Ampnation Magazine | Vol. 2 Issue I Jan. 2020

AMPNATION

VOLUME 2 ISSUE 1 JANUARY 2020

MONSTER MIKE SCHULTZ

X X

GAMES ASPEN

MAGAZINE MAGAZINE

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Contents

Better Outcomes People of Color Are Most At Risk

23

Q&A Prosthetic Feet

With Trevor Grimbleby

22

Monster Mike Schultz X Games Aspen 2020

12

Stump for Advocacy and Empowerment

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Health & Fitness Sugar In Your Beverages

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.

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

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.

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.

6 Correspondence

Headline News and Opinion

10 Vascular & Ortho News

Transmetatarsal Amputation (TMA) and Toe Amputation

18 O&P News

Nonprofit That Helps People Who Need Prosthetics

21 TECH News

Mobile Closed-Loop Insulin System Lowers Hypoglycemia Risk in Type 1 Diabetes

34 Show Notes

Amp Life Talk Radio Show Notes

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.

Editor’s Message Sean Harrison contact@ampnationmagazine.com

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 If would like be involved with Amp Nation Magazine please send inquires to: Contact@ampnationmagazine.com 3

Better Outcomes cans with diabetes and an additional 84.1 million Americans with prediabetes are at an elevated risk of developing PAD in their lifetimes. With African Americans 1.7 times more likely than non-Hispanic whites to have diabetes, they are also most at risk of developing PAD. Sadly, African American patients with diabetes are over 3 times more likely to have their limbs amputated secondary to non-healing wounds and gangrene than Caucasians.

These non-healing wounds and gangrene are most often secondary to PAD. For most People of color are most at risk patients, lives and limbs could be saved for amputations. Time to close with access to early screening and the the gap.

AL.com | By Dr. Ralph Redd | Practicing vascular proper interventional care, but sadly this is not happening in communities across surgeon at Montgomery Vascular Surgery Alabama.

As an African American doctor in Montgomery, I am dedicated to closing gaps in healthcare by making sure our communities are healthy, happy, and thriving. The yawning gap between health outcomes for whites and health outcomes for people of different racial and ethnic backgrounds is well documented. We know, for example, that African Americans under the age of 50 are more likely to suffer from heart disease, stroke, or diabetes.

One of the biggest disparities in health stems from complications due to peripheral artery disease (PAD), an all-too-common but easily-preventable chronic illness. PAD occurs when fatty deposits in a person’s arteries restrict the blood flow to the limbs. As a result, the patient experiences intense pain in the legs and eventual amputation, if left untreated.

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A common complication of diabetes, more than 30 million Ameri-

late. Since amputation should be a last resort, we can incentivize doctors to perform vascular evaluation regularly by requiring them to document their efforts to screen patients well before the need for amputation arises.

Finally, I call upon our elected officials to support amputation reduction efforts. Lawmakers should discuss and develop new policies to improve healthcare outcomes throughout Alabama and end the racial disparities that exist for our most vulnerable, at-risk populations. By doing so, I am confident we can reduce the need for amputations in patients diagnosed with PAD. I encourage people to learn more about their risks for developing PAD, especially if you are living with diabetes. Ask your doctor to learn more.

It’s time for Alabamians to come together to end the dangerous racial gap between PAD patients of color and their white counterparts. Our lives and limbs depend on it.

Ralph B. Redd, MD is a vascular surgeon practicing in Montgomery.

Despite Narrowing Gap, Racial Health Disparities Remain AAFP - CDC Vital Signs Report Chris Crawford

The good news is that the death rate for African-Americans declined 25 percent between 1999 and 2015, according to a newly released CDC Morbidity and Mortality Weekly Report(www.

Ending disparities in healthcare is poscdc.gov) (MMWR) and an accompasible—with great effort, the death rate nying Vital Signs report(www.cdc. for African Americans declined by 25% from 1999 to 2016, while the racial gap gov). The bad news is that significant for deaths due to heart disease in people health disparities between black and white Americans remain, with black life aged 65 or older completely closed. expectancy still nearly four years less than that of whites.

We have reason to hope, but we must also demand action.

It’s just this sort of mixed bag of health disparity findings that the Alabama must expand PAD screening AAFP’s new Center for Diversity and and early detection efforts—especially for smokers and patients with diabetes, Health Equity will strive to improve.

Created to educate, advocate and prediabetes, and other cardiovascular collaborate on solutions to problems issues. Undergoing early screening can reduce the probability of an amputation involving such inequities, the cenby 90%, but unfortunately screening is ter will allow the Academy to “take a greatly underutilized. As a result, many leadership role in addressing diversity and social determinants of health as patients don’t know they have PAD, much less understand the risks and what they impact individuals, families, and it takes to save their limbs, until it’s too communities across the lifespan and to Nationally, 200,000 non-traumatic limb amputations occur in the United States each year.

lation overall. However, we still have a long way to go,” said Leandris Liburd, Ph.D., M.P.H., M.A., associate director of the CDC’s Office of Minority The Report Highlights According to the MMWR and Vital Signs Health and Health Equity, in a news release(www. cdc.gov). “Early health interventions can reports, disparities between blacks lead to longer, healthier lives. In particand whites of all ages are narrowing ular, diagnosing and treating the leadbecause mortality rates are declining diseases that cause death at earlier ing faster among blacks than among stages is an important step for saving whites. Specifically, the gap in death lives.” rates between the two races for all causes of death across all age groups Additional Findings was 33 percent in 1999 but fell to 16 Based on data from the U.S. Census percent in 2015.

Bureau, National Vital Statistics System Notably, the racial gap closed completely for all- and the CDC’s Behavioral Risk Factor cause mortality and for deaths from heart disease, Surveillance System, the report reaffirmed conventional wisdom that social among other areas, in those ages 65 and older. and economic conditions such as poverty contribute to health differences between Yet a particularly concerning finding from the blacks and whites. reports was that blacks in their 20s, 30s and 40s are more likely to live with or die from conditions that typically occur at older ages in whites, For example, the analysis showed that such as heart disease, stroke and diabetes. That’s compared with whites, blacks in all age because risk factors for some of these conditions, groups had lower educational attainment such as high blood pressure, aren’t being detected and home ownership rates and nearly twice the rate of poverty and unemand treated in younger blacks. ployment. The authors noted that these risk factors may limit blacks’ access to Also disturbing is the fact that homicide death preventive services, as well as treatrates among blacks didn’t change during the ment options. Additional risk factors that entire period examined. affect health outcomes for blacks include One positive note from the reports, however, is an obesity and limited physical activity. improvement in other causes of death, including According to Kevin Kovach, Dr.P.H., a sharp decline in HIV-related deaths among blacks ages 18-49 -- about 80 percent from 1999 M.Sc., population health manager in the AAFP Health of the Public and Science to 2015. Still, blacks remain seven times to nine Division and a certified health education times more likely than whites to die from HIV. specialist, it’s important that markers of “We have seen some remarkable improvements in health outcomes not be confused with death rates for the black population in these past drivers of health outcomes.

17 years. Important gaps are narrowing due to improvements in the health of the black popu“I think we want to be careful about how strive for health equity.”

we talk about race and poverty and other social factors because, technically, they (especially race) are markers of health outcomes but not the drivers of health outcomes,” said Kovach.

“For example, being black by itself doesn’t cause poorer health -- it is the systematic discrimination and racism that cause poorer health. Without systematic discrimination and racism, we wouldn’t have the large disparities between white and black Americans.

Same with poverty; being poor by itself doesn’t cause poorer health, but not having sufficient resources to support good health is a driver.”

Among other key findings from the report: • Blacks ages 18-64 have a greater risk of early death than whites.

• Disparities in the leading causes of death for blacks compared with whites, including homicide and chronic diseases such as heart disease and diabetes, are already pronounced by early and middle adulthood.

• Blacks ages 18-34 and 35-49 are nine times and five times, respectively, as likely to die from homicide as whites in the same age groups.

• Blacks ages 35-64 have double the risk for high blood pressure as whites.

• Blacks ages 18-49 are twice as likely as whites to die from heart disease.

“It’s important that we continue to create opportunities for all Americans

Stroke Alert Signs

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Correspondence ernment grants, but with the public’s continued support of the Key Tag and Address Label Service, our vital programs for amputees will carry on long into the future,” says Danita Chisholm, Executive Director of the CHAMP Program.

Cutline: Annie Gabriel, age 5, is from Humboldt and has had support from War Amps for years.

3 Bills to Watch that Could Affect Your Rights

News, Opinion & Information

2024. The Education and Labor Committee agreed to send the measure to the full House.

Along with providing more funding for the OAA, the bill would increase the emphasis on services that help older adults deal with social isolation.

Social Security Disability Insurance (SSDI) U.S. Senator Sherrod Brown (D-OH) and Senator Bob Casey Jr. (D-PA) introduced the Stop the Wait Act. Not only are people forced to wait months to qualify for SSDI, but those with disabilities are forced to wait an additional five months for a disability check.

It can be hard to keep up with all the legal information that pertains to Medicare and Social Security bills. The following are some recent bills that you The Stop the Wait Act would get rid of the waiting periods for people with disshould know about. abilities. The waiting periods could furSocial Security insolvency ther harm people’s health by delaying One of the major issues that the Unit- care. In 2017 alone there were more than 10,000 Americans who died while ed States is facing today is the insolvency of the Social Security Disability waiting for SSDI benefits to begin.

Humboldt girl counts on War Amps Insurance program (SSDI). SSDI was created for people who are not able to These Medicare and Social Securiprogram work due to disability so they can have ty bills could greatly change the way Annie Gabriel, 5, and her family are thankful for the support they get. Melfort Journal

a way to support themselves.

The program has obvious flaws, but one of the major issues is that almost half of the eligibility factors used to determine if someone qualifies for the program are not medically based. In addition, the Social Security TrustAnnie is a double leg amputee and, ees report from 2018 shows that the as a member of The War Amps Child SSDI trust fund will run out by 2054, Amputee (CHAMP) Program, is eligible along with Social Security benefits for for financial assistance for the cost of artificial limbs and recreational devices. seniors.

As a new year begins, the family of Annie Gabriel, 5, of Humboldt, look back with appreciation on the support they have received from The War Amps.

She also attends regional CHAMP seminars where “Champs” and their parents learn about the latest in artificial limbs, dealing with teasing and bullying, and parenting an amputee child.

The Making DI Work for All Americans Act targets the SSDI’s outdated qualification process that determines disability by requiring Social Security to update the list of jobs that are available. The bill also has Social Security updating their qualifications used to assess eligibility for SSDI.

“The War Amps has been there for Annie and our family from the beginning.

We attended our fourth CHAMP seminar Dignity in Aging Act in 2019 and because of this support, Annie has developed a positive attitude The Dignity in Aging Act of 2019 was and we couldn’t be more proud,” says introduced by three Democratic and mom Lyndsay. three Republican representatives. The bill would extend the Older Americans The War Amps entered its second Act (OAA) for another five years and century of service this year, and there is still much to do to ensure amputees, increase the funding for the programs like Annie, have the support they need. by seven percent in 2020. It would also increase six percent each year 6 starting in 2021 and carrying on into “The War Amps receives no gov-

older adults and people with disabilities are living in America today and in the future.

Transfer Cade Mays’ Father Sues Georgia After Finger Amputation The parents of transfer offensive lineman Cade Mays filed a lawsuit against the school last month after part of the father’s pinky was amputated during a 2017 recruiting event.

The Atlanta Journal-Constitution obtained a copy of the lawsuit, which was filed by Kevin and Melinda Mays in the State Court of Clarke County on Dec. 5, 2019. According to the lawsuit, Kevin and Melinda Mays, along with their sons Cooper and Cade, attended a dinner with recruits at Sanford Stadium on Dec. 15, 2017. While attempting to get up, Kevin Mays’s finger got stuck in the hinge of a folding chair.

