Tuesday, September 19, 2006

Woman’s prosthetic leg shows spirit


Special to The Advocate Published: Sep 18, 2006

Advocate staff photo by Bryan Tuck

Kelly White gets lovingly attacked by her dogs recently on the front porch of her New Iberia home. White has not allowed her prosthetic leg to curtail everyday life’s chores, and says she someday hopes to begin a support group for those who have recently lost a limb. Left: White shows off her prosthetic leg, airbrushed with her and her husband’s nicknames.

NEW IBERIA -- Although most prosthetics are shades of tan or resemble a metallic extension, White’s left leg looks more like a vacation postcard, with dolphins suspended in a blue ocean.
White said she often receives questions and comments about her colorful leg, and she does not mind the curiosity.
She said she is proud of her leg and wants others with prosthetics to feel the same way.
“It doesn’t bother me to stand out,” said White.
White has had a prosthetic leg since an accident in 1995. While visiting Huntsville, Ala., she witnessed a car accident. A volunteer firefighter, White stopped her car and tried to help.
But while standing in front of one of the cars involved in the crash, another vehicle rammed it from behind and slammed into her left side. It was several days before she regained consciousness.
Doctors in Alabama tried for weeks to save her leg, but infection set in and White told the doctors to “go ahead and cut it off” just below the left knee.
Since then, White has learned to walk again, without a cane or crutch.
Last year White needed another leg, but she decided she wanted something that would stand out, especially when she wore shorts.
“I don’t like to wear long pants. I’m almost always in shorts,” she said.
She found a T-shirt with dolphins swimming in a deep cerulean blue airbrushed sea, and the technicians at Hangar Prosthetics & Orthotics in Lafayette laminated the shirt to her prosthetic leg.
She also had “TJ & Stumpy” written on it, for her husband and his nickname for her.
White’s two children and three step children accepted the loss of her leg early and helped her become comfortable with using her prosthesis.
She said they are even comfortable with their mother showing off her blue leg.
“That’s what kind of helped me through it all, knowing that they didn’t care (she has a prosthetic),” White said.
The 44-year-old White also gave thanks to her mother, Shirley McLean, and her brothers, Mark and Cleo McLean.
“Their support and being there for me when I fell was a big help. They literally helped me with the ups and downs that I had to go through,” White said.
She added that her late father, Bennie McLean, who died in 1990, had taught her from an early age to do for herself and not to depend on others.
She said she hopes her colorful leg inspires other amputees not to be ashamed of their prosthetics.
“I hope people see it and say ‘Why cover it?’ Don’t be ashamed of it, because you’re walking,” White said, adding that, apparently, people are getting the message.
White also has two other legs. One she wears at home that has a flat foot, and her “spare” that, like the decorated leg, has an arched foot. It is not decorated and is more naturally colored.
White said the prosthetic legs have a silicone sleeve with a pin that helps secure them to the leg stump.
John Harris, a prosthetic technician for Hangar, said that more people, especially those in the 20- to 40-year-old age range, are deciding to personalize their prosthetics, which can be made and adjusted in the office.
He credits the trend to popular television shows, like those on the Discovery Channel, that feature amputees and athletes being fitted for new, specialized prosthetics.
Wounded war veterans returning from Iraq are also gaining media attention for people fitted with prosthetic limbs.
“A lot of the stigma about prosthetics is lost,” said Harris. “The public is more informed.”
Black limbs decorated with red and orange flames seem to be one of the more popular styles, Harris said.
However, he has also seen a ranch brand on a leg, various patriotic themes and even one leg with a picture of an Indian on the side. He said that a technician can use “almost anything” or apply any color in the final layer of the prosthetic’s casing.
White said she does not believe decorated prosthetics will ever be a hit with older patients but that younger ones might show interest in them, because they can be personalized to be stylish or to show off the wearer’s individual personality.
She said she has seen the popular flames design and has heard of a man who used an iron-on T-shirt transfer to place a vintage-looking patriotic eagle on his leg.
Harris said he arranges for White to meet and mentor new amputees in the Acadiana area because of her energetic lifestyle and personality.
White, a Franklin native and 1980 graduate of Franklin High School, is still a volunteer firefighter and also takes calls for Acadian Ambulance.
“I’m always doing something,” said White. “I haven’t figured out how to relax.”
Story originally published in The Advocate

Monday, September 18, 2006

Goff: Launch of the 2006 Landmine Monitor Report

Thursday, 14 September 2006, 9:04 am
Speech: New Zealand Government
Launch of the 2006 Landmine Monitor Report

Disarmament Minister Phil Goff paid tribute to the work of those dedicated to the eradication of landmines at the launch in Wellington tonight of the 2006 Landmine Monitor Report, produced by the Campaign Against Landmines. Mr Goff spoke of the scope and nature of the problem of unexploded landmines and detailed the New Zealand contribution to the fight against all unexploded munitions.


