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"These younger vets want to get back to work, get back to sports," said Reema Malhotra, physician and director of the Elsmere Veterans Affairs Medical Center amputee program, which has begun shifting its geriatric focus in anticipation of caring for Iraq and Afghanistan vets. It hasn't treated any yet. Ironically, war -- the cause of so many amputations -- has historically accelerated improvements in prosthetics, with the military leading the way in research, sparing no expense. Last year alone, the Department of Veterans Affairs spent almost $50 million on artificial arms and legs for the 8,400 vets who needed them. "If there's one good thing that comes out of this war, there's going to be a huge advancement in prosthetic componentry," said Frank Austin, a physical therapist at Christiana Care Rehabilitation Services and Therapy. The latest limbs are "actually powered up, moving toward the bionic stage," Austin said. "That's exciting for my generation, who grew up watching the 'Six-Million Dollar Man.' " But the high-tech limbs aren't practical for many amputees, regardless of their age. And all the bionics in the world don't make it easier to lose a limb. Giving up is not the answer Kislow was 19 and still growing when he got shot in the right heel, right arm, head, back and side during fierce fighting in Paktika Province. A sergeant in his unit, Victor Cervantes, saved his life, shooting the insurgent who had shot Kislow. A second insurgent shot and killed Cervantes. Kislow then shot the second insurgent, using his left hand.Cervantes' name is tattooed on Kislow's right arm, as is the name of his Army unit -- 82nd Airborne -- above a skull with wings. When Kislow awoke from surgery with his right leg gone below the knee, he was angry, then defiant. "If you lay in bed and feel like you wish you would have died, you're going to die," he said. "If you say, 'I want to go out there and kick more ass,' you're going to go out there and kick more ass." Eugene Smallwood felt a little less gung-ho. He watched his foot turn purple a few years ago and knew it couldn't be saved. Later, after his stump became infected, surgeons took off his lower, then upper, leg.
"I got more depressed when they went above the knee than below the knee. ... I still get depressed. That's just part of life, I guess." Members of the Amputee Support Group of Delaware try to help people like Kislow and Smallwood adjust. Regardless of how it happens or at what age, losing a limb has the potential to destroy a life, said Rick Hofmann, who survived Vietnam but lost his leg in a motorcycle accident in North Carolina. "The emotional aspect of it is rarely talked about," said Hofmann, who is certified by the Amputee Coalition of America as a "peer group member" and visits with new amputees to offer support. Not everyone is able to adjust. Last spring, one man committed suicide. "Who knows what pressures build up and from which direction?" said Hofmann, who wishes information about the support group was more readily distributed by area health professionals. "You never know what is in a person's soul. ... But the peer group can act as a safety valve. If you're having a panic attack at 3 in the morning, you can pick up the phone and talk to someone who's been where you are." Hofmann didn't waste much time learning how to adapt to his "abbreviated" condition. "You start where you stand," Hofmann said. "Yeah, it's inconvenient as hell, and it sucks, but what's next?" Earlier this month in Horne's office, Smallwood stood with a walker to try a prosthesis for the first time. He hadn't walked in almost a year. "Just take your time," said Horne, who opened Independence Prosthetics and Orthotics in Newark last September. Now 33, he lost his right leg below the knee after he had bone cancer when he was 15. Last year, he ran Newark's Main Street Mile, using a special prosthesis designed to withstand the impact of running, Anxious and unsteady, Smallwood struggled to push his hip forward so the artificial knee wouldn't buckle. But he was stiff and uncoordinated after sitting in a wheelchair for almost a year. Horne made adjustments to the hydraulic joint, using a tool similar to one used for bicycle repairs.
"Can you just let your pelvis kind of roll forward?" Horne asked, crouching at Smallwood's feet to observe. "Let your weight come through. ... You feel like you're really putting weight through?" "Oh, yeah. I feel it on that bone." "Where do you feel it on the bone? In the front?" Winded, Smallwood blew out his breath. "How you doing?" Horne asked. "Doing good," Smallwood said, stopping to rest. "Do you see where the potential is here?" "Oh, yes." It will probably take Smallwood about six months to get comfortable with the new limb, as Horne continues to adjust it to accommodate for swelling in the stump. The VA, which provides all the latest and most expensive technology for veteran amputees, picks up the $19,000 tab. Gone are wooden, 'medieval' ways It wasn't always so.During the Civil War, when an estimated 30,000 amputations occurred on the Union side alone, the government provided primitive wooden socket limbs that cost about $100. Kislow researched the history of prosthetics during his two-year convalescence at Walter Reed. "These dudes were coming back, their legs blown off by cannon balls," he said. "I really don't understand how they did it. ... Back then, all they did was carve a piece of wood. It was uncomfortable, and most people chose not to wear them. They rode around in makeshift chairs or wheelbarrows. Their sons pushed them around in wheelbarrows." During World War II, thousands of vets stood in long lines to receive poorly made prosthetics, prompting Congress and President Harry Truman to reorganize what one general called a "medieval" VA system, according to a February 2008 Naval Institute report on the history of prosthetics in the VA. By the end of the Vietnam War, some prosthetics were controlled by electronics. But until a little more than a decade ago, most prosthetics remained fairly rudimentary, said Christiana's Austin, who has attended conferences to learn how to work with younger war amputees. "When I got out of school 15 years ago, an artificial leg was literally a piece of plastic on a metal pipe, with a hinge joint like a door," Austin said. "Almost like a pirate on a wooden leg." Though advances in the field have been dramatic, most amputees don't qualify for the high-tech artificial limbs, which require candidates who are already very active and function well with an ordinary prosthesis. Smallwood, who hopes to one day return to work at an auto shop, won't be ready to rock-climb with a prosthetic any time soon. "I know I'm going to be restricted somewhat," he said. "But I'd like to be able to go to the store without somebody coming with me to make sure I get into the handicapped cart. ... I'd like to be able to go fishing again." Other candidates for the latest prosthetic technology can't afford it. The Proprio foot, which some refer to as "bionic," costs about $15,000 and isn't covered by most private insurance policies. Others -- veterans who qualify for the technology and can count on the government to pay for it -- think the mechanical limbs are more trouble than they're worth. "The computer technology is not for everyone," said Stephanie Beaman, a physical therapist at Elsmere's VA medical center. "They have to be tech-savvy to use computerized limbs. ... They have to remember to charge their leg."
"He's so active, he would probably break it," said Horne, who tried the bionic foot himself, but broke it after just a week. "That's the problem with the new technology -- it's great that it's out there, but it's not entirely functional. He would break it. Definitely." At home in Bethlehem, Pa., Kislow's friends call him "Tin Man" because one time he blew out a valve on his artificial leg, causing it to creak and hiss while he walked. As he left Horne's office, Kislow offered to do a "burnout" on his 2008 Super Glide Screamin' Eagle, which he started riding a few months ago. Yes, he brakes with his artificial right foot. "I can't do it exactly the way I used to do it anymore, so I find 10 other ways to do it," he said. "It's amazing how the human mind works, how you can see tunnel vision, but then that tunnel's gone, you can see a bigger picture ... " Reluctantly skipping the burnout, Kislow hopped on his bike and roared off, without a helmet, toward home. Amputee Support Group of Delaware More Amputee Resources  31 Meadowood Drive Newark, Delaware 19711 |
