Finding Your Niche: Gaining Success, Satisfaction in Specialty O&P

While many in the O&P profession enjoy the variety working in a general O&P facility offers, for some, building their businesses around a niche market brings success and personal career satisfaction. The O&P EDGE interviewed several business owners who provide post-mastectomy care, animal O&P services, and manufacture of activity-specific devices about why they chose their niches, what makes them work, and what advice they would give others considering a niche O&P business. Animal Ortho Care

Some would say that Derrick Campana, CO, founder of Animal Ortho Care (AOC), Sterling, Virginia, is living the dream. His orthotic and prosthetic skills combined with his passion for helping animals has led to a life of adventure, travel, media coverage, and a certain amount of fame. Campana's December 2017 trip to Botswana to create an orthosis for Jabu, an African elephant, was spotlighted in Animal Planet's premiere episode of Dodo Heroes in June 2018. ("The Dodo" is an online website featuring animal-related stories and videos). The episode also featured the story of Chi Chi, a Golden Retriever that was found in a dumpster in South Korea, her legs bound and rotting. She was rescued, adopted, and trained to be a therapy dog. After amputation of part of each of Chi Chi's legs, Campana created her prostheses. She was named the "most heroic dog" at the 2018 Hero Dog awards. Although he mostly works with dogs, Campana has created devices for elephants in Thailand, gazelles, sheep, goats, cats, and llamas. Beginning, Growth, and Partnership

Campana started Animal Ortho Care in 2005 as a part-time business while he continued treating human patients. His salary funded his business. "I was able to slowly adapt my skills to the veterinary community over time until I jumped completely over to the veterinary market in 2012. And that was a good decision because you want to make sure you can do this effectively at a cost-effective rate as well. But here I am—about 25,000 patients later." Campana later partnered with Caerus Corporation, a veterinary medical device company founded by CEO Fariborz Boor Boor and launched in 2015. Campana became vice president and general manager of the company's veterinary business. Caerus Corporation has an exclusive license for patented canine thermoformable bracing technology from DJO Global. Caerus acquired OrthoCor Medical with its patented and FDA-cleared pulsed electromagnetic field (PEMF) technology for alleviating chronic pain, and L'il Back Bracer with patented bracing technology to alleviate pain in dogs who suffer from intervertebral disk disease (IVDD). Campana also owns prosthetics-focused Bionic Pets independently from Caerus. Although pet owners do travel to Campana's facility, generally the veterinarian or owner orders a casting kit and the resulting mold is sent to AOC for creating the orthosis or prosthesis. Orders come from all over the globe, Campana says. Tips and Advice

Campana urges O&P clinicians interested in starting a veterinary O&P practice to research anatomy and other veterinary care information about animals they might treat and to consider how to adapt their training, experience, and skills to veterinary work. Also essential is learning how to run a business and keep the devices affordable and profitable. He points out that O&P devices for animals can be an affordable and successful alternative to surgeries for managing pain and maintaining or restoring function. "The average cost for orthoses is around $500 and for prostheses, about $1,000; these devices may prevent spending thousands of dollars in surgeries later in [the animal's] life." My Pet's Brace

After 25 years of being an O&P practitioner for people, his love of animals led Jim Alaimo, CPO, to consider opening a veterinary O&P practice. To evaluate whether it would be a viable business, Alaimo sent surveys to veterinarians across the United States asking if they should need custom braces for dogs, would they be interested in his services. The response was favorable, and Alaimo and his partner, Mark Hardin, CPA, launched My Pet's Brace in Morgantown, Pennsylvania, in 2010. They self-funded the business until they had built a track record, and then obtained a Small Business Administration (SBA) loan. Although Hardin has retired, My Pet's Brace now has ten employees and in 2017 moved into a new facility that doubled the space of the previous location with more patient care rooms and a larger fabrication area. During his career, Alaimo has provided O&P care for a menagerie, including llamas, cows, cats, sheep, goats, and at least two ducks, but dogs now compose about 95 percent of his practice, he says. More than 180 different breeds have been treated at My Pet's Brace, Alaimo says. "The smallest dog was four-to-five pounds; the two largest dogs were 258 pounds." My Pet's Brace provides custom orthoses and prostheses using ultralight plastics, carbon fiber, and strong resins to withstand even the wear and tear created by highly active dogs; a veterinarian's prescription or referral is required. If convenient for owners or veterinarians, pets can be cast and fitted in the facility. Otherwise, veterinarians can use a casting kit and send the mold for fabrication. The company also offers custom-made mobility carts from Eddie's Wheels, Shelburne Falls, Massachusetts. Satellite facilities of My Pet's Brace have opened in Knoxville, Tennessee, owned by William "Bill" Kitchens, CO, and in the greater Pittsburgh area, owned by the same owners of Union Orthotics and Prosthetics Co., Pittsburgh, and led by veterinary technician Katie Mirobelli. Both Kitchens and Mirobelli trained extensively with Alaimo; the satellite companies are licensed to use the My Pet's Brace name and products. Advice for Opening a Veterinary O&P Practice