I am pleased to be here to launch this year’s edition of the Landmine Monitor.

This is the eighth edition of the report, which monitors the global ban on landmines, and tracks whether countries are implementing and complying with the Ottawa Convention.

It is a significant undertaking. A network of 71 researchers from 62 countries gathered information to produce this year’s version.

It is a valuable effort by civil society to hold governments accountable to their obligations under the Ottawa Convention. This is critical if we are to eliminate landmines and reduce, and end, the awful impact these weapons continue to have on civilian populations in many parts of the world.

Landmines are weapons that do not discriminate between soldiers and civilians, or adults and children.

We are all aware of the humanitarian consequences arising out of their use including death, amputation of limbs, long-term disability and poverty.

The 2006 Landmine Monitor estimates that there are still an appalling 15,000 to 20,000 new casualties from landmines and explosive remnants of war each year.

The Ottawa Convention

But there is, at least, a positive side.

De-mining progress under the Ottawa Convention has been impressive.

Over 740 square kilometres of land was de-mined by mine action programmes in 2005, more than in any previous year.

State parties to the Convention collectively have destroyed nearly 40 million anti-personnel mines since it came into effect in 1997, and around 700,000 in the last year alone.

The Ottawa Convention is a leading model for how disarmament and humanitarian objectives can be pursued together, and can be achieved through partnerships between states and civil society.

In an otherwise bleak period for the international disarmament agenda, the Convention stands out as one of the few bright lights.

Over 150 States are now party to the Convention, representing around 80% of the world’s nations.

New Zealand has consistently called on the 40 states outside the Ottawa Convention to join this treaty.

The Asia-Pacific could be doing better in this regard. Asia stands out as one of the most mine-affected regions in the world. Yet it also has one of the lowest rates of accession to the Convention.

In the Pacific, I am pleased to learn that the Cook Islands ratified the Convention in March of this year though we are still encouraging others of our neighbours to do so.

New Zealand Position

New Zealand ratified the Ottawa Convention in 1999 and is a strong supporter of the Ottawa process.

New Zealand’s main contribution to global mine action has been through assistance from NZAID, to mine clearance operations as well as the UN’s Mine Action Service (UNMAS).

Mine action assistance is an integral component in peacekeeping and peace building, if long-term sustainable development is to be achieved.

De-mining reduces the loss of life and limb and opens up land for economic production.

New Zealand has a strong reputation for its expertise in de-mining.

Through the work of our mine clearance experts, we have helped mine-affected communities re-build and restore their local economies.

We have supported mine clearance operations in Afghanistan, Cambodia, Iraq, and Mozambique through the provision of technical personnel.

Some 117 New Zealand Defence Force personnel, for example, were involved in mine clearing support in Cambodia.

New Zealand has also provided funding support for non-government organisations involved in mine clearance and mine awareness programmes in Cambodia, Laos and Sri Lanka.

Last year, for example, we gave over NZ$340,000 to the Cambodian Trust School of Prosthetics and Orthotics, to train people to make and fit artificial limbs for mine victims.

Our annual contribution to mine clearance and related development activity in 2005/2006 was NZ$1.3 million, down on the previous year as a number of de-mining operations came to an end.

However, NZAID will increase New Zealand’s funding to the UN Mine Action Service to $500,000 per annum from January 2007.

The New Zealand Defence Force contributes an officer to the UN Mine Action Service based in New York. Another officer is serving as an Instructor to the US Department of Defense Humanitarian De-mining Training Centre.

Our New York-based officer is currently serving in Beirut, coordinating action to clear landmines and explosive materials. This is critical for the prevention of further loss of human life and for facilitating delivery of humanitarian aid in Southern Lebanon.

Most of you will be aware of the serious humanitarian created by the use of cluster munitions in Lebanon.

One hundred thousand cluster bomblets are estimated to be lying on the ground in Lebanon. These need to be cleared before people can safely return to normal life.

We are currently considering what further assistance the New Zealand Defence Force can provide in this area.

New Zealand is also taking the lead, in concert with like-minded countries such as Norway, Sweden, Belgium, Austria, Switzerland, Denmark, Ireland, Mexico and Jordan, in calling for strong and legally binding controls on the design and use of cluster munitions.

I would like to acknowledge the work of CALM in raising awareness of this issue.

Looking to the Future

The next few years are going to be particularly challenging for the international mine ban agenda. Mine-affected States Parties will be approaching their ten-year deadline for the destruction of anti-personnel mines in mined areas, as required under Article 5 of the Convention, and a number will not meet their deadline.

Despite all the good work done, vast amounts of land remain to be cleared.

We are urging mine-affected States to put in place comprehensive and realistic plans, continue to train de-miners and to make use of all available resources.


There is now largely an established international norm against the use of landmines, even amongst those states that have not formally subscribed to the Convention.

Since the Convention came into force, major strides have been made in clearing mined areas, destroying stockpiled mines, reducing the number of new victims and assisting more victims.

