Ampnation Magazine 2019 Vol. 1 Issue 4 by Ampnation Magazine

AMPNATION MAGAZINE OCTOBER 2019

RONALD MANN YAMASAKI PARA PARA JIU JIU JITSU JITSU YAMASAKI WORLD CHAMPION CHAMPION WORLD

Amputee, U.S. Military Veteran and Jiu Jitsu ChampionHas Passed Away BETTER BETTER OUTCOMES OUTCOMES

Eric Davis - Right Place @ Right Time SMOKING SMOKING AND AND LIMBLOSS LIMBLOSS

What FDA Fails To Warn You About

AMPNATIONMAGAZINE.COM

AMPNATION OCTOBER 2019| VOL. 1 ISSUE 4

GREETINGS AMPNATION! Learning To Master Your Mindset Patients and people have ask

IN THIS ISSUE

me how I got over my amputation

A MESSAGE FROM THE

so soon and started walking and

EDITOR/HOST

living again. The main reason I got over my amputation so soon and

was able to return to living my life again is "Focus". I focused on the positive aspects of things.

Message from the Host & Editor

Letting go of the negative.

Sean Harrison

Most of you know my story of how I lost my right foot in a motorcycle crash which crushed and mangled my foot. I have seen and still see this as a challenge and focus on the positive, rather than spending all my energy focusing on the negative aspects of losing my right foot.

The only thing that will make a difference in how you

RONALD MANN Para Jiu-Jitsu Pioneer & Army Veteran. The world lost a true ambassador that represented the amputee community as well as VETS and Martial Arts like no other. Ron was a Champion and Warrior. We honor him with this edition. R.I.P.

BETTER OUCTOMES How Modern Prosthetic Work Lets take a basic look how these amazing devices work and help us regain mobility.

experience amputation and living with disability is how you decide to experience it. If you decide that it is going to be a positive experience and set yourself up for what it takes to get through it, you will get through it.

If you choose to see it as a possibility to evolve and situation, I know it you will make you a stronger person on focusing all your energy on the negative you will more than likely end up fighting a victim mindset for the rest of your

life and being angry at yourself and other people around you. Focus your time and energy on things you can control and not on things you can't. Learning to master your mindset means accepting your new body (self) and taking

control of your situation. Learn the importance of not letting other people's fears and worries define your new reality. Learn the importance of setting great and ambitious goals, breaking them down into obtainable tasks you can do

every day to get back on your feet and celebrate your accomplishments, no matter how small. Your mind is the most powerful tool you have for the creation of good in your life, but if not used correctly, can also be the most destructive force in your life. Your mind, more specifically, your thoughts, affect your perception

A smart artificial hand for amputees merges user and robotic control New e-glove offers realistic human hand-like features for prosthetic users

change as a person and to learn something from the the other side. If you chose to take the other path of

O & P NEWS

VASCULAR& ORTHO NEWS What the FDA Does Not Tell You About Smoking-Related Foot Amputation

VASCULAR & ORTHO NEWS Early combination therapy provides long-term benefits for patients with type 2 diabetes

BETTER OUTCOMES Eric Davis - Right Place @ Right Time A patient's story of loosing his leg and finding himself in just the right placeto get life back on track.

LISTENER OF THE MONTH This is where we show appreciate to our listeners of the podcast Amp Life Talk Radio which part of the Ampnation Magazine family.

and therefore, your interpretation of reality.

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PARA JIU-JITSU PIONEER & ARMY VETERAN

RONALD MANN THE POWER OF JIU JITSU

Ronald served his country both in the Army Reserves and in Active Duty. During his first 90 days transitioning into his new civilian life, tragedy struck and Ronald lost a large portion of his left leg. A once active and revered military hero found himself fighting to regain both his physical and mental balance. Spiraling into tough times and depression he hit rock bottom. It was then that Ronald found a new fight in the world of Para Jiu Jitsu. (continue on page 16)

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BETTER OUTCOMES

The Suspension System The attachment mechanism, known as the suspension system, is an essential part of a well-fitting prosthetic As amputee and someone who works with amputees often I limb. The suspension system can consist of a suction get various forms of this question and see this question the socket, an elastic sleeve, or an old-fashioned arrangement most on social media when I speak with patients. Prosthetic of harnesses and straps. The fitting must be secure and limbs have existed since the time of the ancient Egyptians, snug, not only because it is vital for comfort, but because it where a working prosthetic toe of wood with a leather ensures the prosthetic limb can be controlled properly. In harness allowed the wearer to use the sandals of the time many cases, the socket is a part of the suspension system or to go barefoot. Prosthetics may be necessary because arrangement. In the instance of a prosthetic leg, sockets of missing body parts due to trauma, congenital conditions, may come in the form of a large plastic casing that is or disease. Prosthetic limbs are designed to restore the hollow so the residual limb can be inserted. missing body part’s normal functions. Modern prosthetics are generally created with computer-aided design, but they Making Prosthetic Limbs can also be hand-designed. Of Americans, one in 190 Making prosthetic limbs starts with the design and citizens is presently getting along with the loss of a limb. fabrication procedure and has many steps. It begins with a The leading cause is poor circulation due to the disease of measurement process that is painstaking in its precision the arteries, with more than half of cases occurring in and is later utilized in designing the prosthetic limb. patients with diabetes mellitus. Learn about how modern When possible, the prosthetist starts the measurement prosthetics work now. process even before the patient’s limb is amputated. This allows the fabrication procedure to begin well ahead of The pylon, the internal skeleton or frame of a prosthetic time. Once the swelling has gone down after the limb, is responsible for providing structural support. amputation, a plaster mold is made of the residual limb. This serves as a template so a duplicate of the residual Traditionally, it has been made of metal rods. More recently, limb can be created. This duplicate is then used to lighter composites of carbon-fiber have been utilized to continually test the prosthetic limb’s fit as it is being create the pylons. Sometimes, pylons are enclosed by a fabricated. Newer technologies permit the use of foam-like material that serves as a cover that can be computerized digital measurements to ensure precision. colored and shaped to match the skin tone of the recipient to give the prosthetic limb a more lifelike appearance. Controlling The Prosthetic Limb Pylons transfer weight between the prosthetic ending and Some prosthetic limbs are solely cosmetic and designed the socket. Dynamic pythons are preferred, particularly in only with appearance as the goal, rather than lower limb prosthetics, as they reduce the shocks created controllability. Others are designed with function and by the heel striking the ground. usability as a central purpose. One example is a prosthetic hand that may consist of a split hook like a pincer and can A prosthetic limb’s effectiveness and comfort are generally be closed or opened to grasp objects and perform similar governed by the quality of its fit onto the remnant of the task types. patient’s actual limb. This is professionally referred to as the residual limb, or more informally, the stump. Some Controlling the prosthetic limb meant with practicality in individuals with missing limbs find the term stump offensive, mind can occur in several ways. Body-powered limbs are but it is still widely in use in the medical world. Sockets are utilized by controlling cables attached elsewhere on the the connecting parts of the prosthetic limbs. body. Externally powered limbs, powered by motors, can be controlled by the prosthetic recipient in many ways. One They are painstakingly molded around a cast of plaster is a switch, which permits the device to be moved by taken from the patient’s residual limb. Without a precise fit, toggling buttons or switches. A more advanced method is sockets of the new limbs may damage the remnant of the to have the limb listen to the remaining muscles in the residual limbs, causing tissue damage or discomfort and residual limb that are still capable of contracting. potentially making it too painful to wear the prosthetic limb Electrodes placed on the skin’s surface are capable of for an extended period. As the residual limb is generally measuring muscle movements when the remaining likely to change in size and shape over time, new sockets muscles generate tiny electrical signals upon contraction. are routinely needed. Lasers and 3D printing are now These limbs are called myoelectric. being used to make precise prosthetics.

