Christmas Newsletter December 2021
men
LEGAL EDITION
Welcome to our 2021 Christmas Newsletter. In writing this message and looking back at this time
I remain hopeful we will finally be able to welcome
last year it seems difficult to fathom that a year on we
you all in person to our Striving for Better Conference
are still very much under the influence of the COVID
in June next year, more details of which will follow in
pandemic. Nonetheless 2021 has been a year of
the new year.
getting on with it and working within the constraints that allows us to keep our patients and staff safe whilst still providing the best possible prosthetic and orthotic rehabilitation we are able to. As we draw this year to a close I look back with pride at how our staff have coped and flourished along with their patients and it is great to see so many positive stories during challenging times. The London clinic in Egham continues to grow, at the start of 2021 we were three members of staff, as we finish the year we are eight with a new full time orthotist joining in early ’22.
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For now, I wish you all a happy and peaceful Christmas period and look forward to working with you in 2022. Enjoy the newsletter
Best wishes Matt
Amputation is not the end of the journey, it's the beginning A Vascular Surgeon experiences what life is like on the other side as a result of sudden illness. Dr Neil Hopper, a forty five year old father of two from Wales, had his life turned upside down following a family camping trip in 2019. Whilst camping in Cornwall, Neil found himself and his nine year old daughter Evie, sick with food poisoning. Neil concluded it must have been gastroenteritis or the flu however, whilst his daughter recovered quickly, Neil’s condition deteriorated and he took to his bed at home. The next thing he remembers is waking up in Royal Cornwall Hospital’s Intensive Care Unit with a serious case of sepsis.
completely unexpected”, explains Neil. “I have an appreciation for engineering and the small things like the patterns of the material lined up at the back where the seam was and the air valve being recessed inside, showed me just how much care and attention went into making my legs. Since becoming a patient at Dorset Orthopaedic, it has given me a new level of confidence.”
Neil was transferred to Derriford Hospital in Plymouth where he was due to receive forty sessions of hyperbaric oxygen therapy to try to save his legs. After fourteen three-hour sessions, Neil showed no signs of improvement and his condition began to deteriorate, so the decision was made to rush him off to the operating theatre to have his toes removed. Once the surgeons realised they couldn’t save his feet, they were left with no choice but to amputate both of Neils’ legs below the knee. “Having my toes removed was by far the worst part; however when both my legs were amputated, after feeling rotten for months, I felt so much better and it was almost a relief to have it done, explains Neil. “I went home on a high - I was alive!”
Experienced prosthetist Kevin Shaw has treated Neil and they have developed a strong relationship. “I really do think the world of Kevin and I think he’s amazing”, said Neil. “As a new amputee you’re not in a good place at all, to have someone sit there and listen to you is really nice. He has really helped with the psychological side of it all. Kevin came up with a plan for me which was completely bespoke and it was so nice to have options. He gave me a selection of feet to try out and I picked what was best suited for me. It is the back and forth that I liked with Kevin”, Neil continued. “In the end I went with the Ottobock Challenger Foot which I love and are so much more comfortable. I also went for the Proflex XCs, I can easily swap between them which is nice.”
Being a Vascular surgeon Neil would usually be the one to perform amputations on others. Neil explained, “I have performed hundreds of amputations but never actually knew what happened to the patient afterwards. I had always perceived amputations as the end of the journey when in reality, I was so wrong, it is really just the beginning.” After coming home on cloud nine Neil quickly came back down to Earth when reality struck. “My wife went back to work and my kids were at school, I realised I wasn’t going to be fussed over anymore and was stuck in a wheelchair. It was a really hard time”, describes Neil.
Currently, Neil is enjoying time with his family whilst still working. He has dedicated a lot of his time raising awareness to improving the aftercare for amputees. “I am always looking to challenge myself, the longest time I’ve spent on my feet is an eighteen hour surgery”, said Neil. “I actually do more now than I ever did before my operation; I’ve bought a treadmill and now run a few kilometres a day, I am looking to push myself and look forward to the next challenge.”