We are inching closer to creating a world free of anti-personnel mines.

But there is still much more work to do. The information provided by the Landmine Monitor provides both a sobering reminder of this, and an important gauge, and record, of the progress made so far.

In closing, I would like to pay tribute to the International Campaign to Ban Landmines, the International Committee of the Red Cross and New Zealand’s Campaign Against Landmines.

Their, and your, work has already helped strengthen the Ottawa Convention. Their dedication to projects such as Landmine Monitor will ensure that the profile of the landmine issue remains at the forefront of political and public consciousness, and it will play a central role in moving to the ultimate goal of a mine-free world.


Device to ease pain of amputees

MSU biologist plans "smart" mechanism to release medicine around prosthetic limb.

Kathleen O'Dell

Hundreds of men and women have returned home from service in the Iraq war with one or more limbs amputated — often the victims of roadside bombs.

Many heal and resume active lives with the help of high-tech prosthetic limbs.

But often the pain and suffering doesn't end there, said Paul Durham, a cell biologist at Missouri State University. Amputees are at a high risk of inflammation and infection around the amputation site, made worse by pressure and abrasion from using a prosthetic arm or leg, he said. Skin tends to rip around the scar tissue.

"A lot of them end up with sore stumps," said Durham, who believes there's a way to relieve their pain.

Durham's dream — and one he hopes to fulfill through MSU's role in the Jordan Valley Innovation Center: Develop a controlled-release mechanism for medicine embedded in the lining material of a prosthetic limb that can help block infection, promote healing and inhibit inflammation for the wearers.

"It's a 'smart' device," Durham said. "Long term, we'll have 'smart bandages' that can sense inflammation and release (healing) chemicals to the actual site."

He will work in the JVIC with partners from Crosslink, a Fenton polymer manufacturer.

"We bring the biology side and they bring the engineering-technical side," Durham said. "We'll tell them how much (medicine) to put in and if it's working and on what organism it's working on.

St. John's surgeons who treat amputees will collaborate by evaluating whether the materials and devices work in real life.

Tom Quesenberry, practice manager of Hanger Prosthetics & Orthotics, looks forward to the smart devices for his clients. But he doubts health-care providers will embrace them unless private and government insurers begin reimbursing for these expensive products.

Ken Rutherford, MSU associate professor of political science, had frequent infections on the leg that was traumatically amputated when his vehicle hit a land mine in Somalia in 1993. The left leg, which had to be surgically amputated later, never got infected.

"I can see where that's extremely advantageous for someone prone to a lot of infections ... with that constant release of medicines into the stump," Rutherford said.

Durham anticipates having a product within two years. After tests on bigger prototypes, it's on to the federal approval process before production for widespread medical use.

"My long-term thinking is it will help the private sector, too," Durham said. "If it works for soldiers, it will help people with diabetes and other diseases."

Friday, September 08, 2006

'Smark knee' Jack "Miles" Ventimiglia, Editor September 07, 2006

U.S. Army Ranger Bill Dunham, 38, Rogers, Ark., lost his right leg above the knee as a result of participating in the Dec. 20, 1989, invasion of Panama that ousted Manuel Noriega.

"I was on the spearhead of the invasion and we jumped in at about 500 feet," Dunham said. "After about six hours we were in a defensive position, getting ready to move to some buildings. My squad leader saw some troops move from one building to the next and we started to engage them."

During the daybreak engagement at Rio Hato airfield, Dunham said, his squad leader called for helicopter gun support. Had the fight occurred at night, the helicopter team would have noticed the Rangers' reflective clothing, but with the sun rendering the "glint tape" useless, the 'copter opened up mistakenly on Dunham's team.

Friendly fire claimed two men's lives and wounded two others in addition to destroying Dunham's right leg to the point that he agreed, after an eight-day struggle, to an above-knee amputation.

"The doctors worked real hard to try to save it," he said.

Dunham retired as a sergeant and now, with a master's degree in defense and strategic studies, teaches college students about terrorism and security issues. Most recently, he has been speaking about a medical advancement in the area of bionic prostheses to doctors, physical therapists and insurers, including Aug. 23 at Hanger Prosthetics and Orthotics, 6600 College Blvd., Overland Park, and at Hyatt Regency Crown Center, Kansas City, Mo.

Dunham talks to medical professionals about his "smart knee." He explained the idea, saying that several years after learning how to deal with losing his right leg, he heard from prosthetic experts about a hush-hush, intriguing medical innovation.

"It was top secret. Nobody even really knew it was out there," he said. "They came to me and told me about it, and I was fortunate they chose me to be the person to launch this technology for them."

Popular Science referred to the new bionic technology - called Power Knee, created by Ossur of Reykjavik, Iceland - as the first "prosthesis with a brain." Power Knee is a bionic leg that employs artificial intelligence to communicate with an amputee's working leg, and also is the first artificial leg to replace lost muscle activity with internal motors.