How Modern Prosthetics Work

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I invited a patient to share his story as I felt it was one that others could relate too. Every person who has an amputation goes through a mental and emotional journey that will test every fiber that makes up who you are. It will shake your foundation. What makes up a person determines how well one deals with adversity. Eric Davis was about to have his foundation put to the test. Join me as we read his story. Growing up I was always an athlete in high school I played football track and basketball, always did pretty good at each of those sports. In terms of occupation I have always worked within healthcare, I was a Surgical Technologist in the Operating Room I also cross-trained as an Anastasia Tech and a Radiologist Tech for Stanford University Hospital, so helping people has always been a part of my life. When it comes to the spiritual side I have been an Ordained Elder since I was 18 years old, I am now an Associate Pastor and part-time Chaplin for a hospital. I lived a pretty healthy life up until the last part of 2013. 2014 would prove to be the year that would change my life forever. At the end of the year 2013 I Got Married, that would not last for too long, I suddenly got sick and started to feel symptoms like A flu, I begin to pick up weight over the weeks my thighs and legs and stomach began to become quite bit larger, of course I didn't go to the hospital I continued to try to work and preach and do everything that I was normally doing which turned out to be a big mistake. I had recently bought a house in Tracy, California but I was still commuting to Stanford, California to go to work I would get up at 4:30 every morning but this particular morning when I got up I felt very sluggish I continued to try to drive to work but started to feel really bad so I turned the car around and went back home as I was driving home I could hardly breathe I did not know at that time but my upper respiratory system was failing. As I arrived at my home, I pressed the garage opener pulled the car into the garage but when I tried to get out I couldn't I had no strength and no breath. I reached home at about 5:00 a.m. but stayed in my car in the garage until about 8:30 a.m. Not able to get out my wife at that time had come out to the garage to get something and saw me there. She immediately began to get very afraid I had no breath I couldn't tell her to stop but I just waved her to go back in the house when I finally got out of my car I tried to walk to my master bedroom and collapsed on the floor. I did not know at that time but I was having congestive heart failure and had a mild heart attack I was rushed immediately to the hospital which was around the corner from my home. When I got to the hospital the 1st thing that they did was to check my vitals my blood pressure was 261 over a 161. My blood sugar at that time was 1155 and it had been that way for 4 months.

Eric Davis Right Place @ Right Time I was immediately admitted into the hospital and my lungs were 22% field with fluid, By the end of that night my lungs were 88% Filled with fluid and they would have to perform an immediate surgery, During the surgery, an error was made while trying to puncture my lungs to get the fluid out. That error sent me into a coma for 30 days, when I awoke from the coma I forgot how to talk, walk and use my hands. I forgot essentially everybody that I ever knew except my mother. I was in every Ward that the hospital had, I was in ICU Intensive care unit (30)Days I was in SCU Special care unit (22) Days and I was also in CCU critical care unit (6) Days. My total stay in the hospital was 3 months, as I said I am a preacher so I do believe in God and without me mentioning God there is no mentioning me because he is the reason why I am alive today. I was lying in my hospital having not walked for 3 months. I was sleeping and was awoke suddenly as something told me to pick up my Bible and to read the book of Acts Chapter 3. I did so and found a man that had the same problem that I had he couldn't walk immediately. The Holy Spirit spoke me to swing my legs across the bed but I hadn't moved my legs in 3 months. So, I doubted this, it was at 2:30 a.m. and I was spoken to again by the Holy Spirit to do this three more times before I tried it, I was scheduled to go to a rehabilitation center to learn how to walk at 7:30 a.m. I didn't go. The next morning finally decided to try it and guess who was walking around his Room at 2:35 a.m. yep yours truly. Finally, discharge day arrived and I would go home I was very happy, little did I know my happiest would turn into sadness. The woman who I had married and made my wife, had another man in my house while I was fighting for my life in the hospital. All of this should have broken me down but my Faith was strong I continued to believe in God, I continued to believe in myself and continued to believe that there was a future for me ahead. Six months went by and my doctor would finally let me go back to work part-time, My first day back to work I was making the long drive to the bay area at 4:30 a.m. it was dark, I was driving and suddenly started to feel funny I didn't know at the time but I was going into another congestive heart failure episode, I also was having a panic attack and my body was going into shock I continued to try to drive but I felt like I should get off of the freeway just in case I blacked out because I did not know what was going with my body. I tried to pull off of the freeway but I was not able to get the car totally of the freeway. Finally got the car stopped, there I was again trapped because once again I had no strength and no breath, finally through the grace of God I was able to open the door and slide my body out on to the freeway , yes the

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BETTER OUTCOMES

freeway. The problem I had now was my legs were sticking out on the freeway I tried to pull myself under my truck but I was not very successful my legs were still sticking out. It was dark and my fear was someone would not see me and run over my legs. And then a truck stopped it was a Hispanic gentleman and he was a construction worker, he was trying to ask me what did I need, "do you need help" but I couldn't speak at all! So we had a real problem I knew I had freaked him out because he did not do anything and just a ran off back his truck. Leaving me there, as I begin to blackout with my head on the asphalt my body and my legs were still sticking out onto the freeway. I saw the wheels of a car drive up, they were Mercedes Benz rims. The person who got out of this car approached me on the ground and said to me, I know what's wrong with you and I'm going to help you until the Ambulance gets here. He was a cardiologist, he began to help me a few minutes later a CHP patrolman on a motorcycle drives up he does not know that the gentleman is a cardiologist. The first man identifies himself as a cardiologist and asks the CHP could you please call 911 the CHP responds 911 is already here I've been an EMT for 26 years. So, I had a cardiologist and in EMT helping me as I lay in the side of the freeway. I have two things to say, God is real and God is good.

Eric Davis Right Place @ Right Time In 2017, I was dealing with a really bad foot infection, they treated it with antibiotics and my foot got better but this would go on for the next two years. Back and forth to wound care for this foot that was not healing. Finally, my doctor said it has come time to amputate the foot as it is not healing. I fought him on this as I didn't want to lose my foot. That night I took a look at my foot one more time and thought to myself I will never have it again and this made me upset. I was angry at my surgeon, I was angry at the world, I was angry at my family and I was angry at God. After the surgery, I was sent to Encompass Rehabilitation Hospital in Modesto, CA. my doctor explained that this is a place that is going to work with and not allow you to lie in bed and how this would be good for me in my recovery. This is all good but I was still trying to figure out the small things like what was I going to do with my life? I sat there in my bed just looking out the window, I was ready to give up on life and give up on everything. This all accord just recently this year 2019. Little did I know that God would send a gentleman into my room that would change my life again forever, Mr. Sean came into my room and into my life to tell me that I shouldn't give up he's a tall handsome strong strapping looking dude, who looked as though he never experienced any problems in his life. I'm looking at him and I'm saying you don't know what

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VASCULAR& NEWS ORTHO What the FDA Does Not Tell You (continued)

The numbers say more than a million people in the world could be living with peripheral arterial disease (PAD) and that 9 out of 10 people with the condition are known to be smokers or ex-smokers. But few have ever been told that smoking also increases the risk of vascular disease in their legs and ultimately, if left untreated, the loss of a leg. These are hardcore facts that medical professionals can't or won't tell you because of fear, well now you know. So, what are you going to do about it? Stop smoking and save a limb.