As part of his rehabilitation, Neil received his first pair of prosthetic legs from the NHS and worked incredibly hard on his recovery and set himself a goal of eventually being able to return to work. Neil wanted to see what other options were out there as well as wanting a ‘sportier’ pair of legs to accomplish another one of his goals - to be able to play football in the garden with his seven year old son, Harry. This desire motivated Neil to visit a private clinic. Neil went for a consultation at Dorset Orthopaedic's Southern Clinic in Ringwood and hasn’t looked back since. When Neil first went to Dorset, his socket fitted but his liners kept splitting. Dorset however decided to make Neil a brand new socket; “I really appreciated this and it was
“If I could give any advice to people who are going through a similar ordeal, the last 2 years I have experienced the biggest highs and lows of my life. It is important to hold onto the good stuff. I feel my life is simply following Plan B now rather than A”, explains Neil, “But-Plan B is unwritten so I get to write it now. I spend a lot of time speaking to my patients who are about to become amputees. They ask me 'what is it like?' and I always say it is not as bad as you think it is. It’s weird, not bad. You need to get your head around that it’s different, not worse and that’s a good place to start. I was an overweight unfit bloke not renowned for my coordination so if I can do it anyone can do it. It’s going to feel strange but in most people they do get better. Sometimes it’s a nice feeling that I can step on my son's Lego without pain, plus… my feet never get cold!” Legal Edition I 3
Case Study
An older, active individual who sustained a traumatic transfemoral amputation
Today’s older generation have never been more diverse in the activities which they participate in. Many older individuals participate in sporting activities, continuing to compete and improve their fitness well beyond retirement age. This case study is an example of an older lady who sustained a traumatic transfemoral amputation and managed to return to most of her pre-accident activities within the following year. Her achievements are a prime example of how, with the right support and prosthetics, older individuals can return to a full and active lifestyle.
The individual Mrs X was an active 71-year-old at the time of her injury. She enjoyed cycling around her local area and further afield, walking her dog, Pilates classes, playing tennis, and attending shoots. She had spent her working years in a variety of different countries all over the world supporting her husband who was deployed by the army, and also teaching English to foreign school children. She described how she would arrive in a foreign country such as Uganda or the Middle East and “just have to get on with things” as her husband would not be around to help settle in. This resulted in Mrs X being an independent and resilient individual who assumed that, following her accident, she would be able to resume many aspects of her life.
The accident Whilst out cycling in October 2019, Mrs X was hit by a road sweeper which had pulled out of a side junction into her path. A passer-by managed to apply a tourniquet around the upper leg to control the bleeding and an air ambulance was called to extract her from the scene. Initial attempts to salvage the knee were unsuccessful and Mrs X underwent a left transfemoral amputation soon after the event.
Initial assessment Mrs X was first seen at Dorset Orthopaedic in January 2020 for an initial assessment. She had remained in her wheelchair up until that point and had sadly given her dog away as she was no longer able to walk her. At that point she could transfer herself independently on and off the bed and floor and could balance with minimal support on her remaining leg for a few minutes.
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She had a positive and realistic outlook regarding walking again and a supportive husband who had the same expectations. The residual left limb was of good length and shape for prosthetic fitting and had healed well with no unhealed areas. Mrs X had been working diligently on early amputee exercises provided by the physios to maintain range in the lower limbs. Crucially, this meant that no tightness in the anterior or lateral hip muscles had developed which might compromise initial walking ability. Mrs X was otherwise well but initial assessment revealed a stiff right hip which was likely to be osteoarthritic, and some impingement signs in her right shoulder.
Planning Dorset Orthopaedic had been asked to put forward a plan for prosthetics and rehabilitation on a private basis. We initially suggested that she trial a Kenevo microprocessor knee, which would provide good stability and safety whilst allowing progress towards knee flexion in the swing phase of gait. However, we were aware of the likelihood that her walking speed might improve to the point where this knee would be unsuitable as it is designed for the slower walker. In which case, she might be a candidate for a Genium microprocessor knee as this would not limit her walking speed and still provide a good degree of safety with its features of stumble recovery, yielding, and continuous monitoring via its advanced electronics. Supporting her fittings would be physiotherapy sessions of two-three hours and then three separate periods of intensive rehabilitation.