Unlike Lee Majors from the 1974 "Six Million Dollar Man" TV series, Dunham discussed bionic technology without the required "suspension of disbelief" that comes with sci-fi. The robotics- and computer-driven device is an everyday part of Dunham's life.

Dunham, the world's first and only person to use the production model, said Power Knee works using a recording device planted in his left shoe. The device captures information about how his left leg works, then sends directions to imitate the behavior to the bionic knee on his right side.

"It takes that information when I take a step and transmits that via Bluetooth (wireless) technology over to the prosthesis. The prosthesis has a computer built in, and gears, and processes the information from the sound side - actually tells the motors what to do based on what happened on the other side," Dunham said. "They communicate back and forth, so the leg actually walks with me as opposed to me kind of dragging the leg behind."

During his first 16 years as an amputee, Dunham said, he could not walk step-over-step upstairs. Instead, he used the step-and-drag walking system that is familiar to anyone who has had an injured leg and has tried to climb stairs on crutches.

"You'd come to a stair, you'd take a step up with your sound side, and then you'd drag the prosthetic device behind you up to the same step," he said.

The bionic knee does not require Dunham to drag his right leg.

"With this device, when I take a step up on the sound side, the prosthesis reads that and then it actually causes the knee to bend," he said. "I place the foot where it needs to go and when I put pressure on it, it knows it's in the right place and it actually powers me up, over the next steps."

Robotic gears give the knee power to lift, Dunham said.

"You can hear the gears working," he said. "Being able to lift somebody who weighs 200 pounds up and over a step, and to mimic the movement on the sound side is very, very advanced. No other prosthetic device has ever been able to do that."

One drawback is that, unlike "the bionic man" with an almost all-bionic body, the real bionic device is based on reality and works only for people missing a single leg.

"If you're missing both legs you can't wear this type of prosthetic device because it takes one sound side to cause the prosthetic side to work," Dunham said.

For those who can use the device, he said, nothing else on the market comes closer to acting like an organic leg.

"It's the most fluid for me. It feels the most natural because it's actually walking with you," Dunham said. "I'll never say it's the same thing, but it's got a very nice gait, the way the leg walks with you. It feels very good. It's some pretty phenomenal technology."

©The Johnson County Sun 2006

The New Wartime Body by Izzy "Socket" Klatzker, Clamor

When amputee vets return from Iraq, they may get the latest technology available for replacement limbs, but they rarely get the job training or physical and emotional support they need to rejoin civilian life.