The a story: Woman who had legs amputated because of smoking may also lose her ARMS. https://www.express.co.uk/news/uk/465517/Womanwho-had-legs-amputated-because-of-smokingdisease-may-also-lose-her-arms

comfortable on camera, understand modeling for still photographs, being natural and themselves. Dynamic, confident individuals. Submission Deadline Date: Tuesday 10/8 Submission Instructions: Please email snapshots / headshots and brief bio / resume to casting@ninaday.com Photo Topic: Lifestyle Company Name: Nina Day Casting Address: 526 West Street, Suite 502 New York NY 10001 Castings for International directory of disabled media professionals and performers. Browse or search for demos United States and photos of exceptional disabled actors, models, experts, Contact Name: Nina Day Contact Phone: 2129296462 spokespeople, athletes, writers, dancers, entertainers, models, producers, photographers, painters, musicians and Contact Email: casting@ninaday.com Views: 144 more.Casting Directors and Photographers, find your disabled talent, spokespeople, or crew here! To see more castings and job listings go to: Some castings for talent: Project Name: Tech Brand / Phone Lifestyle Advertising Shoot Call type: Casting Call Project type: Photography Casting for: Lead Pay / Incentives adults: -Session Fee: $500 + Agency 20% - Usage Fee for 3 years for the library: $3,000 + Agency 20% Total Session + 3 year usage + Agency 20%: $4,200 -4th year renewal option: additional $1,500 + 20% (+20% only applicable for talent with agents) Performer must be based in: New York, NY Union? None / Non Union Production Location: New York, NY Gender: Either Gender / No preference Disability: Arm Amputee, Double Arm Amputee, Leg Amputee, Above Knee Amputee, Below Knee Amputee, OCTOBER 2019 Double Above Knee October 10-12 2019 - Bilateral Above-Knee Amputee Amputee, Double Below Knee Amputee, Single Amputee, Bootcamp - Hanger Clinic's second BAKA Bootcamp in Multiple Amputee, Quadruple Amputee, Down Syndrome, 2019 will be held in Washington, D.C. October 10Paraplegic, Quadriplegic, other 12. Decide to Rise! Register: Equipment: Any Disabled Equipment http://www.hangerclinic.com/newAge Range: 30-50 patient/events/Pages/bootcamp.aspx Veteran? Not Required Location: AC Hotel National Harbor Role / Character: Unique, Interesting Talent who are Washington, D.C. Area differently abled. 156 Waterfront StreetNational Harbor, MD 20745 Contact Role Description: We are casting a range of every bootcamp@hanger.com to help with room reservations, day people for a lifestyle shoot using technology. We are as the deadline for self-booking rooms has passed. looking for differently abled talent who are effortlessly Registration: $20 per person

EVENTS CALENDAR

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O&P

News

A smart artificial hand for amputees merges user and robotic control EPFL scientists have successfully tested new neuroprosthetic technology that combines robotic control with users’ voluntary control, opening avenues in the new interdisciplinary field of shared control for neuroprosthetic technologies.

translates this into finger movement of the prosthetic hand. The amputee must perform a series of hand movements in order to train the algorithm that uses machine learning. Sensors placed on the amputee's stump detect muscular activity, and the algorithm learns which hand movements correspond to which patterns of muscular activity. Once the user's intended finger movements are understood, this information can be used to control individual fingers of the prosthetic hand. Because muscle signals can be noisy, we need a machine learning algorithm that extracts meaningful activity from those muscles and interprets them into movements," says Katie Zhuang first author of the publication. Next, the scientists engineered the algorithm so that roboticautomation kicks in when the user tries to grasp an object. The algorithm tells the prosthetic hand to close its fingers when an object is in contact with sensors on the surface of the prosthetic hand. This automatic grasping is an adaptation from a previous study for robotic arms designed to deduce the shape of objects and grasp them based ontactile information alone, without the help of visual signals.

EPFL scientists are developing new approaches for improved control of robotic hands - in particular for amputees - that combines individual finger control and automation for improved grasping and manipulation. This interdisciplinary proof-of-concept between neuroengineering Many challenges remain to engineer the algorithm before it can be implemented in a commercially available and robotics was successfully tested on three amputees prosthetic hand for amputees. For now, the algorithm is and seven healthy subjects.

The results are published in today's issue of Nature Machine Intelligence. The technology merges two concepts from two different fields. Implementing them both together had never been done before for robotic hand control, and contributes to the emerging field of shared control in neuroprosthetics. One concept, from neuroengineering, involves deciphering intended finger movement from muscular activity on the amputee's stump for individual finger control of the prosthetic hand which has never before been done. The other, from robotics, allows the robotic hand to help take hold of objects and maintain contact with them for robust grasping.

still being tested on a robot provided by an external party. "Our shared approach to control robotic hands could be used in several neuroprosthetic applications such as bionic hand prostheses and brain-to-machine interfaces, increasing the clinical impact and usability of these devices," Silvestro Micera, EPFL's Bertarelli Foundation Chair in Translational Neuroengineering, and Professor of Bioelectronics at Scuola Superiore Sant'Anna. Source:Ecole Polytechnique Fédérale de LausanneJournal reference:Zhuang, K.Z. et al. (2019) Shared human–robot proportional control of a dexterous myoelectric prosthesis. Nature Machine Intelligence. doi.org/10.1038/s42256-019-0093-5.

How shared control works The algorithm first learns how to decode user intention and

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O&P

News

New e-glove offers realistic human hand-like features for prosthetic users People with hand amputations experience difficult daily life challenges, often leading to lifelong use of a prosthetic hands and services. An electronic glove, or e-glove, developed by Purdue University researchers can be worn over a prosthetic hand to provide human-like softness, warmth, appearance and sensory perception, such as the ability to sense pressure, temperature and hydration. The technology is published in the Aug. 30 edition of NPG Asia Materials.

said. The fabrication process of the e-glove is cost-effective and manufacturable in high volume, making it an affordable option for users unlike other emerging technologies with mind, voice and muscle control embedded within the prosthetic at a high cost. Additionally, these emerging technologies with mind, voice and muscle control embedded within the prosthetic at a high cost. Additionally, these emerging technologies do not provide the human-like features that the e-glove provides.

