Shriners moving near BJC campus

Final negotiations under way for $150 million Shriners Hospital to be built in the Central West End

St. Louis Business Journal - December 31, 2007
by Lisa R. Brown

Shriners Hospital for Children is moving forward with plans to build its new $150 million hospital within the BJC HealthCare complex in the Central West End.

After a year-long search process, Shriners Hospital is in the final stages of negotiations to purchase a nearly 6-acre property at 4400 Clayton Road, according to sources familiar with the negotiations. Upon completion of the new hospital, Shriners plans to close its hospital in Frontenac, where it has been based for nearly a half century.

Chesterfield rehab hospital sold to joint venture

Grubb & Ellis Healthcare REIT Inc. said it formed a joint venture with Duke Realty's BD St. Louis Development LLC subsidiary to buy a Chesterfield hospital building and campus from Duke.

The hospital is master leased to St. John's Mercy Rehabilitation LLC, a joint venture between St. John's Mercy Health System and Centerre Healthcare.

Financial terms of the deal, which closed Dec. 20, were not disclosed in a release late Friday. Duke Realty holds a 20 percent interest while Grubb & Ellis Healthcare REIT maintains an 80 percent ownership interest in the joint venture and acts as managing member, according to the release.

The 50-bed, 112,000-square-foot hospital, at 14561 N. Outer 40 Road, west of Timberlake Manor Parkway, opened in July. The more than seven-acre property also hosts a two-story, 90,000-square-foot parking garage that can accommodate 286 vehicles.

St. John's Mercy Medical Center in Creve Coeur partnered with Clayton-based Centerre Healthcare Corp. to build the $25 million, three-story hospital. Duke Realty developed the facility and retained ownership of the land and structure.

St. John's is a member of the Sisters of Mercy Health System, which oversees 18 acute care hospitals and one heart hospital in Missouri, Arkansas, Kansas, Oklahoma and Texas.

Centerre develops and operates inpatient rehabilitation facilities in partnership with acute care hospitals.

Duke Realty was represented by Philip Mahler and Jeffrey Cooper of Savills Granite of New York. Financing was provided by National City Bank and arranged by William Bennett. Asset management services will be provided by Grubb & Ellis Co.

Grubb & Ellis Healthcare REIT is sponsored by Santa Ana, Calif.-based commercial real estate services firm Grubb & Ellis Co. (NYSE: GBE).
Indianapolis-based Duke Realty Corp. (NYSE: DRE) is an office/industrial real estate development and services firm.

SSM restructuring local operation

Friday, December 21, 2007
St. Louis Business Journal

SSM Health Care-St. Louis is restructuring its operations, including dividing some of its hospitals into north and south regions, the organization said Thursday.

SSM said it is creating the north and south regions to enhance a regional approach focused on delivery of medical services, patient satisfaction and patient safety. The new organizational structure comes with new leadership.

Mike Graue, the current executive vice president of St. Louis network operations, will now oversee the south region as executive vice president of operations/south region. The south region includes SSM Cardinal Glennon Children's Medical Center, SSM St. Mary's Health Center, SSM St. Joseph Hospital of Kirkwood (the future SSM St. Clare Health Center) and SSM Rehab.

Steve Johnson, president of SSM DePaul Health Center, will become the executive vice president of operations/north region. Johnson will oversee operations for SSM DePaul Health Center, SSM St. Joseph Health Center, SSM St. Joseph Hospital West and SSM Behavioral Medicine.

Also, SSM Health Care named Sherlyn Hailstone executive vice president and chief operating officer of SSM Cardinal Glennon. Hailstone has served as president of SSM St. Joseph Health Center in St. Charles since 2005. The company has begun the search process for Hailstone's replacement.

SSM Health Care said it is also searching for a regional vice president/chief nursing officer who will oversee patient satisfaction and safety and the nursing practice.

"Our primary goal has always been to provide exceptional care for our patients and meet the health care needs of our community. We believe these organizational changes will further strengthen our ability to deliver on that goal," Jim Sanger, president and CEO of SSM Health Care-St. Louis, said in a statement.

The changes come a month after Sanger replaced Ron Levy, who announced he was leaving the health system's St. Louis organization in October. Sanger was previously president and chief executive of St. Mary's Good Samaritan Inc. in Southwestern Illinois, a two-hospital joint operating venture. Sanger was hired 10 years ago to lead the operation, which consists of St. Mary's Hospital in Centralia, part of the SSM network, and Good Samaritan Regional Health Center in Mount Vernon, part of the Felician Sisters health system.

St. Louis-based SSM Health Care (SSMHC), a health care ministry founded in 1872, is one of the largest Catholic systems in the nation. It is also one of the largest health-care providers in Missouri. SSMHC owns, operates and manages 20 acute-care hospitals.

Promoting Your Allied Healthcare Practice Tip #5: Don’t talk negatively about your competitors

You might even want to say something complementary about them. In healthcare especially, being perceived as greedy or overly competitive will hurt you. If yours is the only practice making sales calls and asking for referrals, that could become even more of a perception. When you make sales calls, make it your mission not merely to increase business but also to benefit people. Your competitive presence might provide the incentive that raises the quality of care across your region. And as a resource available to your patients’ physicians, you add value to the care they provide, too.

When competition is seen as an important but friendly (and fun!) game, everyone has the chance to win. But when competition devolves into warfare and turf battles, everyone looses, especially your patients and their doctors.