What happens when one's body becomes the war zone, the setting for patriotic pride, and the argument for technological advances that alter scientific and economic landscapes? It often means returning with a different sense of self and relationship to one's body for U.S. soldiers back from Iraq. Re-entry varies from the conceptual to the physical, and amputee veterans are returning from the Iraq war faced with transitioning back to civilian life without straightforward support to navigate the military health care system or job opportunities.
The Homecoming
Jody Casey, formerly a 19 Delta Cavalry Scout sniper now organizing with Iraq Vets Against the War (IVAW), set the tone of our conversation, "I wasn't ready for re-entry. I wasn't briefed about anything regarding re-entry. So, on top of dealing with the anger and isolation of being back, I also had to be my own advocate." Casey advocated for work, securing mental and physical health care in a society that does not understand the realities of war. Counseling programs "were pushing all these pills my way without even hearing what I was going through, then they set me up with a counselor who has never known combat."
He faced similar frustrations when looking for employment. "The job on the top of the list was to be a teller at Wal-Mart. No offense to anyone who works there, it's just that I felt unseen, insulted, and under-valued... They trained us only to re-enlist or work for Black Water Security or KBR." [Kellogg, Brown and Root is a former subsidiary of Halliburton] Both are mercenary war-profiteer subcontractor companies currently patrolling, fighting, and "providing security" at a much higher pay rate than U.S. soldiers receive in Iraq. Casey stressed the enormous need for worker retraining programs and a modified GI bill that includes part-time and vocational students. "I only got trained to kill and be a solider."
Casey matter-of-factly shared some ideas about how a worker re-training program could look. He suggested vocational training, something akin to "helmets to hardhats," utilizing an apprenticeship model, but provided by the Army. "Such a program could help you retrain from war on many levels because right now they are unleashing unstable people back into society."
The Body
Sources from Walter Reed Army Medical Center in Washington, D.C., estimate that since the onset of the Iraq invasion and occupation upwards of 400 U.S. soldiers have come back needing amputations and prosthetics (30 percent have multiple amputations). According to icasualties.org, since April 2003, between 18,000 and 20,000 U.S. soldiers' injuries include second- and third-degree burns, bone breaks, shrapnel wounds, brain injuries, paralysis, and eye damage. In addition, 9,744 U.S soldiers wounded in action returned to duty between 2003 and 2004, while 8,239 soldiers did not return to war.
Illustration by Jonathan Allen
"The rocket went through my leg like a knife through butter. It was a terrible scene ... there was just blood and muscle everywhere," Tristan Wyatt, 21, reported in a November 9, 2003, L.A. Times article entitled "Hospital Front." A rocket had cut off his leg and those of the two other soldiers with him four months earlier in Fallujah, a type of injury treated frequently at Walter Reed. Doctors Dennis Clarke and Jim Kaiser both reported (upper extremity) amputations from the elbow down, (lower extremity) above the knee or through the hip resulting from roadside bombs, bullets, and IEDs (Improvised Explosive Devices). Kaiser concluded that "explosion injuries are vicious; they affect multiple body parts; for example, if one gets hit on the right side, part of the right leg, arm, and oftentimes their face gets exploded and pocked-up."
"We were always working with a base of 100 patients at any point in time," began Dennis Clarke, a visiting Orthoist-Prosthetist who specializes with lower extremity amputees. "On any given day, Walter Reed's orthopedic wing has about 50 inpatients and another 180 outpatients," says Jim Kaiser, who spent one week as a guest prosthetist at Walter Reed's Occupational Therapy Department in 2004. Working consistently, with hardly a break for lunch, they made fittings for new prosthetics and adjustments on old ones, and cleanings of amputation sites were constant.
"There was always something to do and someone to see to. We were very, very busy," Kaiser continued. "Some prosthetics we made were arms; most were leg/lower extremity from explosions and many of the same people had multiple amputations." Two factors -- the war's urban setting and quick response time -- have vastly increased the survival rate for the wounded compared to Vietnam. However, since Vietnam, the number of those wounded in action has risen from 3 percent to 6 percent, according to Wendy Y. Lawton in the George Street Journal, December 10, 2004. Dennis Clarke continues, "When one third of your patients have more than one limb missing, the work and stress and attention is different and accelerated."
The Technology
"Vets are provided with a training leg with the most high-tech components (mechanical parts) and myoelectric hands and elbows. Civilians do not get offered such things. These vets motivate research for new technology ... being tested on vets by such companies as Ossur and Otto Bock," remarked Chicago orthoist-prosthetist John Angelico of Scheck and Siress.
In the field of orthotics and prosthetics (O and P), an orthoist specializes in planning, making, and fitting orthopedic braces, and a prosthetist makes artificial body parts (limbs and joints) called prosthetics, prosthetic devices, or singularly, a prosthesis. Hip disarticulation is an amputation through the hip joint removing the entire lower extremity. What was once a rare surgery has become more commonplace in the field since the Iraq war. Myoelectrics utilizes the electrical properties of muscle tissue from which impulses may be amplified, a technology that adapts and compensates for the wearer's natural gait and any irregular terrain, slopes, or steps. The most commonly used device on vets coming from Iraq is the C-Leg, a myoelectric leg developed by the companies Ossur and Otto Bock.