“As a result, Plaintiff Kevin Mays’ right pinky finger was partially amputated as the subject folding chair wedged against the column,” the lawsuit said.

“His severed finger shot across the floor.”

Georgia offensive line coach Sam Pittman picked up the severed finger off the floor and put it on ice, according to the lawsuit. Kevin Mays was taken to Piedmont Hospital in Athens, but his finger could not be re-attached.

Kevin Mays continued to have pain, swelling and decreased mobility as a result of the amputation, and he later had surgery. The lawsuit states that he continues “to suffer pain and decreased use of his right hand” and “to suffer lost income and has incurred and will continue to incur, medical expenses.”

The lawsuit names Georgia’s Board of Regents and Athletic Association, as well Mity-Lite, the folding chair manufacturer, and five unnamed people, among the defendants.

Kevin Mays is seeking general damages for pain and suffering and loss of labor, damages for past and future medical expenses and income, interests and costs and punitive damages. Melinda Mays is seeking general damages for loss of consortium.

Cade Mays spent two seasons with the Bulldogs and played in 14 games in 2019. He entered the transfer portal this week, and he reportedly plans to transfer to Tennessee, according to ESPN. Mays is a native of Knoxville, Tenn., and his brother has signed with the Vols.

Thomas Mars, Mays’s attorney, told 247 Sports that he does not believe Cade Mays will have to sit out a year of eligibility due to the circumstances.

After Mars’ comments, Georgia released a statement on the lawsuit.

“Unlike Mr. Mars, we will not engage in a public discussion of a student eligibility matter, other than to wish the best for Cade and his family,” the statement said, per The Athletics’s Seth Emerson.

“Although the Mays lawsuit is a public document available on the Internet, no one at UGA was authorized to discuss it, we’re not aware of anyone who did so, and the reporter who broke the story of the lawsuit has stated that he was not

notified by anyone at UGA.”

Non-profit paying deductible costs for Lexington teen who received prosthesis LEXINGTON, Ky. (WKYT) - One amputee is surprising another by helping to pay for a prosthetic leg.

Source: WKYT

For one teenage girl, this new leg is a game changer as she puts a new foot forward in accomplishing her goals in life.

At 15, Harleigh Spartman shouldn’t have to be learning to walk on a new leg, but life isn’t always fair.

“I used to really love running,” Spartman said.

It was two years ago when cancer took her leg. So the steps she took today were pretty big ones.

“She’s been wanting a running leg since the beginning,” said Harleigh’s mother, Angela Spartman.

Whatever burdens she’s carrying, the cost won’t have to be one of them, thanks to Jenn Andrews, a woman who knows exactly what Harleigh is going through.

Andrews lost her leg to sarcoma in March of 2018. As an avid runner, she wanted to help other amputees stay active, so she started an organization to bridge the gap that insurance doesn’t cover.

She paid the rest of Harleigh’s deductible so she can get back to being active.

“I wanted to be able to run again, I wanted be able to do races again,” Andrews said. “I quickly learned how expensive it was to be a young active.”

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Correspondence

News, Opinion & Information

Legends owners Danielle and David Man Has Amputated Arm Preserved taxidermists to preserve it.

Finding a shop willing to ply their trade Swift used dermestid beetles to strip

by Taxidermist Annie Gabriel, 5, and her family are thankful for

An Alberta man came up with a very unusual solution for what to do with his amputated arm—he took it to a local taxidermist and had him prepare the bones for display CBC News reported.

Almost 20 years ago, Mark Holmgren borrowed his brother’s motorcycle for a quick joyride. Unfortunately, taking a corner at high speed brought his outing to an unexpected end.

“I was just driving too fast, turned the corner and I wiped out,” he told CTV. “I tore the nerves in my shoulder. It was a brachial plexus injury and from that day I could never use it. Couldn’t move it, couldn’t feel it.”

Despite the arm never recovering feeling or motion, Holmgren resisted having it amputated, believing that medical science would one day be able to let him use it again. However, after two decades of waiting, he decided to lose the limb and contacted the University of Alberta Hospital to schedule its removal.

However, Holmgren had grown attached to his right arm over the years, and didn’t want it to end up in the hospital’s incinerator. So he hatched a plan with a local taxidermist to turn the amputated limb into a one-of-a-kind souvenir.

Holmgren picked up the arm from the hospital about a month after the operation and kept it in a garbage bag 8 in his freezer while he auditioned

the necrotized flesh from the arm, then reassembled the bones into their original configuration and connected them together.

On Facebook, they called it “the oddest project we have ever had but one of the most fulfilling.”

Holmgren was able to pick up the finished arm right before Christmas, and brought it to his family holiday dinner, where reactions were varied.

He told CTV “Some of them wanted to touch it, some of them don’t want to touch it. It’s just mixed feelings when people see it.”

He told the station he plans to keep the arm behind his kitchen sink.

It is legal in many countries to take possession of any amputated or otherwise removed body parts after surgery. There is no U.S. federal law restricting the possession of body parts unless they are Native American, but a few states have implemented restrictions on private ownership of human remains.

In 2016, Oklahoma woman Kristi Loyall had her foot and lower leg amputated to treat cancer, KFOR reported. She had the limb skeletonized in a similar fashion on human flesh was a challenge, but eventually Legends Taxidermy in Dray- to Holmgren’s arm and now travels the ton Valley consented to clean the flesh world with it, documenting its journey on her Instagram page. from Holmgren’s severed arm and sterilize the bones for display.

Man who lost half his leg says doctors have REFUSED to save his stump

alcohol, suicidal thoughts.’

Mr Lovell said daily tasks such as going to the toilet or making a cup of tea would cause him to ‘break down’ because it was so much more difficult than before.

An amputee who lost half of his leg due to a blood clot has told how doctors have refused to save his dying stump.

He said: ‘I was a fit healthy lad, I worked seven days a week and all of a sudden I’m dragging myself across the floor of my bedroom.’

By Vanessa Chalmers Health Reporter For Mailonline

Ben Lovell, from Halifax in Yorkshire, is desperate to keep the remaining part of his right limb.

Mr Lovell was due to marry his fiancée, Laura, 33, in November 2018, but less than four weeks before the wedding, a professors and they all say my leg, as The 41-year-old had his shin bone it’s been blocked for twelve months now, trip to the doctors about a lump in his amputated two years ago, after his foot should be dead. groin almost put a halt on the day. turned white from a lack of circulation.

Tests revealed a second major blood ‘It should be of no use to me whatsoDoctors discovered he had a blood clot inever, but I can still do what I can do clot was blocking off circulation to both his leg, revealing it was responsible for because I’m pushing that blood into it.’ of his legs, which had to be treated with cramps in his calf that he had suffered another bypass. for months.

Mr Lovell’s life-changing ordeal began in February 2017, when he started feeling ‘My left leg cleared with a heparin drip Medics are reportedly shocked that his cramps in his right calf. and my right leg needed another byleftover stump hasn’t already died bepass. I managed to walk down the aisle cause the main artery to his thigh is now He went to see his GP who put the six weeks later and we got married,’ Mr completely blocked by another clot. cramps down to sciatica, a pain caused Lovell said. by the compression of the sciatic nerve, But he says NHS medics are reluctant which runs from your hips to your feet. Things were looking up by 2019. He to operate on his leg to unblock the clot had regained confidence, started his and save his stump.

Five months went by with no improve- own company that provided shoes ment. Mr Lovell said he was eventually for amputees, and attended a mental Mr Lovell fears having the remaining partrushed to Bradford Hospital after his foot health program. of his leg cut off when it dies will leave turned white. him unable to get a prosthetic and renHe said: ‘I’d had a really good year in der him wheelchair-bound.

A typical symptom of a blood clot, also 2019, and then on my wife’s birthday, which was in September, we were going called deep vein thrombosis (DVT) The father-of-two admits that he is in occurs, is a red, swollen leg. It can also out for a meal for dinner and I popped pain every time he takes a step, but can turn the skin a blue color. down to the doctors and she couldn’t put up with the daily agony because ‘at find a pulse in my groin again.’ least I can still walk’.

Tests at the hospital revealed that there Mr Lovell said finding out his femoral was no blood circulating to Mr Lovell’s Mr Lovell has been left to try and reartery was blocked was a ‘massive kick foot due to a blood clot in his leg. habilitate his stump by himself, using in the teeth’ after coming so far. exercise to push blood through to his In September, he was given a sevdying upper leg. en-hour bypass operation in an attempt He claims that doctors are reluctant to perform more surgeries to save his to save his leg.

When asked about why he is annoyed stump. It is not entirely clear why. by the NHS decision to not operate, he An arterial bypass creates a new route said: ‘I want to save my leg. for blood to get into the leg, typically by Amputating the stump further would be a last resort. Because there is a lack of using a piece of another blood vessel.

‘The higher up you amputate it, the blood flow reaching it, the area may not harder it is to walk. If goes too high, I heal. Mr Lovell also does not want to But the procedure was unsuccessful, won’t get to wear a prosthetic.’ and Mr Lovell was told to have the best have his leg amputated any more. chance at living a normal life he would Mr Lovell, a former road worker, added: need to have his leg amputated.

There are no future plans for Mr Lovell’s ‘I may be still in pain every time I take a stump, and in the meantime, he is having regular scans and tests to monitor step, but at least I can still walk.

On November 29, Mr Lovell underwent the situation.

‘My femoral artery (the main artery in surgery to remove his leg. Back at home both legs)... is completely blocked all the after his surgery, he struggled to adapt The decision has prompted Mr Lovell to way from my stomach all the way down to life as an amputee. seek healthcare privately or abroad to to my leg. treat the lack of blood flow to his leg.

He said: ‘Having to come home and ‘The only thing keeping my [amputated] adapt now to living life with one leg was leg alive at the moment are the little just hard, just very hard. blood vessels and they [doctors] don’t know how long that’s going to last for.

‘I went through probably a good twelve ‘I’ve spoken to doctors, specialists and

months of being low. I turned to drugs,

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Vascular& Orthopaedics Transmetatarsal Amputation (TMA) and Toe Amputation Transmetatarsal amputation (TMA) is a surgery to remove part of your foot.

You may need a TMA if you have poor blood flow to your foot or a severe infection.

doctor before starting.

Diet It is common after this type of surgery to have a decreased appetite and some weight loss. Even if your appetite is poor, you should try to eat well to promote healing. Eating small meals more often may be better than eating three large meals a day.

The number one problem patients have after going home is not getting enough fluids. This can make you feel tired and weak and slow your healing. It is very important to follow the guidelines below.

•Drink at least 8-10 (8 oz.) glasses of water or juice per day. Avoid drinks with caffeine. Caffeine causes your body to lose more fluid.

•Eat at least 3 fiber-rich foods each day. Food rich in fiber include most fruits and vegetables (such as apples, dates, beans and peas). Also, whole grain breads and cereals (such as bran products and oatmeal). Try eating prunes or drinking prune juice.

Activity After surgery you may notice that you tire more easily. This is normal and will decrease as you get your strength and energy back. Staying active will help you gain strength. It will also help Care of the Incision prevent constipation. You should be as When you leave the hospital, your inci- active as you can but also take time to sion is most often closed with stitches rest. Slowly increase the amount of acor staples. These will be removed by tivity you do each day. When sitting in a your doctor at a follow-up visit. Wash chair or in bed, keep your legs elevated. your incision with soap and warm water When walking, follow the instructions every day. Use a mild, fragrance-free from your provider. Sometimes you can soap. Wash it gently with a clean wash- use a heel weight bearing shoe. Somecloth or gauze but do not scrub. Rinse times, you may not put any weight on well and dry gently. Allow the incision your foot. and skin around it to dry completely before putting on the dressing. Wrap Are you at risk for poor blood flow the foot loosely with dry gauze unless to the legs and feet? You are more your doctor gave you other directions. likely to have poor blood flow to the Do not soak in a tub. Do not use any legs if you: lotions, alcohol, powders, or oils on •Smoke your incision.

