that I have had these issues for awhile. Sometimes it's my fall, other times it's that SIDS baby or the pediatric full arrest or the dead husband that I couldn't help and had to break that news to his wife on Christmas morning. Yes, we all deal with it. I have just chosen to stand up and say I am a Paramedic, I am an Amputee, I am a PTSD sufferer, and this is OK.


If this is you, if you want to talk I am available. You can contact me via my email at ProstheticMedic@gmail.com You have complete and total privacy. No one and I mean NO ONE you do not want to know will no. I promise I won't say a word. I care about you and all my readers. Weather you are an amputee, member of public safety, or just a normal person feel free to reach out. Someone is here who is willing to listen.

Until Next Time.

PM

Hosting an AMA on Reddit

I'm doing an AMA on Reddit right now...come on and join in. If it doesn't take off I may try again later tonight!

Prosthetic Medic

The Amputee Interface

One lesson I have learned as an amputee is that no matter how great the technology in your prosthetic; be it a myoelectric hand, a microprocessor knee, or a bionic ankle, that tech is completely useless without a proper interface. In the case of amputees I'm talking the socket. For the uninitiated, the socket is the part of the prosthetic that the limb goes into. There are several different methods of attaching the socket to the body, but all of them have one thing in common; if it doesn't fit right it doesn't work. Currently, I have been waiting over 6 months for my socket. When it finally arrived and was put together it was 6 months and 30 pounds too late. It no longer fit. When I put it on my leg went straight to the bottom of the socket, appropriately called "bottoming out." This is when your residual femur makes contact with the bottom of the inside of the socket. This is pain that is difficult at best to describe. The best I can approximate the feeling is like the worst toothache you have ever experienced, only inside your femur.

What makes socket fittings so difficult is that they are entirely dependent on the patient's weight, activity level, and individual body chemistry (do they swell or do they shrink throughout the day). This means that you can't just run down to the local mega mart and pick one up. They have to be tailored to each individual. That is the frustration. If you gain weight or lose weight you have to start the process all over. Ask any amputee, we live and die by our sockets. Yes, we all long for the latest and greatest prosthetic, but we mourn the loss of a great socket.

A great example is the current bilateral below knee amputee on "Dancing with the Stars" Amy Purdy. Yes, she has some great prosthetic feet, but I'm more impressed with the fit of her sockets. They fit like they belong on her leg. They don't look like an awkward juxtaposition. They smoothly transition from her leg into her prosthetic. This is how a socket should fit. This is the goal every amputee who wears a prosthetic strives for. The technology is out, there are new sockets available. The trick is finding a prosthetist who is willing to learn new techniques.

As for me, I had to go to the prosthetic office again today and make yet another adjustment to my new socket. That leaves me in my ill fitting and painful socket for a few more days. While it is painful and I can't wait to get the new one; I'm thankful that I have the opportunity to try new tech and speak out on a problem that exists in every facet of amputee life. No matter what body part you no longer have, we all need the interface technology to catch up with that of our prosthetics.


FYI...For you lower limb amputees out there check out these sockets.

RevoLimb
High Fidelity
MAS

Till next time..

PM

A Call to Arms!

This is a call to arms. To everyone in a public safety field. To everyone who has a loved one who has been ill. To everyone who can help. 

Picture this scenario:
You arrive on scene of yet another run, inside you find an elderly man lying bed, weak and frail. He is covered in God knows how many days of his own filth. You and your partner go to move him from his bed to the cot when you feel something on your forearm...great, you think, I just got his nastiness on me, I'll wash it off with some hand sanitizer in the truck.

Days, Months, possibly Years pass, you notice yourself getting sick, you are smart enough to see the jaundice in the mirror. You head to your local ER and find that you have Hepatitis C, your mind flashes back to that elderly and frail man, at the ER they told you he had Hep C, you ran the tests, took the drugs, but it wasn't enough. Now your only hope is a liver transplant, but Workers Comp says you don't qualify and you have long since been forced into a medical retirement. Where do you turn now?