Lee and Min Ku Kim, an engineering doctoral student at Purdue and a co-author on the paper, have worked to While a conventional prosthetic hand helps restore mobility, patent the technology with the Purdue Research the new e-glove advances the technology by offering the Foundation Office of Technology Commercialization. The realistic human hand-like features in daily activities and life team is seeking partners to collaborate in clinical trials or roles, with the potential to improve their mental health and experts in the prosthetics field to validate the use of the ewellbeing by helping them more naturally integrate into glove and to continue optimizing the design of the glove. social contexts. A video about the For more information on licensing a Purdue innovation, technology is available at https://youtu.be/lF1VYzKagNo. contact the Office of Technology Commercialization at

The e-glove uses thin, flexible electronic sensors and miniaturized silicon-based circuit chips on the commercially available nitrile glove. The e-glove is connected to a specially designed wristwatch, allowing for real-time display of sensory data and remote transmission to the user for post-data processing. Chi Hwan Lee, an assistant professor in Purdue's College of Engineering, in collaboration with other researchers at Purdue, the University of Georgia and the University of Texas, worked on the development of the e-glove technology. Lee and his team hope that the appearance and capabilities of the e-glove will improve the well-being of prosthetic hand users by allowing them to feel more comfortable in social contexts. The glove is available in different skin tone colors, has lifelike fingerprints and artificial fingernails. "The prospective end user could be any prosthetic hand users who have felt uncomfortable wearing current prosthetic hands, especially in many social contexts," Lee

otcip@prf.org. "My group is devoted to developing various wearable biomedical devices, and my ultimate goal is to bring these technologies out of the lab and help many people in need. This research represents my continued efforts in this context," Lee said. The work aligns with Purdue's Giant Leaps celebration of the university's global advancements in health as part of Purdue's 150th anniversary. That is one of the four themes of the yearlong celebration's Ideas Festival, designed to showcase Purdue as an intellectual center solving realworld issues. Source:Purdue UniversityJournal reference:Kim, M.K. et al. (2019) Soft-packaged sensory glove system for human-like natural interaction and control of prosthetic hands. NPG Asia Materials. doi.org/10.1038/s41427-019-0143-9.

I would love to hear from you, your thoughts are important. What type of content would you like to see more of in Ampnation Magazine? contact@ampnationmagazine.com

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VASCULAR& NEWS ORTHO What the FDA Does Not Tell You About Smoking-Related Foot Amputation The Surgeon General's message is clear: "smoking kills." But smoking not only kills. It also results in foot and lower extremity limb loss due to Peripheral Arterial Disease. Yesterday, the Food and Drug Administration unveiled the graphic new warning labels for cigarettes aimed to illustrate a variety of health consequences related to tobacco use. Smoking is responsible for approximately 450,000 deaths a year, and the Surgeon Generals message is clear: "smoking kills". Smoking not only kills but also results in foot and lower extremity limb loss due to Peripheral Arterial Disease (P.A.D.). The nine warnings DID NOT include any imagery indicating that smoking causes foot and lower limb amputations.Smoking is the number one cause of P.A.D., according to the Peripheral Artery Disease Coalition. Peripheral Artery Disease develops when arteries become clogged, resulting in decreased blood flow to the legs and feet. This can result in the need for amputation. The U.S. Department of Health and Human Services indicates that "one in every 20 Americans over the age of 50 has P.A.D." and that "eight to 12 million people in the United States, especially those over 50" are affected. "Diabetes and vascular disease are the leading causes of limb loss and major drivers of increased limb loss incidence in the U.S.," according the Amputee Coalition, adding that "PAD is a common cause of amputation; 1 to 2 percent of all people with PAD will progress to major amputation." Furthermore they indicate that dysvascular disease results in 54 percent of limb loss amputations (approximately 92,000 amputation each year).

The of limb loss amputations (approximately 92,000 amputation each year). Restricted Blood Supply PAD - which is also called peripheral vascular disease (PVD) - occurs when deposits of fat build up in arteries and restricts blood supply to the legs. This process is called atherosclerosis, which can also lead to heart attacks and strokes. Around half of all people with PAD experience no symptoms, making the condition a largely unknown killer.Left untreated, PAD can cause tissues in the leg to die, causing conditions like gangrene and critical limb ischaemia (CLI) where blood flow to the limbs is severely restricted. These complications result in amputations in around 3 out of 10 cases.Quit Smoking 'to Reduce Risk'In a statement, Dr Mike Knapton, associate medical director at the British Heart Foundation, says: "We do know that stopping smoking is the single most effective way of reducing your risk of developing this potentially deadly disease and with No Smoking Day on March 9, now is a great time to prepare to start your quitting journey." Approximately 30,000 adults have the most severe form of the condition, which results in at least 9,000 amputations per year."I see patients - the vast majority of whom are smokers - repeatedly having to go through painful surgery to ease the suffering of PAD. Inhalation of smoke leads to high concentrations of nicotine, which compromise the cutaneous blood-flow velocity and increase the risk of the formation of microthrombi. Consequently, amputees should abstain from cigarette smoking during the phase of healing. Preferably, the habit should be broken one week before surgery, which is the requisite period for the process of coagulation and the fibrinogen level to normalize and for free radicals to be eliminated.

The risk of smoking related foot and limb amputation is real. There are stories of people loosing limbs due to smoking So why not include this risk as a visual warning and part of but they never seem to make the make the main news as this new strategy? cigarettes are big busy. Here is such a story: Woman who had legs amputated because of smoking may also lose Experts at the British Heart Foundation say more than a her ARMS. million people in the UK could be living with peripheral https://www.express.co.uk/news/uk/465517/Womanarterial disease (PAD) and that 9 out of 10 people with the who-had-legs-amputated-because-of-smokingcondition are known to be smokers or ex-smokers.The disease-may-also-lose-her-arms warning comes in the lead up to No Smoking Day, which health campaigners say represents an important opportunity to quit smoking.

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What the FDA Does Not Tell You (continued) V&O NEWS The Peripheral Vascular Consequences of Smoking To be very blunt about it; Cigarette smoking is associated with an increased risk and extent of advanced atherosclerotic vascular disease in peripheral as well as coronary arteries. The likelihood of claudication, amputation, stroke, abdominal aortic aneurysm, and failure of vascular reconstruction is higher in smokers than nonsmokers. Smoking exerts its deleterious effects through many interactive mechanisms. Nicotine and carbon monoxide produce acute cardiovascular consequences, including altered myocardial performance, tachycardia, hypertension, and vasoconstriction. Smoking injures blood vessel walls by damaging endothelial cells, thus increasing permeability to lipids and other blood components. Among metabolic and biochemical changes induced by smoking are elevated plasma, free fatty acids, elevated vaso-pressin, and a thrombogenic balance of prostacyclin and thromboxane A2. Chronic smoking is associated with a tendency for increased serum cholesterol, reduced high density lipoprotein, and other lipid effects, that contribute to atherosclerosis. In addition to rheologic and hematologic changes from increased erythrocytes, leukocytes, and fibrinogen, smokers have alterations in platelet aggregation and survival that produce thrombosis. Considering the ubiquitous repercussions of this menace, vascular surgeons should play an active role in motivating their patients to quit smoking. (Author links open overlay panelWilliam C.KrupskiMD, Annals of Vascular SurgeryVolume 5, Issue 3, May 1991, Pages 291-304)

The Relationship of Cigarettes Smoking to Peripheral Arterial Disease A correlation between peripheral arterial disease (PAD) and smoking was reported early in the twentieth century. Today, smoking remains one of the most important risk factors for the development of PAD, as well as its only avoidable risk factor. This association is relevant for both genders and occurs at every age. Approximately 90% of patients with PAD have a history of smoking. Smoking elevates the risk of PAD several fold. Taking into account other risk factors, such as hypercholesterolemia and diabetes, approximately 75% of PAD is attributable to smoking.