•Are over age 50 A toe amputation is a surgery to remove one or more toes.

Pain Control It is normal to have some pain at the suture line and in your foot after surgery. Your doctor has prescribed pain medicine for you to use at home. This is often the same medicine that you have been getting in the hospital. As healing occurs, your pain will improve and you will need less pain medicine. Your pain may be relieved with an over-the10 counter pain reliever. Talk to your

•Have high blood pressure •Have high cholesterol •Have diabetes •Do not exercise •Have heart disease in your family

How do I take care of legs and feet with poor blood flow?

•Look at legs and feet daily for sores, scratches, cracks, blisters, and redness.

Report them to your doctor or nurse.

•Wash your legs and feet daily with

mild soap and water. Avoid soaking.

Dry well.

•Put lotion on dry skin daily.

•Let a doctor or nurse clip your toenails or show you how to clip them.

•Wear shoes that fit well.

•Wear white cotton or wool socks.

•Check shoes and socks for stones, sharp things, or holes.

•Do not use heating pads or hot water bottles on legs or feet.

•Never go barefoot.

When to Call You should look at your amputation site every day. Please call your doctor if you have: •An increase in redness or warmth at the amputation site.

•Red streaks on your skin that extend from the site where the stitches are.

•Bulging or swelling at the incision.

•New drainage or bleeding from your incision.

•Open spots between the stitches where the skin is pulling apart.

•A fever higher than 101.5°F (38.5°C) by mouth for two readings taken 4 hours apart.

•If you notice the skin along the incision is getting darker or turning black.

Leg Pain Could Spell Peripheral Artery Disease for Some (HealthDay News) --

Leg pain while walking or doing other activities could be a sign of peripheral artery disease, an expert says.

Peripheral artery disease (PAD) develops silently, narrowing blood vessels until a shortfall in the supply of nutrients and oxygen causes cramps and leg pain, explained Dr. Faisal Aziz, chief of vascular surgery at Penn State Health Milton S. Hershey Medical Center.

“Pain with physical exertion is a classic, hallmark sign,” Aziz said in a Penn State Health news release. “When it gets really bad, it can form wounds on the legs that do not heal or cause blackening of the foot or toes.”

Risk factors for peripheral artery disease include age and gender. Men and all people 65 and older are most likely to develop the condition. Other risk factors include smoking, high blood pressure, high cholesterol, uncon-

trolled diabetes and heart disease.

Anyone who has risk factors and pain in their legs should talk to their doctor, Aziz advised.

“If you aren’t exercising or walking enough, you won’t even know you have it until it has silently progressed,” he said. “Most physicians will also recommend that you walk more to help the condition because that encourages your body to form other vessels around the blockage.”

Medications that treat risk factors such as high blood pressure, cholesterol and insulin levels may be helpful, but peripheral artery disease can’t be reversed after it starts.

• •

•

toms of PAD for something else PAD often goes undiagnosed by healthcare professionals.

People with peripheral arterial disease have a higher risk of coronary artery disease, heart attack or stroke.

Left untreated, PAD can lead to gangrene and amputation.

Added risks for PAD Other factors can increase your chances for peripheral artery disease, including: • •

Your risk for peripheral artery disease increases with age.

High blood pressure or high cholesterol puts you at risk for PAD. If you smoke, you have an especially high risk for PAD. If you have diabetes, you have an especially high risk for PAD.

• “Whatever blockages have occurred will not go away unless they are stented or • bypassed,” Aziz said. “But risk-factor modification can slow the progression of the disease.”

The good news In cases where walking doesn’t improve the condition, 70% to 80% of patients can be helped with minimally invasive procedures in which balloons or stents are placed in blood vessels to improve circulation.

If you’re at risk for peripheral artery disease or have been diagnosed with PAD, it’s worth knowing that: •

• More serious cases may require surgical bypass, where blood is rerouted from the damaged vessel to a good one nearby, Aziz said.

•

About Peripheral Artery Disease (PAD) PAD is similar to coronary artery disease (CAD) Peripheral artery disease is a narrowing of the peripheral arteries serving the legs, stomach, arms and head. (“Peripheral” in this case means away from the heart, in the outer regions of the body.) PAD most commonly affects arteries in the legs.

Both PAD and coronary artery disease (CAD) are caused by atherosclerosis.

Atherosclerosis narrows and blocks arteries in critical regions of the body.

Quick facts about PAD

PAD is easily diagnosed in a simple, painless way.

You can take control: Follow your doctor’s recommendations and strive to lead a heart-healthy lifestyle.

Some cases of PAD can be managed with lifestyle changes and medication.

It’s important to learn the facts about PAD. As with any disease, the more you understand, the more you’ll be able to help your doctor make an early diagnosis. PAD has common symptoms, but many people with PAD never have any symptoms at all.

Learn the facts, talk to your doctor and take control of your cardiovascular health.

Learn more at the The American Heart Association website: https://www. heart.org/en/health-topics/peripheral-artery-disease/about-peripheral-artery-disease-pad

The most common symptoms of PAD involving the lower extremities are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again.

Be aware that: •

Many people mistake the symp-

11

Stump For How To Start Up A Support Group

Advocacy and Empowerment We’re In Your Corner

Understand The Purpose of Your Group

Sources: WikiHow and ACA

Understand your motivation for starting a support group. The Why & What the This subject comes up quite often to me from other amputees looking to do group is all about will help you focus something for amputees in their area. your time and energy wisely.

Living through difficult circumstances can be emotionally and mentally exhausting. Having a support group can make you feel less lonely or stressed and give you a sense of control over your situation.[1] Even if you don’t currently know anyone who has gone through your unique experiences, you can seek out the advice of others and build a community of support.

First, look for existing groups by using Google or ACA (Amputee Coalition of America) website. Chances are that at least one support close to you. You may be able to join an existing group, or if no groups exist in your area, then you maybe able to form one.

To find any existing group, search for the terms or conditions you are seeking with the words “support group”.

You can also narrow your search to your local city or county.

Obtain any how-to guide, or group starter kit, that the ACA offers (they provide this free on-line).

While it’s perfectly acceptable to need the support of others, you should not start a support group solely for your own needs. Use your experience and your understanding of what you need How often do you plan to meet? to offer that support mutually, ensuring that everyone in your group will have This is a very aspect of any support and the support that they need for their can make or break the group as far as problems. the success of the support group.

Find your squad, having key people you can count on for your support group in case of an emergency. People who can run the support group in your absence.

Things happen, these people will play a crucial role in keeping the group going if anything should happen to you. People will come to depend on your support group so always have a “Plan B”.

Determine the scope of your group. You want to help as many people as possible, but if a group gets too large it may be difficult to allow everyone adequate speaking time. At the same time, you don’t want to be too narrow and restrictive with your group’s parameters.

Knowing the ideal scope of your group will help you when it comes time to open your group to others.

Consider how often your group should meet. Are the issues pressing enough to warrant weekly or even twice-weekly meetings? Will participants need time to implement strategies and plan for future meetings? Is there a support system in place in case of emergencies during the time between meetings?

As an amputee you understand the importance of these issues as it takes more time for amputees to get ready to go places. They are constantly jumbling medical appointments.

TIP: Register Your Support Group

By registering your support group with the Amputee Coalition, you are joining a nation-wide network of people who Determine whether your support group help individuals and families on their will be short-term or long-term. Know- journey through limb loss or limb difing whether you will be working under ference. As a registered support group, time restraints will help you plan out you will receive: your group’s agenda and determine Seek out professional assistance before what needs to be accomplished and • Copies of our bimonthly magazine, when. you start a support group. That way, inMotion, copies of First Step and once you organize your group, you educational materials will have the guidance you need to get Ask yourself whether the issues you • Group website listing in our national started. Social service workers, clergy, hope to address are permanent, lifeSupport Group Network and meetlong issues, or issues that are temand physicians or therapists may be ing listings on our calendar (thouhelpful in various ways, from providing porary or cyclical. Support for people sands visit every week) living with chronic health problems will • Free participation at our Annual referrals or meeting space to locating probably require a permanent group, other needed resources. These can Support Group Leader Summit, held become very valuable you as they may but a support group for students strugat the Amputee Coalition’s National gling in school, for example, will probahave rooms you can use, people who Conference bly not need to meet during the sumare interested in your group, printed • Shared ideas, networking and news materials and brochures, guest speak- mer, when school is out. As an amputee through our monthly support group support group your goal should be long ers, etc. Always reach out to local leader conference calls term as limb-loss is a permanent conbusinesses they could can be key in • Personal support from our staff at spreading the word about your support dition will affect the person for the rest supportgroups@amputee-coalition. of their life. Your is something they will group with flyer & ad placement. org or 888.267.5669 x8146 count on being there.

12 Ask other groups how they got started. Learning from others, even if their group addresses different needs than the group you want to start, can help you plan out everything you’ll need from the ground up.

community website, library, community center, clinic, or post office.

Mail copies to key people who you think would know others like yourself. Submit your notice to newspapers and church bulletins.

Also, check to see if there is a local “self-help group clearinghouse” serving your area to help you get started.

Determine your group’s format. The Advertise your support group’s meetthree most common support group for- ings in rounds. Send out an initial mats worth considering: notification several weeks in advance (if possible), then a follow-up notification a • Curriculum-based - in which readfew days to one week before the event. ings are “assigned” and discussions This will help maximize exposure and center around a given reading’s remind interested parties that an event issues. is approaching.

• Topic-based - in which topics are introduced and discussion centers Hold The Meeting on that week’s topic.

• Open forum - in which there is Run meetings efficiently. After deciding no pre-determined structure, and on the format and frequency of your discussion topics vary as members group, you’ll need to focus on how bring them up best to run each meeting. Your group

Location, Location, Location Find a suitable meeting place and time. Try to obtain free or very lowcost meeting space at a local church, library, community center, hospital, or social service agency. Chairs should be arranged in a circle and avoid a lecture set-up.

Great Minds Think Alike Look for a room capacity slightly higher than your anticipated crowd size. Too big of a meeting space will feel cavernous and empty; too small will feel cramped and uncomfortable.

Reach out to like-minded people. Find a few others who share your interest in starting a group by circulating a flyer or letter that specifically cites how to contact you if one is interested in “joining with others to help start” such a group.

You may also want to ask people you know to refer you to others who might be interested.

Include your first name, phone number, and any other relevant information.

Make copies and post them at places you feel are appropriate, e.g., a local

co-founders, discuss and revise your mission statement.

Do not make any promises of success or achievement in your mission statement. Promising results may deter members from returning if they do not achieve those results in a forecasted time period.

Your Team Share responsibilities and delegate work in the group. Decide who will be the primary contact person/people for the group. Consider additional roles members can play in making the group work.

Decide which tasks you’re willing to trust to others in the group. Appoint those tasks with an understanding that each role will include great responsibilities.

Be clear in giving instructions and laying out the terms of each role.

Give credit to everyone who contributes. Let them know that their efforts are appreciated.

What’s In A Name?

Choose a name for your group. Share a few options at your first meeting for may benefit from having some kind of additional feedback and ideas from structure/schedule, but it’s important to members before deciding. The nambe fluid and open to the needs of your ing process should be a fun aspect of members. creating a support group, and should allow everyone to have equal input.

• Make your group’s objectives clear.

If there is a schedule, stick to it.

Spread The Word • Be punctual, and ask that your members are also punctual.