This story is very similar to what happened to Joe Tomaso. Now Joe needs our help, our brother is reaching out in his time of need and we need to reach back. I'm asking for whatever you can give, be it money, a kind word, or spreading the word about this fundraiser. Let's rally around our own. Please spread the word


This is a scenario that is possible in anyone's lives, not just EMS. How many times do you pay attention to the small scratches and cuts on your arms? How many times have you found blood or another fluid on your work pants, shirt, boots, gear? Please consider reaching out and showing support to a real world hero. 

www.gofundme.com%2F7q0fs8&h=tAQEATTS9

Yes It's Painful; but It's Worth It

Fear. Fear is a commonality among all us carbon based lifeforms with a sentient brain. Tonight I have been writing on my (hopefully soon to be done and released) book. I started remembering when I first started having the nightmares associated with PTSD and could feel the fear start to build up inside me. As the fear built, I had a flashback of some sage advice Kate gave to me after I woke her up thrashing my way through another nightmare. Here's is an excerpt from this section of the book. I thought it was appropriate for you guys to read.

{It was during these moments of doubt that I first started having flashbacks of my fall and the subsequent hours afterwards. I would have flashes of memory, hear myself begging Kate not to let them amputate my leg. Flash again, and I can feel the splash of the cold spray of water ricocheting off of the rocks at the bottom of the falls, I look down to see my mangled appendage and start to feel the burn in my ankle where the skin had burst open with the rotational force of my toes spinning 180º to where my heel once held residence. Then as quickly as they started, they would end. Leaving me in a panic; sweating, heart racing, trying desperately  to catch my breath that is just out of reach. This only concreted my doubts in my mind. I begged to keep it; now I want them to remove it? It doesn't make sense. As I am going down this rabbit hole of doubt and despair, Kate would anchor me back into the real world. The most poignant moment took place late one night; close to New Years. We were both sound asleep when I found myself grasping that branch; dangling off the edge of the waterfall. I look to see Chase's face and terror written on it. Without warning the branch gives way and I wake up in a cold sweat, my fight or flight senses running overtime attempting to take control of a situation that occurred months prior. I woke Kate up with my thrashing. This had become common place as my mind attempted to stitch together the events I had unconsciously blocked out. She whispered softly to me that I was O.K. It was a dream, and I am safe at home. She asked me why I thought I started having these panic attacks after meeting with Dr Ross, and I had no answer for her. She continued on to tell me of some of her worse days in Baghdad, Iraq. Kate is a sufferer of PTSD as well. She lived the life that most people will never experience, and that is a blessing. We had told each other our horrific stories of patients we have cared for, but this was different. It was a different level of intimacy that I wasn't prepared for. She told me that the reason I'm suffering from these attacks now is because there is an end to my suffering in sight. In order to prepare for the closing call of this unfortunate act in the play of my life, my brain had to get the events in order. Yes, it's going to be painful, but it is going to be worth it.}

That last line. That is some of the most concrete truths that I have ever had told to me. Life is painful (at times), but it is worth it. Anything I have ever decided to do, if it was going to be worthwhile, it was a fight to achieve. Becoming a paramedic was painful; aside from the seemingly unending clinicals and ride time; during that time my marriage ended, my son was taken hundreds of miles away from me, and I felt like I had hit rock bottom. Yet, looking back, the decision to become a medic led to that marriages end, which led to Kate being in my life. It was painful, but it was worth it. 

I can say the same about becoming an amputee. This has been the single most terrifying time in my life. I have lived years in uncertainty. I have dealt with setback after setback. I have lost so much...and I would do it all again. I lost my leg and gained my meaning in this life. I am meant to serve as an example, an advocate, or as the fine people at Stanford dubbed me "persistently disruptive but in a good way." I lost a part of my body in order to gain a better understanding of what it means to be a patient. I have treated thousands of people in my career, but I had never taken into consideration what it meant to be a patient. Now, I have a profound respect for the "other side" of medicine. The fear, the doubt, the anguish of the unknown. Yet I know now that It is going to be painful; but it is going to be worth it!

