The cover story by Judith Philipps Otto in the January issue of The O&P EDGE, “The Weighty Challenges of Bariatric Care,” focuses on techniques and components to meet the needs of heavier patients who need O&P care. This Online Exclusive offers additional suggestions from O&P practitioners.
·       If the patient is significantly overweight, the socket can be reinforced by putting in composite layers of carbon fibers to strengthen it and prevent breaking.
Kevin Carroll, MS, CP, FAAOP(D), vice president of prosthetics, Hanger Clinic, headquartered in Austin, Texas, and Jack Lawall, CPO, Lawall Prosthetics & Orthotics, headquartered in Philadelphia
·       Don’t be reluctant to do multiple check sockets, and take the extra time to make sure it fits really well. I’ll do as many as I need to get it right. Once they laminate, it’s a lot harder to fix.
Michelle Hall, CPO, FAAOP, Gillette Lifetime Specialty Healthcare, St. Paul, Minnesota
·       Involve your patient; explain the steps and make him or her part of the fitting process. It changes the dynamic and promotes better understanding, interaction, and cooperation.
Jennifer Dowell, CPO, clinical support prosthetist, WillowWood, Mt. Sterling, Ohio
·       Make sure you and your bariatric patients are both on the same page about what their responsibilities are and what the practitioner’s responsibilities are. Because if you don’t agree, it’s an exercise in futility.
Eric Schwelke, CPO/L, director, Kessler Prosthetic & Orthotic Services, Livingston, New Jersey
·       Explore professional journals’ coverage of obesity studies; familiarization with how the medical community deals with the subject on an orthopedic basis would be very appropriate.
Frank Snell, CPO, FAAOP, Snell Prosthetics & Orthotics, Little Rock, Arkansas
·       The prosthesis may be held on by using a pin locking liner that is extremely stretchy to accommodate the patient’s size. Outer sleeves are also available to contain tissue that rolls up over the top.
Kevin Carroll
·       Everyone has comorbidities or problems; everybody who loses a limb is sensitive to it because they don’t feel whole. We don’t change our attitude if they’re obese.
Jack Lawall
·       Communicate honestly. If you’re in unfamiliar territory, admit that your first attempt might fail—but you’re not going to give up as long as your patient is also willing to try.
Michelle Hall
·       Society can be very judgmental; be aware of patients’ sensitivities about their weight, and ensure that clinic staff are taught to respect their feelings.
Kevin Carroll
·       Address patients’ weight in terms of general health expectations; it’s not that they’re overweight; they’re trying to get healthier. I’m there to provide the best options that really work for them. We both have to participate in the conversation.
Jennifer Dowell
·       Most patients are comfortable talking about their weight. We’re here to help patients of all sizes and body shapes—patients need to be able to set realistic goals for themselves. Once the goals are achieved, it is important to work with your care team to set new attainable goals and continue to progress.
Jack Lawall
·       Get your patients talking: There are a lot of little things that they don’t think are important, but are important to us: “Sometimes I feel like the foot’s falling asleep,” for example, can be a clue that sparks our imagination and helps us problem-solve.
      Jack Lawall
·       Involve family helpers, and make sure they understand the importance of keeping Mom or Dad mobile and active, even if the activity is just putting on the prosthesis every day. Many large individuals can’t bend far enough to don their prosthesis unaided.
Kevin Carroll
·       Networking with experienced colleagues is invaluable. The American Academy of Orthotists and Prosthetists Lower Limb Prosthetic Society is a great way to share or learn from others’ expertise.
Michelle Hall
·       [The extra time, extra effort, extra check sockets]…it all adds up, and a lot of people may panic in those situations and not want to deal with it, but the willingness to be creative and try, try again—I think we owe that to our patients.
Michelle Hall
·       Even measuring a larger patient takes different equipment—and a different mindset. You’ve got to think outside the box sometimes.
Jack Lawall
·       Problem-solving may require substitutes or customizing of too-small equipment like fitting stands, walkers, or parallel bars. But solutions can be found if you try.
Michelle Hall
Finally, several clinicians mentioned that while prosthetists aren’t qualified to give medical advice on diet and nutrition, it may help to refer patients to their primary care physician for such guidance, or direct them to the Healthy Weight Website at www.cdc.gov/healthyweight/index.html.