Publicize and run your first public meeting. Permit ample time for your Hello My Name Is... core group members to describe their interest and work, while allowing Draft a mission statement or a stateothers the opportunity to share their ment of purpose. This should be done view of what they would like to see the with the help and input of your core support group do. group of co-founders, so that everyone feels that they are a part of the proIdentify common needs the group can cess and can provide insight on what address. they hope to get out of the meetings.

The mission statement should provide Determine whether you should enact a structural framework for the group’s a confidentiality policy to keep inforvalues, purpose, and goals, and what mation shared at your meetings from will be done to meet those goals. leaving the group. This may put members at ease and make those who feel Your mission statement should be brief reluctant to share their experiences and to the point. Aim for 2-3 sentences more comfortable going forward. at most.

Make plans for the next meeting. Allow Focus on intended outcomes rather everyone to socialize informally after than methods when drafting your mis- the meeting to reinforce the sense of sion statement. community, spread information about the next meeting.

With the help of your core group of 13

V& O

News & Information

Hot Water Soak May Help Ease Poor Leg Circulation (HealthDay News)

Could soaking in hot water followed by light exercise work as well on peripheral artery disease (PAD) as a longer bout of exercise does?

The authors of a new study suggest it could, but some PAD experts aren’t convinced.

Peripheral artery disease affects about 8.5 million Americans. Only about one in four people in the United States is even aware of the disease, however.

PAD occurs when cholesterol builds up in blood vessels supplying blood to the legs. This slows or even blocks the flow of blood. Symptoms include pain or cramping when walking (claudication), loss of muscle mass, skin that’s cool to the touch, and sores or ulcers on the legs or feet that are slow to heal, according to the U.S. Centers for Disease Control and Prevention.

Regular physical activity and supervised exercise programs are key treatments for PAD. If someone is a smoker, quitting smoking is crucial. Treatment also includes controlling blood pressure, cholesterol and diabetes, the CDC says.

In the new study, researchers compared blood pressure and walking distance in two groups, each with 11 PAD patients.

out of the water and performed 15 to 30 minutes of calisthenics, the study can’t say whether or not heat therapy is a replacement for exercise,” said Bruno Roseguini. He is an assistant professor of health and kinesiology at Purdue University in West Lafayette, Ind.

idea of using heat therapy to alleviate symptoms of claudication “provocative.”

“While [this study] didn’t achieve the goal of showing heat therapy being more effective than supervised exercise, it did seem to demonstrate that heat therapy somewhat improved the patients’ ability to walk, by an average of 10%, similar to what supervised exercise achieved,” he said.

Roseguini also noted that the study wasn’t an equal comparison. The exercise group averaged just one session a week compared to the heat therapy group that averaged four times a week. Yang said the heat therapy likely inOne group did up to 90 minutes of creased circulation around the clogged walking and resistance training once Dr. Darren Schneider, director of the or narrowed blood vessels in the legs. or twice a week. The other group Center for Vascular and Endovascular -- dubbed the heat therapy group Surgery at New York-Presbyterian and All three experts pointed out that the -- soaked in a pool with warm water Weill Cornell Medicine in New York City, study was small, with just 22 people (about 102 degrees Fahrenheit) for 20 said heat therapy might help people total, so any findings would need to be to 30 minutes and then did up to 30 walk more. Pain is common when peo- replicated in a larger study. minutes of calisthenics three to five ple with PAD walk. times a week. They were encouraged to But would it hurt if you decided to give submerge up to their shoulders.

“People who get pain when they walk, this hot water treatment a try on your don’t want to walk,” Schneider said. own?

“There was no evident difference “So this therapy is not necessarily a between the effects observed in heat replacement for walking, but this might Roseguini said being under supervision therapy via spa bathing and a superhelp get some improvement in walkis best. If you decided to try it on your vised exercise program,” wrote Ashing.” own anyway, it would have to be done ley Akerman and colleagues from the carefully, especially if you tried to use University of Otago and Dunedin Public For people who can’t walk, such as pa- hotter water, such as in a hot tub.

Hospital in New Zealand. tients with joint disease or knee problems, Schneider said this might be an “You’ve probably seen warnings at hot Three PAD specialists who reviewed the alternative. tubs for people with heart disease. findings said it’s too soon to say that There’s a risk of blood pressure falling,” having a hot water soak allows you to Dr. Yi-Ming Yang, associate director of he said. Someone whose blood presforgo a longer exercise session. peripheral intervention at Lenox Hill sure is seriously low could get dizzy and fall, or possibly even pass out.

14 “Because the study participants got Hospital in New York City, called the

As for more locally applied heat, such as a heating pad, Roseguini said that method is likely too small to create changes in the body’s temperature.

And, that’s what may have induced the improved circulation. His group is studying whether water-circulating pants that heat up the lower body might help.

The study was recently published in the American Journal of Physiology -- Heart and Circulatory Physiology.

More information Learn more about the prevention and treatment of peripheral artery disease from the American Heart Association.

SOURCES: Bruno Roseguini, Ph.D., assistant professor, department of health and kinesiology, Purdue University, West Lafayette, Ind.; Darren Schneider, M.D., chief of vascular and endovascular surgery, and director of the Center for Vascular and Endovascular Surgery, NewYork-Presbyterian and Weill Cornell Medicine, New York City; Yi-Ming Yang, M.D., associate director, peripheral interventions, Lenox Hill Hospital, New York City; June 2019, American Journal of Physiology -- Heart and Circulatory Physiology

Smoking Puts Blacks at High Risk of Serious Artery Disease: Study (HealthDay News)

African-Americans who smoke appear to be at greater risk for peripheral artery disease, or PAD, new research has found. Additionally, the findings suggest that smoking intensity – how many cigarettes a day and for how many years – also affects the likelihood of getting the disease.

Smoking increases black Americans’ risk of peripheral artery disease (PAD), a new study warns.

PAD -- a narrowing of arteries that provide blood to the arms, legs, brain and other organs such as the kidneys -- can lead to stroke, kidney failure, erectile dysfunction, pain in the legs when walking and loss of limbs.

Mississippi Medical Center in Jackson.

looked at the relationship between smoking and PAD in participants in the To learn more, Clark and his team an- Jackson Heart Study, the largest single alyzed medical records of about 5,300 site cohort study investigating cardioparticipants in the Jackson Heart Study, vascular disease in African-Americans. a large-scale investigation of heart disease risk factors in black Americans. The new research, as well as the JackParticipants were 21 to 84 years of age. son Heart Study, are funded by the National Heart, Lung, and Blood InstiSixty-eight percent said they never tute (NHLBI), and the National Institute smoked; 19 percent said they were of Minority Health and Health Dispariformer smokers, and 13 percent were ties (NIMHD), both part of the National current smokers.

Institutes of Health. The new findings appear in the January issue of the JourCompared to nonsmokers, current nal of the American Heart Association. smokers were twice as likely to have early signs of PAD in their lower exEven though PAD is more prevalent tremities, and eight times more likely to in African-Americans than in whites, have high calcium buildup in the aorta, prior studies about the disease did the body’s main artery. not include significant numbers of African-Americans. This limited the Those who smoked 20 or more cigaresearchers’ ability to single out the rettes a day had much higher odds for specific effects of smoking in this popPAD than those who smoked less than ulation from other risk factors, such as 20 cigarettes each day, researchers hypertension, diabetes mellitus, and found. obesity.

The study was recently published in the For the study, researchers divided the Journal of the American Heart Associa- 5,258 participants into smokers, past tion. smokers and never smokers. After taking into account other risk factors, they “Establishing a clear association beassessed smoking intensity and found a tween smoking and peripheral artery dose-dependent link between cigarette disease in this particularly vulnerable smoking and PAD. Those smoking more population can help guide our efforts than a pack a day had significantly to lower their risk and to help them higher risk than those smoking fewer improve their health,” Clark said in a than 19 cigarettes daily. Similarly, those journal news release. with a longer history of smoking had an increased likelihood of the disease.

Dr. Mariell Jessup is chief science and medical officer of the American Heart Study: Cigarette Smoking and SubcliniAssociation. She said the findings cal Peripheral Arterial Disease in African offer strong evidence of the specifAmericans of the Jackson Heart Study exteric life-threatening risks facing Afrinal link . J Am Heart Assoc. 2019;8:e010674. can-Americans who smoke.

DOI: 10.1161/JAHA.118.010674.

CONTACT “This type of research can be useful nhlbi_news@nhlbi.nih.gov mailto: in the development of clear messages 301-496-5449 targeted to our African-American pop- Ask for press officer on duty ulation to underscore the real physical costs of tobacco product use,” Jessup added.

PAD affects 8 to 12 million people in the United States and 202 million worldwide, especially those age 50 and older. It develops when arteries in the legs become clogged with plaque, fatty Black Americans are twice as likely deposits that limit blood flow to the as whites to have PAD. Smoking is a legs. Clogged arteries in the legs can known risk factor for PAD, but little has cause symptoms such as claudication, been found previously about its specific pain due to too little blood flow, and inimpact among blacks. creased risk for heart attack and stroke.

“Peripheral artery disease is a major disease burden in the African-American population,” lead author Dr. Donald Clark III said. Clark is an assistant professor of medicine at the University of

The impact of cigarette smoking on PAD has been understudied in African-Americans, even though PAD is nearly three times more prevalent in African-Americans than in whites. The current study

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O &P News

Nonprofit That Helps People Who Need Prosthetics

Buying a Prosthetic Is Expensive. This Tennessee Nonprofit Wants to Fix That Buying a prosthesis isn’t cheap. That price doubles if you need a second one, or is slightly more if you want a running blade.

For a below the knee amputee, a single running blade can cost nearly $3,500. Go above the knee—requiring a knee socket—that cost goes up to $8,000 to $9,000. And if you’re a family with a child who seeks a prosthesis, those costs become almost annual as you regularly have to re-fit and re-size as the kid grows.

This makes access to an active lifestyle a challenge during the developmental years. It also challenges adults who face amputations from being able to play sports or do something as simple as walk through a grocery store parking lot.

running blades, they believe with Fann and a few other life would’ve been drastically amputees and became sold different. on the program.

“We had about 10 human Even as a world-class athfeet on our team,” he said. lete competing on interna“People ask me if running tional stages, including tak- with a blade is an advaning track gold and bronze at tage. Heck no. You’re missthe Paralympics, Fann said ing bones and muscles you people often tried to take no longer have and replace pity on him and didn’t see that with a piece of carbon That independence is treahim as an athlete.

Often, it fiber.” sured for anyone, so a nonis that mindset that preprofit in Nashville known as Anyone in need of a prosAmputee Blade Runners (ABR) vents amputees from even getting a chance to compete thesis, whether that’s a is working to remedy that for in a sport they dream of running blade for track and amputees of all ages and inparticipating in. other sports or a prosthesis terests around the country. for more stability or a foot “People reach out from all So, Fann and Fitzsimmons for basketball, is able to over the country, and we set up a nonprofit that helps apply for one through ABR. typically try to help around people who need prosthetics It doesn’t have to be for 100 people a year,” Joshua athletic purposes, but they Southards, executive director by fitting, teaching how to use, and giving prosthetics most often handle athletes of Amputee Blade Runners, told Runner’s World. “It’s not to people who might not be like runners to basketball able to afford them. players who compete at amjust about fitting and setting “I’m not an amputee, but ateur and even Paralympic people up with prosthetics; I’m constantly in awe of levels. it’s about empowerment. We what people can do,” Southshow them how to use it and ard said. “That’s why we Once accepted, you are how to advocate for themwant to do anything we can asked to come into Nashville selves.” to help people be the best for about a week to be fitted that they can be and help and test out what you might The group was created in them get to where they nev- want to do with your pros2011 by two guys who are er thought they could be.” thesis. Also, thanks to partnow specialists with prosThat’s what drew Southard nerships with a Nike store thetics: Aaron Fitzsimmons to the nonprofit. He was that closed and donated the and Ryan Fann, a single-leg first introduced to ABR when shoes to ABR, and the local amputee who grew up with he worked at a vascular surFleet Feet store, recipients a running blade. Without the gery group that performed also receive a single shoe assistance and support from amputations in Nashville. without having to pay for others who helped him and Then, he did a Ragnar Relay both—a single-leg amputee 18 others competing with

only needs one.