The aim of a comprehensive rehabilitation programme is to restore an optimum quality of life for the individual Progress The Kenevo microprocessor knee was trialled initially. This knee has three modes; A, B, and C. Mode A is essentially a locked knee which will yield into flexion when sitting down, allowing the user to load both legs equally. Modes B and C allow for knee flexion during the swing phase, with mode C allowing for the knee to yield in a controlled manner whilst descending stairs or slopes. The goal of period one was to gain independent walking with the Kenevo knee, exploring which mode was most appropriate and progressing onto elbow crutches prior to the first lockdown. Our aim was to ensure that Mrs X would not have to spend an indeterminate period in her wheelchair waiting for services to resume. Intensive periods two and three took place in the Summer and Autumn and were divided into shorter periods of full or half days with the aim of achieving an element of community rehabilitation and trialling cycling and swimming. By the time the first lockdown restrictions were reduced, Mrs X had achieved a largely independent gait at a speed which was within the upper limits of the Kenevo’s range. We therefore opted for using a Genium microprocessor knee which would not be speed restricted and provide the additional features described above. During this period, Mrs X was supported to trial a couple of different tricycles and opted for a Danish made tricycle which was very stable as it had double front wheels and single behind. This also had a large front basket so she could take it to her local shops. Other community based activities undertaken were walking on the beach, outdoor slopes in forest areas, escalators and moving walkways, adventure golf, and endurance walks of a mile. Alongside these various activities, a programme of strengthening and gait re-education continued with various challenges to balance reactions.
Gait challenges included speed changes, stride length changes, carrying items of varying weight and size, stepping over obstacles, turning and stairs. Swimming was challenging to undertake as local pools were closed, so we hired a local hydrotherapy pool and tried a waterproof version of the Genium knee, known as the Genium X3, to enable safe and dignified access to the pool. We had previously tried accessing a pool without use of a waterproof leg and found this to be overly challenging if done on a regular basis without personal assistance. As Mrs X was keen to be able to go to pools and the beach, we put forward a case for a Genium X3 and this was indeed the leg that was finally funded. Mrs X gradually achieved many of her own goals during the year she has spent with us undergoing prosthetic changes and rehabilitation. She has been able to walk independently in her local area, in particular to her local shop. She uses walking poles when out and about as her walking routes often involve a trip to the allotment or a walk back across fields and through woodland. She has also been able to resume attendance at her local shoots with her husband and social group. She decided, early on, not to attempt tennis, feeling that she had been nearing the end of this sport anyway due to a shoulder problem and not wishing to consider wheelchair tennis. Her case manager has been successful in gaining funds for the above-mentioned tricycle for Mrs X to cycle to her local shops and venture further afield in time as her confidence grows. Mrs X is now able to drive the 45 minutes to and from our clinic so is, again, independent in her mobility needs.
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The wonderful world of case management An audience with Lauren McCluskey, LMC Case Management.
Q. Can you tell us about your background and what led you to where you are today?
of good specialist providers for other injuries, but little in the way of dedicated CM for amputees.
A. I have worked within healthcare and rehab for about 20 years now, beginning as a rehab assistant working within the Occupational Therapy Department.
Using my skills and setting up to work on my own was the natural progression because loss of limb is traumatic in any circumstance, but when it is an event like an accident at work or a car accident, it’s devastating. Having a skilled clinician, with a background working with amputees, coordinating rehabilitation is vital. There are a lot of specialist case management companies for other injuries but not necessarily dedicated to amputees.
