Megan Patel: An Enduring Friendship

Prosthetist and Client Began Working Together Two Decades Ago [caption id="" align="alignright" width="250"] Patel with her daughter. Photographs courtesy of the Patel family.[/caption] David Jolly, CP(E), was well into his prosthetics career at Monroe BioTechnology's Appleton, Wisconsin, clinic when six-year-old Megan (Voissem) Patel lost her right leg below the knee after she became trapped on a train trestle over the Fox River. The accident happened April 20, 1993. That day, Patel had joined her grandfather and nine-year-old twin brothers on a walk to the river to watch the flowing water from the snowmelt. They were on the tracks over the river when a train came, says Patel, who remembers trying to run back toward land, but her right leg became wedged in the trestle. "My grandpa yelled to the three of us to get to the side and hold on," Patel says. The train managed to stop above Patel and her brothers, but not before severing her right leg and the toes on her left foot. Patel, now 28, and a married mother of a one-year-old daughter, says her brothers "received only splinters" from the accident, but her grandfather drowned. A First Visit Patel had been in the hospital nearly three weeks when she met Jolly for the first time. Jolly says he met Patel through a family friend, a surgeon. "He described the background of the injuries and indicated that the family was interested in gathering more information from us," says Jolly, who took an immediate liking to the little girl. That first encounter may have had something to do with an article Jolly had read in Reader's Digest years earlier, "The Little Girl Who Couldn't Walk." It was about a child who couldn't run because she had bilateral transtibial amputations and how getting prostheses had changed her life. "The article introduced me to a world about which I had no knowledge," says Jolly, who was then inspired to volunteer at a local prosthetics practice. That practice ultimately hired Jolly, and he went on to obtain the necessary education to become a certified prosthetist. "It was years later that I met Megan and her family. It was my turn to help a little girl who couldn't run," he says. A Friendship Begins Within six weeks of the accident, Patel was fit with a temporary prosthesis and had already reached a point where she was standing and beginning to walk. "Right away David made a waterproof leg for me for that first summer," says Patel, who taught elementary school in St. Louis for four years before having her daughter last year. "I was always able to participate in things. By the end of that school year, I had gone back to school in a wheelchair." In the beginning, she went to physical therapy (PT) four times per week, and the physical therapist debrided her leg and foot during the visits after using hydrotherapy. Patel says she reduced her PT to three times per week for two years, then twice per week for three years. "We had the fortunate circumstance of locating our Appleton satellite office in a medical office building attached to Appleton Medical Center hospital, and we were able to act in a multidisciplinary manner for Megan's care," Jolly says. "This did make it possible for physicians to see her in conjunction with physical therapy or prosthetic appointments and allowed us to intervene early on and be consistent in keeping her active and progressing." She says she remembers her residual limb being extremely sensitive. "I wore many bandages, so [socket] adjustments had to be made so there were no pressure points," Patel says. Additionally, she had to have a new prosthesis made every six to nine months due to how quickly she was growing. That meant a lot of trips to Monroe BioTechnology. [caption id="" align="alignright" width="350"] Patel remains active, shown here hiking with her husband.[/caption] "The appointments were long, and I was at David's office often," Patel says. "I wanted my leg to look like a real leg, and David took time and had a lot of patience to help...[do that]. He made me feel comfortable and my time in his office fun." Fun meant letting Patel stay in the lab with him while he worked on her prosthesis and she wheeled around on a stool. Jolly says he remembers a time Patel came during the holidays when she was about nine years old. "We were in the lab area of my practice and she sang 'Rudolph the Red-Nosed Reindeer' to me while I worked on her prosthesis." It's All in the Sleeve Because Patel suffered a traumatic injury, Jolly says, there was considerable soft tissue damage and skin grafting necessary to preserve her right knee joint and the remaining part of her left foot. But the surgical sites were sufficiently healed within a matter of weeks to allow initial prosthetic restoration. "I believe her initial socket design was a total surface bearing supported by endoskeletal componentry including a SACH foot," he says. "She wore soft synthetic socks over her residual limb. The device was suspended by an elastic airtight sleeve. Megan has a short residual limb, and as she grew, the stress on her knee joint required additional support." Jolly added a single lateral multiaxial side joint. "We continue to support the device with a custom-designed suspension sleeve," he says. "We also added a gel liner to the design in order to mitigate shear forces that might irritate the grafted tissue." As Patel grew, Jolly also changed to Flex Foot components to improve her mobility and reduce the weight of the prosthesis. "This is essentially the design that she is using today," he says. The suspension sleeve Patel uses—a Syncor Durasleeve—has served her well, Jolly says. "It has been particularly beneficial because I could customize the design, adjust the circumferences, lengthen the sleeve as needed, provide interior reinforcement panels as needed, [and] create a pocketed area over the patella to minimize stress while maintaining an airtight seal." The tissue over Patel's patella, however, is particularly fragile, Jolly says. "It has been beneficial to adjust the design of the sleeve to minimize compression over this area." Patel says she and Jolly have always kept in touch even after she moved away to attend college in Minnesota. "If I needed work done on my prosthesis, I would travel home, and David would make the time for me in order to do the needed adjustments," she says. "While I was in college and even after I moved to St. Louis, I usually only had time on weekends, and he graciously met with me then." Patel and her husband moved to Cincinnati in June 2013. They hope to return to Wisconsin next June when he completes his medical fellowship. Though Patel is working with a local prosthetist, Jolly, who attended her wedding, continues to work with her regarding any type of modifications to the sleeve design. "We do keep in touch by text and by phone," says Jolly, who retired in 2012, but who, with his wife, continues to own Syncor, Abrams, Wisconsin, which produces and distributes prosthetic suspension products. "I continue to help Megan with any design requirements associated with the Durasleeve that she uses," he says. Family Support and Two Regular Legs Patel says having the accident when she was a child has made her the person, wife, and mother she is today. Coping with such a traumatic event is easier for young people, she says. Because the accident happened at such a young age, Patel says she doesn't remember how it was to walk with "two regular legs, or even to have toes on my [left] foot." "How I walk now is all I know," she says. Growing up, Patel says she wanted to be treated like any other child. "I didn't want special treatment or to be the center of attention. My parents made me accountable for my chores. I began mowing the lawn around age 13-my artificial leg wasn't an excuse not to do this- and any other responsibilities my brothers had," she says. Patel's experiences as a child will have an influence on how she will raise her daughter and future children, she says. "I am grateful to my parents for their push to make sure my leg wasn't holding me back from everyday life," Patel says. "My husband and I want to raise our children this way, too. If our kids are fully capable, they will be held accountable for their everyday responsibilities. Even while I was teaching, I found it important that children don't make excuses for not getting work done. Children are extremely resilient. If they go through a traumatic experience, they can bounce back and continue their lives just like anyone else." Both the prosthetist and his longtime client agree that family also played an important role in Patel's recovery. "Megan's parents were very forward-looking, positive, and optimistic. Megan has shared those traits and has always utilized any technology I could offer," Jolly says. "Even on the most difficult days, I've never known her to spend time with self-pity. It's her attitude and family support that made an unbearable situation tolerable. She was a very courageous child, young lady, and now a young mother." Betta Ferrendelli is a freelance writer based in Denver.

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Megan Patel: An Enduring Friendship

Prosthetist and Client Began Working Together Two Decades Ago

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Aspects of Gait: Part II

From the Patient’s Point of View

Nine Researchers Cited by Medicare Say That Proposed Cutback on Prosthetic Care Not Based on Science

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