Neuroscientists Uncover Brain Region Involved in Voluntary Behavior

Scientists at the California Institute of Technology have deciphered the activity of an area of the brain that could one day prove vital in the development of neural prostheses--within-the-brain implants that would translate thought into movement in paralyzed patients. The results of this study were published as the featured article in the November 8 issue of Neuron...

The experiment shows that it is "the monkey's own choice that activates these areas," says Cui, and not the sensory stimuli provided by the visual target it sees on the computer screen. This finding is significant, Andersen says, because "this is the earliest stage in the brain found so far that is actively related to movement plans." ...

The lab is working toward the development of implanted neural prosthetic devices that would serve as an interface between severely paralyzed individuals' brain signals and their artificial limbs--allowing thoughts to control movement. To assist in designing a more optimal prosthetic, they are now examining whether the decision to make a reaching motion is first made in PRR, or is made in another area of the brain and then transferred to PRR to form the movement plan.

Physician Ranking Program. Is O&P Next?

Check out this story! Allowing patients to rank their providers would be a fantastic idea for the orthotic and prosthetic field, too!

Promoting Your Allied Healthcare Practice Tip #4: Be a Valuable Resource

Be a valuable resource. Don’t show up and just ask for more business. Your business exists for your patients, and so does any healthcare practice. For them, you exist to help them serve their patients better. Have one thing in mind like free home visits or consultations that they can remember easily and pass along to a patient. Bring a newsletter with interesting, quality information, or leave behind a good article from a magazine you picked especially for them. You want to be the expert they think of when a patient comes in with unique problems not solved by your colleagues in the field.

Scientists Help Panda Find Love

by Yakub Qureshi in The Manchester Evening News

SCIENTISTS from Salford are helping a three-legged panda in China find love.Experts from the city's university are flying half-way round the world to fit the romance-starved bear with an artificial limb.

The panda, named Nui Nui, lost her paw in a fight and has been unable to feed or mate since.There are only an estimated 2,000 giant pandas remaining and zoologists around the world are working on a breeding programme to save them from extinction - but the species are famously reluctant to mate.

Dr Glyn Heath, an expert in animal prosthetics, and his team will travel to Beijing next month to create and fit a prosthetic and train the animal to use it. He said: "We will be performing a procedure which will transform Nui Nui's life and ensure that she is able to reproduce and nourish herself."We will only know the final design of the limb once Nui Nui has been clinically assessed. "However, we envisage that it will feature a hook or false thumb enabling her to grab bamboo from the trees for food.

"We will engineer the leg so that it will bear the animal's full body weight, allowing her to balance on all fours, while walking around and standing."Specialists at the School of Health Care Professions in Salford are rapidly gaining a reputation for being able to help stricken animals. Dr Heath trained to build prosthetics for humans, but has since created mini-chariots for disabled rats and false legs for injured dogs.Since Nui Nui lost her paw in a fight with three other pandas, she has been unable to grasp bamboo and keepers at the Shaanxi Province Rescue Centre have had to feed her by hand.

The animal has also been unable to walk or balance herself properly, making breeding all but impossible.Dr Heath has successfully fitted artificial limbs for animals that otherwise have been put down, but Nui Nui will be the first panda he has treated. He said: "I'm confident Nui Nui will take to her new leg - most dogs we've worked with have been able to walk almost immediately after we've fitted false limbs."It's rewarding to know we're playing a part in protecting such a beautiful species."

NPR Story about Medicare Fraud

I enjoyed listening to this NPR story yesterday afternoon on KWMU. As Greg Allen says, fraud in the medical equipment, prosthetics, and orthotics industry gives the rest of us a bad rap. I guess now we know how lawyers feel, right? Patients and their family members should always check to make sure they actually received the services their statements claim they received, and doctors should make sure they only sign for services they ordered.

Allied Healthcare Promotions Tip #3: Smile

Smile. When you visit medical offices to connect with your referral sources, make it your goal to brighten someone’s day just a little bit. You don’t have to be clever or get the place roaring in laughter, but if you’re grumpy over the traffic, because business is slow, or because no one will talk with you long, it will show. Small talk is under-rated, as long as you don’t waist anyone’s time. Be the one they enjoy to see walk in the door.

American Healthfront

P&O Care recently appeared in a segment of American Healthfront on St. Louis NBC affiliate KMOV4. The two minute segment features two of our prosthetists, Jon Wilson and Greg Doerr, as well as two of their patients, Denise and Sharon.

Patient Testimonial: Denise

An amputee talks about her experience with P&O Care and what it's like to be a shoe-shopper and a mother of two.

Allied Healthcare Promotions Tip #2: Don't Wast Anyone's Time

Healthcare practices are very busy, and you might be resented if you contribute to making patients wait to see their practitioner. It’s fine to show up unannounced; sometimes you can visit more places in less time this way. But if you don’t have an appointment, you must be willing to leave something behind, ask graciously for a call-back number, or try to find out when would be a good time to return. If your contact has time to talk, don’t stick around for more than a friendly hello and 15-20 second summary of why you are there this time. Bring a newsletter or brochure with you, maybe some pens or tape measures, and ask if he or she has any questions or feedback. If you want, see if there might be a better time to come back and give a more thorough presentation. If you can get in and out in less than 1 minute, more power to you. In the unlikely event that your contact isn’t busy, chewing the fat a little while won’t hurt at all.

Healthlink Outtakes

Have you ever wondered what it's like to film a commercial? Check out this authentic behind-the-scenes peek at the filming of our two-minute news clip that appeared on KMOV4's "American Healthfront" September 6, 2007. It might make you laugh.

