THE PARA SPARTANS CHAMPIONS

AMPNATION MAGAZINE VOLUME 1 ISSUE 6 DECEMBER 2019

AMPNATION GREETINGS AMPNATION! As we approach the holidays your mind is probably on family, food and friends. And if you are one of the brave souls, travel. With all of this going on it is easy to forget something that is very important around this time of year which could affect your wallet. Weather a new or current amputee this information is very important to life as it may cause a delay in you getting prosthetic care. When Does Your Medicare Deductible Reset? Your Medicare deductible resets on January 1 of each year. The Medicare deductible is based on each calendar year, meaning that it lasts from January 1-December 31, and then it resets for the new year. If you’re signing up for Medicare for the first time, and your coverage starts sometime during the middle or later-part of the year, your deductible will still reset on January 1. This year, the Medicare Part A deductible is $1,408, and the Medicare Part B deductible is $198. So, if you’re on Medicare, you would need to meet these deductibles before Medicare starts covering your medical bills. If you are in the process of getting any DME, Durable medical equipment (DME) coverage could be affected by this if you don’t get it authorized before the cut off date. Prosthetics, if you are working with a company make sure you have a discussion with them about getting everything in before it’s too late. Make sure whatever you are trying to get has been covered and will not be affected this reset. A Publication For Amputees Ampnation Magazine publishes unbiased journalism that seeks to “empower and inform” amputees and those affected by limb loss. The magazine’s audience is primarily amputees and their families and is provided free electronically (digital) to anyone who subscribes subscribe@ ampnationmagazine.com and there is a hard copy available for purchase ass well. Each issue covers health, well-being, better outcomes of amputees living and thriving, O&P News, Vascular News, Tech and products & services. INSIDE THIS ISSUE 5 Better Outcomes Empathetic Listening 6 Correspondence Headline News - How soda impacts diabetes risk 8 Vascular & Ortho News When to Treat Type 2 Diabetes as a Vascular Disease 16 O&P News Grad student helps make prosthetic sockets out of recycled plastic 19 TECH News Apps that help you

Now, if you find yourself on the bad end of this situation there is some hope. There is a way to avoid paying Medicare deductibles, which is to have a Medicare Supplement – also called a Medigap plan.

There are 11 total Medicare Supplement plans, and each one varies in terms of price and benefits.

The 3 most popular plans are Plan F, Plan G, and Plan N, because they provide the most coverage.

You can read more about Medicare Supplement Plans F, G, and N by here: https://www.medicareallies.com/senior-insurance-blog/how-to-compare-popular-medigap-plans-f-gand-n.

However, many of the Medicare Supplement plans help pay for your Medicare deductibles.

Feature Contacts Better Outcomes - Editor@ampnationmagazine.com Correspondence - Editor@ampnationmagazine.com Vascular & Orthopedic - Editor@ampnationmagazine.com Prosthetic & Orthotic - Editor@ampnationmagazine.com Q&A - Editor@ampnationmagazine.com