The words I hate

Can't. Can Not. Impossible. Not feasible. Unlikely. These are all words that as an amputee I have grown to hate. Once you have a limb removed society has an entire list of things that you "can't" do. Ask an amputee, I assure you they have a list of things they can no longer do. Not because they don't want to, but because it has been told to them that they can't.

I bring this up because I've been doing a lot of research on the upcoming Paralympic Games. I'm lucky enough to know a dual paralympian; she is an olympic rower (who won the bronze medal) and this March, competing in the biathlon in Sochi. She is also a bilateral above knee amputee. Can't isn't in her vocabulary. Luckily for her, it wasn't in her families dictionary either. This is the difference maker. Do the people you surround yourself with fill you with doubt or with support? I've been blessed enough to have an army of supporters. I was also raised to believe that anything was possible. My stepfather beat the phrase "Can't never could no nothing" into my head. Aside from giving you grammer nazi's a heart attack, it meant that if I said I can't do something, it just meant it was hard and I didn't want to. Like Yoda said, Do or Do Not, there is no try. That has become part of my core philosophy. I have realized that being an amputee just requires me to take alternate paths to the same goals. It may take me longer, I may have set backs, and I will get frustrated. That's allowed, you can get upset, you can get mad, you can throw a pity party and wonder why me?, but quitting is not an option. Have your moment, then dust off and get back to work.

This is where I am at now, I've had my set backs, I'm ready to dust off and get back to work. With my new socket finally being framed, and set to be delivered, I have a new breath of air. I'm hopeful for the future. I'm not sure where I will land, I'm not sure what I'm going to do, but that's the exciting part. I have an open road ahead and with Kate and the kids by my side I'm ready for a new adventure to begin.

I want your leg...how much?

Life as an amputee can be perplexing. Aside from the things you would expect to be challenging; learning to walk again, gaining balance, learning to fall, stairs....there are other parts of this lifestyle that just confuse me. 

Case in point; when it comes time for me to get a new prosthetic device I have to work my way through a ballet of hoops and red tape. It's not as simple as my physician saying "Joe needs this prosthetic in order to live the life he is accustomed too." No! Instead we submit to my insurance company which prosthetic I need. They will either 1.)reject it outright and say I have to choose a prosthetic from their list of approved devices; 2.) Offer to pay a very minimal amount towards said prosthetic and leave me to cover the rest; or 3.) Stall. 

These are the tactics I am up against each time I try to get a new leg or foot. I've faced this recently. I was attempting to get a microprocessor controlled foot that would mimic the effect of having a functional ankle...I got approved for the foot. The problem was, they weren't willing to pay their share. They wanted to pay much less than my coverage provided. This leaves me once again fighting the appeal process, this time, I chose not to fight. I let this battle go...many times amputees are forced to make these choices. I have learned the lesson of when to fight and when to back down...pick your battles indeed. 

Why am I going on and on about how difficult it is to get an appropriate prosthetic? What does this have to do with you? I'm glad you asked...but first a few more questions to post to you. How much is it worth to you to be able to walk? How much money would it take for you to give up that ability? What about the ability to pick up silverware? How much is that worth? The reason I ask is because this is the reality of thousands of amputees in the United States. Amputees who could benefit from the technology available, but just not available to them. 

I ask all these things to emphasize the importance of a petition I just posted to www.Change.org 

All I am asking is for you to sign this petition, to get the attention of the President and Congress, to have them realize that Americans are suffering and it is pointless. Please sign the petition to pass a National Insurance Fairness Act for Amputees. 