"Besides a good orthotics and prosthetics skills background, you need to love dogs," Alaimo says. "You need a separate facility, not the same building used to care for human patients." It's also a "hairy business," Alaimo says. "Dogs shed, and if they're nervous, they shed more. We vacuum three times a day, clean the patient care room after a patient leaves, and shampoo the carpet once a week. Any pet accidents are cleaned up within minutes." Alaimo continues, "We see the gamut of orthopedic injuries every day. Our goal is to help pets have happier lives. We do anything we can to give the pet a better quality of life and make the owner more comfortable too. It's a very rewarding business." Texas Assistive Devices

When Ron Farquharson, Brazoria, Texas, lost his right hand in an industrial accident and started wearing a prosthesis, he was frustrated with the lack of a quick-disconnect wrist that would allow him to rapidly interchange terminal device tools for different uses. So he decided to make one. He took some design concepts and drawings to Johnny Rouse, a machine shop owner, and the N-Abler—and a new company, Texas Assistive Devices (TAD), was born. The current four iterations of the N-Abler (N-Abler II-V) are the flagship products of a large family of tools that can quickly be inserted into the device for whatever the person with an upper-limb prosthesis wants to do: There are cooking tools and kitchen utensils, and gardening, carpentry, mechanic, sporting and recreational tools, and others. Many of the products are made of strong and light aircraft quality aluminum. Farquharson's wife Janet, a partner in the business, and Rouse, who provides creative contributions and ability to turn Farquharson's concepts into high-quality machined reality, have been indispensable to TAD's success. Farquharson traveled to various symposia, professional conferences, and trade shows to educate O&P professionals, case managers, occupational therapists, and others about TAD's products. The company also launched a website and garnered requests and comments from users, which Farquharson says has been essential. The company started in the Farquharsons' garage, and as it grew, they built a shop about 100 yards from their house, putting money into the business until it became profitable. "We had a learning curve in running a business," says Janet. "It helps to develop a relationship with one of the bigger companies, especially if they like the products. They liked and wanted to sell our products and they gave us good advice." The Iraq-Afghanistan conflicts boosted their business, with sales to Walter Reed Army Medical Center and Brooke Army Medical Center. The military connection also helped TAD become better known within the O&P community. It took three years of trying to obtain a specific L-code for the N-Abler, including an appeal, before the couple was invited to make a presentation before a Centers for Medicare & Medicaid (CMS) advisory panel. "One of our major customers was on the panel, and gave us guidance on the process," Farquharson says. "Finally, in 2006, we received a code for our patented wrist units: L-6624." When the Farquharsons retire, they plan to turn ownership over to the employees. "We have a moral obligation to keep providing these products," Farquharson says. "Amputees need them." TRS Prosthetics

