Scott McDowell: Answering the Call

When it's quiet at the Montrose Township Fire Department (MTFD), Michigan, you can find Scott McDowell in the fire hall trying a different footing for handling the hose line or practicing a new approach for climbing into the trucks. He once needed help in pulling his boots on and off his prosthetic feet, but now he uses a heavy-duty shoehorn to do the job himself. McDowell, 39, is a volunteer firefighter with the MTFD and a certified paramedic with Twin Township Ambulance (TTA), New Lothrop, Michigan. He is also a husband and a father, and when he's not busy with the activities of family or vocation, he can be found visiting and providing support to others who have undergone an amputation. When he visits with new amputees in the Flint, Michigan, area, he tells them that despite having bilateral transtibial amputations, he can do most anything that the other firefighters can do—he's just found a different way of doing it. [caption id="" align="alignright" width="491"] Kapa discusses control tips with McDowell for proper placement of the weight line to increase control of the prostheses while walking down uneven, sloped hills. Photographs courtesy of Jackie Bremer, Bremer Prosthetic Design.[/caption] McDowell began his journey toward firefighting and paramedic work after several years of working in waste management. He says he decided to transition to a new career by earning his emergency medical technician (EMT) license and attending the local fire academy. "I knew there was more to life than where I was at," he says, adding, "I felt like I was made [to be an EMT]." He was three-quarters of the way through paramedic school, however, when an infection nearly took his life. Career Interrupted On May 22, 2011, McDowell was trimming trees and burning brush in his yard when he began to feel fatigued. He still went to work that afternoon at TTA, where he was already employed but left early because he was experiencing flu-like symptoms. He also had pain concentrated in his upper thighs, which seemed unusual to him, so his wife of ten years, Jennifer, drove him to the hospital. Physicians there attributed his illness to overexertion and sent him home. The McDowells hadn't even reached their driveway when he says he insisted they turn around and return to the hospital. The nausea, dizziness, and burning sensation in his legs had worsened, but physicians again could find no explanation except that he'd "overdone it" and sent McDowell home, this time with pain medication. Though a smoker, McDowell says he was otherwise very healthy—nothing in his medical history could point to what was happening to him at that time. His condition continued to deteriorate during the next six hours at home, so McDowell returned to the hospital for a third time. He says he was so weak that he had to be pushed through the doors in a wheelchair. Medical staff ran a battery of tests that revealed liver damage and kidney failure, and a spinal tap showed signs of meningitis. By the time an intensive care unit (ICU) team rushed him to the Henry Ford Medical Center, Detroit, Michigan, McDowell was in a state of semi-consciousness. He says he only remembers bits and pieces of that time—being in such intense pain that it hurt to be covered by a sheet, his wife trying to keep him conscious by clapping her hands, and the physician telling him that he would have to drill a hole in his head to relieve the swelling of his brain. Despite the severity of his condition, McDowell survived; he regained full consciousness after five days. During those five days, he dropped 65 pounds off of his normal 185-pound frame. His limbs were so swollen from edema that his legs wept fluid as he tried to sit up for the first time. McDowell spent six weeks at Henry Ford, slowly regaining strength as his body battled the infection. Teams of specialists examined him in waves, he says, never reaching consensus on the mystery illness. McDowell was discharged once he proved that he could walk, albeit not well, to the nurses' station and back. He says he recuperated at home and tried to manage the pain with medication, but his leg inflammation was still steadily increasing. By day 16, he says he was unable to stand up from the couch, so Jennifer took him to the local hospital. This time the physicians had a diagnosis: he had gaseous gangrene in his legs and would need to undergo bilateral transtibial amputations. New "Normal" McDowell says he remembers the feelings of loss he experienced in the early days following the amputations. "It's like losing a parent," McDowell says, who lost his mother to cancer in 2004. "[For me], losing my legs was comparable." Coming to terms with "the new normal," he says he wondered if he would always be wheelchair-bound and not be able to keep up with his daughters or go hiking again. [caption id="" align="alignright" width="376"] Kapa evaluates the alignment and single-limb stance control on initial test sockets specifically designed for water use and scuba diving.