Let's Real For A Moment I have worked in the prosthetic field as an Advocate for patients over the past 7 years since my amputation. I have come both types of patient those with diabetes and those vascular issues. The number thing I have found to be the common factor among all is cigarettes. There's a lot of infomration out there on the effects of smoking and how it is bad for you, any honest doctor will tell to you stop Cigarette smoking is one of the most important risk factors smoking to better your health. Unfornately, people only see for peripheral arterial disease (PAD). Smoking increases the what they want to see. Even patients who have under gone an amputation still are in the hospital craving a cigarette. risk of PAD by several fold and is a more influential risk Denial is deadly. factor for PAD than for coronary artery disease. Multiple pathophysiologic mechanisms may account for the From 2005 to 2011, 32,025 qualifying amputations were prevalence of atherosclerosis in cigarette smokers. These performed in California. Of these, 11,896 were DMinclude abnormalities of endothelial function, lipoprotein associated (n = 1,095), PAD-associated (n = 4,335), or metabolism, coagulation, and platelet function. Smoking associated with both conditions (n = 6,466). PADcessation (discontinuing/stop) decreases the risk of associated amputation rates and combined PAD/DMcardiovascular morbidity and mortality, and may improve associated amputation rates have changed little since functional capacity in patients with PAD. Therapies to 2009 after decreasing substantially over the prior 5 years, promote smoking cessation include counseling, nicotine but DM-associated amputation rates have continuously replacement, and bupropion. Healthcare providers must enhance their efforts and target smoking cessation as increased since 2005. California residents older than the age of 80 years had the most dramatic decrease in PADa modifiable risk factor in patients with PAD and other associated amputation rates from 2005 to 2011 (i.e., from manifestations of atherosclerosis. [Rev Cardiovasc Med. 317 to 175 per million Californians). Men with PAD/DM had 2004;5(4):189-193 amputation rate 1.5 times higher than those of patients with PAD alone and 5 times higher than rates of DM patients. In women the difference between patient with PAD and PAD/DM was not seen; however, these rates were 2.5 times higher than patients with DM alone.

AMPNATION | PAGE 11

V&O NEWS

DAVE GANAS

Preventable amputations associated with high-risk diseases are no longer decreasing despite continuing advances in care and education. Octogenarians with PAD represent the highest risk group for amputation, but DM-associated amputations have increased since 2005. Buerger's Disease Buerger's disease is a rare disease of the arteries and veins in the arms and legs. In Buerger's disease â&#x20AC;&#x201D; also called thromboangiitis obliterans â&#x20AC;&#x201D; your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi).

Causes The exact cause of Buerger's disease is unknown. While tobacco use clearly plays a role in the development of Buerger's disease, it's not clear how it does so. It's thought that chemicals in tobacco may irritate the lining of your blood vessels, causing them to swell. Experts suspect that some people may have a genetic predisposition to the disease. It's also possible that the disease is caused by an autoimmune response in which the body's immune system mistakenly attacks healthy tissue.

Tobacco Use Cigarette smoking greatly increases your risk of Buerger's This eventually damages or destroys skin tissues and may disease. But Buerger's disease can occur in people who lead to infection and gangrene. Buerger's disease usually use any form of tobacco, including cigars and chewing first shows in your hands and feet and may eventually affect tobacco. larger areas of your arms and legs. People who smoke hand-rolled cigarettes using raw Virtually everyone diagnosed with Buerger's disease tobacco and those who smoke more than a pack and half smokes cigarettes or uses other forms of tobacco, such as of cigarettes a day may have the greatest risk of Buerger's chewing tobacco. Quitting all forms of tobacco is the only disease. The rates of Buerger's disease are highest in way to stop Buerger's disease. For those who don't quit, areas of the Mediterranean, Middle East and Asia where amputation of all or part of a limb is sometimes necessary. heavy smoking is most common. Symptoms Buerger's disease symptoms include: Tingling or numbness in the hands or feet. Pale, reddish or blue-tinted hands or feet. Pain that may come and go in your legs and feet or in your arms and hands. This pain may occur when you use your hands or feet and eases when you stop that activity (claudication), or when you're at rest. Inflammation along a vein just below the skin's surface (due to a blood clot in the vein). Fingers and toes that turn pale when exposed to cold (Raynaud's phenomenon). Painful open sores on your fingers and toes.

Quit Using Tobacco In Any Form Virtually everyone who has Buerger's disease has used tobacco in some form, most prominently cigarettes. To prevent Buerger's disease, it's important to not use tobacco.Quitting smoking can be hard. If you're like most people who smoke, you've probably tried to quit in the past. It's never too late to try again. Talk to your doctor about strategies to help you quit.

See your doctor if you think you may have signs or symptoms of Buerger's disease.

AMPNATION | PAGE 12

VASCULAR& NEWS ORTHO

Early combination therapy provides long-term benefits for patients with type 2 diabetes A new study, VERIFY (Vildagliptin Efficacy in combination with metfoRmIn For earlY treatment of type 2 diabetes) presented at this year's Annual Meeting of the European Association for the Study of Diabetes (EASD) in Barcelona, Spain (16-20 Sept, 2019), and published simultaneously in The Lancet, is the first to show that early combination therapy using vildagliptin and metformin in patients newly diagnosed with type 2 diabetes (T2D) leads to better longterm blood sugar control and a reduced rate of treatment failure than metformin alone (the current standard-of-care treatment for patients newly diagnosed with T2D).

This eventually damages or destroys skin tissues and may lead to infection and gangrene. Buerger's disease usually Vildagliptin (also known by its trade names of Galvus and first shows in your hands and feet and may eventually affect Zomelis) is an oral drug used to treat type 2 diabetes, and larger areas of your arms and legs. belongs to the class of drugs known as dipeptidyl peptidase-4 (DPP-4) inhibitors. By inhibiting this key Virtually everyone diagnosed with Buerger's disease enzyme, DPP-4 inhibitors promote secretion of insulin by smokes cigarettes or uses other forms of tobacco, such as the pancreas, and inhibit production of glucagon, and thus chewing tobacco. Quitting all forms of tobacco is the only help control blood sugar and avoid hyperglycaemia. way to stop Buerger's disease. For those who don't quit, amputation of all or part of a limb is sometimes necessary. Metformin has been the first line treatment for T2D for several decades (the exact time varying by country), and Symptoms belongs to the biguanide class of diabetes drugs. Buerger's disease symptoms include: Currently, the first-line treatment recommended for type 2 Tingling or numbness in the hands or feet. diabetes is metformin monotherapy, with combination Pale, reddish or blue-tinted hands or feet. therapy only introduced later following treatment failure. Pain that may come and go in your legs and feet or in your arms and hands. This pain may occur when you This study, led by EASD President Professor David use your hands or feet and eases when you stop that Matthews (Oxford Centre for Diabetes, Endocrinology and activity (claudication), or when you're at rest. Metabolism, and Harris Manchester College, University of Inflammation along a vein just below the skin's surface Oxford, UK) and colleagues, included 2001 patients from (due to a blood clot in the vein). 254 centres in 34 countries, with 998 randomised to Fingers and toes that turn pale when exposed to cold receive early combination therapy using vildagliptin and (Raynaud's phenomenon). metformin, and 1003 randomised to receive initial Painful open sores on your fingers and toes. metformin alone, across a 5-year treatment period (enrolment occurred between 2012 and 2014 and follow-up See your doctor if you think you may have signs or of the final patients was completed in 2019). symptoms of Buerger's disease. The study was divided into 3 periods. In study period 1, patients received either the early combination treatment with metformin (individual, stable daily dose of 1000 to 2000 mg, depending on the patient's tolerability) and vildagliptin 50 mg twice daily, or standard-of-care initial metformin monotherapy (individual, stable daily dose of 1000 to 2000 mg) and placebo twice daily.

