Amar Patel: Figuring It Out and Moving On

Amar Patel. Photographs courtesy of Chris Lake.

When Amar Patel lost his left arm due to injuries he sustained in a car accident, he and his prosthetist were determined not to let his amputation get in the way of Patel's dream of becoming a dentist. What they didn't know, however, was that their work toward that dream would become more important for both of them than reaching the goal itself.

In May 2012, Patel had just finished his second year of dental school in San Antonio, Texas, and was driving to Dallas, Texas, where his family lives. He was tired from studying the night before and fell asleep at the wheel. He recalls that when he opened his eyes, his car was crossing the highway toward a service road. The car started to flip, the windshield shattered, and he tried to brace himself with his left arm. The next thing he knew, his left arm was gone.

He was rushed to a nearby hospital where physicians reattached his arm, but his recovery from that surgery was not successful. "I had the arm for seven days, but it was too far infected and it wasn't viable," Patel says. "I decided to have it amputated."

The loss of his arm above the elbow was a shock, but he was determined to return to school. He started working with an occupational therapist and began interviewing prosthetists to find one who was willing to work with him on a difficult task with a tight timeline. That's when he met Chris Lake, CPO, FAAOP, owner of Lake Prosthetics and Research, Euless, Texas.

Lake says that Patel reminded him of some of his military patients returning from a war zone. "He is highly motivated and highly functioning, with a get-it-done kind of attitude." Lake says he started interviewing dentists to figure out what duties they need to do in their day-to-day jobs and talked to Patel about potential prosthetic hands that would work for him. Eventually they decided that the Ottobock Michelangelo Hand was Patel's best bet because of its strong grip force and proportional programmability.

Finding the right hand, however, was just part of the challenge. Heterotopic bone was forming at his amputation site, which made a comfortable socket fit difficult to obtain. Lake says that when this happens, most patients wait awhile until the bone stops growing or until they can have surgery to have it removed. Those weren't options for Patel though.

"He wanted to go back to school and didn't have time to wait," Lake says.

A 3D model of Patel's humeral bone is shown inside the prosthesis, which has an air bladder that Patel can pump up as needed for comfort.

Lake ended up making a 3D print based on a CAT scan of Patel's residual limb. With the print, he and his team designed a specific type of socket with heat dissipation windows and an air bladder so Patel could pump it up for comfort. They made a socket that allowed Patel to comfortably raise his prosthetic arm for extended periods of time, as dentists often are required to do in their work.

Patel says that, meanwhile, he got to work in his school's dental labs. He had to retrain himself on techniques that he had learned prior to his accident. "I spent six months working in simulation mods on mannequins and seeing all of the different ways I could do things versus how they had taught me."

When problems arose, the pair worked to overcome them. For instance, when there was a fear that Patel might accidentally drop a mirror into a patient's mouth, Lake had a machinist design a dental mirror with a ring attached so Amar could put it around his finger and ensure that it didn't fall.

"It was really a strong team effort, and we pulled together and seemingly met all of the needs required," Lake says.

However, there was one requirement they were not able to overcome: Patel has no sensation in his prosthetic hand. He was told by school administrators that being able to feel and knowing the true strength of his grasp were necessary to practice dentistry, from giving local anesthesia to patients to feeling his way around their mouths.

"The barrier I could not get around was the sense of feeling," Lake says. "I was ready to rally people together, but ultimately it came down to not being able to feel, and that was the deal breaker."

Patel demonstrates uninhibited abduction in his preparatory prosthesis.

After considering the concerns of the school's dental board, Patel says he decided to leave dental school. "Apart from deciding to amputate my arm, that was probably the hardest and most difficult choice I ever had to make," he says. "I felt like it was for the best, but even still, it was a hard choice to make-especially when I had already spent two years in dentistry."

While it wasn't the outcome that either Patel or Lake wanted, both say the experience was beneficial and helped them to learn and grow.

Patel says the whole experience made him rethink his career path. Now he's applying to medical school. "I felt like medicine was a better career choice for me after what I've been through and how medicine impacted my life personally," he says. "There are a lot more options for me to utilize my prosthesis and maximize my potential in medicine instead of dentistry."

However, he says, the time working to become a dentist was not wasted. "I don't think I'd have the same confidence to pursue my career in medicine without spending those six months working every day in the dental labs," Patel explains. "Even when I met with patients, a few of them were hesitant at first. When I showed them I could perform at a quality level, they gave me a lot of praise and supported me."

Lake says that working with Patel has pushed him to a new level with his patient care. "Usually people have a difficult limb but perhaps not such a tight timeline, or they have a dexterous type of pursuit but their limb is well-managed and not complicated," Lake says. "Amar happened to check all of the boxes for high difficulty, high expectations, and high need."

Now, Lake says, the solutions he found while working with Amar are benefiting his other patients. "With Amar's situation, we were forced to mature in our understanding of material science. Now that we have learned more, we are doing what we did for him for lots of people. It really helped us grow clinically. The use of air bladders and heat dissipation windows have become standard operating procedure in our practice."

Lake adds that working with Patel has also prompted him to study more about how patients can have some sort of feeling in their prosthetic limbs. "A lot of times, the real drawback to what a patient can do has to do with feeling," he says. "If patients can have sensory feedback in their prosthetic hands and know how strong they are gripping, it would give them an exponential amount of return."

No matter what, Patel says, he plans to keep pushing forward as he has done since his amputation. "There might be something that crops up and stops me for a day or two, and then I figure it out and move on."

Maria St. Louis-Sanchez can be reached at msantray@yahoo.com

Amar Patel: Figuring It Out and Moving On

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