Canine Niche

Ben Blecha, CPO, didn't realize how much growing up on a farm in rural Nebraska would shape his future—personally and professionally. An illness, a culture of community involvement, the distance to services, and raising animals all played a role. When in high school, Blecha was diagnosed with osteosarcoma. As a result, he had seven inches of his femur and his right knee replaced. Two years later he broke the internal prosthesis out of his femur and had another knee replacement, which eventually became infected. "I was in need of a high above-knee amputation, but my foot and tibia were still good," he remembers. As a result Blecha had a rotationplasty—a rare procedure for an adult, he says. [caption id="" align="alignright" width="300"] Ben Blecha enjoys the creative process of making custom braces for his canine patients, namely the stifle brace, which is equivalent to a knee brace in humans. Photographs courtesy of Monica Mercer.[/caption] Blecha's cancer and subsequent amputation meant having to make many five hour drives across the state from his home in Benkelman, a town which had about 900 residents at the time, to Omaha to see his prosthetist. Though it was an inconvenience that there wasn't a prosthetist in the Benkelman vicinity, perhaps what Blecha remembers most about those long drives for his fittings was returning home and the generosity of his neighbors. "There was always food and groceries on the table, waiting for us," remembers Blecha, now 36 years old. "People just came together and did anything they could to help me, and I just appreciated that so much." Growing up around animals also had an early impact on Blecha. On the farm, there was never a shortage of dogs, cats, and livestock. "We had hogs and cattle, usually a dozen cats around, and three or four dogs," Blecha remembers. His uncle is also a veterinarian, who still practices in a small town about 50 miles from Benkelman. Blecha has fond memories of helping him to treat animals in his clinic. In college, Blecha was originally studying to become an engineer; however, as an amputee himself and knowing how difficult it was to properly fit a prosthesis, he decided to change his major to one that would lead him down the O&P path. Blecha applied to the University of Texas Southwestern (UT Southwestern) Medical Center Allied Health Sciences School, Dallas, and graduated from its O&P program in 2001. He completed his orthotic residency at UT Southwestern, and then worked as a staff orthotist at Shiners Hospitals for Children—Greenville, South Carolina. He completed his prosthetic residency at Rehab Designs of America (RDA), Kansas City, Missouri. [caption id="" align="alignright" width="250"] The benefits to Blecha's custom brace design are two-fold: it is less invasive and it is less expensive than surgery.[/caption] In 2005, Blecha decided to move to Denver, Colorado. There, he worked briefly for Colorado Professional Medical before he opened Sky Prosthetics. His idea was that in addition to helping O&P patients along the Front Range, he would provide outreach prosthetic care to those in need in rural Colorado and Nebraska. It was during this time that Blecha also began doing volunteer work. To date, he has made nine humanitarian medical trips to Guatemala. "Now that I am better, I wanted to return the favor," Blecha says, referring to the years when Benkelman residents helped him and his family through his ordeal with bone cancer. As an amputee, Blecha is able to provide a personal perspective to the clinical care he provides his patients. Though a person happens to have an amputation, "being an amputee shouldn't be the focus of your life," he says. Pet Pioneer In 2006, Blecha's uncle encouraged him to visit Alameda East Veterinary Hospital, Denver, founded in 1971 by Robert Taylor, DVM, MS. The facility was known as one of the leading veterinary hospitals worldwide, and Taylor was doing the latest in veterinary orthopedics and rehabilitation. Equipped with the latest in technology, the vet hospital was also unique in that it had a biomechanics lab on-site for animals. "There are not many biomechanics labs in the country for humans, and they had one for animals," Blecha says. "It was pretty fascinating." In 2006, Blecha began to work with Taylor, who retired in 2007, and Carrie Adrian, PhD, PT, CCRP, who was director of physical therapy at Alameda East at the time. She is now the director of rehabilitation services for the Colorado-based VCA Animal Hospitals. It was during this time that Blecha formed Ace Ortho Solutions—which makes custom braces for animals, primarily— as a sister company to Sky Prosthetics. Adrian says she wasn't too impressed with the adaptive technology for dogs that was on the market in the early to mid 2000s. She says she was "totally impressed", however, with the braces— namely the stifle brace, which is equivalent to a knee brace in humans—that Blecha designed. The benefits to Blecha's design are two-fold: it is less invasive and it is less expensive than surgery, Adrian says. "I have zero evidence that these [braces] are better than surgery," she says. "But it is certainly an alternative to surgery. Ben has taken his time to do things right. He's methodical about what he's done. It is something that he can back up with his biomechanical understanding." Blecha is a pioneer of sorts when it comes to making custom animal leg braces. At the time, there were few other experts in the field to consult or textbooks to read. However, because his fourlegged patients have the same kind of biomechanical problems that humans face (a dog's cranial cruciate ligament [CCL] is similar to the anterior cruciate ligament [ACL] in humans), that made the challenge a little easier. After he stopped working with Alameda East in Denver, Blecha continued working on his own to redesign and advance many leg-bracing techniques for dogs. After a few years of trial and error, the process of making custom braces for dogs has started to come together, Blecha says. "While the biomechanics may be similar, fitting animals can be different," Blecha says. "The hurdle is the fur." Plastic adheres well to human skin, not so well, however, to the animal's fur. Blecha said his training at Shiners also proved useful. "Dogs and kids are kind of the same," he says. "Dogs can't talk, and sometimes kids won't tell you where it hurts." Blecha faces ethical and medical requirements to make custom braces for dogs just as he does when he fits his human patients with a custom prosthesis. "I am not a mad scientist," he says. "We follow the same code of ethics for animals as we do for humans. A vet and a physical therapist have to be part of the fitting process." From a business perspective, billing for his four-legged patients is simpler than with a typical human O&P practice since he does not face L-Code requirements and does not have to deal with insurance companies or Medicare. However, because he provides orthoses made from custom casts to remote clients, he has encountered an unexpected challenge. He gets calls for custom braces from all over the world—Canada, United Kingdom, Romania, Australia, and South Africa—and has found that working internationally can prove a little tougher given the shipping tariffs, he says. Since those early days when Blecha worked exclusively with Alameda East Veterinary Hospital, he has brought Sky Prosthetics and Ace Ortho Solutions to his native Nebraska, where he set up shop back in his hometown. This decision has been a good one from a personal perspective, Blecha says, because he likes the slower pace of rural living, and professionally because it has allowed him to concentrate on growing both sides of his O&P business. Blecha estimates that he makes about ten biomechanically designed braces a week for his canine patients that range from a stifle brace for the knee, a hock brace for the ankle, to a jointed and non-jointed carpal brace for the wrist. He has also made braces for cats, a calf, and a flamingo at the Denver Zoo, but he works primarily with dogs. Currently, Blecha says he maintains a "good balance" between his Sky Prosthetics patients and his Ace Ortho Solutions patients. He envisions within the next two or so years to be making more custom braces for animals than fitting prostheses for humans, at least 90 percent more. Blecha says he enjoys aspects of fittings for both humans and animals. He likes helping his human patients reach their goal of overcoming obstacles associated with having an amputation. Making custom braces for dogs allows him a creativity he doesn't have with his Sky Prosthetics patients. Betta Ferrendelli can be reached at betta@opedge.com

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