"I was surprised the veterans were receiving [myoelectric technology]. We had to struggle with the VA (Veterans Administration) to authorize knee technology. It took a year to get authorization. And then years later Walter Reed was giving that away to anyone." Jim Kaiser shared his insights on how the army has improved treatment of amputee vets. "Then, a vet could get one knee prosthesis, a carbon flex foot mechanism and a spare prosthesis. Their goal was to make sure a vet has a prosthesis to wear and one spare." While the standards apply today, the technology and care are so vastly different that it seems that the army is more willing to support vets from Iraq than their predecessors from Vietnam. Greater research and development of upper extremity technology has triggered a $4 million grant from the federal government for Dr. Kuiken at the Rehabilitation Institute of Chicago. According to Kaiser, "It was the most money spent on prosthetics since Vietnam."
Dennis Clarke explained that the Department of Defense has created a "dream team" of experts brought in on a contractual basis since early on in the war. The volume and complexity of these injuries make it essential to bring in outside specialists. "Now there are three people permanently on staff at Walter Reed in the Prosthetics Department as well as the additional civilian folks brought in."
When wounded on the battlefield, soldiers are flown to the Landstuhl airbase in Germany. Marines are sent to Bethesda while the Army is sent to Walter Reed, with all surgical procedures performed stateside. Innovations in sanitation, swelling control, and the use of digital cameras and scanners complement the plaster molds taken for every patient needing a prosthesis.
They send the records to Iowa for the Socket Interface, creating a personalized socket or suction system and joining it to the actual prosthetic device. The Socket Interface is done entirely on CADCAM -- computer designed, computer manufactured technology -- in approximately 48 hours with minor adjustments and alignments in person, but largely done on the computer. The success rate is high.
According to Clarke, the rehabilitative process is comprehensive, "Daily therapy of walking on parallel bars, transferring from one position to the next, and ultimately using crutches, to using one crutch, to using a cane. This process can take from 2 weeks to 2 months. Some patients were there eight weeks total, some were there 18 months."
The future may hold a very different series of events, technologically speaking, for U.S. vets needing prosthetic devices. According to Lawton's George Street Journal article, "$7.2 million from the Department of Veterans Affairs was earmarked in 2005 for a team of researchers working to restore natural movement to amputees -- particularly Iraq veterans. Within five years, scientists based at Brown [University] and the Massachusetts Institute of Technology hope to have created 'bio-hybrid' limbs that will use regenerated tissue, lengthened bone, titanium prosthetics and implantable sensors that allow an amputee to use nerves and brain signals to move an arm or leg. Work through the Providence VA Medical Center falls into six research programs."
"The prosthetic industry is moving forward because of war," Dennis Clarke observed. "War is the single driver of technology in our profession. The net effect of these young and vibrant amputees is that they are pressing forward and doing well; that makes us look good. Technology does not lead change. Need leads change, and war is good for business because it necessitates need. One could argue that as earnest an anti-war statement could be made regarding the same issues." When people talk about war being good for business and good for technology, it's important to recognize who ultimately benefits and who pays with their lives. Recruiters are enticing people into war with promises of making money, but soldiers are not coming back wealthy. Soldiers are coming back in body bags or with serious injuries. With their lives and bodies changed, vets come back owing more money in the face of increased medical expenses and often in worse situations than they were in upon leaving.
The Figures
According to Corey Flintoff on the NPR program Day to Day, the cost of the invasion of Iraq could top $2 trillion -- much greater than any Bush administration estimate -- when estimates include long-term costs such as replacing worn out or destroyed military equipment, debt incurred to finance the war, and providing lifetime care for disabled veterans.
The most commonly needed device by Iraq vets is the myoelectric arm that ranges in price from $25,000 to $35,000 (according to Dr. Kaiser). The C-Leg microprocessor knee costs $50,000 with additional costs of components. Expensive technologies, yet these figures fail to consider vets' other healthcare costs such as surgeries, medications, doctor's appointments, and physical therapy.
Insurance programs sponsored by the Veterans Administration include the Service-members Group Life Insurance (SGLI), with the supplements of the Traumatic Service-members Group Life Insurance (TSGLI), Veterans Group Life Insurance (VGLI), Family Service-members Group Life Insurance (FSGLI), and Service Disabled Veterans Insurance (S-DVI). Each consists of its own rules and regulations, claims processes, fiscal calendars, and terms of eligibility. The TSGLI took effect on December 1, 2005, as a new program for service members who suffer from severe trauma: total or partial blindness, total or partial deafness, hand or foot amputation, thumb and index finger amputation, quadriplegia, paraplegia, hemoplegia, third degree or worse burns, traumatic brain injury, and coma. Yet, the myriad regulations dictate that beneficiaries had to file claims with the SGLI prior to December 1 in order to apply for TSGLI.