Churck Norris & Diabetes

See the latest quips about this awful disease, from people who know, at http://loldiabetes.com.

Amputee's Experience

An Amputee talks about the need for parity in insurance coverage for prosthetic care.

Coping with Amputation: The Top Ten Online Articles from the National Limb Loss Information Center

1. Getting Ready for an Amputation


2. Body Image, Relationships, and Sexuality after Amputation


3. About Depression


4. Do you Suffer in Silence? It Could Hurt Your Health


5. How Physical Therapy Can Help in Your Recovery after Amputation


6. When a Parent Loses a Limb: Helping Children Cope,
   Cuando un padre pierde una extremidad: Cómo ayudar a los hijos a entenderlo


7. National and regional support groups reach out to new amputees


8. Pain Management and the Amputee
   Control del dolor y el amputado


9. Ways Children Adjust to Limb Loss
   Cómo se adaptan los niños a la pérdida de extremidades


10. Going Public: Moving Beyond the Barriers That Keep You Inside
    Mostrarse en público: Cómo derribar las barreras que nos impiden salir

Allied Healthcare Promotions Tip #1: There is No Little Guy

Some sales advice will tell you to only focus on VITO, or the Very Important Top Officer, such as a physician. That’s crazy. Yes, many times doctors will be very involved in where their patients receive allied health care services, but many will also defer to their nurses or medical assistants. Receptionists have very important jobs but get very little respect, and they know it; so if you respect them, learn their names, and maybe even ask them about themselves once in a while, you are much more likely to get the meetings you need with the people they serve. Good professionals respect the opinions and first impressions of their assistants. If you come across as arrogant, smug, or condescending, forget about it!

Promoting Your Allied Health Care Practice

Over the next few weeks, I will be periodically publishing my top ten tips on how to personally promote your allied health care practice. Here is a preview:

1. There is no little guy.
2. Don't waste anyone's time.
3. Smile.
4. Be a valuable resource.
5. Don't talk negatively about your competitors.
6. Don't be pushy.
7. Don't ever treat people like they owe you.
8. Emphasize quality and accountability.
9. Gather information.
10. Keep your loyal users happy.

These tips will also appear in the weekly e-newsletter of Outsource Marketing Solutions.

Tips for Marketing Your Health Care Practice

I have found two articles by marketing consultant Elizabeth Mansfield incredibly helpful in provoking new ideas for promoting P&O Care. I think many of these tips could easily be adapted by any health care practice seeking to increase the number of people they can serve. In "Marketing 101" in the O&P Almanac, Mansfield gives her "Top Ten Marketing Tips." In "Diabetes and Niche Marketing," in O&P Business News, Mansfield recomends that any group serving large numbers of diabetics tailor some of their literature and programs specifically for this sizable demographic.

Government Research Continues on Arm Prostheses

Over the past ten years or so, the increasing prevalence of type 2 diabetes in our society has led to more resources being devoted to research and development of better below-the-knee prostheses. Not so with the field of arm prosthetics. Too few people across the United States loose their arms, compared with those who loose legs, to make significant investment profitable.

Now, prompted by veterans returning from Iraq and Afghanistan, a government agency known as DARPA within the Pentagon has begun funding new initiatives to make natural, lighter weight, more versatile prosthetic arms.

There is an excellent article in The Boston Globe on one of these new arms still in development. Here is an excerpt about the inventor:

Kamen hopes the market for the product won't get too big. But he's gratified to see the arms being used by patients, and he brags like a proud parent about what they can do with them. For example, one patient shows off by picking up individual M&Ms, and another can use a power drill. "We've given them a new perspective on life," Kamen said.

Award-Winning Blog and Newsletter Lift St. Louis Health Care Practice

Early in 2007, Prosthetic and Orthotic Care, Inc., launched a new blog, The Care Digest. Winner of a Gold Star awarded by the popular marketing consultant Elizabeth Mansfield, this blog is an electronic version of P&O Care’s popular print newsletter by the same name, available for download on their website at http://pandocare.com/news.html.

The Care Digest’s frequent blog posts profile patients and practitioners, and it allows anyone to rate their experience with the clinical practice. It also summarizes news and provides commentary with a personal perspective on the P&O industry here in St. Louis and around the world. Together, the blog and newsletter reach over 1,100 people in St. Louis and enable P&O Care to connect better with their patients and referring health care professionals. “We hope patients take the opportunity to upload their own commentary, pictures, video and unique stories,” says blog creator Bill McLellan.

Both versions of The Care Digest form part of an innovative outreach campaign begun just over a year ago. Since August 2006, the successful plan has enabled P&O Care to grow from five prosthetists and orthotists to eight, and from twelve to twenty employees. Prosthetists Manny Rivera and Dan Luitjohan came on in 2006, and Orthotists John Lartonoix and Shawn McAdams started this year. The practice also added orthotic intern Luke Brewer and prosthetic resident Maggie Ware-Smith in June and July. With the addition of Bill McLellan as Director of Sales and Marketing a year ago, P&O Care has a dedicated liaison coordinating the crucial relationships among patients and their doctors, nurses, therapists, prosthetists and orthotists.