Here is the Link

http://www.change.org/petitions/president-of-the-united-states-and-u-s-senate-and-u-s-house-of-representatives-pass-insurance-fairness-for-amputees-nationally?share_id=bYYcmiomFP&utm_campaign=share_button_action_box&utm_medium=facebook&utm_source=share_petition

I'm Back

I'm finally back online. The last time I was able to sit down and write on this blog I was in a very dark place. My depression and PTSD had been the worse it has been since I had my injury. To be honest, I wanted to quit. For the first time in a very long time I wished I hadn't gotten back up. Luckily, life has a way of showing you the real important things in life. The night after I had wrote the last blog post here, I was sent a message by a new amputee that I had spoke to right after her amputation. She reminded me of the words I had said to her a few months ago..."I'm not saying its going to be easy, if fact, it will be the hardest thing you will ever do...what I am saying is that it is not the end of your life. It's worth it." Having those words return to me, along with the love and support of my family and friends, has helped drag me out of my pit of despair. I'm not back to where I want to be. I'm still working on finding out who I am now. I am mourning the loss of who I used to be...thanks to some therapy I realized that I haven't done that yet. The beautiful part is...I finally feel like I am healing. 2 Years after my last surgery, I can honestly say my physical wounds are now just scars, but my mental wounds are finally on the mend.

I'll be clear, we are still in quite the financial bind. I want to return to work, I just have to find out where that will be and in what capacity. I'm still looking. I will find it.


On to some more positive news. I have been accepted back to Stanford Medicine X. This year I will be going as a presenter and I will be giving an Ignite! style speech. (If your not familiar, an Ignite format speech is a concise 5 minute presentation set to 20 slides that boost your message). You can find the ignite speeches from past presenters at Medicine X by searching YouTube for Medicine X.

As I continue to grow and heal, I can only hope that I can spread the message I am trying to live. I am an amputee. I am also a father, husband, son, friend, paramedic, the list continues on. My lack of a leg is part of who I am. I know I speak about it a lot...but it does not define me. What defines me is how many times I get back up...Fall down 9 times...get up 10.

Until next time.

PM

Inside the Bell Jar

I decided when I started this blog I would not only chronicle my triumphs but also my defeats. Tonight will be the latter I'm afraid. 

Let me start with this. There is a certain stigma attached to mental health in America, yet an untold amount of us suffer from some sort of mental illness. We are quick to judge those who have a mental disease, saying that they should "just get over it," "Have you tried to just get up and decide to stop being [fill in your choice of mental ailment here], and the like. This is wholly unacceptable. Would you ever conceive asking a person with a the flu (an ailment that we all suffer from eventually) to "just get over it," or a person with cancer to decide to not have cancer anymore...that is how ridiculous we as a society need to see the stigma associated with depression, PTSD, bipolar disorder, and the like. 

I have been battling depression since I started having the issues with my prosthetic. I began to feel handicapped for the first time since losing my leg. These feelings started building with the loss of my job and the impending holidays. The feeling of not being able to provide for my family, and relying on others to ensure that my children had a wonderful Christmas. Don't get me wrong, I am thankful for my friends and family that helped us provide a wonderful holiday for our boys, we were able to give them a very Merry Christmas and continue the illusion that nothing is different. We have made it our goal, as I believe my family did when I was young, to never have our boys feel like they are "poor." When I was growing up I had no idea that we lived in a "poor" area in West Virginia, we had food on the table and I never needed anything. I want to ensure that my children have this and more. 