Empathetic Listening Improve the Patient Experience by Honoring the First Golden Moments to Understand Patient Needs and Values AMA Hub As healthcare providers one of the most important things we do is listen. Are you doing it right? Does it really matter? How we listen can improve our practice and the quality of care we provide to our patients. Empathy begins with “engaged curiosity about another’s particular emotional perspective.”1 Empathetic listening builds on the concept of being attentive in an effort to gain a better understanding of another person’s experiences. Empathy is also described as the capacity to put one’s self in another’s shoes to feel what that person is going through and share their emotions; the recognition and validation of a patient’s fear, anxiety, pain, and worry; and the ability to understand patients’ feelings to facilitate more accurate diagnoses and more caring treatment. Empathetic listening fosters the connection between the patient and physician and can effectively alleviate difficult conversations. Patients who feel understood are often more open and responsive to their physician’s advice. In return, physicians may have an improved sense of professional satisfaction and joy in work. There are 5 STEPS to Listening With Empathy: 1. Connect with Empathy by Honoring the First “Golden Moments.” 2. Listen for Underlying Feelings, Needs, or Values. 3. Remain Present When You Are Listening. 4. Look for Cues That the Patient Has Finished Speaking. 5. Reflect on Your Experience. Step 1 Connect with Empathy by Honoring the First “Golden Moments. Expressing empathy is a key ingredient to enhancing the patient experience. In fact, 65% of patient satisfaction has been attributed to physician empathy.2 Regardless of their medical condition, patients often arrive for the visit with emotions such as anxiety, fear, and apprehension. By connecting with empathy, you can help to dissuade those fears and convey that you and your care team are listening to their concerns. The feeling of being understood by another person is intrinsically therapeutic. It bridges the isolation of illness and helps to restore the sense of connectedness that patients need to feel whole. The foundation of empathetic communication is based on accurately understanding the patient’s feelings and effectively communicating that understanding back to the patient so the patient feels understood.3 Empathetic listening can be used in emotionally charged situations. You might try it with a patient who is experiencing grief related to an illness or with a co-worker who is having a work-related conflict. As you practice empathetic listening, use body language to show that you are actively listening. You can do this by sitting next to or near the speaker, leaning in their direction, and maintaining eye contact. Make sure your arms are not crossed, as this can signal to the speaker that you are closed off and not really listening. It is also helpful not to focus solely on a computer keyboard or screen with your back to the patient. As patients tell their story, periodically echo or summarize to further demonstrate that you heard what they had to say. In a clinical situation, the first few minutes of the encounter are precious. During the initial patient visit, you may feel pressured to dive into the various clinical tasks that need to be completed. However, if you leap into these tasks without listening to the patient, you may miss critical information. Take the time to honor the first “golden moments” of the visit by setting aside distractions such as charts, computers, phones, alarms, and pagers. Giving the patient your full attention at the start of the visit prevents important issues from surfacing at the end, and will allow you to better understand the patient’s concerns or symptoms. While the first few minutes of a visit are important, you should continue to be fully attentive throughout the interaction to ensure that you capture any concerns that may be revealed later in the visit. Step 2 Listen for Underlying Feelings, Needs, or Values. Sometimes feelings may be right on the surface, but at other times they can be hidden. Patients often mention emotional situations, and then wait for a practitioner’s cue that it is okay to continue. As the patient explains the situation, watch for feelings hidden in body language, facial expressions, or other non-verbal cues. As your interaction continues, take your own emotional temperature and note your own internal feelings like anxiety, sadness, or frustration. Use the patient’s non-verbal cues to assess if this is an opportunity to switch from medical questioning to empathetic listening. To switch to empathetic listening, allow for a brief pause in the conversation, soften your tone of voice, and ask a question that is directly related to your interest in the patient’s feelings. This strategy invites the patients to express their concerns, and allows you to address the patient’s unique needs. We all have common needs, but different ways of acting in response to these needs. When we focus on needs and values, we can identify ways in which we are the same. During empathetic listening, keep focused on the patient’s underlying need, rather than communication style or behavior. You may not know what the need is at first—be open to hearing the need. There might be situations where you may not be able to identify the feeling that the patient is experiencing. In those circumstances, it is important to emphasize that you are interested in hearing about the patient’s experiences. Expressing interest invites more expansive conversation, and increases the probability that the patient will reveal underlying feelings. Step 3 Remain Present When You Are Listening. Give patients an opportunity to express their feelings to completion, without interruption. Their feelings and values will surface if they are given ample time to express themselves in a welcoming environment. Focus on moments when the patient seems to display the most energy around a topic (e.g., more rapid speech, change in 4

The UCSF ACT Program hosts an annual amputee basketball and mobility clinic. Led by the Warriors Basketball Academy and the AMP1 Basketball Team, the clinic teaches fundamentals of the game in a supportive team environment. The clinic is designed to focus on skill development and mobility for those affected by limb loss while encouraging a healthy and active lifestyle. Participants of all activity levels and experience are encouraged to attend.

NEW THIS YEAR: The clinic will be held at the new Warriors Basketball Facility (former practice facility for the Golden State Warriors) in downtown Oakland. Be among the first to play on their newly renovated courts! The address is 1011 Broadway, Oakland CA 94607

Registration Required Please register by contacting Erin.Simon@ucsf.edu

The AMP1 Basketball Team is comprised of amputee athletes who connected while seeking opportunities to play competitive stand-up basketball. AMP1 demonstrates that all you need is courage, motivation, and heart to follow your dreams.

The mission of the UCSF Amputee Comprehensive Training (ACT) Program is to assist those affected by limb loss in maximizing their physical and functional mobility. We support a community of individuals motivated to engage in activities they enjoyed prior to amputation and recover a healthy and active lifestyle.

