Monday, August 24, 2015

Artificial Limbs - Luxury or Not?

In the news today, Medicare is proposing that payment be made for only ONE artificial limb set in an amputee’s lifetime.  What Medicare does, private insurance companies follow.  I have not seen any details, like the age when one becomes an amputee – just a blanket one per lifetime.  While indeed expensive, many amputees consider artificial limbs a medical necessity, much like diabetic supplies or catheters.  To an amputee, they are not totally optional, and new ones are needed as one grows.

I know there are some awesome artificial limbs created today – not only those which allow basic function but those which allow sports and dancing, etc. – individualized to allow as much “normalcy” as possible.  Again, limbs are very expensive.  Still, there is a current, ongoing debate as to whether or not they should be considered a luxury.

As a high double leg amputee, my experience with artificial limbs was just for basic walking.  No frills, just function.  As you will see below, my journey was difficult and expensive.

The sights, sounds and smells of a prosthetics office are unmistakable.  I can still smell the fiberglass – a strong, distinctive odor that many consider offensive.  I spent lots of time in such an office.  During my appointments, I could watch workers sawing, cutting, sanding, or polishing the limbs they were creating.  Their hands, faces and aprons were totally covered in a white powdery material that misted from them as they moved.  And that smell.  No mistaking that smell – over-powering and never changing.

I remember well my appointments at the “Missouri Valley Brace Shop.”  I can still see my prosthetist.  I always had the same one.  He was an elderly (to me!) man with a very kind face, soothing words, and gentle hands.  He was always, always covered in the fine white powder from head to toe.  While it looked white, his full-length apron was gray.  His face, hands and hair were also white except where he had been wearing goggles. A cloud of white dust traced his every move.  He was so soft-spoken you could barely hear him.  He was very kind and gentle as he molded plaster around me – a cradle to sit in to which my left leg would be attached.  Eventually, I was totally covered in hardening plaster from the waist down.  As I lay on the hard table, I slowly felt entombed as the plaster warmed, hardened, and tightened.  I knew I could not move or it would cause them to start over.  I worried every time about how they would get the cast off.  I fretted that the loud “saw” they used would slip and cut right through me.  Eventually my “cast” was cut down one side and I wiggled out of it.  Manufacture of my artificial limbs could now begin.

I had several ‘dates’ with the prosthetics office, but at the age of 9, it was decided that my artificial limbs should be taller because clearly a 9-year-old was taller than a 3-year-old. My limbs would now bend in the middle just like a real knee.  They would be somewhat more cosmetic too, especially since I was a girl.

When I returned for a fitting, adjustments were made with black marking pens, loud shavers and saws.  The brand-new white straps and buckles, not yet showing any sign of wear, were tightened around me.  Half of me was now artificial.  It was hard to imagine how I would move them, let alone walk in them.  I was convinced that these ‘bendable stilts’ were dangerous and that I would fall a lot.  Nonetheless, they stood me up and gave me crutches.  Being taller was a completely new experience.  The floor was so far away.

They took me to a room with a long rubber mat on the floor, going from one end of the room to the other.  There were railings on both sides of this ramp and mirrors at either end.  An attendant held onto a white sheet tie placed around my waist to prevent a fall.  My soft-spoken prosthetist watched each step, carefully watching for signs of rubbing or irritation.  When he was happy with the fit, I began a 3-month hospital stay during which I learned to walk in them.

I wore artificial limbs for most of my childhood and they served me well but when I began a more independent life, they soon became impractical.  This was the beginning of my life in a wheelchair.

I also had an artificial arm for a short time when I was about 3.  Apparently, however, I used it more as a weapon to my younger siblings, so it was taken away.  I tried an arm again in my early 20s but for me, I could function better without it.

Manufacture of artificial limbs has advanced drastically in function, cosmesis and cost since my experience.  In fact, it amazes me what is done today.  Maybe if I were younger…  The process of achieving a perfect fit is still tedious but eventually artificial limb(s) become an integral part of an amputee.

Had I continued with artificial limbs, I would have needed many updates.  I would have wondered why had my insurance company not covered this medical need of mine.

This controversial debate is ongoing right now. Let’s help the insurance companies make the right decisions.  Let’s help them establish parameters that will work for both sides.  They need to hear our concerns and understand better the needs of an amputee.

Send me your comments below.  I believe our conversation will be helpful to those tasked with making these important decisions.