“We don’t want to be the biggest P&O practice in town, just the best,” says CEO Jim Weber. “This business is all about providing a superior clinical service, not just manufacturing limbs and braces. Though not widely utilized by health care practitioners, good marketing ensures that competition works the way it’s supposed to. Patients get more for their money, such as fast, quality service and complementary home visits.” McLellan adds, "Turning a quality newsletter into a blog is easy and fun. It's a good idea for any professional practice, whether in health care or other fields of specialized service. Blogs are interactive and easily updated with stories, pictures, and online video; and they provide an excellent way to stay connected with patients and colleagues."

To sign up for the e-mail or snail mail versions of The Care Digest, or to become a contributor on this blog, contact Bill McLellan at BMcLellan@PandOCare.com. P&O Care is a team of health care professionals with a common goal of creating innovative prosthetic and orthotic solutions to help people live their lives to the fullest by regaining their mobility, strength and independence. Their care centers are located in Des Peres, MO, and Fairview Heights, IL.

The prosthetics lab at Walter Reed Army Medical Center

This is exactly how we laminate our prosthetic sockets, too. The infrared oven heats the plastic; and the vacuum pump, that thing making all the noise, pulls the plastic down smooth and tight over the carbon fiber, which usually has some kind of fabric over it.

Josh Sundquist, CNN Hero

CNN recently profiled Josh Sundquist, creator of the online amputee network "Less than Four," or <4. The website provides a place for amputees to meet, talk about their prostheses or other interests, and create a blog about themselves. According to CNN, it has over 200 members and 10,000 viewers, but judging by the number of calls we've received from people who saw the clip, it might have many more soon.

The Fastest Man on No Legs

Robotic Prosthetics

IBC Rootbeer Commerical

She Glides on Ice

Earlier this year, P&O Care did a profile in The Care Digest on Janetta Roggers. Since then, these two videos of Janetta have been viewed over 16,000 times online. Always adventurous, Janetta is continuing to experiment with new activities, the latest being soccer.

The Walks the Mall

The Amputee Network: After losing leg to speeding car, Chandler man walks tall as prosthetist

The Amputee Network: After losing leg to speeding car, Chandler man walks tall as prosthetist

Virginia Parity Push

Here's a great article on the push for prosthetic parity in Virginia.

http://www.roanoke.com/business/wb/wb/xp-132817

In Missouri, by contrast with Virginia, the effort to get a prosthetic parity law on the books is being led by a committee of amputees, rather than a prosthetic company like P&O Care. The Missouri Coalition for People with Limb Loss will, of course, eventually raise money from prosthetic companies to hire a lobbiest, and it's only right that we help. But patients who have been denied coverage by their insurance companies are leading the push here.

We would also take issue with the characterization of prosthetic parity as a traditional "mandate." Limb loss is a tragic, sudden (even when caused by diabetes) medical condition, the kind of thing that health insurance exists to cover. No one will cut their limb off to benefit from "mandated" prosthetic coverage. We will simply see more amputees going back to work and fewer depending on Medicaid for their prosthetic coverage. Less than ten years ago, insurance policies used to all cover prosthetics on their own. Why not now?

Late Morning

It's almost 10:00 am and our Fairview Heights crew is just getting into the office. They didn't over-sleep. Police set up a perimeter, blocking off our office, in their man-hunt for an individual who shot and killed his estranged wife and the step-father of his girlfriend yesterday in Georgia. Early this morning, he fired at Fairview Heights police and hit a patrol car.

Eventually, they found him in a corn field between our office and another building which houses the local IRS office. Unfortunately, the suspect shot himself before he could be apprehended. More information can be found at http://www.ksdk.com/news/news_article.aspx?storyid=129883.

The delay has postponed a few patient appointments at our office and at some local nursing homes where we frequently travel.

What Happens in Vegas...

Next week, the American Orthotic and Prosthetic Association (AOPA) hosts its anual National Assembly in Las Vegas at the Venitian Resort, Hotel, and Casino from September 17-20. P&O Care will be represented by the three amigos, Jim Weber, CEO; Jon Wilson, CPO and Clinical Director; and Dennis Richards, CO and Orthotic Team Leader. Also attending will be our super-talented office manager, Wanda Stephans, and our (currently single) Director of Fabrication, Mark "Doc" Woodson.

AOPA's National Assembly is the largest gathering of prosthetists and orthotists in the U.S. each year. It offers a chance to swap ideas, network with colleagues all over the country, take in a few continuing ed courses, and schmooze with vendors.

Watch Us on TV (Hi, Mom!)

Just a reminder, P&O Care will be covered on a special “news” program tonight, September 6, on KMOV 4 at 6:30. Instead of Entertainment Tonight, American Health Front will profile 11 St. Louis-area health care groups that are improving technology and patient care. Yes, it is (technically) an advertisement, and no, we are not above doing a half-veiled infomercial. Two real patients are featured in our two-minute clip, and no actors were harmed during filming. Let us know what you think, whether it’s cheesy or fantastic.

Practitioner Profile: Maggie Ware-Smith

P&O Care's newest prosthetic resident is the super-talented and friendly Maggie Ware-Smith. Maggie graduated this year from Northwestern Medical School in Chicago with graduate certificates in both prosthetics and orthotics. After growing up right here in Clayton, she attended the University of Virginia where she graduated with a bachelor of science in mechanical engineering in 2006.


This past July, Maggie started her year-long prosthetic residency, seeing patients and building limbs with P&O Care's Jon Wilson, CPO. She plans to do an orthotic residency after she gets her ABC certification in prosthetics next year. Maggie hopes to practice someday as both a prosthetist and an orthotist, capable of providing the same patients with artificial limbs and custom bracing. P&O Care is lucky to have such an ambitious rising star.