The Department of Veterans Affairs (VA) benefits booklet is a confusing description of programs, muddling the options available to vets. Examples of the poor wording include terms like "severely disabled" or "otherwise in good health" as requisites for coverage. This represents a bureaucratic nightmare considering that a soldier may need multiple insurances to meet their medical and life expenses. Yet, who judges good health and on what basis? Such are the obstacles encountering returning veterans who frequently are incapacitated, possibly not conscious, and focused elsewhere upon arrival from combat. The booklet makes no mention that vets can get a liaison or advocate to help mediate their medical needs. Taking initiative is vital to accessing any of these benefits.
The rate of injury is steady with no end in sight. Private individuals are pooling resources for research projects and individual vet support projects alike (with others listed at www.fallenheroesfund.org). The Intrepid Project has contributed over $14 million to military families, yet many more families will need help so long as operations in Iraq and Afghanistan continue. Elizabeth Bernstein wrote in "The Gift Shift," a November 25, 2005, Wall Street Journal article, describing that "the president of the Intrepid Fallen Heroes Fund had collected well over half of the $35 million the fund needed to realize its big goal to build a center in Texas where U.S. troops can recover from war wounds and be a research facility for prosthetic protocol technologies."
The high caliber technology provided to Iraq amputee vets has had a side effect on the access to care for non-vet amputees. Jim Kaiser states that "The climate in the sector of health insurance is that of [suppressing] technological costs." According to Kaiser, "Blue Cross considers a C-Leg experimental; the technology has been available in the U.S. for five years and in Europe for nine. The insurance companies use terms like 'situational, experimental and lack of medical necessity' in order to deny people access to technology that is becoming the norm in its field. Myoelectric arm technology is 30-years [old], which insurance companies continue to dismiss as experimental. If one does not have bills covered by the VA, how does one pay to keep up with the expanding field? One possibility is that non-vets just don't get to participate in this new technological landscape unless independently wealthy or have very committed and convincing doctors on their side. Perhaps non-vets may just have to wait for the insurance companies to catch up."
Dennis Clarke elaborated that one hope for The Fallen Heroes Fund facility is to collect enough data to lobby mainstream non-military insurance companies. "It's a fact that the industry has not proven its case yet. We need to prove to the insurance companies what the real benefit of these technologies are, how much better are these than the old ways. Our next step is to change the standard practice of insurance companies." How many more soldiers must demonstrate such necessity in order to raise the bar for all amputees?
The Adjustment
The IVAW website quotes Douglas Barber, later found dead by his own hand, "All is not okay or right for those of us who return home alive and supposedly well. What looks like normalcy and readjustment is only an illusion to be revealed by time and torment. Some soldiers come home missing limbs and other parts of their bodies. Still others will live with permanent scars from horrific events that no one other than those who served will ever understand."
Soldiers face a range of realities upon return. Some re-enter with a broad support network, adequate medical coverage, and stellar care. Others return feeling like absolutely nothing is intact and any possible resources are inaccessible and inadequate. Jim Kaiser stresses, "It is essential to provide constant quality follow-up care [to the veteran] once [he or she is] released from the VA system." However, he worries that what is offered post-release pales and is lacking compared to what is offered immediately post-injury. In his practice of 120 people, 16 percent are disabled. "It is important to hire disabled people in the business of improving prosthetic care and not to shut people out." These needs for support, recognition, and employment may seem obvious to some, but they do not go without saying.
Returning to active duty may seem like the lone option to some vets. Jody Casey had few prospects upon arrival home from Iraq. After being part of the U.S. military industrial complex, staying in can be easier than extricating oneself. "A significant percentage (10-20 percent) of amputee soldiers remains in active duty," Dennis Clarke explains. "With prosthetic technology, one can do more than ever after sustaining these types of injuries and recover faster ... these soldiers are specialists in their field, and it is better to bring back experienced solders with good training and combat experience."
Throughout the VA literature and my conversation with Dennis Clarke, much emphasis was put on remaining in active duty. The push -- after being injured, healing, receiving state of the art medical care -- is to get back in the game. Those soldiers on active duty are rewarded with medical care coverage and accolades. Soldiers who choose not to return have far fewer options. The war practically creates a "super-soldier" archetype with bionic limbs and a taste for combat with vengeance running through them. The focus on active duty inhibits considering alternatives, divesting money and lives from this war. The creation of the invincible wounded warrior serves as propaganda for the war machine.
Jody Casey addressed the concept of support. "They don't want you to know what your rights are ... I had no idea where my local VA was or what my medical coverage was." He discovered that his coverage was "two years of full medical and six months of dental." The IVAW and a veterans' support group are his community now and have become integral to his life. Having served in Iraq, working with IVAW and Vets for Vets has provided Casey with a different viewpoint of what the Iraq war is about -- war profiteering happening at every level. "This is not about liberation" he concludes, "it's about a few people making a lot of money on the back of the poor and now people like me have to pay for it with their whole selves."
Izzy "Socket" Klatzker lives in the hills of Tennessee, tends goats and chickens, enjoys loving, organizing, learning, writing, critiquing, imagining and creating.