“We can show people how to do it on a computer,” Holcomb said. “Knowing what I can do with scanning and 3D printing, this can all be digitized.

“Brent was the first person to believe in me.”

Though Wright had been working with fused deposition modeling (FDM) 3D printing – with the use of a hot glue gun – for three years, Holcomb introduced Wright to a Hewlett-Packard (HP) Jet Fusion 3D 4210 printer. EastPoint president Paul Sugg purchased the printer and the post-processing station, and Holcomb and his family moved to North Carolina from Ohio this summer to start Additive America inside EastPoint, located at 310 Airport Road.

“A big thing with additive manufacturing for me is that it’s manufactured in the USA,” Holcomb said. “We’re taking jobs that would go to China and we’re keeping them here. And manufacturing here in Eastern NC, there’s such an opening for that.”

Holcomb began programming machines for 3D printing seven years ago and entered the world of additive manufacturing between 2015 and 2016 when HP stepped into the 3D-print22

then pour plaster inside the cast to mold the socket. But prostheses have advanced throughout the years, way before Sugg’s time. “The old way of doing it, you would literally bring in a tree trunk to the guy and he would hollow it out,” Sugg said. “He would press it on your leg, whittle it some more so you could wear it. having an additive manufacturing company in town is going to be a great selling point for Kinston and Lenoir County,” Holcomb said. “We’ve been hearing the most that people are excited about a new manufacturer coming.” But what’s most important to Holcomb and Sugg is the feedback they receive from patients like Srulevich.

“It’s been developed from wood to lamination to now 3D printing.” Holcomb said the $500,000 printer is the only privately-owned HP 3D printer in the state. “I woke up from surgery with no arm and no leg,” Srulevich said. “It was a challenge. I wore legs that were held on with an air cushion. They were heavy as anything else. The 3D printer does a better job than traditional prostheses.

Q A & In the United States alone, approximately 185,000 amputations occur each year, and over 2 million people are living with the loss of a limb. I called upon more than I would like to say to consult with patients who are facing one of the toughest life decisions - to amputate or not. Most have not choice in the matter they just don’t know it. I work with several doctors and help them and their patients by providing valuable insight to life as an amputee. I speak with patients and their loves ones about what to expect. As an amputation specialists and editor of this publications and host of Amp Life Talk Radio, answering questions about the process, from the reasons for amputation, to returning to favorite activities, sex & intimacy after the procedure. I decided to do a Q&A on this topic, below you will find some of the most common questions I get from patients and family. Q: What are some reasons for amputation? A: An amputation is the surgical removal of part of the body, usually an arm or leg. There are three main reasons for amputation. 1. The limb has been affected by gangrene, which is when the body’s tissue begins to die as a result of lack of blood supply. 2. There has been a life-threatening danger to the person’s health, such as when the part of the body has been affected by cancer or serious infection. 3. The limb has experienced a serious trauma, such as an injury that has crushed the limb or a significant wound. Q: What are the different types of amputation? A: There are many different types of amputation. The easiest way to explain is to divide them into lower limb and upper limb categories. Lower limb amputations: • A partial foot amputation involves the removal of one or more of the toes. This type of amputation affects walking and balance. • Ankle disarticulation involves amputation of the foot at the ankle level. • A below the knee (or transtibial) amputation is an amputation of the leg below the knee joint, so the individual retains use of the knee. This is the most Sean Harrison Hanger Clinic Patient Advocate Manager Amputee Life Coach the hand on the wrist joint. • A below elbow (or transradial) amputation involves removal of the forearm below the elbow joint. • In elbow disarticulation, the forearm and the elbow joint are removed. • Above the elbow (or transhumeral) amputation is the removal of the arm above the elbow. • Shoulder disarticulation is the removal of the entire arm, including the shoulder blade and collarbone. Q: What can someone expect following an amputation? A: Immediately following surgery, the focus is on healing the residual limb, which is paramount for longterm recovery goals. Healing of the wound at the amputation site typically occurs within 3-4 weeks. The scar takes significantly longer, approximately 12 to 18 months, to heal on the inside. Wound management during this early phase is very important to promote healing of the underlying soft tissue and to reduce the risk of infection. The goal is to maintain a soft, pliable tissue over the scar and shape it through compression to allow for a prosthesis and weight bearing moving forward. Coming to terms with the psychological impact of an amputation is often as important as coping with the physical effects. It’s very common to experience negative thoughts after an amputation, especially if it was done in an emergency situation without time to prepare for the effects of the surgery. Many people report feeling emotions of grief, similar to experiencing the death of a loved one. It is important to seek support from trained professional peer visitor as needed to help in the process of emotional healing. Q: What is a prosthesis and how does it work? A: A prosthesis is an artificial limb which is created by a certified prosthetist. The parts vary depending on the level of amputation and the mobility of the user. The rehabilitation team collaborates to ensure that the prosthetic user has the most appropriate prosthetic components to allow for optimal mobility and activity. What to Expect When Facing Amputation common amputation in the older population. • A through-the-knee empty amputation involves removal of the lower leg and the knee joint. The residual limb is still able to bear weight, as the whole femur (the longest bone in the leg) is still intact. • In a hip disarticulation, the whole limb is removed, including the femur. When possible, a variation of this procedure is done to retain part of the upper femur and hip joint for better shape and profile when sitting. • A trans-pelvis amputation (or hemipelvectomy) involves removal of the entire leg and part of the pelvis. Upper limb amputations: • A partial hand amputation can include fingertips or part of the fingers. The thumb is the most commonly lost digit, which limits grasping ability. • A metacarpal amputation is the removal of the whole hand, leaving the wrist intact. • Wrist disarticulation involves removing 23