AMPNATION | PAGE 13

V&O NEWS

Treatment response was monitored by patients visiting their centre every 13 weeks, when the patients' level of glycated haemoglobin (HbA1c -- a measure of blood sugar control) was assessed. If the initial treatment did not maintain levels of HbA1c below 53 mmol/mol [7·0%]) during period 1, confirmed at two consecutive scheduled visits, 13 weeks apart, then this was defined as treatment failure and patients in the metformin monotherapy group received vildagliptin 50 mg twice daily in place of the placebo and patients in the early combination therapy group continued on combination. This second period was thus a phase of two arms where allocated early combination therapy approach was being tested against a later, metformin with vildagliptin-ifnecessary combination strategy. Subsequent failure requiring insulin treatment was assessed as an end-point for second failure by two further visits with loss of glycaemic control.

During period 2 when patients in both groups were (or could be) receiving combination treatment, the relative risk of losing blood sugar control was also reduced by 26% among those randomised to receive the early combination treatment, compared with those who transferred to combination therapy after their first treatment failure. This showed that the early combination therapy strategy approach was superior to a sequential strategy approach involving later intensification of the failing monotherapy with a combination therapy, as demonstrated by a durable effect on blood glucose levels. The authors believe the better long term 'durability' of blood sugar control seen in the combination group could be due to the complementary mechanism of action between the two drugs.

The authors say: "The findings of VERIFY support and emphasise the importance of achieving and maintaining early glycaemic control" and refer to previous studies (such as the UK Prospective Diabetes study), in which early Physicians would then move patients onto insulin therapy. treatment intensification was associated with a legacy However, patients who did not fail in period 1 but effect, where the reduction in vascular complications in the maintained good glycaemic control (HbA1c below 53 intensive group was maintained or strengthened over 10 mmol/mol, 7%), continued administration of their years after study completion. In the Diabetes and Aging randomised study medication (early combination or initial epidemiology study, an HbA1c value above 6·5% (the metformin monotherapy) for up to five years. threshold for T2D diagnosis in the USA) for the first year following diagnosis was associated with worse The primary efficacy endpoint was the time from outcomes (increasing microvascular events and mortality randomisation to initial treatment failure, defined as HbA1c risk) over the subsequent 10 years of follow-up. measurement of at least 53 mmol/mol (7·0%) at two consecutive scheduled visits, 13 weeks apart, during The authors point out that durable HbA1c values below period 1. 6.5% are unlikely to be achieved with monotherapy alone. They say: "Real-world evidence has shown how delayed A total of 1598 (79·9%) patients completed the 5-year treatment intensification after monotherapy failure results in study; 811 (81·3%) in the early combination therapy group increasing time spent with avoidable periods of and 787 (78·5%) in the monotherapy group. The incidence hyperglycaemia, raising a crucial barrier to optimised care. of initial treatment failure during period 1 was 429 (43·6%) The durable effect we observed with an early combination patients in the combination treatment group and 614 strategy in the VERIFY study provides initial support for (62·1%) patients in the monotherapy group. such an approach as an effective way to intensify blood sugar control early after diagnosis and potentially avoid The median observed time to treatment failure in the future complications." monotherapy group was 36.1 months, while the median time to treatment failure time for those receiving early They conclude: "Early intervention with a combination combination therapy could only be estimated to be beyond therapy strategy provides greater and durable long-term the 5-year study duration at 61.9 months. Both treatment benefits compared with the current standard-of-care approaches were safe and well tolerated. monotherapy with metformin for patients with newly diagnosed type 2 diabetes." The risk of losing blood sugar control (going above HbA1c 53 mmol/mol (7.0%) or more, twice) was approximately Source: Diabetologia http://diabetologia-journal.org/ halved in the early combination treatment group compared with the monotherapy group over the 5-year study duration (a statistically significant 49% relative risk (RR) reduction).

AMPNATION | PAGE 14

BETTEROUTCOMES

what I'm going through everything in life is good for you until he sits down takes off his leg!! I almost fell into another coma!! This one is self-induced. ..lol! from shock. I am currently a network and server guy that's all I deal with is computers day today but after talking to Sean for just 2 hours I knew what I wanted to do with my the rest of my life I wanted to become an advocate. I wanted to help other people and let them know that they don't have to give up on life. I try never to misrepresent my God the Lord Jesus I give him all praise, but I asked him and he also allows me to give Mr. Sean some praise this man change my life and I'm sure he has changed the lives of many others. I'm doing very well with my prosthetic leg now. While in rehabilitation at Encompass I scored all "A" pluses on all of my tests in rehabilitation before I received my prosthetic leg. They said that I scored the highest of anybody that they ever knew, I was in a wheelchair for one month before my prosthetic leg. Once I got my first prosthesis I got up and started moving, after one month from receiving my first leg I am now being fitting for a second socket because I am so active, my limb is shrinking and changing so fast. It has not even been three months, I say that not to boast in me or to make anyone feel like I am someone special but yet I am special because God chose me to show other people that you don't have to give up on life is not over life is just beginning I also want to give a great "shout out" to Hanger Clinic and the staff at the Stockton, California clinic these people are amazing and they have helped me very much. It is my desire to work for Hanger Clinic under my mentor Mr. Sean. I want to help as many people as I can and I will do so because I'm putting my mind towards it I want to encourage anyone that reads this you can do anything that you want to do you just have to set your mind to it. I appreciate Ampnation Magazine for allowing me to share my experience with you so until the next time I want to you to tell someone, anyone dealing with limb loss they can make it! Maybe one day I will meet you on a track running the 100 meters or maybe that maybe walking up the side of a mountain or maybe swimming in a swimming pool.

Eric Davis Right Place @ Right Time

Eric at Encompass Rehab.

Thank You! Eric Davis Amputee Contacting the Editor if you have a story and would like to share, please send a detailed email to: contact@ampnationmagazine.com Please provide as much details as possible.

AMPNATION | PAGE 15

RONALD MANN

Ronald came across my radar one-day when my phone rang, Don McGuire was on the end all excited about this guy named Ron Mann. He told me this guy was a one-man wrecking machine with one leg. Of course, that caught my attention as I was looking for amputees for my podcast "Amp Life Talk Radio", Don told me this is the guy to have on my show. He passed on his details to me. Later that day I did some research on him, wow! This guy sounds perfect for a guest on the show. I reached out to him and he was open to being on the show. As with most guest, I don't know anything about them except for what is out there on the internet. During his interview he and I connected, Ron was a man with a warrior's heart, in it's simplest form you do what has to be done day after day, and never quit. Being a Veteran the warrior and humanitarian instilled in him taught him without courage, compassion falters, and that without compassion, courage has no direction. But the most important thing a warrior's heart can do is heal, and if you follow it, it will lead you anywhere you need to go. This is what I saw in Ron. Early Days Ronald Mann was a typical boy with a typical childhood. Brought up in a rural suburb of Lansing, Michigan, Ronald ran around playing cops and robbers and other similar games with childhood friends. As he got older he knew that once he graduated high school he wanted to enlist and serve as a Combat Medic. Ron Mann was raised in a family whose military service tradition dates back to the Civil War. His relatives fought in World Wars I and II, as well as the Korean and Vietnam wars, among others. When he finished high school, signing up for the army was the thing to do. Ron was proud to follow in the footsteps of his family members. Ron chose to be trained as an Army medic. In his early twenties, he served overseas in Korea, near the Demilitarized Zone. He started learning jiu-jitsu while there. At first, his tour in South Korea seemed just like another overseas assignment, but a skirmish in the border area would prove otherwise and would change everything. At 22, Ron was collecting and bagging his friendsâ&#x20AC;&#x2122; remains, strenuously matching body parts along the way.

