By James Fraser
The Pacific Northwest is a dangerous place to live. Loggers dropping chain saws, fishermen caught in their own nets, motorcyclists slipping on wet Seattle hills-these are only a few of the reasons Harborview Medical Center sees approximately 150 amputation cases a year.
More than half of these surgeries come from traumatic injuries, as opposed to the disease- and age-related amputations done at most hospitals. As a result, Harborview is nationally recognized as a leader in amputation technology and techniques. And its profile has continued to grow in recent years, as dangerous military incursions in Iraq and Afghanistan have added a new class of potential amputees to the pool.
The University of Washington is also a leader in rehabilitation medicine and an innovator of artificial limbs. The Seattle Foot, invented by former UW faculty member Ernest M. Burgess and colleagues, was a breakthrough in 1985. Its patented spring construction gave lower-body amputees a more active lifestyle-even running marathons was now a possibility. The invention influenced a new generation of prosthesis technology and drew medical leaders in amputation to Seattle.
The U.S. Army had little need for these amputation experts until the recent U.S. military commitments. Now it is drawing on innovations at the University of Washington to serve soldiers at hospitals in Washington, D.C., and San Antonio.
"In peacetime they don't see a lot of amputations," says Orthopaedics and Sports Medicine Professor Douglas Smith, a national authority on amputation. "So, when the war on terror started, the military dedicated a lot of resources to developing these centers of excellence for amputee care." Since the spring of 2002, Smith has been to Walter Reed Army Medical Center in the nation's capital and Brooke Army Medical Center in Texas to consult on establishing amputee facilities for some 250 soldiers returning with the loss of a limb.
"The Army came to Harborview because we have been doing (amputations) for so long, we could jump-start their education, give them suggestions on how our clinics are run, and tell them what works for young people," says Smith.
At Harborview, Smith and a team of nurses and prosthetic facilitators typically create a slow rehabilitation plan. However, the military decided that recovery for physically fit soldiers could be quicker. "The military has taken a track that makes the rehabilitation more aggressive," Smith says. "They get people walking on the limbs sooner, they're moving toward higher technology sooner. This group of injured soldiers is moving faster than I have ever seen before."
One example is Sergeant Douglas Moneymaker of the First Cavalry Division (serving under Maj. Gen. Peter Chiarelli). On Sept. 11, 2004, Moneymaker and five other members of Charlie Company came under attack in Baghdad's Sadr City.
The guerilla-style insurgency relies on minor, often hidden, improvised explosive devices (IEDs) that spread shrapnel to cripple or kill. "They're hard to see," Moneymaker says of IEDs like the one that hit his Bradley Fighting Vehicle that day. Of the six soldiers in the vehicle, three were thrown clear-escaping major injury. Moneymaker and two others were trapped as the Bradley rolled over and rested on its hood for what seemed like hours.
A 23-year-old former oil worker from Fritch, Texas, Moneymaker was pried from the wreckage in a matter of minutes-but those moments set him on a journey to a temporary military hospital in Baghdad, then a large military hospital in Germany, and finally back to Brooke to await surgery.
His left leg was a mess. He had significant muscle damage to his calf and bone damage to his femur. Doctors gave him a choice: amputate below his knee or try to save the entire leg. The leg might be salvaged with consistent surgeries, but there would be less mobility than with a prosthetic. "They are really good about letting you make the decision," Moneymaker says. "There was definitely no pressure either way from them."
Moneymaker chose amputation. "More than likely it would have to be amputated down the road and the recovery would have been longer," he says.
Smith first thought the Army's rapid-recovery processes were pushing the limits. A consultant to the military amputation board that decides rehab procedures, he has typically favored a more conservative approach. But now he's a believer, having seen soldiers running quarter-marathons or playing pickup basketball within months of their surgeries. He says he's beginning to use rapid recovery on some of his younger patients in Seattle, with similar results.
These successes, he says, have been a matter not merely of aptitude but of environment.
"We are encouraging people to talk more and ask more questions. I think that we are in a sense providing an environment that helps people break down some isolation barriers of their own," Smith says. "I think one thing the military has done well is that by making centers of excellence, they've gotten soldiers in the same spot-seeing, observing, participating not only in their own, but in each other's, rehab."
Role models are important. More than a decade ago, Harborview placed amputees in their own section of the hospital. "There is nothing like talking to another person who has been through what you're going through to help," Smith says. "It stimulates you to rehab better. You start to say, 'If they can do it, I can do it.' "
An incredible drive is something Smith has come to appreciate about the volunteer army. For the first time in American military history, all injured soldiers are offered the option of returning to full service. According to Smith, about 95 percent of the amputees say yes when they first enter the hospital.
"They are doing this because this is what they want to do," he says. "You see it in their eyes. They've gone through an amazing amount of training, and they want to keep doing what they do."
Rehab for Moneymaker has been frustratingly slow- but not because of the amputation. Fitted with prosthetics in November, he says he was walking with 100 percent capability before the new year. But continuous swelling due to an unrelated knee surgery, along with a bout of pneumonia, have kept him at Brooke for more than six months. Water aerobics and light weightlifting have become his new day job. As of late April he was still sifting through mounds of disability paperwork and starting to make plans away from the military-possibly a return to the University of North Texas, to finish his undergraduate degree.
Even though he was one of the initial amputee soldiers sent to Brooke, Moneymaker says he was inspired by those who were ahead of him. "Seeing these guys move around and get back to normal life is really encouraging."
James Fraser is a senior at the UW Dept. of Communication and was a Columns intern when he wrote this article.
To Baghdad and Back: Page 1 | Page 2 | Page 3
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Questions for the Vets. A web exclusive with questions to those serving in Iraq.
Loss and Recovery: UW Expert Aids Army Amputation Units