Decision to Amputate Keeps Swift in the Driver Seat

Bert Swift was a typical boy who loved playing sports, riding motorcycles, and trying to keep up with his brothers when he was diagnosed with Ewing's sarcoma in his left arm in June 1974. "I was living the simple, basic, uncomplicated life of a ten-year-old," he says. "I had no idea at the time how threatening, how lethal, Ewing's sarcoma was." He began receiving chemotherapy, which lasted two years, and over the course of that summer, had radiation treatments. Initially Swift was able to keep his left arm, but the side effects of the radiation, which left first, second, and third degree burns on his arm, led to his decision to have it amputated a few years ago. "The long-term effects of the radiation therapy decreased my circulation," he says, "which led to brittle, dense bone tissue, causing me to break my arm three times, which ultimately lead to diminished mobility over the years." In addition, Swift had osteomyelitis multiple times, and each recovery reduced the function of his arm. Amputation, The Best Option Swift, who lives near Providence, Rhode Island, says initially he was relieved he was able to keep his arm. "I'm glad I didn't lose it," he says. "I was the youngest of seven kids and I had to pedal faster, run faster to keep up with my brothers. I wanted to continue playing football and hockey, so I couldn't let cancer stop me." His left arm remained roughly the same small, underdeveloped size it was when he was first diagnosed with cancer. He managed to live and work most of his adult life primarily using his right arm. "I did use both arms for everything I could, but my right arm was the go-to, stronger, more dominant arm, but I didn't avoid using my left arm when I could." In the spring of 2018, however, Swift says he began to notice his left hand was cold to the touch. "From my past experiences I already knew this was the result of a major circulation problem," he says. "Before even speaking with the doctors, I suspected that amputation was going to be the best option for me." Swift says he ultimately chose a transhumeral amputation for two reasons: A transradial amputation would not have solved all his problems, and he believed there was more potential in using a prosthesis. "The amputation provided me an opportunity to get back to doing activities I loved and had certainly missed out on over the years of my decreased mobility," he says. "It was only when I knew that my arm was truly a goner due to complete loss of circulation that I willingly chose to amputate, in the knowledge that I had the best chance ever to live my life again. Yes, it was a choice, the most radical of three, but it was the best for my overall health and although transhumerus is a more difficult prosthetic application than the transradial option, it was the best route for me." Swift, a digital illustrator and photographer who loves to drive fast, high-performance vehicles, is not one to stay idle. "Ever since I started my cancer treatment, my life has required determination to continue the most meaningful activities that brought me joy to overcome obstacles of physical limitation and the overbearing safeguards of the well intentioned. I had coaches that kept me on the bench, either because they thought I was physically inhibited, or they needed to protect me from injury—this despite being reliably at every practice and hustling right alongside my teammates." This did not resonate well with Swift. "It only made me skate harder, check harder, shoot harder," he says. "It set a pattern that would be part of my life forever." TMR Brian Pelkey, CO, cofounder of New Beginnings Orthotics and Prosthetics, Warwick, Rhode Island, met Swift about three years ago when he came for an amputation consultation. "Bert already knew he needed an amputation prior to his surgery, but he wanted to educate himself before the surgery," Pelkey says. In 2018, Swift had amputation surgery and targeted muscle reinnervation (TMR) simultaneously. The TMR allowed him to use five innervated sites on his upper arm rather than the two standard sites, Pelkey says. Perfect Candidate Initially, Swift had a myoelectric prosthesis that used a conventional control method. His first prosthetic arm made it difficult to execute movements and moving it was counterintuitive, he says. "As a user, I had to serve the device rather than the device serving the user. I have five reinnervated sites on my upper arm, however, my first prosthetic device only allowed me to use two of them." Swift's TMR made him a perfect candidate for the Coapt Complete Control Gen2 pattern recognition system, Pelkey says. "It allows him better use of his five innervated sites and more intuitive control of his prosthetic limb," he says. Pelkey says Swift had surpassed the capabilities of his initial control system. "He was ready to move on to a more advanced and intuitive system like Coapt," he says. "Bert had also lived with diminishing movement for years, so he had not been able to make many movements that the Coapt technology and his prothesis now allow him to make." As an example, Pelkey says Coapt allows Swift to have supination and pronation of the wrist, which he could not do before having the technology. "Bert trains himself to make these movements on his own," Pelkey says. "And the Coapt system's myoelectric pattern recognition with the help of Coapt's Control Coach AI program helps him to do so." Coapt has helped Swift remain independent, Pelkey says. "Bert is a very self-sufficient individual…. He can calibrate his system on his own, download new software, and make adjustments as necessary," Pelkey says. "It has spoiled me as a prosthetist because he doesn't have return visits as frequently as others may." Pelkey says Swift is the perfect patient. "Even when he is frustrated, which isn't frequently, his frustration doesn't overcome the end goal," Pelkey says. Pelkey says Swift also enjoys working with and learning new technology, and Swift agrees. "I enjoy taking the time to work with my prosthetic system," Swift says. "So I can better understand the technology and hopefully help to educate and improve the lives of others in the same position." Lifelong Impact Having limited use of his left arm for so many years made an impact on his life, Swift says. "Slowly losing your ability to do what you love changes your outlook," he says. "The idea that you can get back to doing those activities again is motivating. I'm fortunate to have the opportunity to get back to doing what I love and taking it day by day." Because Swift has spent so much of his life with limited use of his left arm, he can often function better without his prosthesis but resists the temptation to do without it. "I can comfortably go without my prosthetic and still be proficient, but I know that there's no progress without immersion, so I make a point of wearing the device to fortify my daily routine and build awareness in my mind that it is there to be used," Swift says. He compares wearing his prosthesis to his camera, which he always carried with him as a college student. "When I was a student, I did this and learned a valuable lesson—if you don't have your tools, you can't use them when you need them." Swift's case isn't typical of most limb loss, Pelkey says. "It was a planned, scheduled, and well-thought-through decision," he says. "Bert's ability to use his arm decreased with time before his amputation, so he was happy to move on to something more functional. Although there was no accident or cause of serious trauma, he certainly has supportive family and friends." Swift says he was lucky in that his amputation was planned. He was in a healthy frame of mind to prepare for the loss of his arm, he says. "I was fortunate in my experience that I didn't have to recover from a specific physical or psychological trauma or injury," he says. "There are so many ways to arrive to the amputee status, and mine did not come as a surprise to me." Swift says it was a "great opportunity to move forward with my life, to maximize what has been given to me and pursue a great life. I knew a lot about how much the prosthetics field had advanced and was—and still am—excited about what my future holds." O&P EDGE Betta Ferrendelli can be contacted at betta@opedge.com.

Decision to Amputate Keeps Swift in the Driver Seat

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Decision to Amputate Keeps Swift in the Driver Seat

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Related posts:

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