Sunday, September 03, 2006

'Strength Over Stroke' by Holly M. Pullano

When Garrett Mendez looks back at the eventful and courageous year he has just lived, he and his friends and family all agree that he is almost exactly the same person as he was almost one year ago. And he is the same fun-loving person, with the same trademark grin, except for a few minor details the fact that he has become a stronger person; both physically and mentally, he has a fresh perspective on the fragility of life and has realized a new mission for the future. All of this may seem like a stretch for a teen just barely out of out high school, but it all becomes clear upon learning of Garrett's "miraculous" recovery after suffering from a rare brain stem stroke at the age of 19. The stroke, which struck the active, healthy teen for no real rhyme or reason, left him completely paralyzed, unable to see or speak, and required him to eat through a feeding tube and breathe through a respirator. And on Sunday, only nine short months later, Garrett, a Trumbull resident and recent graduate of Fairfield's Notre Dame Catholic High School, is hoping to lace up his hockey skates and take to the ice in Sunday's fundraiser for Hockey Fights Cancer. Hockey Fights Cancer is a joint initiative founded in 1998 by the National Hockey League Players' Association and the National Hockey League to raise money and awareness for those battling cancer and other illnesses. "I knew he was going to pull through because he's always been such a strong person," said Garrett's close friend Brittney Kish, with whom he attended high school and now the same college. "He's the same person and I always tell him what an amazing person he is. He always has a smile and a positive attitude." Eileen and Gary Mendez said their son's friends have been a "mainstay" during his illness and recovery. "They treat him just like they used to before the stroke," Eileen said as she sat in the family's kitchen with her husband and son bustling around her. "It's just been normal business." A natural athlete, Garrett had been a four-year varsity hockey and lacrosse player at Notre Dame, and was most recently on a junior hockey team at Western New England College in Springfield, Mass., where he attended college. But that all came to a grinding halt last year on the day after Thanksgiving when he began to complain to his father that he wasn't feeling well after playing in a recent hockey tournament. The following morning Eileen found her son lying unresponsive in his bedroom. "We couldn't wake him up, and my first thought was that maybe he had a stroke," Gary recalled on a recent August afternoon. "I didn't even know what that meant because 19-year-olds don't get strokes. They couldn't find a reason for why it happened, and at first they were not certain he would survive." But this year, the Thanksgiving holiday is certain to have an entirely new meaning to Garrett and his loved ones. Only weeks after the stroke, Garrett began to make "gigantic leaps and bounds" in his recovery process, according to his parents and therapists. After spending three weeks in the intensive care unit of St. Vincent's Medical Center, Garrett was transferred to Gaylord Hospital in Wallingford to undergo rehabilitation. "His cognitive abilities were intact he was aware of everything, but he could not move or express himself," said Eileen, who explained that the particular type of stroke that afflicted Garrett is the "most devastating stroke you can have." But Garrett, who always has been a fighter, fought back once again. In only eight weeks, he proudly walked out of Gaylord with the assistance of a walker. "His therapists would look at me and say 'this is not the same kid,' because every day Garrett would outrun the goals they set for him," Gary said, with a positive light in his eyes. "He's always been an extremely hard worker, and he's never accepted the fact that he can't do something." The family was also quick to pay tribute to Gaylord Hospital, which Gary refers to as "the Rolls Royce of its kind." Eileen explained that every staff member the family encountered there quickly became like a member of the family from the nurses all the way to the maintenance workers. "They told us to just believe in what they could do, and we did," she said. "They were all absolutely amazing, and now they're our family for life." Flash forward to today, where Garrett is able to do almost all of the activities that many take for granted: walk, eat almost anything including his favorite food Cold Stone Creamery ice cream, go to the beach and joke around with his older sister Jen. He is coaching a youth hockey team, and he plans to return to college in January. "He knew all along that he was going to come out of it," Gary said. "You could see his determination and the will all along. It was amazing." But while Gary explained that Garrett's recovery has been well outside the norm, for Garrett, it is "not fast enough." Although Garrett is on the fast track to recovery, his mother explained that his speech remains heavily slurred, which makes it difficult for him to easily communicate with those other than his family and close friends. "Another thing that might bother him is that he's still not able to drive," Eileen said. But similar to all of the other challenges he has met, Garrett is determined to meet these latest goals head on. He regularly attends Gaylord on an outpatient basis to receive different types of rehabilitation, including speech, physical and occupational therapy. He also participates in pool therapy and golf and kayaking clinics that have helped him to regain his strength. "We didn't think he would even walk until November," Gary recalled. "But this is uncharted territory, and in his case, he's making a chart of his own. His thought process all along was, 'I'm going to get better.'" Eileen added that Garrett's team of therapists "kept rewriting his goals" because he would master things very quickly throughout his recovery process. But if his miraculous comeback is not enough, Garrett, who wears a wristband proclaiming "Strength Over Stroke," also explains that he has big plans for the future. "He wants to go into orthotics and prosthetics as a profession and volunteer at Gaylord, because they helped him so much," Eileen said. "He met his goal and was able to walk out of Gaylord, and now he wants to be able to give back by helping others," Eileen said. When the family was asked what the most important lesson they have learned throughout their son's ordeal, they quickly responded that it had brought the family and their entire community closer together. "The most important thing to learn is that tragedy hits us all, but we band together," Gary said. "These things either pull families apart or bring them together." "As bad as you think it is, it could always be worse," Eileen added. "We were lucky in so many ways Garrett has been such an inspiration to so many people, and we have been overwhelmed by the support of his friends," Eileen said. This overwhelming sense of friendship and community is certain to come together on Sunday, where Garrett is hoping skate onto the ice to drop the ceremonial puck for the Hockey Fights Cancer fundraising event. The event, entitled the "Finest/Bravest Hockey Tournament," will take place at the Wonderland of Ice, 123 Glenwood Ave. in Bridgeport over the course of the weekend. Hockey teams from the New Haven, Bridgeport, Stamford, Danbury and Waterbury police departments and the Fairfield, New Haven and Danbury fire departments will compete in a pool play tournament format. The games take place from Thursday to Saturday and will culminate with the "main event" on Sunday. Sunday's festivities will kick off with championship games at 1 and 3 p.m., followed by the all-star game featuring Garrett's Friends All-Stars vs. the Finest/Braves All-Stars at 5 p.m. A fundraiser party including food, drink, silent auction, dunk tank, activities for kids, and live music by the band Remember September will follow the all-star game. Tickets are $10 and children under 10 are free. Tickets are only required for Sunday's event; all other days are free. For those who are unable to attend the event but would like to make a contribution, donations payable to "Bridgeport Police Hockey" can be sent to the following address: Bridgeport Police Department, Attn: Sgt. Granello, 300 Congress St., Bridgeport 06604. For more information about the Finest/Bravest Hockey Tournament, contact 203-913-2783 or visit www.bridgeportpolicehockey.com.