While searching for jobs I came to a realization. The way I see myself, and as I have come to realize, the way most people in public safety and medicine is directly tied into our job title. I am a Paramedic, Kate is a Combat Medic/EMT, John Smith is a Police officer, etc....We are so entwined with our profession that we cannot disconnect ourselves from it. So...What happens when that disconnect is forced? How do you sort through what is left and find out who you are without your title.? This is where I am currently. I am still holding out hope that I can return to work as a Paramedic, hopefully as a flight medic (which I believe would be much more challenging mentally, but a little less physically tasking). Yet, I am mourning the loss of my identity. I focused so much on returning to work as a medic, that I never considered how to cope with the day that I cannot return to work as a medic. Don't get me wrong, I'm not giving up on my goals, I'm just faced with the reality that even if I was a healthy bipedal Paramedic, there comes a day when EMS is no longer an option. 

This leads me to the early hours of Thursday morning. The past week or so I have been in the throws of a full blown PTSD/Depression downward spiral. It got to the point that Kate was worried about me, being honest, I'm not suicidal by any means, I just felt as if I was drowning. I couldn't get up, I haven't wanted to do...well anything. After some coaxing by Kate and Janelle (for those who have been reading for awhile, Janelle was the paramedic I did my ride time with when I first started back as a medic). They convinced me that I have had some personality changes and they were very worried about me. I checked myself into the ER to be evaluated and set up with a therapist. The difficulty in being well known in the Emergency Field in a relatively small city is that you know most of the people that work in the Emergency Departments. This was no exception, making it harder to walk in and admit that I have a problem (knowing the stigma attached to mental health). 

Today, I took my first steps towards fixing myself. I went and spoke with the therapist they recommended. I feel the same as I did a few days ago, but I am going to try to fix these problems inside of my head. I urge you, especially those reading this in EMS who are kept up with the nightmares and constant thoughts of "It's my fault, I could have done this or that better", or just those runs that you can't let go of, go talk to someone. There are options. A study was recently posted on facebook showing that Paramedics and EMTs suffer from PTSD in drastic numbers and do not seek help. I'm guilty of this, we are told to suck it up and move on. Clean your truck, get your gear ready, and go on the next run, no matter how traumatic the run before was. Don't be afraid to use the resources available to you, you have options. Talk to someone. 

I'm still "in the bell jar" as my wife puts it. My job prospects aren't panning out, and I'm not sure how we are going to make it, but we will. I have always been told that when you hit rock bottom, it's a great place to build a foundation...I just didn't realize that sometimes life wants you to build a basement as well....

This has been one of the hardest posts for me to write. If it's rambling I apologize, honestly, I just had to get this out of my head and onto paper. I hope it helps someone out there...I'll post updates as I continue on this new journey. 

PM

2014 Confusion

I'm confused...those that know me know that this isn't necessarily a new onset of confusion, but a long drawn out process that seems to be exacerbated by my unemployment. Here is my dilemma. I'm about to turn 32 years old, and I still don't know what I want to be when I grow up. I have all these grand dreams, but have no idea how to start making them come to fruition. I want to be a paramedic, but I have come to realize that this is only a short term solution to a long term problem. While I am physically capable of performing the tasks required of me right now...I'm not sure I can continue in this line of work for another 20 years. EMS is a profession where, even with a perfectly healthy body, lasting an entire career without a crippling injury has become an oddity. The rising use of emergency rooms as personal physicians has placed an overwhelming burden on an already strained system, resulting in a physical demand on the street level emt/paramedic that cannot be maintained.

This leaves me with my dreams. I hope that I can turn these into a reality. I am trying to figure out how to start a career as a motivational speaker (although I hate that term). I want to spread the message to anyone who will listen that debilitating injuries and chronic illnesses are not the death sentence they appear to be. If I have learned anything from my amputation, and the amazing people I have met as a result, is that the only limits you have are those you place on yourself. I have realized while searching for a new full time job, that I get extremely offended when people place limitations on me due to my prosthetic. Recently, I was speaking to a friend about a job, one that requires walking on uneven terrain, sometimes for long distances, and immediately was greeted by the chorus of "you can't do that, you need another option, etc..."

I am going to make this a short post tonight. I plan on getting back into writing on this blog more, one of my many resolutions for the year.

Until next time...
PM