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RONALD MANN

Ron was trained to remain calm during battlesâ&#x20AC;&#x201D;and he did so while rescuing his injured comrades in the fieldâ&#x20AC;&#x201D; but the aftermath of the event was a lot to process. It remained a footprint on his mindâ&#x20AC;Śtoo real to ignore, too deep to erase. Ron was later stationed in Fort Bragg, North Carolina. Things were better for a while, but tragically, and as fate would have it, there was a plane crash and the young medic found himself faced with marred bodies once again. After his tour of duty, Ron decided to getaway. He went home to the Midwest. One day, as he was stunt riding his motorcycle with a friend, there was an accident and he lost the lower half of his left leg. He told how he felt when he woke to find his left leg missing below the knee. He was devastated. When Tragedy Struck... Ron was like most young guys his age living life on life on the edge, add a motorcycle to that mix and things can get dangerous. One-day while doing stunts on his sport-bike with a friend he miscalculated his stunt and was struck by his friend who was supposed to pass by him at a high rate of speed. The collision fractured his left leg, as a combat medic he saw this and figured he would okay as they should be able to repair it from what he has seen in war injuries. While en-route to the hospital on a helicopter he flat-lined twice. When he arrived at the ER while still conscious he told the surgeon "don't take my leg", "telling the doctor not to bring him back if he had to take his leg", but the doctor did. Still a young man, he had to face the rest of his life as an amputee. This would lead him through some dark days, and then even darker days. The loss was more than he could fathom, and several times, he considered doing something about it. At the time of this accident, Ron didn't have medical insurance coverage. He had just been discharged from the military and only had 90 days of coverage, this accident took place 92 days after. He was discharged home with his family. Ron was 24 years old at the prime of his life. He had no idea what to expect or what he was going to do. He told me during our interview on the podcast, he felt his life was over. He said the first 30 days were the hardest for him, he was looking for others in his situation but couldn't find anyone or support.

that he ready to end it, he said, "he was at his family's house and found a gun, he had it ready to use to end his life. He remembers, at that moment he said to himself, your not going to go out like this, not like a punk, if you go, you out fighting, life is too precious". With the help of friends, family and a good practitioner who would make his first leg and told him; "you can do anything you want." He began to believe, things started to happen. And his family who had to raise money for him to get his prosthetic leg. He then started to work out and train, he was on the Army's Taekwondo Team and was looking for a gym that would allow him to train but no gym would take because of his amputated leg. And then finally he found a gym (American Martial Arts & Fitness Academy) that would let him train but they made it very clear to him, you will not be treated any different than anyone, we will not cater to you because of your missing leg. If you don't like it you can go home. That was what Ron needed to hear and have at this point in his life. Eventually, drawing from his upbringing and spirituality, Ron resumed training as a kick-boxer. He gradually made his way to the big leagues, competing and winning against fully able-bodied fighters in different parts of the country.

It was not easy at first. Ron had to pry open the first gym Martial Arts was something that had always helped him in doors and convince the owners that he could do just as hard times, it gave him purpose. He told me on my podcast, well as anybody else, but he was up to the task. In fact, the

AMPNATION | PAGE 17

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RONALD MANN challenge fueled him. Ron became successful and moved across the country following opportunities. Eventually, he became a state champion in Michigan. Which is funny because he was banned from of Michigan for a long time and was not able to fight. He had to travel to other states.

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In fact, he had to sneak into one of his first fights in Chicago because they would not let him fight as an amputee. He wore long pants for the weigh-in and while in the ring at the start he had his teammates all around him to hide his leg. He got a 2nd round knock out in the last 3o seconds of the round with an ax kick. It was at that moment he realized that he is equal to any other fighter out there. He said he was so excited, he went to the center ring and pulled his leg off and raised it above his head. The place went quiet, and then ... the exploded with cheers, everyone was in shocked, no one knew he was an amputee. Fame and success were a lot to handle. Ron started to drink to manage, but the drinking got out of control and impacted his training. Soon, he could not keep up physically and the whole thing collapsed seemingly as quickly as it had sprung up. The result, he found himself living on the streets of the Tenderloin, in San Francisco. “I was a ‘banger.’ I took care of a territory for some dealers, making sure other people did not take it over.” Ron was stabbed during a fight and nearly died in the hospital. When none of his friends from the street went to see him, he Ron had moved back to Washington DC where he starting realized that he had to get his life together. training at Yamasaki Academy under Professor Fernando Yamasaki and head coach Sean Diveny. Having a job was He met his first 12-Steps Program sponsor on the street, helpful as a veterans housing case manager, helping “this guy who had a big smile that you could not get away veterans out of homelessness and back into life. Sean from.” It was rough at first, but Ron managed to rekindle his Diveny once said, “Everything in Jiu-Jitsu is adaptable.” relationship with family and moved back to the Midwest. This is something every amputee can relate to. Living with limb-loss is about adapting to our new path. There, he got a job helping veterans and went back to his martial arts training. Ron’s belief in Buddhist principles and his jiu-jitsu training have given new meaning to his life. He has found the strength to rebuild and grow.

AMPNATION | PAGE 18

RONALD MANN Mann, "He’s right." There is no one perfect Jiu-Jitsu body type. It is a cerebral art, you have to be able to deal with adversity and stress in a real-time situation. I live with adversity every day I wake up and put on my prosthetic. JiuJitsu helps me overcome preconceived limitations on and off the mat. I would like to make Para Jiu-Jitsu sustainable for me and see that as my ultimate path. It is a passion that burns my soul. Anyone who has interacted with or read about some of these people, who have been dubbed “adaptive athletes”, knows how inspiring they are. Ronald Mann was one of these people. These strong individuals undergo the same grind like the rest of us, some without the use (or absence) of one or more limbs, others with systemic health issues. Ron and I connected as I am part of a Para Spartan Team which is about getting people limb-loss into Spartan racing.

What Is Para Jiu-Jitsu Para Jiu-Jitsu was created to allow equal competition between disabled athletes. Our categories rank from B1, simple amputation, to B13, complete wheelchair-bound. We also include sight impaired and autism/on the spectrum. All of us at the tournament fought in the ablebodied divisions as well. We do this to show that we are equal. We ask for Para divisions for us to be allowed competition between people of the same ability level. One of the guys came up to me right after his fight and was crying with joy. He told me he thought that he would never be allowed to compete in a tournament because of his limitations.

The UEAJJF has allowed him the opportunity to show his Ronald Mann put together the World Para Jiu-Jitsu Festival family and the world he is equal. in Abu Dhabi, who is himself a para Jiu-Jitsu competitor (an amputee), personally coordinated this event and worked This was Ronald Mann's dream and he made it come not with the UAEJJF to put it on. just for him but thousands of others affected by limb-loss or difference to compete in the world of Jui-Jitsu.