Because kids often come in and grow out of their prosthetics, they offer continual support and assistance as they get older or need maintenance.

“We do a heck of a lot to get people the running blades they need,” Southard said.

“Luckily, we have some help from places like Fleet Feet, who said to send our people over to them, and they would determine the best shoe a person needs for whatever they were tying to accomplish.

They’d give them the shoe and maybe a pair of socks, too.”

Despite working with amputees around the country, most funding for ABR comes from the Nashville area. Southard does his best to bring in additional funding from various grant programs and also asks for fundraising from applicants, but he hopes to grow the organization more nationally and continue to change lives all over the nation.

“We recently worked with a girl whose parents never thought she’d be able to run,” Southard said. “When she got a prosthesis through us, she did cross country, and it also gave her the confidence to join the debate team. It’s not just about mobility. It’s investing in the whole person.”

Barbie unveils new inclusive dolls with vitiligo and another with prosthetic limb Barbie Dolls Diversity range (2020) - In pictures The makers of Barbie have announced their plans to reveal an inclusive range of dolls - including one with the skin condition vitiligo and another with no hair - in an effort to increase the diversity of their range.

The California-based company Mattel said it wants to provide a ‘multi-dimensional view of beauty and fashion’ and ‘represent global diversity and “inclusivity,” with the additions to its Fashionistas line.

The new models, which include a Ken doll with long hair and a Barbie with a prosthetic leg, will be rolled out throughout 2020, with the vitiligo doll set for release in the spring.

The manufacturer explained they hoped the doll would allow ‘kids to play out even more stories they see in the world around them’.

The Barbie Fashionistas line was first introduced in 2015 to represent girls with a variety of skin tones, eye colors, hair colors and textures, body types and styles so that its young customers could “find a doll that speaks to them.”

The new Barbies join more than 170 dolls within the diverse range, which is aimed at “showcasing a multi-dimensional view of beauty”.

The range includes a doll with no hair (pictured to the right) to reflect new catwalk trends as well as hair loss, the company said.

A Barbie doll with vitiligo (pictured to the right) also joins the range which was created with the help of a dermatologist to ensure the skin condition was accurately represented, it said. When Barbie posted a prototype to its Instagram channel last year, it quickly became its most liked post ever.

There’s also a Barbie with a gold prosthetic leg, the second in the Fashionista range to have a prosthetic limb. The first was created in partnership with 12-year-old disability activist Jordan Reeves last year.

A new Ken doll with luscious golden locks (pictured below) also features in the collection.

The dolls are proving popular, according to the brand, with over half of all dolls sold worldwide last year belonging to the diverse range.

Of the top 10 best sellers, seven were diverse, including a doll which uses a wheelchair. In the UK, both of the Barbie dolls with wheelchairs were the two bestselling individual Fashionistas dolls while globally, the bestselling individual Fashionistas doll of 2019 was a curvy doll with afro hair.

Fashionistas dolls retail for £11.99 each. The vitiligo doll will be available in spring, while the doll with no hair and doll with prosthetic limb will be available later this year.

For more see the Daily Mail and Evening Standard

19

BetterOutcomes to pursue a healthy lifestyle,” said Timothy Cunningham, Sc.D., lead author and epidemiologist with the CDC’s Division of Population Health, in the release.

“Public health professionals must work across all sectors to promote health at early ages.”

Center for Diversity and Health Equity’s Perspective Danielle Jones, M.P.H., manager of the new Center for Diversity and Health Equity, told AAFP News that a number of factors could have led to the African-American death rate dropping 25 percent from 1999 to 2015.

still more likely than whites to report being in fair to poor health and have more frequent “mental distress days” at every age.

“It’s not enough to extend the length of an individual’s life without considering the quality of years lived,” Jones said.

As for family physicians’ role in improving African-American patients’ health, Jones pointed out that the report noted blacks ages 18-34 were less likely than whites to have a personal doctor or health care professional they see regularly.

For example, the start of the 21st century brought with it an increased recognition of the need for a population-based approach to health, she noted.

“I think having that relationship with a family physician is critical to achieving optimal health over the life course,” she said. “I think family physicians, with the help of organizations like the AAFP, can develop strategies that identify “Our most at-risk and vulnerable com- opportunities for early engagement munities were directly targeted with in- with young adults that support them at terventions to prevent and minimize the every stage of life.” effects of chronic disease and establish positive healthy behaviors,” Jones In speaking with family physicians, said. “Also, the level of advancement in Jones said she’s learned there’s a lot medical technology in that period has of passion for and need to address been exponential in the development issues of disparity and inequity in their of treatments for acute and chronic practices. “However, most don’t know conditions previously considered unwhere to start or they don’t feel emtreatable.” powered to do so,” she said.

As to what’s being done about the ongoing high rate of homicide in African-American communities, Jones said she thinks the nation is entering a time when community engagement and activism is at an all-time high. “Not only are individuals insisting upon action by their local, state and federal governments, they are also enlisting the support of advocates and allies,” she said.

The Center for Diversity and Health Equity will fill this need by equipping family physicians with the skills they require and also engaging other stakeholder groups in the AAFP’s mission locally and nationally.

“I envision the center’s role as one that not only focuses on providing solutions at the individual level, but also at the level of our health care systems and Jones applauded the AAFP on its stance infrastructure,” Jones concluded. on gun violence and encouraged all family physicians to read the recommendations from the call to action(anStory highlights nals.org) on firearm-related injury and death the Academy developed along • The death rate for African-Ameriwith seven other medical organizations, cans declined 25 percent between which was published in the American 1999 and 2015, according to a College of Physicians’ Annals of Internal newly released CDC Morbidity and Medicine in 2015.

Mortality Weekly Report.

• Still, sizeable health disparities “Individuals and chapters can also look between black and white Americans to coalitions in their state for ways in remain, with black life expectancy which they can be part of this continustill nearly four years less than that ing dialog,” Jones added. of whites.

• A particularly concerning finding Overall, she cautioned that although from the reports was that blacks this report highlighted improvements in in their 20s, 30s and 40s are more 20 African-American health, blacks are likely to live with or die from con-

ditions that typically occur at older ages in whites.

Mobile Closed-Loop Insulin System Lowers Hypoglycemia Risk in Type 1 Diabetes Endocrinology Advisor.com

TECH

Automated insulin delivery by a mobile closedloop control (CLC) system represents a feasible option for glycemic control in type 1 diabetes, according to study results published in Diabetes Care.

Insulin pumps with built-in CLC algorithms allow for fine-tuning of insulin delivery by an automated system.

Mobile CLC systems controlled by the patient on devices such as smartphones may provide advantages over traditional systems, including accessibility and improved ease of system updates. To determine the feasibility of this system in managing glycemic levels, researchers compared the ability of mobile CLC and sensor-augmented pump (SAP) therapy to reduce the frequency of hypoglycemia in patients with type 1 diabetes.

Closed-loop systems controlled by the patient on devices such as smartphones may provide advantages over traditional systems, including accessibility and improved ease of system updates.

The mean percentage of time spent at >180 mg/dL was 40%±17% at baseline and 34%±11% during follow-up in the mobile CLC group The multicenter randomized unblindcompared with 43%±18% and ed trial (ClinicalTrials.gov Identifier: 39%±15%, respectively, in the SAP NCT02985866) included 127 patients group, with a risk-adjusted mean (47.2% women; 86.6% white) with type difference of -3.0% (95% CI, -6.1 1 diabetes from 7 university diabetes to 0.1, P <.0001 for noninferiority). centers in the United States. Patients Secondary hypoglycemic end points were randomly assigned 1:1 to the mo- (eg, time spent below <54 mg/dL bile CLC group (n=65) or the SAP group and <60 mg/dL) also occurred less (n=62). Both groups were provided with frequently in the mobile CLC group a continuous glucose monitoring system (P <.001 for both). that was controlled via Bluetooth connection with a smartphone in the mobile The benefits of mobile CLC were CLC group. Primary outcomes were the particularly pronounced at night: percentage of time spent with glucose comparing the CLC and SAP groups, levels of <70 mg/dL and >180 mg/dL the mean difference in time spent during weeks 3 to 13 of continuous glu- below 70 mg/dL was -2.3% (P cose monitor use. <.0001) during self-reported sleep In the mobile CLC group, the median percent time spent in active CLC mode was 69%. The mean percent time spent in the target range (70-180 mg/dL) was higher in the mobile CLC group (64%) compared with the SAP group (57%; P =.0074). The mean percent time spent at <70 mg/dL for the mobile CLC group was 5%±4.2% at baseline and 2.4%±1.7% at follow-up compared with 4.7%±4.9% and 4.0%±3.4% in the SAP group, respectively. The risk-adjusted mean difference between groups was -1.7% (95% CI, -2.4 to -1.0; P <.0001 for superiority).

“Mobile [CLC] can be an appealing alternative to artificial pancreas systems with control algorithms embedded in the insulin pump, offering certain potential benefits such as more elaborate user interface, portability across devices, and improved user experience,” the researchers noted.

Given the observed superiority in reducing risk for hypoglycemia and noninferiority in exposure to hyperglycemia in their study, the investigators concluded that “mobile CLC is a feasible and promising approach, especially with a more refined system that would ensure better device connectivity.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.

Reference

Kovatchev B, Anderson SM, Raghinaru D, et al.

Randomized controlled trial of mobile closed-loop control [published online January 14, 2020]. Diabetes Care. doi:10.2337/dc19-1310

periods, and the mean difference for time spent above 180 mg/dL was -6.9% (P =.0015). Time spent in the target range overnight was also improved with mobile CLC compared with SAP therapy (mean difference, 6.6%; P =.0002).

The study researchers noted that the use of closed-loop mode in the mobile CLC group was temporarily suspended for up to 2 weeks for some participants because of problems identified with data transfer.

In addition, disruptions in wireless signal limited the amount of time the CLC system was active.

Pick up a copy on Amazon.com 21

MONSTER MIKE SCHULTZ

X Games returns to Buttermilk in Aspen, Colorado for the world’s best action sports, music and festival experience — on snow! All sport competitions are free and open to the public.

X Games Aspen had a musical with some of the world-renowned artists as they took the stage alongside the most progressive winter athletes at Buttermilk which was held on January 23 26. Live coverage of the event aired on ESPN and ABC.

race, he drifted off course, flying off his snowmobile and landing on his left leg.

He suffered from a severe compound fracture to his knee and after multiple surgeries had his leg amputated above the knee.

After engineering his own prosthetic knee, which utilizes a patented linkage system and a mountain bike shock, Mike earned a motocross adaptive silver medal at the X games. It was after this that Mike realized the need for advanceBut there was one event we kept a ments in high impact adaptive sports close eye on, Adaptive ShowBike Cross prosthetics and founded BioDapt, Inc. in which featured a person we were keep- July 2010. ing an eye on. Mike Schultz.

Making the Moto Knee available to active amputees across North America.

Who Is Mike Schultz?

Currently more than 100 wounded solSchultz has been a lifetime lover of action sports and an amputation of his diers, extreme athletes and amputees left leg above the knee left him looking wanting to return to an active lifestyle are using Mike’s prosthetics. That same for a solution to help him to continue year, Schultz became the first person to performing at a high level. In 2008, win a gold medal at the X Games and 22 while competing in a snocross

Winter X Games...After his amputation, he started snowboarding in 2009.

