Thursday, May 24, 2007

Crafting new limbs to help improve lives

Carlo Lira brings many skills to bear as a prosthetist-orthotist

By Mark Coleman

Carlo Lira took advantage of a family connection to make his move from California to Hawaii, where he has been a prosthetist-orthotist at Honolulu Orthopedic Supply for the past eight years.
Lira said his father, Vincent, who was in the business for 45 years, became friends with Honolulu Orthopedic owner Rodney Pang when the latter was in residency in Los Angeles.

"I was just a kid back then," Lira said, "but we kept in mind that I would be offered a job in Hawaii if I ever pursued the business, and, of course, I did."

Lira's education includes Mark Keppel High School in Alhambra, Calif.; an associate of arts degree in prosthetics and orthotics at Cerritos Community College; a bachelor's degree in health-care management and human resources from California State University, Dominguez Hills; and certificates in the field from institutions such as UCLA and UC Riverside.

Prior to moving to Hawaii, Lira was working at Sunny Hills Orthopedic Services Inc., in Fullerton, Calif. He also has worked at UCLA, Loma Linda Center and a VA medical center in Los Angeles.

Lira moved to Hawaii, he said, because, " I really just wanted to get out of the rat race and find a slower, nicer environment for myself and my children. And I think I have."

Lira, 48, and his wife, Yolanda, have a son, 22, and a daughter, 19, and live in Mililani.

Lira's employer, Honolulu Orthopedic Supply, currently is located in Kapalama, but next month is moving to the Kakaako area.

Question: Do you have a job title?
Answer: Yeah. I'm a certified prosthetist-orthotist.

Q: What does it mean to be a prosthetist?

A: To be a prosthetist is, we do the replacement of a lost limb through artificial means. So we're basically doing prosthetic arms and legs.

Q: And what does an orthotist do?

A: An orthotist basically will fit and manufacture any type of orthopedic brace for the body.

Q: Like neck braces and such?

A: Back braces, foot braces, arm braces -- anything for the extremities and torso.

So they're both a little different (prosthetics and orthotics). Some of my colleagues are certified in both, but my boss (Rodney Pang) and myself have to be certified in both.

Q: Certified by whom?

A: Certified by a national board on the mainland called the American Board of Certification in Orthotics and Prosthetics.

Q: How long have you been certified like that?

A: I'm currently 48, but I got certified as a prosthetist when I was around 30, and I got certified in orthotics when I was around 35.

Q: Do you have a workshop where you build these artificial limbs and braces?

A: Yes.

Q: What kinds of tools and materials do you need?

A: We have some basic hand tools, mostly machine shop-type tools or woodworking-type tools. And then we have some basic equipment like grinders, bandsaws and buffers.

Q: What about the materials?

A: The materials could be anything. We work with mostly plastic, so we work with thermal plastic and laminated plastic. Thermal is all the polyethylene, polypropylene ... And then the laminated plastics are more like fiberglass, carbon graphite.

We also work with various components, and some of the componentry we work with are aluminum, stainless steel, titanium, and carbon graphites.

Q: What is carbon graphite?

A: It's like a woven material. It's black in color and it's extremely hard -- bullet proof in some cases.

Q: It sounds like Kevlar.

A: Stronger than Kevlar. We work with Kevlar, too.

When we work with a custom socket, it could be any of those materials, but we also work with the componentry because it's one thing to fabricate a custom socket using all those materials, but we also utilize some premade stuff that we can combine.

Q: How sophisticated is the technology in the field these days? Is there a lot of electronics involved?

A: We're starting to get into a lot more of the microprocessor stuff. We're currently working with a prosthesis called a C-leg. It's a computerized leg, basically. It's got microprocessors in it, and there are signals that it can pick up, sent from the computer and the software. It's a "smart" leg. So we can do things like for walking speeds, or going up and down stairs or inclines.

Q: What about artificial limbs that respond to mind waves?
A: Uh, not completely. Somebody's working on that somewhere, but nobody is doing it as a practice. There have been attempts, but nothing solid yet.

Q: Do you have to work closely with your customers, to get measurements and such, or is it somewhat impersonal?

A: It's very personal. The patient comes to our office and there's an introduction. The patient always comes in with a prescription -- we're always filling prescriptions. So we're almost like a pharmacist or a physical therapist. Sometimes we make recommendations.

But anyway, we will measure, cast, fit and then fabricate. We do all the steps necessary to get a comfortable, accurate and functional brace or prosthesis.

Q: How long does it take you to build an artificial limb?

A: It can take us two to three weeks.

Q: Do you build these products by yourself or do other people help you?

A: We work as a team, and the department is broken up between clinicians and technicians. The technicians do most of the fabricating.

Q: So which are you?

A: I do all of it. (Laughter) I could do either one, but structurally we should have it that the technicians do all the fabricating work and the clinicians do the clinical work.

Q: What is the clinical work?

A: It's the actual hands on shaping, fitting and meeting all the specifications.

Q: How many other people do you work with?

A: I would say about 12. That's everything from secretaries to technicians and managers and clinicians.

Q: Do you have a lot of customers on the neighbor islands?

A: We do outer island clinics, because the neighbor islands don't have full services for prosthetics and orthotics. So we'll do clinics there, usually at medical centers throughout the islands.

Q: What do you mean "do a clinic"?

A: We do a clinic where the doctors have already coordinated with us that they will be sending patients to us, and then we go ahead and we start to build up our list of patients. We'll go in and evaluate and assess, make some recommendations, and provide our services, whether it's a prosthesis or a brace.

We also service all the local hospitals here, and a few convalescent homes as well. The hospitals call us to provide braces for some of their post-operative cases, like for somebody who has been in a car accident.

So we're really on the go around here.

Q: So what's the most common artificial limb that you have to work on?

A: The most common is the below-the-knee prosthesis, because of amputations. Most amputations are at that level because if that patient has diabetes, and has a gangrenous foot, the doctor wants to make sure they capture all the gangrene, so they amputate below the knee.

Q: Do most of your patients take this pretty well?

A: Well, that's a little hard to say. Some do, some don't.

Q: It must be pretty emotional sometimes.

A: It can be very emotional, so we do have to wear different hats. One of them, as far as getting into this business is, we do have to play psychologist.

But this is a strange field, because to get into this field, you have to be a craftsman, and have a medical background, and nowadays, a computer background, and also the human background, because you have to give these people hope that they're going to be OK, and that they can continue on with their illness or their deficiency. And we have to guarantee that our services are going to work.

Most of what we do is to rehabilitate the patient, to help them become ambulatory, to help them function again and go back to work. And occasionally we have a few patients that want to swim or even run, requiring special sports prosthetics. And we have all kinds of special prosthetic componentry to help with that.

Q: What do you like most about your job?

A: Well, I've always liked working with my hands. I like building things, and I do like to do custom work and go off the beaten path, to be creative and manufacture something unique and special for the patient.

The other part of that is you have to like people. You have to want to help people. We do a lot of that here, too.

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