Lasting Impressions in Patient Care

We asked practitioners to share their stories of patients who presented unique challenges or left a lasting impression on them. The patients—a Paralympian, a father, a preschool teacher, a Ukrainian soldier, and a transplant recipient—are as different as January and June, but what they have in common is the experience of limb loss or mobility challenges and a caring clinician who helped them navigate their challenges. A Preschool Teacher When Caitlin Bowman Martwinski, MSPO, was a student in the University of Pittsburgh’s O&P master’s program, she met Amy, a woman with bilateral transtibial amputations who was Bowman Martwinski’s patient model. Amy would share funny stories about her days as a preschool teacher. “Her students would say, ‘Miss Amy, if I tickle your fake legs, will you fake laugh?’” [caption id="attachment_260398" align="alignright" width="212"] Photograph courtesy Instagram.com[/caption] Amy also said she often felt alone as a person living with limb loss. “She told me that she felt no one outside of our field really cared about her or the unique challenges that come with being an amputee,” says Bowman Martwinski, who graduated in May and is an O&P resident with Children’s Healthcare of Atlanta Orthotics and Prosthetics. Around the time of that conversation with Amy, Bowman Martwinski had just returned from attending an AOPA Policy Forum in Washington DC. “Sharing my experiences about the Policy Forum with Amy gave her hope that there were people beyond the O&P profession who cared about her daily struggles and were willing to try to pass legislation to help improve her life,” Bowman Martwinski says. A Husband and Father Cassandra Delgado, MSPO, CPO, clinical director at Prosthetic and Orthotic Associates (POA) and Handspring Clinical Services, New York, has worked with a man with quadrimembral amputations as a result of sepsis for the last four years. She began treating him after he had been discharged from a rehabilitation center and came to POA for care. Delgado says he first came to POA during the height of the pandemic in May 2020. “It was such a challenging time not only for the practice, but also for this client when the world was essentially closed,” Delgado says. “We had to take on not only the role of the prosthetist, but a significant part of the hands-on care that other specialties were not able to do at the time because they could only provide virtual care.” Another difficulty Delgado faced was the patient’s size—he’s six foot six inches tall and weighed around 350 pounds. “He’s no small guy and is an extremely active father,” Delgado says. “Considering that I am only a little over five feet, it was a challenge for me.” [caption id="attachment_260399" align="alignright" width="180"] zoeytoja/stock.adobe.com[/caption] Delgado’s client uses bilateral transradial skin-fit myoelectric sockets with multiarticulating hands. He uses a left transtibial and a right knee disarticulation prosthesis. For ambulation, he has activity-specific upper-limb prostheses he uses with crutches. Thankfully, Delgado says, scanning and 3D printing have helped her in this realm, “Otherwise those plaster models would have me break into a sweat.” Her patient has been able to lose weight with the help of Mounjaro injections recently. “This has truly been a tremendous help to my client, as it has improved his mobility, trunk flexibility, and endurance,” Delgado says, adding that the weight loss has also meant a lot of volume change. “We have been on a journey of quite a few socket replacements and always trying to optimize his suspension,” she says. “I have trialed so many different suspensions, designs, and componentry to try to meet his needs.” Delgado says her client has an optimistic outlook on life, which has helped with his care. “He called asking me my thoughts on him going down waterslides,” she says. “He has two young children, and he is always looking for ways to keep up with them. This client has an excellent mechanical and creative mindset, which allows us to keep his care moving forward and challenges me to think bigger.” A Ukrainian Soldier Mark Hopkins, MBA, PT, CPO, Dankmeyer O&P, Maryland, has been in O&P for more than 30 years. The short answer as to why he made a career in O&P is that he likes taking care of people and making things. “Put those two together and you find my real passion, which is finding practical solutions for problems,” he says. “O&P really is the perfect fit. And, honestly, thank goodness it fits my interests so well as O&P is a tough profession. I don’t think people realize all the effort that goes into practicing O&P to a level of performance that [one] is expected to be good at—the work with the customers, the end users, their families, as well as colleagues and referral sources.” [caption id="attachment_260400" align="alignright" width="230"] Photograph courtesy Dankmeyer O&P[/caption] In April, Hopkins started working with a new client, Anton Bekesh, a Ukrainian soldier