This was where I decided to study to be an OT, graduating in 2006. My passion for working with amputees started when I did a rotational post in a prosthetic limb centre for an NHS trust. Then working as clinical specialist, giving postgraduate training. I’d worked with case managers within prosthetics; it was something that lent itself to my OT background. In 2019, I set up my own case management company, providing evidence-based rehab for catastrophically injured people. Q. Having started as an OT and then moving into case management, are there similarities between the two professions? A. OT skills transfer really well into case management. Case management, like OT, is holistic; you’re supporting the individual and their family through the journey, looking at everything for the physical, psychological, accommodation, and social needs after an injury. Although you’re not treating the individual, you’re coordinating everyone, ensuring their needs are addressed. Q. Having gone from working at a case management company to setting up on your own, did you find it straightforward or challenging? A. I saw it as a natural transition; it had its challenges, but I felt there were a lot 18 Striving for Better Supplement 6 I Legal Edition
Q. Is that the reason you initially got into case management? A. I was working within NHS management, where you naturally progress up the career ladder, but I felt I was underutilising my clinical skills. Mainly because I’d worked with case managers for a number of years and knew their role, and it really interested me. Q. What do you love about the case management industry? A. That you’re an advocate for the injured person. Providing the skills to champion what that individual needs to regain their life. Whilst rehabilitation sits outside litigation, you are required to communicate closely with the legal team. I think it’s essential to understand the legal process and stakeholder requirements. Whilst my commitment is to the injured person, you’re driving for the best functional outcome. Q. How would you describe good case management in rehabilitation for clients?
A. A good CM empowers the individual to navigate the rehabilitation journey. It’s not just about coordinating the rehabilitation, but providing strong clinical rationale for your recommendations, and demonstrating this to the funding parties, highlighting the lack of NHS provision and showing the legal teams what interventions are needed for the individual. That’s vital in terms of prosthetic rehabilitation, you want to ensure the individual has the right prosthesis and rehab to maximise recovery. Q. How do you think companies like Dorset Orthopaedic can help case managers through that process and what value do they add? A. As a CM, it is essential you have a trusted clinician network. The biggest thing is that there is clear communication from the outset. One of the advantages is accessing the complimentary and immediate needs assessments that Dorset Orthopaedic offers; this is such a valuable tool because it provides a clear outline at the beginning of cost, and immediate prosthetic needs, and then that’s clear to the legal teams why getting a private provider is important early within the rehab journey. Q. What are the most important things when case managing a client? A. Without doubt, it’s the holistic approach because you’re dealing with many different aspects of someone’s journey. You have to have a goal focus on what you’re doing; using outcome measures to underpin the credibility of case management is really important, and the ability to build a strong rapport with the person that you’re working
A good case manager empowers the individual to navigate the rehabilitation journey
with. You might have a plan in place, but sometimes things don’t go to plan, so you have to have a plan B. the families of your clients, it must take quite a toll on the family? A. It does; peoples’ roles may have changed, such as being a spouse to becoming a carer. It could also have an impact on the children, especially in traumatic circumstances; you’re not only helping the individual, you’re helping the family cope and understand the amputation and the journey the individual is going through. The family need to be willing to challenge are so many aspects going on in terms of how they’re feeling; they may not be able to work or do things with the children; you have to have as a CM to get both the individual and their family through rehabilitation. Q. Where do you think the industry’s biggest challenges will be over the next few years? A. The biggest challenge recently has been Covid-19. The pandemic has actually provided case managers opportunities to streamline how we work, and to me, a really good CM is one that frequently meets with the injured person and the treatment teams but using remote platforms has become more commonplace during this time. It’s so much easier to get an MDT together remotely.
There are so many opportunities in case research, providing an evidence base for is huge; it’s becoming commonplace to be challenged on your recommendations, so having a strong evidence base to back it up is becoming more important, money within the rehabilitation claim. to be working with Dorset Orthopedic? A. Through recommendation from another CM that I was working with. When we look at private prosthetic providers, I tend to go from recommendations. impressions when you walked through the doors or had a conversation with Dorset Orthopaedic?
A. There are many amazing moments. An example is a client of mine that is a low functioning amputee, that has some straightforward goals. The impact Dorset Orthopaedic has had to his life has been fantastic! The speed of his rehab through the residential programme has been amazing. Q. What advice would you give to other case managers looking for a prosthetic rehab clinic? A. Pick up the phone. The team at Dorset Orthopaedic, even if it’s not one of their clients, they will be willing to help. And I their Complimentary Rehab Assessment, this is something that can be done very quickly and early in the individual’s rehabilitation journey, so take advantage of it to show all the parties involved what needs to be done to get the best outcome.
