O&P Practice Adds Social Worker: Clinician Helps Patients and Practice Navigate Challenging Processes

In 2002, Anthony "Tony" Walker had an intense pain in his right leg. He thought he might have injured it while working his construction job. When the pain persisted for a few days, he took his wife's advice and visited a physician. "That's a tumor," he remembers the physician telling him. Walker was 32 years old at the time, and that was the last thing he expected to hear. "It never popped into my mind," he says. Walker was diagnosed with osteosarcoma, an aggressive, deadly cancer that occurs more often in teenage boys and is rare for someone his age. He spent the next three years undergoing many unsuccessful reconstructive surgeries trying to save his leg. Finally he reached a point where the pain had become unbearable, and he grew tired of walking with crutches. "They told me I'd be walking without crutches after nine or ten months," Walker says. "Three years later, I was still using them. I didn't want to have to do this anymore so I made the decision to have [my leg] amputated." Walker says he remembers his physician telling him no, because "it's so final," and he wanted Walker to take more time to think about his decision. Walker, however, knew what he wanted. "I'm the one who asked for it," he says. Before Walker had the transfemoral amputation procedure done in 2005, he was able to research what his life would be like without his right leg. His wife was a physical therapist, so he spent time talking to some of her clients. Walker says his primary focus was to continue to be as independent as he had always been before he was diagnosed with cancer. During his research, however, Walker did not spend much time studying specifics about prostheses. "I was more concerned about making sure I could get around and being ambulatory," says Walker, who had two small children at the time. Help from a Social Worker Walker says he knows he made the right decision regarding amputation. Looking back with the perspective of years past, however, he says he believes he would have benefitted greatly from the assistance of a social worker-a trained professional to help him navigate the arduous, life-altering path of undergoing amputation, and to lend a knowing, caring hand on the long psychological road to recovery. "A social worker would have been helpful," says Walker, who spends his professional days now as a comedian. "It would have been a good time to have someone like that help me when I was first going through everything. It would have made the transition a lot easier. In the beginning, it was pretty rough because I felt like I didn't know anything." Walker says having a social worker as he prepared for his pre- and post-amputation life may have also helped him when it came to addressing issues such as insurance matters, the prosthetic fitting process, and concerns about his prosthetist. "You learn quickly that one size does not fit all," Walker says. "And my prosthetist at the time thought once he fitted me, his job was done. He'd get mad at me whenever I had an issue. You really come to learn that this whole thing is a journey, not just a destination." A New Era Begins Progressive Orthotics & Prosthetics, Albertson, New York, owners and founders Sal Martella, CPO, and Dan Bastian, CP, met in the mid-1990s while working for another company. They soon discovered they shared many things in common, including similar views when it came to caring for and helping their patients. Both men agreed that was lacking at the O&P practice where they were working. Bastian, 49, who also had osteosarcoma as a teen and underwent a transfemoral amputation in 1989, remembers telling Martella, "This is crazy. Either we buy his place or we open our own." The owner, however, didn't want to sell, so Bastian and Martella opened Progressive O&P, which marks its 15-year anniversary this month. Since its inception, the practice has grown to include two additional practitioners and, after much consideration, Martella and Bastian, president and vice president respectively, added another dimension to their practice in April: They hired a licensed clinical social worker, one of the first to work solely with an O&P practice in the Long Island, New York, area, according to Martella. Melissa Antonucci, LCSW-R, with 18 years of experience in the field, joined the practice-the "R" designation means she has psychotherapy privileges. It was a decision the owners considered carefully-given that the O&P profession is facing a more difficult time addressing a plethora of insurance queries as well as Recovery Audit Contractor (RAC) audits, and many O&P businesses are closing their doors because of the related financial burdens. [caption id="" align="alignright" width="300"] Martella works to mold a transfemoral socket for one of his patients.[/caption] "We wanted to bring someone like Melissa on board and knew it would be another salary for us to consider," says Martella. Bastian agrees. "We were leery about it in the beginning because of the potential implications to our business." Adding more staff doesn't come without risk, the owners agree. A Perfect Fit Martella knew Antonucci from the North Shore/Long Island Jewish Health System, where she worked as a social worker and where Martella still goes regularly to help his patients as they prepare for the next steps after amputation surgery. Martella and Bastian both say they knew Antonucci would be a perfect fit for their facility given her background in psychology and social work. Antonucci is an extension of Progressive O&P's philosophy toward its patients and practice, the owners say. "She had the right skillset," Martella says. "We felt her addition would be well worth it. She completes the team." Bastian adds, "Melissa lives by the code that her job is to carry the weight of the crisis for the people she helps." [caption id="" align="alignright" width="250"] Martella modifies a transfemoral positive model for one of his patients.[/caption] Antonucci's extensive experience allows her to help clients and act as their advocate, Martella and Bastian say. She provides clients with support that extends beyond their orthotics and prosthetics: She helps them excel in life after their injury or limb loss, the owners say, including assisting Progressive O&P's patients who exhibit frustration when being fit with prosthetic legs. She also aids the patient in dealing with the insurance process- working to ensure the carrier will cover the most appropriate device for the patient. She acts as the patient's voice, Martella and Bastian agree. When the insurance policy won't cover an expense, Martella and Bastian say they and Antonucci work as a team to decide what the next best step will be for that patient. Antonucci says she understands completely the pressures and stress a patient such as Walker could feel as he considered amputation and tried to regain a normal and productive life. "Relearning is very scary," Antonucci says. "Patients come here thinking they can't do it, but we help them find the strength within themselves to get on with their lives, and eventually they are stronger for it." Antonucci says she is prepared to assist the gamut of patients who come to Progressive O&P for care. "It could be anyone," she says. "A new amputee, or someone who has been an amputee for years and is going to be trying a new prosthesis." Antonucci says she also hopes to instill in her patients that it's normal to have bouts of depression, disappointment, or frustration during all phases of their care. "These feelings are okay because they are a part of everyday life," she says. "Who feels 100 percent okay all the time? That's not realistic." Antonucci also benefits the practice by assisting Progressive O&P with completing insurance claims, which, until she started, was gobbling up a great deal of Martella and Bastian's time-a role they say benefits patient care in freeing up the practitioners' time for patients. "With insurance companies requiring so much more information, the time constraints from that were literally crippling us with our patient care," Martella says. Antonucci says she recognizes insurance companies are more concerned with the bottom line than the patient focus. "We're a business too, but we're all about our patients," she says. Betta Ferrendelli is a freelance writer based in Denver, Colorado.

O&P Practice Adds Social Worker: Clinician Helps Patients and Practice Navigate Challenging Processes

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High Heels a Snap with New Prosthetic Foot

UMich Seeking Volunteers for Upper-Limb Prosthetics Survey

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