who has a transfemoral amputation of his left leg because of combat trauma. “He came to us through a nonprofit that focuses on helping injured Ukrainian soldiers,” Hopkins says. Dankmeyer helped facilitate appointments with its partners at Johns Hopkins Orthopedics and Physical Medicine and Rehabilitation (PM&R), where Bekesh received surgery and rehabilitation as part of his care. “We were asked to provide new prostheses for him following his residual limb revision surgery in preparation to return home. The recommendation was a prosthesis for everyday use and a special-use prosthesis designed for running.” Despite his injuries, the soldier is young, active, and wants to get back to being able to work, run, and exercise again, Hopkins says. “He was interested in osseointegration and a bone-anchored prosthesis or a surgical limb revision to improve prosthesis socket fitting. He wants to achieve a very high level of function including running and sports.” Bekesh’s case has presented its own set of challenges, Hopkins says. He’s married, and they just had their first child, a girl. “He was anxious to get treatment and get home as soon as possible,” he says. In addition to the challenges of fitting a new prosthesis, there were other hurdles to overcome, including a limited budget and time. Bekesh does not speak English and has some stress-related issues due to the trauma of war, Hopkins says. “He had the hard part of being away from his home and family, not speaking the language or fully understanding the culture, or navigating the US healthcare system, including the commercial insurance benefits issues,” Hopkins says. “He also had and is recovering from surgery.” The soldier, who returned home in October, not only wrestled with the patience that comes with socket fitting and relearning to walk, but he’s also had to deal with the unknown in terms of how long he would be able to stay in the United States, Hopkins says. Bekesh currently has three prostheses. The first, which he received in Ukraine, has a seal-in socket, a mechanical hydraulic knee, and a carbon fiber foot. “The report is that he did use his [initial] prosthesis some, but the suction socket did not work well due to the condition of his limb at the time, and he was not able to use it to achieve successful everyday use even for basic walking or running,” says Hopkins, who was the point person between Dankmeyer and the Johns Hopkins healthcare team. “We organized the timeline and helped [Bekesh] stay on track with the many steps along the way.” That included the technical design of the prosthesis and insurance coverage, as well as all of the clinical work to design, explain the options, cast, measure, make, fit, adjust, and remake the prosthesis. Teamwork, assistance, and diligence helped to make Bekesh’s stay and care in the United States not only tolerable but successful, Hopkins says. “We both had a great team of people supporting the work, which included his US-based nonprofit sponsor who has done an incredible amount of work supporting [his] needs,” he says. “The Dankmeyer administrative and technician teams have worked diligently and quickly to support our work and meet his needs. The Johns Hopkins Orthopedic Surgery and PM&R teams provided guidance on [osseointegration] and provided a nearly perfect residual-limb revision surgery and tireless rehabilitation service.” A Paralympian Barry Campbell, CO, served in the Navy and Marine Corps as a hospital corpsman and has been involved in orthopedics since he was 19 years old. He has been with Hanger Clinic for 25 years, and a clinic manager in Overland Park, Kansas, since 2008. “The reason for my longevity is being able to help patients achieve great outcomes,” he says. “I love to empower them.” One of those patients is Rachel Watts, a triathlete from St. Joseph, Kansas, who competed in the Paralympics in Paris this summer. Watts was diagnosed with multiple sclerosis (MS) in December 2018, and her physicians told her she should find a new hobby to substitute for her love of running. [caption id="attachment_260401" align="alignright" width="212"] Photograph courtesy Instagram.com[/caption] Watts, however, was unwilling to give up a sport she loved and spent so much of her life doing. Campbell started working with Watts in 2022, when she came to the Hanger Clinic with a bulky AFO that was not a good fit her mobility needs. “I noticed she was struggling with walking just a short distance,” he says. After performing many manual muscle tests, Campbell says he determined that Watts was “very strong for having MS at such a young age.” Knowing that her goal was to continue running, the team at Hanger came up with a plan for custom bilateral AFOs that were functional enough for her to not only run, but sprint. Campbell casted for bilateral SpryStep Flex AFOs, which were fabricated by Thuasne. “Rachel is currently using these AFOs and continues to run, swim, and cycle,” he says. Campbell says given Watts’ athletic grace and abilities, there have