The Sound of Prosthetics in Action

What is the sound of two hands clapping? We have no idea. But we do know exactly how a prosthetic pin sounds when it clicks into the locking mechanism of a custom socket. Now, you can too. Listen on NPR's All Things Considers as Physical Therapist Sandy Diamond describes why she loves this sound, part of their series Sound Clips.

John Lartonoix, ABC Certified Orthotist

John Lartonoix (a French name pronounced Lar-ton-wah) became an ABC Certified Orthotist is 2001. To prepare him for this exciting career, John earned a bachelor degree in Exercise Science from Appalachian State University and an associates degree for Physical Therapy Assistant. Then, he interned with an O&P company in the St.Louis area where he met and worked side by side with Jon Wilson, now P&O Care's Clinical Director.

In 2000, John and Jon both attended Northwestern Medical School's Orthotic Program and often talked about working together in the future. However, after graduating John Lartonoix took a residency in Columbus, Ohio, for Columbus Orthopedic, and Jon Wilson returned to St.Louis to form P&O Care. Columbus Orthopedic was later purchased by the Hanger Corporation and was an extremely respected practice. The office serviced all local hospitals including Children's Hospital and the Ohio State University Hospital.

In his patient care, John says he was lucky enough to be exposed to most aspects of the orthotic field. "I worked closely with several doctors from the Children's Hospital developing a strong pediatric background. In 2006 P&O Care developed a need for a certified Orthotist, and I was looking for new career experiences. After meeting with Jon Wilson and Jim Weber, CEO of P&O Care, I found what I was looking for. P&O Care is a group of wonderful people who make for an amazing team. I see such a variety of patients each day, which allows me to help people in many different ways. Being part of the P&O Care team enables me to do my job with care and pride."

Rocket-powered Mechanical Arm Could Revolutionize Prosthetics

[This is no joke.]

Science Daily — Combine a mechanical arm with a miniature rocket motor: The result is a prosthetic device that is the closest thing yet to a bionic arm.

A prototype of this radical design has been successfully developed and tested by a team of mechanical engineers at Vanderbilt University as part of a $30 million federal program to develop advanced prosthetic devices.

"Our design does not have superhuman strength or capability, but it is closer in terms of function and power to a human arm than any previous prosthetic device that is self-powered and weighs about the same as a natural arm," says Michael Goldfarb, the professor of mechanical engineering who is leading the effort.

Read the full original article at http://www.sciencedaily.com/releases/2007/08/070820130638.htm.

Introducing Shawn McAdams

P&O Care is excited to announce the addition of orthotist Shawn McAdams, who brings warm patient care and highly skilled craftsmanship to our profession. Shawn just completed his residency in orthotics with C. H. Martin Co. in Macon, GA. He graduated from Northwestern Medical School’s Orthotics and Prosthetics Practitioner Program in 2005, and he has worked in the field since he became an orthotic and prosthetic technician in 2001. This December, Shawn will be taking his board exams for ABC certification in orthotics. Until then, he will be supervised in all his patient care by P&O Care’s Lead Orthotist, Dennis Richards, who has been an ABC Certified Orthotist since 2004.

Farewell, Jen

On August 24, 2007, P&O Care will sadly say goodbye to Jennifer Burget, one of our talented ABC Certified Orthotists. Ms. Burget has worked with us since 2005. She will be working at the Jefferson Barracks VA Hospital as an orthotist treating our veterans. Next Friday, prosthetist Greg Doerr is hosting a party for the company and our spouses or dates to celebrate Jen's time with us and bid her farewell. Manny will be blending the margaritas.

We Want Your Feedback!

We at P&O Care are eager to hear from you, the readers of The Care Digest, especially our patients and colleagues in health care. Anyone can leave a comment on this blog, either anonymously or with your name if you have a Google account. Let us know what you think of the blog or any other aspect of our patient care. Just click "comments" below to leave your own.

Hemicorporectomy Prosthesis Discovered

For Michael Mason's last story, he had to travel to Baghdad. His article "Iraq's Medical Meltdown" appeared in the July issue of Discover Magazine. This time, Michael came to St. Louis. He is working on a story about one of the most radical surgeries anyone could undergo: hemicorporectomy, which in plain English means the body gets cut in half, right below the belly button.

Last Friday, Mason was in town interviewing Dr. Frank Johnson at St. Louis University, who performs the procedure, and Jon Wilson, CPO, at P&O Care, who has developed a prosthesis that helps these amputees live normal lives. Saturday, he was on to Kansas City to visit one of their patients living with the device, John Neill. Shaped like a bucket and lined with ROHO cushions to distribute pressure, the prosthesis enables hemicorporectomy, or trans-lumbar, amputees to sit upright, walk with their hands, and even drive a car. Without it, they would be confined to a bed, where they could develop the same sores that often caused their amputation.

Jon Wilson’s abstract, “A New Concept in Prosthetic Interface Design For Hemicorporectomy Amputees Utilizing ROHO Comprehension Therapy: A Case Study for a Prosthetist’s Perspective,” received the prestigious Howard R. Thranhardt Lecture Honorarium for the American Orthotic and Prosthetic Association. Look for Michael Mason's story about hemicorporectomy in the September or October editions of Discover Magazine, which is currently read by about two million people every month.

