Thursday, August 23, 2007

Science aids airman on path to mobility

Developed for an injured dolphin, ‘Easy Gel’ limits amputee’s pain
By Patrick Winn - Staff writer
Posted : Tuesday Aug 21, 2007 15:21:42 EDT

Brian Kolfage had reasons to be skeptical. After all, the triple-amputee could hardly count the techniques doctors had devised to help him settle into prosthetic legs without stinging pain.
Now there was this Irish practitioner named Kevin Carroll, a supposed wizard with prosthetics, claiming he’d found the solution: a gel-like cushion he invented for a dolphin with an amputated tail.

A dolphin?

“I said, ‘Uh, OK. I guess we’ll try it,’ ” Kolfage said. “I didn’t really think it would work.”

He distinctly recalled Carroll walking into an Arizona treatment center, laying down a hunk of the jelly and doing handstands on it to prove the substance’s worth.

After they lined the sockets in Kolfage’s steel legs with the material, he attached them and, miraculously, jumped up and down with little pain.

“Instantly, I felt it working. It kind of mimics fat. It was gushy but didn’t bottom out,” Kolfage said.

Life has tested Kolfage each day since he lost his right forearm and both legs. A mortar hit him Sept. 11, 2004, when the former senior airman was assigned to the 887th Expeditionary Security Forces Squadron, serving at Balad Air Base, Iraq.

Kolfage left his tent to grab a water bottle about 2 p.m. He made it 20 feet before a 107mm artillery round sailed over the wire and practically liquefied his lower limbs. His right hand, he recalled, looked like a dog chewed on it.

He awoke three days later at Walter Reed Army Medical Center in Washington, D.C., with his hand and both legs gone. Doctors checking for internal bleeding left a long scar from his breastbone to pelvis.

Kolfage’s resolve was strong. His recovery, considering his near-fatal injuries, was fast. But the airman could not overcome pain he felt standing upright on prosthetic legs. His left leg was removed at the pelvis, and bone spurs — bony growths that often jut out after amputations — were thinly covered.

His body weight bearing down on those spurs was excruciating.

“There’s no fat or tissue covering those spots. Just a little skin,” he said.

Practitioners tried scores of different cushioning materials on Kolfage’s legs. “They probably made 50 pads out of foam. Even my dad was sending bucket loads of stuff, anything he could find,” he said.

No matter the material, walking was deeply painful.

The answer finally emerged last year, in the form of a prosthesis expert and a tailless marine mammal.

A fisherman found the baby bottlenose dolphin in 2005 in the waters off Cape Canaveral, Fla. It was flailing in a crab trap, its mouth caught in rope and its tail losing circulation in a clamp. The state’s Harbor Branch Oceanographic Institution adopted the dolphin, named it Winter, amputated its badly injured tail and found it a home in the nonprofit Clearwater Marine Aquarium.

A pet project

Carroll, an Orlando resident who heard Winter’s story on the radio, detected a challenge. His job title is vice president of Hanger Prosthetics and Orthotics. His job description is more compelling: visiting amputees around the nation and providing unorthodox solutions to those with the most difficult problems.

In 2005, Winter became his pet project. The dolphin was relying on its rounded tail nub and flippers to swim, an adaptive technique that could damage its spine. Carroll wanted to design a prosthetic tail for Winter, but he knew he couldn’t use the standard foam pads used to secure prosthetic legs to humans.

So, with an Italian chemical engineer also living in Florida, Carroll helped develop a tacky, transparent, gel-like cushion they call “Easy Gel.” It fits around Winter’s nub, securing a socket fixed to a jointed plastic tail. Winter, about 20 months old, now performs routinely at the aquarium while adjusting to the gel and new prosthesis.

New challenges

Carroll, who is nearing his 29th year as a prosthetist, had seen bomb-blast wounds similar to Kolfage’s many times before: He began his career treating bomb injuries, a toll of “the Troubles” — the conflict between Catholics and Protestants in Northern Ireland. From those beginnings, Carroll has carved his niche as the man to call when prosthetic treatments plateau. His firm, Hanger, has assisted Hurricane Katrina evacuees, given an injured Marine a camouflage prosthetic arm and aided an adolescent who tripped a mine in postwar Kosovo.

The war in Iraq has presented Carroll with fresh challenges.

“In my position, I see some awful cases,” he said. “Brian would be up there with the worst of them.”

About seven months into his work with Kolfage, Carroll perceived parallels between Winter’s missing tail and Kolfage’s missing legs. Kolfage’s bony spurs, he said, “are very pointy. If you put pressure on the tip of your small fingernail, it’s like that coming through the skin.”

“But Brian just floats on the gel,” he said. “He just sinks into it, but the socket is still stable.”
The seemingly simple solution has finally given Kolfage the ability to walk, his ticket to mobility and freedom.

Kolfage was deemed too injured to continue serving in the Air Force. But through a program called Helping Airmen Recover Together, the service secured him a civilian position as the security manager at Davis-Monthan Air Force Base, Ariz. He lives in Tucson with his wife, Nikki, who married him at the hospital several months after the accident.

Kolfage is one of 312 airmen wounded in action during Operation Iraqi Freedom. Throughout the military, he’s among only three or four triple amputees from the war. Yet with only one limb intact, Kolfage can shave, type and even drive.

“I’ve learned like a baby to do everything all over again,” he said.

Kolfage would wear his prosthetic legs more often, he said, if it weren’t for Arizona’s sun-baked summers. Walking already costs him about 300 percent more energy than the average person. The signature on each of his e-mails reads: “Pain is inevitable, suffering is optional.”

As for plans to unite with his finned counterpart in Florida, Kolfage is noncommittal.

“One day. Maybe,” he said. “You know, if I’m ever down there.”

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