been few challenges with her care. Communication in care between Campbell and Watts has also been especially helpful. “It’s as simple as successfully communicating with each other to come up with a plan so Rachel can meet her goals,” he says. A Transplant Recipient Alan Lett, CPO, has been working in O&P for 30 years. He owns WVA Orthotics & Prosthetics Center, West Virginia, a business he started with his parents in 1997. He says he developed an appreciation for helping people at difficult times in their lives at an early age. “My father is a retired CPO, and my grandfather was a CO,” he says. “Once I was in high school my summer job included working in the lab pouring plaster, sweeping the floors, and any other task that needed to be done.” Since October 2023, Lett has been treating a 29-year-old woman who has a transtibial amputation on her left leg due to complications that resulted from a lung transplant in the spring of 2023. Lett’s patient wears a definitive prosthesis with a total surface bearing socket, a gel locking liner, and shuttle lock. She is wearing a Flex Walk-type foot with a multiaxial feature. Lett says the biggest challenge he faces with the patient is that he believes she would benefit by having an articulating hydraulic control ankle to allow her to more easily do the required therapy to improve her leg function. [caption id="attachment_260402" align="alignright" width="189"] Iryna/stock.adobe.com[/caption] There’s one problem, however. “Her insurance does not cover the code for the ankle,” he says. “They don’t recognize the code or even have it listed in their fee schedule, so it is considered noncovered. They do the same thing with the codes for all the microprocessor-controlled components.” Lett says he has reached out to his state senator for help. “He says he’s interested in what challenges we are facing in healthcare in our state,” Lett says. To date, Lett has not received a response from the senator, despite several attempts to reach out to his office. “Those wheels turn so slowly, so no resolution yet, but [the patient] is working with her rehab program with her current foot and is doing the best she can,” Lett says. Words Tell The Story Bowman Martwinski’s master’s research focused on bibliotherapy, or the use of children’s books to increase positive orthotic attitudes in pediatric patients, as well as increasing awareness about disability to their peers. As part of the project, Bowman Martwinski wrote and her sister illustrated Anthony’s Amazing AFOs and tested its effectiveness, along with two other books about AFOs. [caption id="attachment_260403" align="alignright" width="302"] Courtesy Bowman Martwinski[/caption] “We found all the books were effective in our pilot data,” Bowman Martwinski says. “But the real reward was seeing this implemented in practice.” Bowman Martwinski gives the example of a young patient who had severe anxiety about being casted and was often nervous and uncomfortable during casting. Bowman Martwinski says when she left to adjust the braces, she let the little girl read the books from the study. “When I came back into the room, she was another kid,” Bowman Martwinski says. “She told me, ‘I’m ready for the casts now!’ She was so excited to show her mom how she was like the character in the book.” Bowman Martwinski says the experience has had a profound impact on her. “It demonstrated how as clinicians we can contribute to evidence-based practice to help our patients have better outcomes.” She adds that her little patient loved her book and talks about it at each appointment. Lasting Legacy Delgado says she knew she wanted to go into O&P clinical care by the time she was in the fourth grade. She would visit her grandmother, who had bilateral amputations due to dysvascular complications, in a nursing home. Professionally, working with the patient who has quadrimembral limb loss has helped Delgado work with interdisciplinary teams to ensure that her patient has the best possible care and outcomes. “I have grown immensely from being able to learn from other specialties surrounding his care,” she says. “Personally, it has reminded me that our lives can easily be forever changed in a split second and to appreciate every single day I have.” And though Amy, the preschool teacher, passed away earlier this year, a part of her remains. “In a generous gesture, she willed a scholarship to send every student in the class after me from Pitt to go to the AOPA Policy Forum in the hopes that it would inspire future clinicians to be advocates for their patients,” Bowman Martwinski says. “It was touching and humbling to see how simply me being at the Policy Forum ‘walking the walk’ to support our patients, rather than just saying ‘I support you,’ had this massive effect on Amy’s life and the lives of others.” Betta Ferrendelli can be contacted at betta@opedge.com .

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Lasting Impressions in Patient Care

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