The entire U.S. Paralympic snowboard team in the LL-1 and LL-2 classes use his company’s prosthetic knee (Moto Knee) and foot (Versa Foot) this season.

Mike son of Scott Schultz and Carrie Johnson has one brother, Chris. Mike is married to Sara Schultz they have one daughter, Lauren, who enjoys going after new challenges and her hobbies include motocross, snowmobiling, mountain biking, horseback riding, skiing and working in his shop. Mike was inducted into the Athletes with Disabilities Network Hall of Fame in the U.S. in 2010.

Mike Schultz dominated Adaptive Snow BikeCross at the X-Games Aspen 2019.

He won by a commanding 22 seconds over silver medalist Tyler Brandenburg-

X Games Competition History For Mike Schultz X Games X Games X Games X Games X Games X Games X Games Winter X Winter X X Games Winter X X Games Winter X Winter X Winter X Winter X Winter X

Aspen 2020 Aspen 2019 Aspen 2017 Aspen 2016 Aspen 2015 Aspen 2014 Los Angeles 2013 Games Aspen 2013 2011 2010 2010 2009 2008 2007 2006 2003 2002

SNB Adaptive Snow BikeCross SNB Adaptive Snow BikeCross SMB SnoCross Adaptive SMB SnoCross Adaptive SBD Snowboarder X Adaptive SMB SnoCross Adaptive MTX Racing Adaptive SMB SnoCross Adaptive SMB SnoCross Adaptive MTX Racing Adaptive SMB SnoCross Adaptive MTX Racing Adaptive SMB SnoCross SMB SnoCross SMB SnoCross SMB SnoCross SMB SnoCross

1st 1st 1st 1st 12th 1st 1st 1st 1st 1st 1st 2nd 17th 9th 16th 19th 30th

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MONSTER MIKE SCHULTZ

Mike and family; Wife, Sara Schultz and daughter, Lauren Schultz. They truly are a family that plays together very well. I see a future X-Games superstar in the making with Lauren as she has a great coach.

er. He wanted a new challenge, so he attempted to qualify for Aspen 2020 in Snow BikeCross. He competed in both XG qualifiers in December, but didn’t make the field.

Mike has earned 9 XG gold medals in his career and is one of only two athletes in X Games history to win gold in three different sports. An above-the-knee amputee, Mike owns Biodapt, a company specializing in artificial joints/limbs.

For those of you who don’t know what this sport (X-Games and Adaptive SnowBike) is all about let me try to explain.

X-Games

X Games added the first adaptive motorsport event in 2008 (Motocross) and adaptive Snocross in 2010. There were 8 Adaptive and 8 Para (sit-down riders with different levels of paralysis) Snowbike competitors in this years 2020 X Games which were two separate medal events. It was the second year for these snowbike classes, and X Games does an amazing job showcasing this event and they did this year as well (see the full race here: https://youtu.be/9g7SzEW8N-k). This year it was broadcast live on ABC..

tions to their machines and specialized prosthetic equipment.

Para class - athletes with paralysis from varying levels that prevents them from standing on the bike. The riders in this class all have specialized crash cages and controls on their machines.

Athletes - between both these classes, there are retired pros like AMA motocross Champion Doug Henry, WPSA Snocross multi-time Champion Blair Morgan, Snocross pro and Paralympic snowboard Gold medalist Mike Schultz and other riders from different levels of amateur motoPhoto Credits: Wayne Davis cross.

How Do They Do It? Adaptive class- athletes with either Regarding the X-Games said; upper or lower limb amputations.

“Pretty crazy to have just won my 10th 24 They typically need modifica-

How Do Modern Prosthetics Work?

This is a question I get on a daily basis from new and current amputees.

Prosthetic limbs have existed since the time of the ancient Egyptians, where a working prosthetic toe of wood with a leather harness allowed the wearer to use the sandals of the time or to go barefoot. Prosthetics necessary because of missing body parts due to trauma, congenital conditions, or disease. Prosthetic limbs are designed to restore the missing body part’s normal functions. Modern prosthetics are mostly created with computer-aided design, but they can also be hand-designed. The leading cause is poor circulation due to the disease of the arteries, with more than half of cases occurring in patients with diabetes mellitus.

If you’re an amputee (or a friend or family member), you probably have many questions. What happens next?

What can I expect? Can I resume activities I used to enjoy? What type of prosthetic device will I get? How do they work? These are questions that are best answered by your prosthetist and the rest of your health care team as they create your treatment plan. We invited Trevor Grimbleby who is a clinic manager of Hanger Clinic in Modesto, California to handle this Q&A on prosthetic foots. To give you a better understanding on one aspect on how modern prosthetic work.

Trevor has been involved in the rehabilitation realm for 10+ years. His path began in Physical Therapy, with an emphasis on gait and proprioception, and eventually transitioned to Orthotics and Prosthetics. Trevor focuses on patient centered rehabilitation with a multi-disciplinary emphasis. He strives to create community collaboration, improve the patient experience, address missing realms, and develop O&P awareness.

I have the distinct privilege to work with Trevor and was able to get a moment of his time away from work to ask him some questions about prosthetic foots and the number of factors that must be considered when selecting the right foot/feet for your lifestyle. These factors included your amputation level, age, weight, foot size, activity level, goals and occupational needs. The following is what I was able to put together from our talk. I hope you find this information useful.

Trevor, Q: First, the basics, what should every amputee know about feet?

A: Honestly, to each their own. – There

Q&A Prosthetic Feet 101

cost aside, prosthetic feet made of carbon fiber are commonly used and most manufacturers use carbon fiber in a wide spectrum of feet due to its lightweight and energy storing properties. Alternatively, there are a few manufacturers who have explored and found success with variations of fiberglass and composites instead of carbon fiber; with the goal of increased flexibility and “smoothness” as a result of material compositions.

Q: Comfort, does comfort matter?

A: Comfort can be represented in various ways; but ultimately, Comfort is King! If you are competing in a 100 yard dash or need a literal carbon fiber spring to bounce around on, you might sacrifice comfort for performance. The comfort, ground compliant capabilities, rollover, lack of a “dead spot”, heel and toe feel, and the users overall satisfaction with a prosthetic foot can alter the prosthetic wearers experience greatly.

Trevor Grimbleby Hanger Clinic Manager

Q: Motion, do feet move and how does that work?

A: All feet move, they just have different mechanisms of how that movement is achieved. Some feet Modesto, CA move at a point of articulation at the ankle such as a hydraulic or microare many different types of feet, for varprocessor foot (MPF), SACH feet will ious functions, different styles, differing experience a movement into foot brands, and diverse mechanisms for sucflat based on a softness at the heel, cessful task completion. Clinicians might while multi-axial feet will adapt to prefer a differing brand even though the the ground via a split heel and/or foot’s function might be classified as the foot or bumpers around the proxisame. Users might experience ankle-foot mal adapter. Differing manufactures systems differently due to daily demands, and designs of feet will determine socket fit/alignment, and categories. how that specific foot actually moves. Honestly, if you look close Q: The foot prosthesis, what makes enough at the image of a prosthetic up a foot, a complete foot on a deankle-foot you will be able to tell vice? Materials? what functional/bio-mimetic capabilities it can perform.

A: The prosthetic foot, simply put, contains an attachment point to the prostheQ: Energy, what is meant by sis proximally and provides ambulatory energy? function through the cycles of gait. How the foot performs during the gait cycle A: When the term energy is brought (and each phase) truly depends on the up in prosthetics, it is typically material properties and structural engireferring to dynamic-response feet. neering of the ankle-foot system. Some In a dynamic response foot, as the feet contain materials that make them user loads the toe aspect of the foot lighter but do not have the same energy a potential energy is created and return or bio-mimetic properties that a thus released during late stance heavier foot might have. Additionally, phase. Energy storing feet can be prosthetic foot materials can determine very useful for active users or an incost as well. A SACH foot’s foam makeup dividual who really likes feeling the is going to be less expensive than a cartoe and utilizing that function. bon fiber, dynamic-response foot. With 25 But, ultimately it is potential

LIMB LOSS AWARENESS EVENT

Run, Walk & Kick SATURDAY, APRIL 18, 2020 | 8:00 A.M. – 4:00 P.M. Encompass Health | 1303 Mable Avenue | Modesto CA, 95355 April is limb loss awareness month, and Encompass Healthcare and Hanger Clinic have partnered up to bring you Run, Walk & Kick, an event aimed at raising awareness for the limb loss and limb difference community, their families, and caregivers. The day will be filled with expert knowledge and education for those affected by limb loss as they build their independence through increased mobility. This event is open to anyone in the limb loss and limb difference community, family members, therapists, caregivers, and volunteers.

EDUCATION + ACTIVITIES + PEER SUPPORT •

Gait training and assessments

•

Prosthetic evaluations, assessments and physical therapy tips

• • •

Walking clinic and walking course Two mile fun run & walk Nutritional advice for diabetics

• •

Virtual Reality: MiGO peer support Amputee classes: Putting on & cleaning liners, socks, prosthetic sleeves, etc.

FOR QUESTIONS OR TO VOLUNTEER, CONTACT: Sean Harrison, Hanger Clinic | (209) 672-7347 Lisa Clawson, Encompass Health | (209) 404-9876

CONNECT WITH US (877) 442-6437

|

HANGERCLINIC.COM

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A

energy and the foot’s keel must be deflected in order to create a return.

Prosthetic Feet 101 With Trevor Grimbleby Q: Does height matter?

A: Build height can really matter. Build height, or the measurement between the ground and the distal end of prosthetic socket, will determine what components can be used. Lower build height, less options. High performance A: When progressing towards prosthet- carbon fiber blades do produce more ic foot selection, have a very honest potential energy with the ability to load and open conversation about goals, more, increased displacement, which expectations, and concerns with your is only possible with a taller overall practitioner. Selecting a foot should be profile. Modern, low profile feet do a fun, mutual effort. During compohave excellent function; but increased nent selection there will be times when build height opens up many more (and specific insurance coverage might not better) options. allow a certain type of foot. Do not be discouraged, discuss future goals with Q: Price, is there a big difference in your practitioner and what options are cost? available. Ultimately, insurance coverage changes, plans change, and foot A: Manufacturer price is going to be capabilities will always progress. based on materials, complexity of design, function, and whether or not a Q: How does activity level into semicroprocessor is incorporated. Costs lection a foot? are mainly associated based off of reimbursement and L-codes used for the A: Based on manufacturer guidelines, chosen foot. If one arrives at a situaalmost every foot has a selective cate- tion where cost is an issue, maybe due gory determined by the patient’s weight to copay or deductible, I would discuss and activity level. These categories functional advantages and/or maybe normally range between a low, moder- pursue hardship programs for assisate, and high activity level. Therefore, tance in costs. Higher functioning feet from a manufacturer’s guidelines the will cost more, but in the world of proscategory foot should match activity lev- thetics there are many different options el to obtain proper function and prevent that can be appropriate for most cases. premature breakdown. Additionally, different foot styles are going to be able Q: What is a Solid Ankle Cushioned to support differing activity levels. For Heel (SACH)? example: if you are planning on running daily, a dynamic response foot might be more appropriate than a microprocessor foot (MPF).

Q: What should amputees know about and consider when selecting a prosthetic foot to meet their needs?

Q: What is a Elastic (flexible) Keel Foot?

A: The prosthetic keel is the material or section of the foot which would extend beyond the anatomical metatarsals. The goal of a flexible keel foot is to provide a smooth rollover at the loss of push-off capabilities. Unlike a dynamic response foot, the flexible keel foot will not provide a push back when loading the toe.

Q: What is a Single-Axis Foot?