Helping Landmine Victims

I just read an excellent article in The O&P Edge by Brady Delander called "Clearing the Way for a Safer Future." It's about an organization called Clear Path International. Here is an excerpt:

"Clear Path International (CPI) is a nonprofit humanitarian organization dedicated to serving survivors of unexploded ordnance, such as landmines and cluster bombs, from past wars and conflicts. According to CPI, someone somewhere in the world is injured or killed by an accidental detonation involving some type of these deadly explosives every 30 minutes. In order to assist as many survivors as possible, or family members of those who are killed, CPI has established programs in four locations across the globe...Afghanistan, Cambodia, Thai-Burma Border, and Vietnam."

Get a Grip

The first prosthetic hand with individually moving fingers is now on the market. Think: Luke Skywalker at the end of The Empire Strikes Back. Myoelectric prosthetic arms and hands have sensors that pick up electric impulses from the muscles of the arm. Until now, those impulses have been able to open or close a hand, control grip strength, and rotate a wrist or elbow. But the i-Limb hand by Touch Bionics in Scotland has tiny motors for all four fingers and thumb. With it, amputees can pick up a coin, turn a key, punch keys on a cell phone, or lift a coffee mug.

Touch Bionics released the i-Limb July 29 in Vancouver, British Columbia, at the World Congress of the International Society for Prosthetics and Orthotics. There's no word yet on whether Medicare or insurance companies in the US are going to pay for the i-Limb hand, so unfortunately, distribution is limited to people who want to pay out of pocket.

Chance Encounter Lifts Two Amputees

Fifteen years ago, Denise Hoffmann lost her left leg above the knee during her freshman year of college. But a couple months ago, a chance encounter in the P&O Care waiting room enabled her to encourage a new amputee, Sharon Shutz. Sharon had just lost her leg when she was hit by a car in a St. Louis-area mall parking lot. Seeing and talking with another woman about the same age, with the same AK amputation from trauma and the same difficulties shopping for shoes and jeans, gave Sharon the courage to look forward to her own future with confidence. The encounter also excited Denise, who got to see new technology now available as her old prosthesis was wearing out.

Next month, Denise and Sharon will both be featured in a segment about P&O Care on American Health Front, a half-hour show about advances in medical technology. It will air after the evening news on KMOV 4, September 6, at 6:30 pm. It's the relationship that our prosthetists and orthotists develop with their patients, and sometimes the relationships they develop with each other, that we feel make P&O Care a special place.

Run, Oscar, Run!

The most famous amputee in the world right now is perhaps South African sprinter Oscar Pistorius. The Paralympic world record holder in the 100, 200, and 400 meter races is trying to qualify to represent his country in the 2008 Olympic Games in Beijing, China, but not without protest from the IAAF, which governs the Olympics. Some people worry that Pistorius' two prosthetic feet give him an unfair advantage over able-bodied athletes. Tests are now being done, and the outcome will determine if Oscar gets to compete against the most elite runners in the world or if he'll have to stick to racing against other amputees.

Oscar Pistorius doesn't have calves. His J-Shaped "Cheetas," passive prosthetic feet powered entirely by his quadriceps, mimic the spring of the human foot and achilles tendon. But whereas the spring in the our step can return over 200% of the energy we put into it, Pistorius' feet only return less than 95% energy, because he has no calves. One objection claims that Oscar's prostheses don't fill with lactic acid during a race like an able-bodied runner, but weakening calves still provide more energy than the best passive mechanical device. Other objections state that Pistorius' legs are more aerodynamic than human legs and don't use energy from his body. However, gait studies have always shown that below-the-knee amputees actually burn more calories and use more oxygen moving the same distance as able-bodied people. Again, the man has no calves! He's so slow exploding out the blocks that the second half of his lap is actually faster than his first.

The PowerFoot One prosthetic foot, recently manufactured by iWalk, actually incorporates computer processors and battery-powered motors to replace the function of the calf and achilles tendon. This and other bionic devises like Ossur's Power Knee promise to enhance the prosthetic industry, if their size, weight, and price can ever come down. When that day comes, that IAAF better watch out! But until then, there's no way that passive prosthetic feet like the ones Oscar Pistorius wears could give anyone an unfair advantage over sprinters with calves.

MO Medicaid Re-Instates Payment for Orthotic Devices

The Missouri State Legislature has just re-instated payment for orthotic devices, which it stripped from coverage in 2005 in a rash of cuts to the program. A judge ruled last year that Missouri violated federal law in its arbitrary decisions to cover some devices and not others. Just this week, P & O Care received the new fee schedule from Medicaid, outlining how much they will pay for custom braces, boots and shoes, and other orthotic devices.

In 2005, the Missouri State Legislature was also ready to cut prosthetics from Medicaid coverage, but citizens from across the state called their legislators and P & O Care’s Clinical Director Jon Wilson, CPO, our CEO, Jim Weber, and one of our patients testified before a legislative committee. At the time, the trade journal O&P Almanac reported that it was their testimony that saved prosthetic coverage for Medicaid recipients, but unfortunately orthotic coverage was still stripped.

This decision led to the bizarre situation in which Missouri would pay thousands of dollars for a prosthesis but would not pay a few hundred dollars for a custom boot that could have prevented the amputation. Now two years later, we’re thankful that they’ve finally decided to pay for both.

Technician Profile: Mark “Doc” Woodson

Doc’s been there from the beginning. P & O Care’s Lead Technician opened the company in 2002 with Jim Weber, Jon Wilson, and Wanda Stephens. Since then, we’ve grown to almost twenty employees and seven practitioners, several of whom Doc has trained. He taught our prosthetists Greg Doerr and Manny Rivera how to fabricate artificial limbs back when they were first getting into the field, and right now he’s training intern Luke Brewer before he goes off to Northwestern Medical School’s prosthetic and orthotic program in Chicago. Doc leads our team of technicians, whom patients rarely see but who work tirelessly behind the scenes to make sure their limbs get done on time, fit right, and look spectacular.

