Tiffany Moe: Making the Right Moves

For the most part, Tiffany Moe endured childhood more than she enjoyed it. Life seemed to turn in all directions for Moe—except the right one. And then in 2007, her life took a devastatingly hard turn, when, at age 15, she was diagnosed with osteosarcoma. However, the subsequent high-level amputation of her right leg at the hip started a journey that has helped Moe look toward the future for one of the first times in her life. She is now driven by a desire to give others a taste of something she largely missed growing up—affection. Mike Filloon, CP, poses with Tiffany Moe. Photographs by Julie Gesellchen, marketing specialist, Great Plains Rehabilitation Services. "I didn't really feel loved when I was younger," says Moe, who bounced around in a number of foster homes as a child. Today, the 18-year-old recent high-school graduate from Detroit Lakes, Minnesota, has plans to attend a religious college and then enter a life in ministry. "I want to show people who feel like I did that they are loved and needed," she says. Two years ago, wanting to help others was likely the farthest thing from Moe's mind. Around the time Moe turned 16—when other kids her age were getting their driver's licenses and preparing for prom—Moe began chemotherapy. The treatment did not work; the tumor in her hip doubled in size. Her entire leg and part of her pelvis were amputated in 2008. Since then she has endured 15 surgeries and struggled with the pain and depression that followed. Feeling down and mostly out of it, Moe got hooked on OxyContin and, subsequently, fentanyl lollipops. It was a familiar pattern for the teenager, who, by age 14, had already struggled with substance-abuse issues. She blamed herself for the difficulties that confronted her, including the drug use, cancer diagnosis, and amputation. Road to Recovery With help from her foster parents, prosthetists, physical therapists, and what Moe refers to as "higher powers," she worked her way toward recovery. While Moe says she felt like her recovery took forever, her prosthetist, Mike Filloon, CP, Great Plains Health Company, Fargo, North Dakota, has a different perspective. "It was long, hard work, but I don't think she knew how hard she was working," he says. "Tiffany made it look really easy." Following a failed first attempt to use a prosthesis for high-level hip amputees, Moe was fitted in October 2009 with a Helix3D Hip Joint System and a C-Leg® from Otto Bock HealthCare, Minneapolis, Minnesota. "She didn't feel like [her initial setup] encompassed her enough," Filloon says. Moe's hemipelvectomy made for several challenges, both for the prosthetist and patient. Filloon, who notes that Moe is the third such patient with whom he has worked, says her entire hip had been removed except for the left pubis, which can't bear weight or handle pressure. "We just tried to put as much pressure [as possible] on the surrounding tissue," he says. "We wedged in the anterior and posterior and went up as high as possible. We kind of worked around the hip." Filloon says that people with hemipelvectomy similar to Moe's rarely achieve mobility using prostheses, even with technology like the Helix3D and C-Leg. Photograph of the Helix 3D courtesy of Otto Bock HealthCare. The Helix3D was launched in 2008, after more than ten years in development. It is called the "3D" because it mimics pelvic rotation, as opposed to a traditional prosthetic hip joint that has a straight line of progression, according to Andrew Micek, Otto Bock associate market manager. The C-Leg uses a microprocessor that receives feedback from multiple sensors 50 times per second to control the knee's hydraulic function and provide stability and mobility. "The Helix introduced several new concepts that hip joints hadn't offered before," Micek says. "External rotation, polycentric design, and hydraulics directly contribute to more stability. Even a flexion assist, as opposed to extension assist, is unique to what hip joints typically offered before.... There hasn't been a whole lot in terms of new hip joints in 20 years or so. It's overdue. From a practitioner's standpoint, I'd be excited to see something new...." When Moe was first set up with the system, she found it difficult to appreciate the Helix3D and C-Leg, no matter how advanced or helpful the prostheses would eventually prove to be. She was weaning herself off heavy pain meds, and her motivation was low. "I was really tired and mood-swingy," she recalls. At first, she says, she found even standing upright to be a challenge. The struggle to get the $50,000-plus worth of technology didn't cross Moe's mind. "He [Filloon] just showed up with it one day," says Moe, whose state-funded insurance plan helped make it possible to secure the high-end prostheses. "When I first got it, I hated it," she says. "But I became more accepting about what happened to me." To help with the process, Moe attended a three-day training program in the Twin Cities that used a gait system to prevent her from falling while she gained confidence that her new leg would provide support. Adaptation Moe says her leg weighed 18 pounds after it was amputated—the same weight as the three-piece prosthetic system. This helped to keep her well balanced. Still, balance was not the most difficult part of her transition to a prosthesis. "You really have to adapt," she says. "I had to build up a lot of strength and, more than anything, trust that I wasn't going to fall." That's where the gait system helped the most. Its harnesses kept her upright as she developed a mantra for making the Helix and C-Leg work for her. "'Step, swing, step, swing.' I said that over and over and over in my head," Moe recalls. It also helped that two other people with similar amputations rehabbed at the training program with Moe, including one older gentleman who provided her with some unspoken motivation. "Even when I was stressed or worn out, I was thinking that if that old guy can do it, I have to do it," she says. Today, Moe is strong and comfortable enough to walk most anywhere on the Helix3D and C-Leg, sometimes with the help of a cane and oftentimes without. Not too bad for someone who just last year thought she would have to use crutches to get around, possibly for her entire life. Another Unexpected Turn But just when life seemed to be turning in the right direction for Moe, her doctors found another lump, and this time it was located near her left hip. "If you get a phone call from your doctor, you know it's not good," she says. "You want to get a letter, not a phone call." While doctors are keeping a close eye on the situation, Moe says her surgeon believes chances are good that the lump is not cancerous. Moe is handling these challenges as best she can, and those around her have noticed some changes. "When I first met Tiffany, she was pretty depressed and didn't talk much about the future," Filloon says. "That's changed. She's made a lot of right moves." Brady Delander is a freelance writer based in Denver, Colorado.

Tiffany Moe: Making the Right Moves

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