A. The clinical team’s communication new amputee that hasn’t been through this and they might be used to the NHS environment, but coming to Dorset Orthopaedic, they see something on a the clinician has to explain things to the patient, and the aftercare. Q. You’ve sent several your clients into Dorset Orthopaedic. Is there a standout moment or experience where your clients have achieved something spectacular?
You’re an advocate for the injured person. Providing the skills to champion what that individual needs to regain their life
Lauren McCluskey
is a Specialist Case Manager and Managing Director of LMC Case Management. Striving for Better Supplement 19 Legal Edition I 7
Christmas Quiz 1. In what year did Raymond Briggs’ classic The Snowman first appear on TV in the UK? 2. Which member of The Simpsons family delivered Channel 4’s annual alternative Christmas message in 2004? 3. Over 30 million people watched EastEnders on Christmas Day 1986 in an episode that culminated in Dirty Den handing Angie Watts what? 4. On Christmas Day 2003, the final Christmas special of which show was aired, called “Sleepless in Peckham”?
9. In which decade was the first televised Christmas address from a British monarch? BONUS: who gave the address? 10. In the 1996 Christmas special of The Vicar of Dibley, what is Geraldine invited to four of on the same day? 11. What is the name of Will Ferrell’s character in Elf? 12. It’s a Wonderful Life is regularly voted the best Christmas film of all time. But in which fictional town is the James Stewart holiday classic set?
5. In Friends, what character does Ross 13. In which city’s suburbs do the invent to entertain his son Ben when he’s McCallister family live in Home Alone? unable to get his hands on a Santa outfit? 14. In which fictional Los Angeles skyscraper 6. The first dedicated Doctor Who does the majority of Die Hard take place? Christmas special was broadcast in 2005, 15. Which actor plays Ebenezer Scrooge in featuring which actor as the Doctor? The Muppet Christmas Carol? 7. In The Office Christmas specials, we learn that David Brent spent his entire redundancy payment on funding a cover version recording and video for which song?
16. In which classic Christmas film does Bill Murray play TV executive Frank Cross?
8. Carols from King’s College has been a regular fixture of broadcasting on radio and TV every Christmas for many, many decades. But where is King’s College?
18. Who had a ‘Christmas Vacation’ in a 1989 festive film?
17. Who plays Kris Pringle in the 1994 version of Miracle on 34th Street?
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19. Name the four principle stars of the 2006 festive romcom The Holiday 20. Which actor is credited as playing Hero Boy, Father, Conductor, Scrooge and Santa in 2004 film The Polar Express? 21. In one of the classic UK Christmas Number One showdowns, Slade’s Merry Xmas Everybody beat Wizzard’s I Wish It Could Be Christmas Everyday to the top spot in which year? 22. In 1975 and 1991 the same song by the same artist went to Christmas number one, what was it? 23. Complete the lyric: “He’s making a list and checking it twice/ gonna find out who’s naughty and nice…” 24. The biggest selling song of 1988 in the UK was a Christmas hit by Cliff Richard, can you name it? 25. Do They Know It’s Christmas has been recorded four times in the UK with different versions released in 1984, 1989, 2004 and 2014. It has two writers, who are they?
HERS
26. In 2009 an online campaign to beat the X Factor winner to Christmas Number One saw which band take the festive top spot? 27. In 1971, John Lennon released a Christmas song with The Plastic Ono Band featuring the Harlem Community Choir that was also a protest song against the Vietnam War. Can you name it? 28. “Baby if you’ve got to go away / don’t think I could take the pain” are the opening lyrics the 1994 UK Christmas Number One. Can you name the song and artist? 29. Who sang Let it Go in the snowy film favourite Frozen? 30. Complete the Wham! Christmas lyrics: “Last Christmas I gave you my heart/ The very next day…”
Email your answers to stuartw@dorset-ortho.com by Friday 14th of January to be in with a chance to win.
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