AMPNATION | PAGE 19

OCTOMBER 2019| VOL. 1 ISSUE 4

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RONALD MANN The motivation behind Mann's endeavor for Para Jiu-Jitsu, "I will always fight able-bodied opponents because my goal is to explore jiu-jitsu as it pertains to every situation, physical or mental. Fighting able bodied opponents raise difficulties for me to overcome. I have limited mobility and range across the mat. It makes me establish a game plan that works for me and break down my opponents. There is no one Jiu-Jitsu body type. We all fight strengths and weaknesses. With Jiu-Jitsu we can overcome that. For the sake of competition, there need to be categories of similar abilities. To truly feel accepted as equal we need to be able to compete against our equals. Just as there are divisions for men, women, and children, UAEJJF is allowing us to compete against our peers. Not everyone wants to compete in an open class. I am fortunate to have the ability and desire to do so. I know that anyone in the United States Para Jiu-Jitsu team would. But for the future, for those who cannot or do not want to, we should be allowed to compete against the same ability level."

competing and winning in his sport. After I won UAEJJF Worlds this spring in Abu Dhabi, I was asked by the head of the para division, Elcirley Silva and Rodrigo Valeria to collect a Para team for the United States. He returned home to America at the end of April and began work right away. He started reaching out to other adaptive fighters that he knew, combing through social media and searching for people with disabilities who train grappling. He was on my podcast talking about this, how we met. The response was surprisingly strong. He able to identified roughly 30 fighters and were able to bring 10 to Los Angeles for the first American Grand Slam to support Para categories. He was able to find 25 athletes from four countries; Costa Rica, Venezuela, Brazil, and the United States to represent the North American continent and were collecting fighters until two weeks before the tournament. There was so much interest that he had already established a list of fighters for the next years event.

This has not been an easy road Ron, he had to put in a lot of work into this personally, as most amputees know things are harder for those of us missing limbs. We use more energy and must find ways to adapt. As Ron said, "It is a labor of love; there are always trials and growing pains."

Ron was a Jiu-Jitsu Master, teaching martial arts to young people. Mann founded The United States Para Jiu-Jitsu Association, which built the para jiu-jitsu team for the inaugural UAEJJF Grand Slam at The Los Angeles Convention Center on September 2017. Ron's life touched Ron has won a gold medal at the World Para Jiu-Jitsu so many along the way, I have seen pictures of him with Festival in Abu Dhabi. Through will and courage, he has family overseas where he has left a big impact in the world defied the stigma attached to physical handicap people by teaching and touching so many lives that he came across. Know as â&#x20AC;&#x153;The Peaceful Warriorâ&#x20AC;?.

AMPNATION | PAGE 21

RONALD MANN was an Army Veteran, Mixed Martial Arts Welterweight Champion (retired), Brazilian Jiu-Jitsu Champion & Master, and LEG AMPUTEE, and the only American invited to participate at The Abu Dhabi World Parajiu-Jitsu Festival. This is a story of overcoming seemingly insurmountable obstacles to obtain one of the highest human physical achievements possible – competing in Mixed Martial Arts.

The Jiu-Jitsu community and entire world suffered a tremendous loss when BJJ purple belt, adaptive Jiu-Jitsu advocate, amputee, and Army veteran Ronald Mann passed away.

The news was shared by Mann’s team, the Yamasaki BJJ academy: “Hello Friends and Family — We were saddened to learn of the passing of one of our very own Yamasaki fighters, Ronald Mann. Ronald passed away on Ronald's Goal September 7th, 2019. A memorial in his honor was held on Ronald's goal was to have para Jiu-Jitsu be considered Saturday, September 14th, 2019 at the Yamasaki Academy EQUAL to conventional Jiu-Jitsu, allowing categories in any located at 12712 Rock Creek Mill Road, Rockville, tournament when there are at least two para fighters, and Maryland 20853. I was unable to make this event and to promote physical and emotional recovery through Jiudecided to dedicate this issue to celebrate his life of Jitsu, showing the world that everyone can be Equal triumph, dedication, and passion for life and martial arts. through JiuRonald was known for helping others, for showing the Jitsu. ability to disabled practitioners, for reclaiming equality for "I want to share the positive power of Jiu-Jitsu with everyone on the mat, and for his life of service to our other para-athletes around the world." country, to our veterans and to those struggling in life — helping all to overcome obstacles.

"For a long time I didn’t know if I could continue to live life broken. With Jiu-Jitsu I am whole again. Now, with the help of the UAEJJF, we are equal." RONALD MANN

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RONALD MANN In closing, I would like to add some comments from those who knew him best his sis Lisa and best friend Ginna Goodenow. They were so generous to allow me to speak with them as they shared some of the moments and memories of Ron. I spoke with Ginna first who told me of how Ron and her met, which was through charity work for children "Kicking for Kids Who Can't" a project she put together.

Kicking For Kids Who Can't is was an event on the National Mall in Washington, DC. Where they held a kick-a-thon to raise money for amputee children who are adapting to life with limb loss. The program supported the Amputee Coalition of America's summer camp program. They instantly connected because of their desire to help people feel whole and complete. They were so close that people labeled them the "Ginger Ninjas" as they both were martialartist and had red hair. This was Ronald Mann, a man who faced his own struggles in life but was out there helping others deal with the hardships they faced.

Taekwondo Team. Ginna and Lisa both told me stories about Ron which included his childhood and his life as a VET. From what I know of him he would like to make sure everyone out there dealing with limb-loss especially VETS to get help from the many support organizations as people dealing with the limb-loss struggle. I know I did after my amputation due to a motorcycle accident much like Ron. His closet friends and family shared their experiences with me of Ron and his life. He truly was a special person just like you and me, he had his ups & downs but he found his true north in martial arts and through that touched so many lives. All warriors have the scars from the battles we have been in but the most amazing thing about a warrior is their compassion. The ability to love, heal and spread unique energy to those that come across their path.

When I think of the qualities of warrior Ron comes to mind; Ambition It’s through hustling that he’ll be tested. His endurance will be tested, as will his purpose, his courage, and his honor. If the modern warrior doesn’t push himself and instead His sister Lisa Briseno contacted me also to share some accepts a life of ease, he’s not a warrior. stories about Ron. Giving me some personal stories of the Definiteness of Purpose skinny young Ronald Mann who know as "arrow" because The man that wakes up with a purpose can call himself a he was so thin with red hair. She told me Ron was just like another young kid growing, he played sports in high school warrior. The man that wakes up for no reason, purpose, and with no direction, needs to create one and find one, and was a bit of a joker as she recalls him and the stuffed his life depends on it. bear that he carried with him. The same bear is still in the family with her son. She recalled him wearing a monkey suit Endurance of the Mind, Body, & Spirit Endure your hardships not because you have no other and laughed. I asked how he got into the military and she option, but because these hardships are what makes you explained just like most kids his age it was a choice after a warrior. coming to a crossroads in life. Ron chose the military. In honor of Ronald Mann a true Warrior and VET who's memory will live forever. You will be missed my friend. It was there he found martial arts. He joined the Army's Godpseed. She told me he was very passionate about his martial arts and helping others. And the GoFundMe page will be used to continue his legacy of helping adaptive martial artists get into the sport.

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Ampnation Magazine 2019 Vol. 1 Issue 4

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