Doc got into prosthetics back in the early Nineties, a few years after loosing his leg below the knee in a trucking accident. He always enjoyed creating things with his hands and helping people, so he was a perfect fit for fabricating prosthetic limbs. Doc says he gets special enjoyment from making the limbs our pediatric patients use to walk. A single father, he and his son love to take road trips out West, often deciding each day where to go next. Doc also has a special knack for numbers and has become better than anyone else at P & O Care at predicting our monthly billing based on the devices in fabrication. Always competitive and ambitious—and incredibly funny—Doc drives all of us to continually improve the quality of care we provide our patients.

The Fight for Prosthetic Parity Heats Up in Missouri and Across the Nation

Do working Americans who pay for health insurance deserve to walk again and return to work if a medical condition lands them with limb loss?

That’s the question before twenty-three state legislatures across the country. Parity laws require health insurance companies to cover prosthetic limbs when deemed medically necessary by a physician, without setting unrealistic price caps or once-in-a-lifetime clauses. When insurers fulfill their obligations, amputees are much less likely to depend on government services like Medicaid.

Medicare, Medicaid, and the Department of Veteran Affairs already provide the coverage required by parity laws. But a movement to cut healthcare costs has led some private insurers here in Missouri to place annual limits on prosthetic coverage, ranging from $1500 to $4000, not quite half the cost of a below-knee prosthesis.

Insurance companies and government payers have always used provider contracts with companies like P&O Care to dictate how much they will pay for different types of prosthetics. But these new caps are imposed directly on patients, regardless of their different needs. Individuals and employers shopping for health coverage should not be expected to know that $1500 is an unreasonable cap on prosthetic coverage. In essence, these insurers are advertising that they cover prosthetics, but when patients need that coverage, it isn’t actually paid for.

One of P&O Care’s own patients, orthopedic surgeon Dr. Matthew Bradley (picture above), has testified before the Oregon State Legislature on behalf of a parity law that seems likely to pass there this year. Now, Matt has plans to use his expertise to help work for parity legislation here in Missouri. Through a new committee, P&O Care is joining with individual citizens, prosthetic providers, and advocacy groups all over the Show Me State to get a parity law passed here in 2008.

Besides Oregon, six other states have already passed prosthetic parity laws, including Colorado Maine, New Hamshire, Rhode Island, California, and Massachusetts, where former Governor Mitt Romney was a key supporter. Missouri Governor Matt Blunt has announced that he is supporting Romney’s bid for President: Does that mean he might support prosthetic parity, too?

Jennifer Burget, ABC Certified Orthotist

Before she became an orthotist in 2003, Jennifer Burget, CO, worked as an athletic trainer for SLU’s men’s soccer and basketball teams, as well as Washington University’s football team. After graduating from the physical therapy program at SLU, she worked as the Director of Orthopedics for a local DME company.

To gain more practical experience, Burget moved to Beverly Hills, California to work under one of the best, most well-respected orthotists in the field, Max Lerman of Lerman and Son. In California, Burget was one of two orthotists serving the highly respected Cedars Sinai Hospital.

After gaining priceless experience in Beverly Hills, Jennifer was ready to return to the Midwest. When she met with Jim Weber, CEO of P&O Care, Burget knew she had found the perfect fit. “Since moving to St. Louis, I have joined an amazing team of practitioners,” she says. Jennifer is dedicated to helping others and always strives for a perfect fit.

Kerth Langeneckert: Trucker, Harley Enthusiast, Amputee

Kerth Langeneckert drives a truck for a living and still loves to ride his Harley Davidson, but in 2005, he was involved in a motorcycle accident that left his left leg badly broken. After surgery, he developed an infection and eventually had to undergo an above-the-knee amputation. He describes himself as “being in a state of depression” after he lost his leg. After his prosthetist Dan Luitjohan made him a new leg, Kerth said, “It’s just good to finally get up out of a wheelchair or crutches and stand on two legs and actually walk on my own.”

Langeneckert’s insurance at the time of his amputation paid for his first prosthesis. His new leg even enabled him to go back to work driving a truck with a manual clutch. After two years, however, his residual limb has shrunk, causing the socket of his prosthesis, the part that fits over his leg, no longer to fit properly. A poorly fitting prosthesis is very painful and can sometimes lead to blisters, infection, and sometimes new amputations or death. Prosthetic limbs do show wear and most amputees experience some change in the size of their residual limbs and require new sockets from time to time. And a new prosthesis may be required, sometimes every 3 to 5 years.

The private insurance Kerth has with this new job won’t pay for him to get a socket replacement so his leg will fit. How was his employer, a trucking company, supposed to know that $2500 is an unreasonable cap on annual prosthetic coverage? Parity legislation (see cover story) is needed in Missouri so working amputees like Kerth Langeneckert can continue to live with the quality of life they deserve.

Dan Luitjohan: ABC Certified Prosthetist, Family Man

In August 2006, P&O Care was excited to strengthen its prosthetic team with the addition of Dan Luitjohan, CP. In addition to caring for amputees who have lost legs to diabetes or peripheral vascular disease, Dan takes a special interest in pediatric and upper-extremity (arm) prosthetics. He has also introduced our team to a new design for above-the-knee prosthetics called the Marlo Anatomical Socket. This socket design allows for greater range of motion, is less visible through tight clothing, and provides a more comfortable fit, especially for high AKs with shorter residual limbs.