The 2019 Para Spartan World Championship was held again in Laughlin, NV setting the stage for one team’s return here for redemption.

Before most of people finished their first cup of coffee on the this Sunday morning, these athletes took to the sandy hills, fighting against gusting headwinds, on a race route filled with 27 obstacles designed to test them and their abilities in every imaginable way.

As we waited for this time to come back around I remember what I felt like last year as we crossed the finish line 5th. And I told myself never again, this year will be different, very different. I know for me losing is hard. I take it to heart. My teammates also did too. They didn’t say anything but I could tell it hurt. We knew we were the better team with over 200 Spartan Races complete between two members of our team loosing was not our plan.

You see quotes all the time on social about getting back up after falling or failing to reach to the top. Well, my life had become one of those, I came back home and faced the music of explaining why we didn’t win. 12 months of swallowing that pill and to make things worst the footage that came out on Spartan TV, hearing a female announcer trash talk our team really put salt in the wound. As the year went we sat back and watched the trash talkers talk and as we did race after race training as a team to get better/ faster.

28 “Winning is great, sure, but if you are really going to do something in life, the secret is learning how to lose. Nobody goes undefeated all the time. If you can pick up after a crushing defeat, and go on to win again, you are

going to be a champion someday.” Wilma Rudolph

This quote speaks is our team. Just because were adaptive athletes that does not mean were not competitive. I know this may be shock to some reading this story but people living with limb-loss can be fierce warriors weather in competitive sports or normal life.

As a team we pulled together last year and decided to put in the time training together as well as individuals. With one gaol in mind... This would be our year. We were the only Para Spartan team to take on Tahoe and complete a Beast, making history as the first ever Para Spartan team to do so. Completing that race was the final step in molding us as a team with “Grit”.

The Para Spartan Championships this year had in my opinion became a legit “Elite Race” as the “new” rules set an even playing field. When I say new rules there were really no new rules, they just were going to enforced this year as some teams from last lack character in following them. With that being said the Para Spartan Race challenged the rigor, the minds, and the hearts of 40 of people who dared to step into the shoes of an “Elite” Para-Athlete world. It was gut check time.

This year there were several members who travel from other countries to be apart of this event. The 10 elite teams were composed of athletes from the USA, Netherlands, Kenya, UK, and elsewhere. Each team featured one wheelchair athlete and three other athletes, medically classified to Paralympic standards.

The famous words every Spartan hears before they go on course; “you gone learn today.” Lives were about to be changed forever. Something Spartan racing has a way of doing, weather good or bad.

Our team set out to set the pace for this race at 12 minutes per mile, may not seem like that fast but when you add in a wheelchair and obstacles it becomes a daunting task. We had trained like this all year, pushing it hard, even in Tahoe at the Beast 9,000ft. elevation we did this just for this event.

Our strategy was simple, a 100+ yard sprint to separate the pack and see who would dare to keep this pace with us. Whoever took the bait would soon realize it was a setup.