A: Like SACH feet, single-axis feet are simple in design and were the original ankle-foot system with articulation (movement). The main advantage of a single-axis foot is the quick foot flat position which leads to increased stability with the ground and at the knee.

The single-axis foot truly set the path for future hydraulic ankles and MPFs. Q: What is a Multi-Axis Foot?

Q: Does weight matter?

A: Weight of the foot needs to be considered, but should not be the deciding factor. Often times a foot that has more articulation, such as a MPF or hydraulic foot, will weigh more than a carbon fiber or composite foot because of the added point of movement and subsequent components/materials.

But, there are occasions where users will trial a heavier foot but the differing function might be worth the sacrifice.

I have also had patient’s tell me that added function makes the foot seem lighter. Ultimately, the whole picture needs to be assessed based off of MMT scores, balance and proprioception, along with anticipated usage.

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A: Posterior third of foot is open-cell foam, hence the name cushioned heel.

SACH feet are very inexpensive, durable, and very lightweight. Though replaced by differing feet as of recently, the SACH is still an “old faithful” type of foot. (Also know as Elastic Keel foot)

A: Multi-axial feet provide movement or compliance in coronal, sagittal, and transverse planes (inversion/eversion and internal/external rotation). These feet are very good at accommodating alternating terrains and thus reducing compensatory pressure or movements to the prosthesis or residual limb.

Multi-axial feet are widely used for active users who know they will walk on uneven ground regularly. Alternatively, multi-axial feet might feel unstable

HEALTH & FITNESS Sugary beverages – of all kinds – raise type 2 diabetes risk by 16% People who increase their daily intake of sugary beverages may confront a 16% higher risk of type 2 diabetes, according to researchers from the Harvard T.H. Chan School of Public Health.

A four-ounce increase in daily sugary beverage consumption over four years was enough to raise the odds.

Whether the beverages were sweetened with added sugar or were naturally sweetened, such as 100% fruit juice, the effect was the same.

In contrast, substituting sugary beverages with tea, coffee or water can change the odds for the better, the researchers found. Replacing one daily sugary beverage with one of these drinks lowered risk by 2% to 10%, wrote lead author Jean-Philippe Drouin-Chartier, Ph.D. The investigators also looked at the effect of replacing sugary beverages with artificially sweetened drinks.

This did not lower risk, the study found. But the researchers said to interpret that result with caution, as people already prone to type 2 diabetes may be more likely to begin replacing sugar with diet drinks.

“The study provides further evidence demonstrating the health benefits associated with decreasing sugary beverage consumption and replacing these drinks with healthier alternatives like water, coffee, or tea,” concluded Drouin-Chartier.

The article was published on-line in the journal Diabetes Care.

How to Create the Right Diabetes Type 2 Diet Plan for You

The term “diabetic diet” is a thing of the past. Nowadays, people with diabetes do not have any strange food restrictions the way we once thought.

It’s not necessary to avoid fruit, eat zero carbohydrates or buy diet food.

But, what we do know is that individualized meal plans that are fiber rich and modified in carbohydrates work best for those persons with diabetes.

We also know that meal plans do not have to be boring or monotonous. You can say goodbye to steamed broccoli and boiled chicken and welcome a variety of foods, cuisines and diet types.

Whether you are vegetarian, vegan, or trying to eat low-carbohydrate, today, you can craft a plan that works for you if you have the right tools.

Keys to a Successful Diabetes Diet Plan Monitor Your Carbohydrates Carbohydrates are the nutrient that impact blood sugars the most. If you have diabetes, it’s important to monitor your carbohydrate intake so that you may discover which foods work best for your blood sugars. Some people with diabetes benefit from following a consistent carbohydrate diet for which they eat the same amount of carbohydrates at the same time daily. Ask your registered dietitian or certified diabetes educator if you’d benefit from eating a fixed amount of carbohydrates at your meals.

In the meantime, start learning more about carbohydrates today: Stock Up on Non-Starchy Vegetables By stocking up on non-starchy vegetables, you’ll increase the volume of food at your meals which can help to reduce total calorie intake. You’ll also increase your fiber intake, which can help to reduce cholesterol and lose weight.

Reduce Your Sodium Intake A diet that is rich in sodium can increase your risk of developing hypertension (high blood pressure), which is a risk factor for developing heart disease. Because people with diabetes are at increased risk of developing heart disease, keeping your blood pressure at goal is important. You will want to avoid adding salt to your food as well as increase your intake of fruits and vegetables, two food types that are naturally low in sodium and high in potassium which may have favorable effects blood pressure. A diet type that has worked for many people with diabetes is called the DASH diet.

Make It Fit Your Lifestyle Nutrient-rich plans that are convenient, delicious, and culturally appropriate will help you make long lasting changes to achieve and maintain body weight as

Nutrition, Exercise & Healthy Living Tips for Amputees well as prevent or delay complications of diabetes. Start making changes by setting simple, tangible and realistic goals. For example, if you never eat breakfast because you are in a rush in the morning, start by eating breakfast three days per week. Or if you have to start work early, pack breakfast in the morning and eat it at work.

Learn how to choose healthy choices when dining out or taking in food.

And if you are not a chef, but want to start cooking, learn about basic skills and simple recipes. It takes time to make new behaviors.

Maintain the Pleasure of Eating Eating should be a pleasant, enjoyable experience. Food is not just about taste, it’s associated with family and sharing. Therefore, being able to maintain the pleasure of eating is a critical component to healthy eating. Sure, it sounds easy on paper, but if it were that easy no one would have difficulty figuring it all out. Aim to find balance by choosing healthy foods most of the time, listening to your body, and eating mindfully.

Find Simple, Well-Balanced Recipes From Credible Resources Many times we know what to eat, but have no idea how to put it all together. Having recipes to help guide you is important for learning about portion control. Recipes can also help you discover new and delicious food pairing and combinations as well as save time on food preparation and meal planning. A great resource was developed by Registered Dietitians of the Diabetes Care and Education practice group of the American Academy of Nutrition and Dietetics. Each recipe was developed by a professional and lists the nutrition content. They also provide tips on what to serve the food with and how to make substitutions.

Get Help If you are having trouble adapting concepts on your own or making your own meal plan, ask for help. If you have diabetes, your insurance should cover diabetes self-management therapy, making you eligible to meet with a Certified Diabetes Educator (CDE). One of the specialties of CDE’s is to develop individualized meal plans to suit not only your nutritional needs but your lifestyle, goals, 29 and culture. Source: ADA

Services Offered Video & Audio Sound Effects & Foley Creation Live Action Shoots Audio Mixing & Mastering Editing Visual Brand & Content Strategiszing Contact Rich@souleffective.com https://www.souleffective.com/ 30

Q&A

Prosthetic Feet 101 With Trevor Grimbleby

to a new prosthetic user.

for You?

Q: What is a Dynamic-Response Foot?

Your prosthesis is a tool and just as there is no single tool perfectly suited for every job, there is no single foot that is perfect for every amputee. Knowing the available options will enable you to discuss this issue clearly with your prosthetist. Evaluate the pros and cons of different feet (weight is a big issue with most amputees) so you can make the best choice for your individual aspirations and abilities. In comparing the potential benefits of microprocessor-controlled systems over other systems, patients and prosthetists should focus on the functional aspects of the prosthetic foot, weight and its level of appropriateness, given the userâ&#x20AC;&#x2122;s individualized needs and goals.

A: As previously discussed, dynamic response feet are intended to store energy with a goal of providing a sense of push-off (toe-off). Dynamic response feet only produce what is loaded into them, but never perform at a true 100% return. This type of foot is appropriate for very active users, who are seeking a push-off feedback.

All answers above are based off of the Atlas of Amputations and Limb Deficiencies: Surgical, Prosthetic, and Rehabilitation Principles Third Edition.

Q: What is a Microprocessor Foot?

A: Microprocessor Feet (MPF) consist of a combination of many different factors.

Most MPFs are driven by a hydraulic and/or a fluid based system which is then altered by a microprocessor. MPFs contain various hardware which can calculate angle, movement, and speed to determine whether to allow plantarflexion (toes down movement) or dorsiflexion (toes up movement) and at what rate. This style of foot is very functional and beneficial on ramps/slopes/hills and uneven terrain. Furthermore, most MPFs can automatically align the prosthesis when footwear is altered, created the ability to maintain the clinically-appropriate alignment. Though they can seem heavy, most users will accept the weight gain due to the added functionality and biomimetic properties.

What Is The Best Prosthetic Foot

Made by hand in small batches with 90 to 98% certified organic ingredients, with intention to heal. We make herbal infusions in an olive oil base to ensure excellent skin absorption and delivery of potent healing benefits. A Product I personally use

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Amp Life Talk Radio Listen on Spreaker.com

MONSTER MIKE SCHULTZ

Gold medal at X games over the last 18 years! Every one has something memorable about it. The thing that stands out about X games Aspen 2020 was the amount of effort I put into snowbike training. My goal was to qualify and compete in the pro class, I committed to a pro level training and preparation for the several months leading into X and made a competitive run at it, but came up a bit short.

The reason for this was to see how far I could take it, I want to show what an adaptive athlete is capable of with some motivation, hard work and the right equipment. Since my injury I have always seen myself as an athlete, not just an adaptive athlete. Even though I didn’t race with the pros, I still enjoyed competing in the adaptive class and throwing down some high flying, fast laps that earned me Gold medal #10! I was also really proud to look across the start line and see all the 6 other lower limb amputees wearing the prosthetic equipment I had built for them (Moto Knee and/or Versa Foot).”

“The other standout moment this year

was competing in the Special Olympics Unified snowboard event and being teamed up with Daina Schilttz. We both put down some clean fast runs and I was so pumped to see pure excitement and emotions on her face as we realized we won the Gold! She has been working toward a gold medal for 6 years!”

As we mentioned Mike is the founder of BioDapt which is a company that designs, manufactures and distributes high performance lower limb prosthetic components used for action sports and other similar activities.

The goal is to manufacture the highest quality and highly versatile components that allow amputees to parFamily Man ticipate in sports and activities. This When Mike isn’t competing, traveling equipment can be, and is used by the world, building legs or motivating many elite adaptive athletes at the his fans, Mike lives a quiet, simple life on his land in St. Cloud, Minnesota with highest level of competition as well as his wife and life-long teammate, Sara, the average person who just wants to get out and be active doing the sports/ and their 5-year-old daughter Lauren.

And we can’t forget his extended fam- activities they enjoy. ily! Horses - Chief, Comanche, Ranger and pony Taz; his cat Silver. While Mike uses his home for his own relaxation, he also opens his home up to athletes who use his prosthetic equipment. It is at Mike’s home where he gets them on horses, puts them on dirt bikes on his backyard track, rides the mountain bike trails with clients to dial in their equipment, but mostly to make them feel back at home in the sports they love.

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Transcripts from Amp Life Talk Radio - The Podcast S4/EP.01 | How liners work

the sleeve and liner overlap. The prosthesis stays attached with pump-activated vacuum or valve-assisted suction.

Liners play an important role in the comfort and health for prosthetic leg users. They fit over your residual limb and go between your limb and the socket (the socket is the shell that encases your limb and connects you to your prosthesis).

Sleeves are made from a variety of elastic materials to maintain a seal. The ideal sleeve offers a good balance of durability and flexibility. A thick sleeve is durable but may tend to bunch up and interfere with the knee’s range of motion.

A thin sleeve has plenty of flex but may not last long.

Your activity largely determines how long a sleeve will last before it stretches out or develops holes, reducing its ability to maintain suspension. Sleeves often include a protective gaiter to extend longevity and sealing ability.

If you use either a vacuum or a suction suspension system, you’ll also need a sealing sleeve.

