Catherine Dwyer: Getting Past Pain and Back to an Active Life

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By Judy Johnson Berna

Catherine "Cate" Dwyer spent most of her adult years using a lowerlimb prosthesis that didn't fit correctly. A wife and mother of six children, she says there didn't seem to be enough time in the day to worry about the pain it caused. But when the pain became so severe that it interfered with her ability to be the active mom she wanted to be, she started researching solutions.

Dwyer and visiting friend

From left: Dwyer and a visiting friend. Photographs courtesy of Cate Dwyer.

Dwyer was born with fibular hemimelia, a congenital condition that results in a shortened or missing fibula. By the time she was 11, after her parents had looked into other, less severe options, it was clear that an amputation might increase Dwyer's mobility. Dwyer says her parents asked for her input about undergoing a leg amputation and that it was a big decision for a child of that age to consider. "I can honestly say that vanity played a part in my readiness to go ahead with the surgery," Dwyer says. Once her physician promised she would finally be able to wear the fashionable boots she had her eye on, she says she was convinced. Meeting with another child who already had been through an amputation, and seeing how mobile she was, confirmed the decision.

The surgery and subsequent fitting of a prosthetic leg allowed Dwyer to be more active in middle school and high school, including playing field hockey in the seventh and eighth grades. "My sisters played sports," she says. "And my friends played sports, so naturally I would too."

Through her adult years, however, her prosthetic leg became increasingly uncomfortable to wear. Because she's missing her fibula and has a fairly severe valgus deformity, her prosthetist told her it was complicated to make her a comfortable socket. Her pain came on gradually with each passing year, but with six young children to care for, she focused on everything except her leg issues. She had grown loyal to her prosthetist after seeing him for many years, but wouldn't give up hope that there might be a way to make a more comfortable socket than the design he kept fabricating for her.

"The problems continued to get worse after the birth of our last child in 2008," Dwyer says, "until I ended up unable to do so many things with the kids that I felt truly handicapped." Her decreasing mobility and increasing pain meant she had to give up doing athletic activities with her family, and she was unable to keep up with her busy household.

Dwyer enjoys a walk with one of her sons

Dwyer enjoys a walk with one of her sons-a benefit of her improved prosthetic solution.

Eventually Dwyer turned to the Internet for answers. She began by researching fibular hemimelia. In the online support groups she found people with similar stories. In the many encouraging posts and comments, she noticed one orthopedic surgeon who seemed to be well respected in treating people who had complications from the condition. With a few clicks of the mouse, she discovered the surgeon practiced at Sinai Hospital, Baltimore, not far from her home. Dwyer says she made an appointment immediately.

At her first visit, the surgeon told Dwyer that she needed a new prosthetic socket. Dwyer gave her longtime prosthetist one more chance: He fabricated a new socket for her, but it was very much like her old ones that were never comfortable. "I had learned to live with pain," Dwyer says. The surgeon was not pleased with the replacement socket either. "She took one look at my prosthesis and said, 'Is this it?' " Dwyer left the office with a referral to Dennis Haun, CPO, Metro Prosthetics, headquartered in Baltimore.

Once she met with Haun, Dwyer says she knew she had found someone who could find solutions to alleviate her pain and growing immobility. He examined her residual limb and assured her that a better system could be comfortable. She left his office that day with a knee sleeve that immediately relieved much of her existing pain, giving her hope that she wouldn't need a revision surgery. "She was never provided with a suspension sleeve [before then] that would reduce the friction between her residual limb and her socket," Haun says.

Dwyer shows off her ramp walking skills on a family camping trip.

For more than a year, Dwyer worked with Haun to find a solution. Finding a liner to support Dwyer's extremely bony residual limb and knee was the first battle. By working with Ottobock, Austin, Texas, they were able to find a custom urethane liner. This made it possible to increase the layers of urethane and provide more even pressure throughout her limb. Her comfort level increased and her skin breakdown problems decreased.

Dwyer gives Haun a lot of credit for never giving up on her and insisting they find a good solution for her. "I never once had the feeling that he thought my [socket] would be difficult to fabricate," Dwyer says. "If the first try doesn't work, he tries again. He makes it work." She now wears through her liners more quickly than she ever has because she's able to be active.

Haun also introduced Dwyer to new foot options. "Cate has a [very long] residual limb that doesn't lend many options for feet," Haun says. With less clearance for the higher profile feet that are generally needed for active individuals with amputations, Haun had to research thoroughly to find one that would work. After several unsuccessful attempts with different designs, they finally found one: the College Park Venture foot with an articulated ankle. "I can ascend and descend hills head on, instead of laterally," Dwyer says. "That is huge for me!" Now that she is able to keep up with her children, she found she has other new abilities. For example, she can go up and down stairs in a step-over-step motion, and she can walk on uneven surfaces without jarring her knee and causing pain. The prosthetic solution Haun found-which also includes a suction suspension with sleeve-improved her quality of life dramatically, she says.

"I can't say enough about what a good practitioner he is," Dwyer says. "He is professional, caring, [and] always willing to answer questions, which is so important to me. And no matter what, he finds a way."

Haun, whose daily goal is to help his patients gain as much independence as possible, says he has enjoyed helping Dwyer find better outcomes. "Helping a patient take the next step in recovery is what I love most. I'm happy to be a part of her life journey and prosthetic care."

Judy Johnson Berna is an elective amputee who enjoys keeping up with her husband and four children in their home state of Colorado. Her first book, Just One Foot: How Amputation Cured My Disability, was released in September 2012. She can be reached via her website, www.justonefoot.com.