TRS Prosthetics, Boulder, Colorado, celebrates its 40th anniversary this year. Founded by Bob Radocy in 1979, TRS is a source for a wide range of body-powered voluntary closing technologies and sports and recreation devices, including devices for kayaking, archery and bow hunting, aerobics, dance, gymnastics, softball, basketball, bicycling, climbing, firearms, golf, hockey, music, photography, weight lifting—the list goes on. Radocy, an enthusiastic athlete, lost part of his left arm in an auto accident in 1971. Unable to find a manufacturer for a prehensor he designed and patented, he decided to start his own company. He partnered with a friend, an assistant professor at the University of Colorado. His partner managed the business end and marketing; Radocy handled engineering and manufacturing. Needing capital, the partners went to the SBA, and using their homes as collateral, obtained a handicapped assistance grant. "The first two or three years were pretty rocky for us," Radocy recalls. "We were having difficulty staying in business." Radocy sought venture capital and changed the company's status from a Subchapter S corporation to a C corporation. The company only brought in about half as much funding as anticipated and was required to give 25 percent ownership to the venture firm. But the capital put TRS back on its feet, and Radocy developed the ADEPT line of pediatric prehensors, the first-ever voluntary closing technology for children. "We developed other sports and recreation products and became profitable in 1984 and began to slowly grow," Radocy says. "But in the 1990s—my partner had left by then to finish his PhD—the venture capital firm went bankrupt and I was able to personally buy back the majority of the stock and regain ownership. From 2010 on, our growth started to accelerate." TRS currently has ten employees, but Radocy does all the engineering and drafting as well as developing creative new ideas for products, some of which have been inspired by requests and ideas from users. Radocy is excited about a new product making its debut this year: JAWS, a heavy-duty, voluntary opening, prehensile-style terminal device that can be used with or without a cable system. JAWS was inspired by inquiries from myoelectric and electric prostheses users wanting something they could use without a harness system for heavy-duty work and recreation, such as driving farm machinery, using various tools, and operating ATVs, jet skis, and snowmobiles. Other new products being developed are still proprietary, but one involves hybrid myoelectric control over a body-powered system, Radocy says. The Total Woman Boutique

Ruth Addison, CMF, is passionate about making life better for women who have had breast cancer. She founded The Total Woman Boutique in Baton Rouge, Louisiana, in 1982, and has not only built her business but also has been a zealous advocate for small business, fitter certification, facility accreditation, and better Medicare and insurance coverage of breast care forms and prostheses. She has been certified as a mastectomy fitter since 2005 by the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC). The company works closely with the Cancer Society of Greater Baton Rouge and surrounding areas, American Cancer Society, breast cancer support groups, and local hospitals, and is also a member of the National Organization of Women's Healthcare network. The Total Woman Boutique offers post-mastectomy bras, breast forms, prostheses, and surgical bras, maternity bras and supports, wigs and hairpieces, skin care products, and compression garments. A seamstress on staff helps certified fitters provide a perfect fit. "I've always said I want to build my business on service and that's what I tried to do," Addison says. Her desire for certification of fitters and facility accreditation was fueled by coming across someone selling post-mastectomy products out of his vehicle and a pharmacist who said, "Come on back, honey, and I'll fit you in the bathroom." She was involved in the OPGA buying group, which was organized to help small O&P businesses obtain some of the manufacturer and supplier discounted pricing big businesses receive. Addison is an advocate for better healthcare coverage by Medicare and private insurers. She is currently advocating for passage of a bipartisan bill, the Breast Cancer Patient Equity Act (H.R. 6980), that, if passed, will expand Medicare coverage to include custom breast prostheses as an option. Addison and her daughter Sherri Spillman, CFm, have been active in humanitarian work, journeying with a medical team to Cali, Colombia, to provide post-mastectomy bras and fittings to women who otherwise could not afford them. Addison began in an 800-sq. ft. facility behind a hospital. There were slow years where she took no salary but instead put the money into building inventory. She now has a 4,100-sq. ft. facility and eight employees, including herself. Her daughter has been with the company for 30 years and her granddaughter, Amy Pinell, who started helping during school vacations, is now part of the company. "I'm 80 years old and still work here six days a week," Addison says. "When I retire, my daughter and granddaughter will continue." Take-away Ideas for Starting an O&P Specialty Business

Aside from the niche-specific advice these business owners offered, each of them expressed love of what they do and commented on the satisfaction they receive from their businesses and from involvement in professional and humanitarian organizations dedicated to better care for human and animals, as well as the happiness they see from seeing their patients gain a better quality of life. In practical ways, they determined if there was a market for their services and products. They worked hard to establish their businesses and publicized their products and services by attending professional events, encouraging word-of-mouth marketing from satisfied patients, and other initiatives. They were prepared to make sacrifices to establish their niche specialty, and they had a plan for funding and growing the business. They also took sound advice from others, including ideas and requests from customers and end users. Above all, they had a passion for what they do and determination to make their dream a reality. Miki Fairley is a freelance writer based in southwest Colorado. She can be contacted via email at miki.fairley@gmail.com .

Finding Your Niche: Gaining Success, Satisfaction in Specialty O&P

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