Liners The liner is a protective cover made of a flexible, cushioning material. Worn over your residual limb, it reduces movement and chafing between the skin and the socket. Liners are designed with specific characteristics to work with different suspension systems.

Selecting the right liner helps ensure that your prosthesis fits well and is comfortable to wear. There a various types of liners, let’s take a look at them.

A Silicone liner provides high stability and good adhesion if your limb has a lot of soft-tissue. It performs best with shuttle-lock suspension. (“Shuttle lock suspension” means there is a pin attached to the end of the liner which inserts into a locking mechanism in the bottom of the socket. The lock connects your socket to your prosthesis.) Soft but resistant to pressure, silicone is durable and easy to clean.

Ottobock recommends silicone liners for individuals with a low to moderate activity level.

Polyurethane has a unique ability to flow away from high pressure. That means the pressure in your socket is well distributed. A polyurethane (sometimes abbreviated as PUR) liner offers a precise, intimate and comfortable fit for all types of residual limbs. These “flow characteristics” and damping of pressure on your limb make it a good choice for sensitive, bony or scarred residual limbs.

Polyurethane performs best with vacuum suspension or suction suspension. Both require a Total-Surface Weight-Bearing socket (TSWB). Ottobock recommends polyurethane for individuals from low to especially high 34 activity levels.

ShowNotes Copolymer is soft, cushiony and highly elastic, offering good protection for low activity for many types of residual limbs. Usually a thermoplastic elastomer, which contains skin-friendly white oil, it is especially good for residual limbs with dry skin. Copolymer performs best with pin or suction suspension. Both require a Total-Surface Weight-Bearing (TSWB) socket. Ottobock recommends copolymer liners for individuals with a low activity level.

Liners are available with a few special features. There are antibacterial additives, textile outer layers for easier application, anatomical shaping, nonstick treatments, variable thicknesses to accommodate sensitive skin, preflexed knees, as well as tough tearand puncture-resistant formulas.

I mentioned sleeves earlier so let’s take a quick look at them.

Sealing sleeves are needed for vacuum and suction suspension. They create a seal around the socket’s top edge. After donning a liner (which acts as a second skin) and a prosthetic sock, you insert your residual limb into the socket. The liner extends beyond the sock, so rolling up the sleeve attached to the outside of the socket creates an airtight seal where

Sleeve features include, a non-stick coating, a textile outer layer for abrasion resistance, and pre-flexed knees for easier bending and wrinkle reduction.

Care tips •

•

• •

• •

The liner, gaiter and sleeve must be carefully rolled on to the residual limb. Pulling will stretch and possibly damage the liner, gaiter or sleeve.

To remove any air bubbles trapped in the liner, place your hands on the sides of the liner and lightly slide them from the bottom of the liner to the top a few times.

Carefully inspect the liner and sleeve for tears or abrasions that may cause a loss of vacuum.

Sleeves and liners should be washed weekly by hand or machine. Dry the liner with a towel, and hang the sleeve to dry.

If the inside of the sleeve or liner feels tacky, you can dust it lightly with baby powder.

Keep a supply of at least two good sleeves, since sleeves need to be washed and dried weekly and replaced when damaged.

The Prosthetic Socket

The prosthetic socket joins your residual limb to the prosthesis and fulfills important functions: It provides a secure connection and assures the proper fit of your prosthesis. In

order to achieve these objectives, the prosthetic socket - depending on the shape and condition of the residual limb and tailored to the respective mobility grade - is individually fabricated for each patient.

The socket is the load-bearing component of the prosthesis that holds the residual limb with the liner and suspension system, connecting them to the prosthesis components. It is typically made of a rigid material, the so-called “laminate”. However, especially for a transfemoral prosthesis, it is also possible to design the rigid component as a frame and integrating a softer material into the rigid frame as the socket. Your prosthetist will inform you about the right combination of the socket design and other components.

Forces in the Prosthetic Socket Various forces are at work in a prosthetic socket, which can affect the fit and adhesion of your prosthesis. With our Socket Technologies products, we want to give you more control over these forces. When these forces are controlled, problems such as pressure points on the residual limb can be avoided. The liner and the corresponding suspension system will be described later on.

Let’s take a look at these forces: Impact movement results from the heel striking the ground. Soft liner materials and shock absorbing prosthetic feet dampen the impact movement.

Pulling movement occurs during the swing phase. With the right liner material and a suitable suspension system, pulling movement can be controlled.

Rotational movement occurs during the stance phase. With the help of special suspension systems and through the shape of the socket, rotational movement can be controlled.

Liner Materials

The liner acts as a sort of “second skin” between the movable soft tissue of the residual limb (muscles, tissue, skin) and the hard shell of the socket.

This reduces movement and friction between the skin and prosthetic socket and there-fore reduces the forces in the socket described earlier.

The liner connects your residual limb to the prosthesis, cushioning the sensitive skin on the residual limb and thereby alleviating problems such as

pressure points. Selecting the right liner is essential in order to ensure the prosthesis fits well and is comfortable to wear.

Proprioception (pro-pre-o-SEP-shun) is a big word with huge importance for amputees: it means awareness of the movement and position of the body and its parts. In a healthy leg, sensory nerves in muscles and tendons tell the brain where your knee and ankle and toes are and whether they are flexing or wiggling. Your suspension system determines the level of proprioception you can have with your prosthesis.

The suspension system that gives you the most secure connection between the socket and your limb offers the highest level of proprioception. That awareness translates to performance and confidence.

S4/EP.05 | Sex and Intimacy Becoming Comfortable With Sex and Intimacy After a Limb Amputation I have decided to tackle discussing a sensitive issue which impacts everybody in the limb loss community — sex after an amputation. My goal is to be honest without being graphic. I am certainly no expert on the subject. But as a sexually active amputee woman who is happily married with two children, I can speak frankly about my experiences.

Sexual contact? We approach the subject often, dissecting its variations, and insisting on its necessity for a healthy relationship. But is sex, even great sex, the same as intimacy?

Is sexual intimacy what we’re actually after?

What about other types of connection?

We frequently express a desire to love and be loved, to feel safe in our relationships, to be known and accepted for who we are – hoping to share our dreams and our failings.

Is this the intimacy that we truly desire?

The answers beg for a clear understanding of the types of intimacy that exist between people, how we achieve them, and how they vary.

Understanding Types of Intimacy So often, we use the term “intimate” in a purely physical context. We refer to a couple as “intimate” in order to express that they are in a sexual relationship.

In fact, this is a narrow and somewhat misleading use of the term, and [experts tell us](http://www.counseling. ufl.edu/cwc/types-of-intimacy.aspx) there are several types of intimacy:

• Intellectual (a rich meeting of the minds)

• Experiential (closeness in activity such that you are in sync)

• Sexual (characterized by shared sensual and sexual expression)

• Emotional (characterized by shared feelings, trust, vulnerability) For purposes of this discussion, let’s talk about sexual and emotional intimacy.

Sexual Intimacy There are times when we hunger for sexual connection, and the longing is physical. Not only might we yearn for intercourse, but we want the press and presence of another person in all his or her sensual splendor – the tastes, scents, sounds, textures – and naturally, visual aspects enhance the experience.

In sex, we let down barriers, and we permit another person into our most private personal spaces.

Sexual intimacy -- involves a degree of vulnerability and trust – for some more than others, and in some scenarios more than others. (Have you ever considered why a “quickie” with your clothes on may be “hot” but less intimate than slowly undressing with your partner? Think about it. It’s a matter of exposure and vulnerability.)

There are times we want (and engage in) sex, not lovemaking. This may occur with no “attachment” whatsoever, with some affection, or with friendship [(friends with benefits)] (https://divorcedmoms.com/5-benefits-of-having-a-friend-with-benefits).

As adults, if we’re paying attention, we understand the nuances of sharing parts – not hearts.

Emotional Intimacy There are times when we seek an emotional bond – being accepted for ourselves, loved for ourselves, sharing our happiness or for that matter, tough times. We crave that state of being that is all about closeness, trust, and comfort. We want a special connection with another person at a deep emotional level.

[Psychology Today describes emotional intimacy](http://www. psychologytoday.com/blog/stronger-the-broken-places/201303/emotional-intimacy) as closeness that requires: “… a high level of transparency and openness. This involves a degree of vulnerability that can feel uncom- 35

fortable or anxiety-producing to many of us.”

When achieved in a relationship, emotional intimacy may act as: “… a formula for enhanced emotional well-being, and physical health as well…”

Note that emotional intimacy does not require physical affection, though certainly for most of us it is enhanced by something as simple as a kiss on the cheek or holding a hand.

Communication: Essential to Emotional Intimacy We can be married to a person for years and never achieve emotional intimacy – keeping in mind that intimacy isn’t a “destination” but rather, an experience or set of feelings. Communication is an essential ingredient in emotional intimacy, but we often communicate superficially about family life, as we:

• Talk about the work day

• Discuss domestic duties

• Strategize over money and schedules

• Organize events around exes and kids.

We also use humor, sarcasm, and activities to fill up our time together.

Intentionally or not, we may “deflect and protect” in order to avoid the very vulnerability and transparency that we need to thrive as a couple.

The Importance of Vulnerability As Psychology Today points out, the vulnerability involved in emotional intimacy is anxiety-producing to many.

One way to alleviate that anxiety is by allowing enough time to pass so trust is well established.

Still, vulnerability is very disorienting when we’re out of practice.

While many of us may feel that [sex is

relationship glue](https://dailyplateofcrazy.com/2013/08/27/when-sex-isglue/) from which communication (and intimacy) will flow, others may deem emotional intimacy the prerequisite to a fulfilling sex life.

And what if that sort of vulnerability is a No Go? What if your partner is unwilling or unable to communicate in a deeply personal way? Does that make him withholding or simply more comfortable with revealing less? Even if the sex is fabulous, will an unsatisfying degree of emotional intimacy leave you languishing?

We may be paired with a partner who doesn’t provide the confidences that we want or need, much less the acceptance of ours. The resulting void is a lack of intimacy that is often the impetus for an [emotional affair](https:// dailyplateofcrazy.com/2011/11/04/ emotional-affairs/), and this in turn, may lead to infidelity.

We Each Experience Intimacy Differently Emotional and sexual intimacy can be tricky; they are not absolutes. On the contrary, what we each need in terms of intimacy will vary: my “deep sharing” will not be yours; yours will not be mine.

Likewise, our comfort level with sexual and emotional intimacy will change over time and evolve according to partner or circumstances.

Consider, for example, the divorced woman who has spent 20 years with one man, now her ex-husband. To say the least, the very thought of getting naked with a new lover could be anxiety-inducing. So she may opt for establishing a foundation of mutual, emotional intimacy before sexual ac-

tivity of any sort. Or, she may intentionally choose the detachment of a hookup rather than putting her heart on the line.

In my opinion, neither is superior; we should choose what works for us, knowing that our choices will evolve over time.

Passion, Love, Sex, and Connection Some men and women are content to keep sex at arm’s length from their emotional core, which keeps their lives “less complicated.” I know single mothers who explicitly operate in this fashion, given that dealing with an ex, raising kids, and holding down a job can make for an emotional overload as it is!

Others crave a convergence of sexuality and a profound degree of trust, transparency, agreement, and connection – the very definition of emotional intimacy – which is highly dependent on both time and communication.

But passion is not predicated on emotional intimacy, just as emotional intimacy does not require physical contact. And [love can take place at an emotional remove](https://dailyplateofcrazy.com/2014/03/21/whenthe-person-you-love-is-emotionallyunavailable/) – or for that matter at a sexual remove. Love, sex, connection – these are a matter of the optimal mix that is comfortable and satisfying for both individuals participating in the relationship.

Ref: https://divorcedmoms.com/ sexual-vs-emotional-intimacy-do-you-know-the-difference/

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