[/caption] Two weeks after his discharge from the hospital, McDowell had his first fitting appointment at Bremer Prosthetic Design, Flint, Michigan. Managing practitioner Nathan Kapa, CP, told McDowell they would have him standing that day. Within minutes of the fitting, McDowell was on his two new feet. "It was a life-changing day," McDowell says. "Absolutely unreal." Kapa says that the aftermath of McDowell's illness presented some unique challenges in his prosthetic care. McDowell's residual limbs were ravaged by sepsis and disseminated intravascular coagulation (DIC), and burst vessels that leaked into the tissue had caused scabbing. Persistent swelling, atrophied muscle, and loose skin from rapid weight loss presented additional challenges in the fitting process. McDowell eventually regained the 65 pounds he had lost, which enabled him to reach new goals in his rehabilitation, but the drastic volume fluctuations prompted rapid adjustments. While McDowell was still weak, he and Kapa began with preparatory fittings using a pin suspension system as a simple solution, and then they moved into suction suspension. Once his limb mass finally stabilized, Kapa fitted him with the Ottobock Harmony® P3 elevated vacuum system he uses today. Returning to Duty After McDowell returned to the fire department, he was initially limited to operating the radios. He said he was soon anxious to go back out on calls and thought that since he was driving his car, he should be able to drive the fire trucks. He called the Secretary of State to request an evaluation for emergency driving ability and was cleared to drive for the fire department. To regain the ability to fight fires, though—which he did in December 2012—required additional work. McDowell says that the way he shifted his stance and used his legs to carry heavy weights had changed now that he used prostheses, so he had to learn new techniques to run the apparatus and pumps from outside the truck. While hours of practice at the fire department and physical therapy were essential to his ability to operate firefighting equipment now that he was using prostheses in this activity, additional modifications of the prosthetic components were necessary as well. "We had to make sure that we could offer the best possible suspension for him without compromising range of motion," Kapa says. To achieve that balance, Kapa modified McDowell's custom liners to provide a high degree of preflexion without lowering the trim lines. The liner would no longer bunch up behind his knee during the preflex motion. He also fit McDowell with Freedom Innovations Renegade® feet, which have a low profile and allow him to run. McDowell is still barred from entering a burning building because his prostheses are not officially approved to withstand the intense heat, but the functional improvements have enabled his firefighting activities on the perimeter. Kapa stresses that while advanced technology has been helpful in overcoming McDowell's challenges, "we always focused primarily on the fit of his prostheses, and I think that is something that a lot of times can be overlooked [in patient care]." In addition to his earlier physical therapy, McDowell now spends time at a gym in a nearby physical therapy center working on core strength to maintain his gait and build his hip muscles to bear heavy loads. The physical therapists there have introduced him to creative exercises that address his unique needs. One such exercise requires McDowell to lift a foot to touch the top of a traffic cone and then bring it back down to the floor. Another exercise calls for him to lean forward to touch the cone with his hand while lifting one leg behind him. Because of his amputations, McDowell has found another way to help people—sharing his experience with other amputees. Kapa says he realized that McDowell's positive attitude could be an asset to others like him, so he encouraged McDowell to volunteer for the Flint-area amputee support network. They distribute McDowell's card at local hospitals, and he comes in to visit patients facing limb loss. "It's as much therapy for me as it is for [the patients]," he says. "It really helps put things in perspective as far as how far you've come." He and his family have received support and encouragement from their church, their medical community, and his workplaces, but McDowell says he knows from countless hours at the fire hall and the physical therapy gym that his ability to improve ultimately lies with him. "It's a lonely struggle. Everyone can empathize with you, but only you can do it." With his training, therapy, and device modifications, McDowell now climbs in and out of the ambulance so smoothly that most patients he handles on paramedic calls have no idea that he uses prostheses. And the best part about being a firefighter and a paramedic? "Knowing that you were able to help somebody when they were at their worst point," McDowell says. "Everybody has that time when they need somebody else."

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Scott McDowell: Answering the Call

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Billing and Collections Q&A

Shaping a Transradial Forearm Prosthesis

ABC Announces 2014 Board Transitions

O&P JOBS

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Certified Orthotist — Full-Time or Part-Time, Pediatric Practice

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