Luitjohan became a Certified and Illinois Licensed Prosthetist in 2001 after completing the prosthetic program at Northwestern Medical School in Chicago and a residency in St. Louis. Dan and his wife Julie live in Edwardsville, IL, and have two young boys. When he isn’t changing his patients’ lives, he can be found chowing down at Fast Eddies in Alton, hiking the bluffs of southern Illinois wine country, and spending time with his family.

Letter to the Editor

The Following Letter to Editor has appeared in the St. Louis Post-Dispatch and the Kansas City Star:

My husband, Ivan, is the bravest and most determined man I know. He was in a near-fatal accident almost two years ago. After several surgeries to save his right leg, it was amputated below the knee. A titanium rod replaced his femur above the knee.

Ivan works in construction. His employer saved his job for him for the seven months it took him to rehabilitate himself. He wears a below-the-knee prosthetic.

He worked hard to be able to go back to work and do the same job he has always done — and he succeeded! But now our future is unclear.

In return for premiums paid for health insurance, we consumers expect to be covered for catastrophic injury or illness. Sadly, without legislation to ensure coverage, many private health insurance providers (including our own) have decided to severely limit or completely deny coverage for prosthetic limbs.

Arms and legs are not a luxury! They are a necessity to lead a productive life. I have contacted my legislators to try to push for a bill to ensure prosthetic coverage without unreasonable limitations. I urge others to do the same. Hard-working people deserve the right to be able to work to support themselves and their families.

Teri Burgener, Republic, Mo.

Nationwide, Current Restrictions to Prosthetic Coverage by Private Insurers Include:

• No coverage for repairs or replacements
• Increased co-pays, deductibles and out-of-pocket expenses
• A cap on benefits if a patient receives a prosthesis from another insurance company
• Annual caps of $1000 to $5000
• $2500 to $7000 maximum lifetime cap
• One prosthesis per lifetime

(This information comes from Action Plan for People with Limb Loss, a publication of The Amputee Coalition of America)

P&O Care Strengthens Orthotic Team and Promotes Richards

This January, P&O Care Strengthened its orthotic program with the promotion of Dennis Richards to Lead Orthotist.

P&O Care now has three certified orthotists serving patients on both sides of the river: Dennis Richards, Jennifer Burget, and our newest orthotist, John Lartonoix.

"I'm excited about our growth," Richards said. "It will enable us to serve more patients even faster than we have before. By making more braces in-house, we should dramatically reduce our turn-around time."

Richards began working with P&O Care in 2002 as an orthotic technician. In 2003, he graduated in the top five percent of his class from Northwestern Medical School's Orthotist Program. He then completed a residency and clinical training, which focused on TLSO applications for spinal deformities and impression techniques for all types of scoliosis.

Dennis received his ABC certification for orthotics in 2004, and since then has designed several new systems including a popular new custom knee brace.

Ossur Introduces New Computerized Foot

There is a new prosthetic foot on the market that claims to be able to think for itself. The Proprio Foot by Ossur utilizes a small motor, computer chip, and complex software to create a more natural gate for active, below-knee amputees.

Until now, a wide variety of prosthetic feet have been designed for various activities from walking around the house to competing in track and field events. Meticulously crafted components such as carbon fiber springs and rubber bumpers make many prosthetic feet similar to human feet in the way they transfer energy, absorb shock, and rotate at the ankle for better stability. But the Proprio Foot can automatically lift the toe just the right amount depending on what a person is doing, something no other foot can do.

Something as simple as sitting in a chair can look very awkward if your toe is always pointing up in to the air, so the Proprio Foot automatically lowers the toe when sitting. Additionally, when some amputees walk, they make a little more effort to keep the toe of their prosthetic foot from dragging the ground. By automatically lifting the toe at just the right moment in a person's stride, the Proprio Foot removes the limp associated with this now-unnecessary thought process.

The Proprio Foot costs between $12,000 and $18,000 and is not yet covered by Medicare, Medicaid, or insurance companies in the United States.

Santa Gets New Leg, Begins Rehab

The North Pole--Breaking News! Santa Clause has just underwent emergency below-the-knee amputation. Doctors attribute Santa's condition to diabetes, complicated by the billions of chocolate chip cookies he eats every year at Christmas.

The Center for Disease Control and Prevention, located in Atlanta, GA, estimates that 84,00 Americans lose their legs each year to complications from diabetes. Diabetes is a disease that weakens the body's ability to regulate blood sugar levels and blood pressure, making it very easy for diabetics like Santa Clause to damage the blood flow to their legs and feet. The same process damages nerves, making it easy for diabetics to injure their feet without ever knowing it.

North Pole, Inc. hopes that Santa's condition creates greater awareness of diabetes and the procedure of amputation around the world. Santa also hopes to increase social understanding for those diabetics who struggle to maintain a healthy diet.

With Santa's mobility temporarily diminished, prosthetists from St. Louis have been making regular trips to the North Pole. Just one month after his surgery, Santa is now doing therapy with his new prosthetic leg. He plans to be right back up to speed by mid year and is eagerly anticipating the Christmas of 2007.

100% Excellent Care!

This January, P & O Care had no deficiencies in our ABC facility re-accredidation.

Osseointegration Offers Promise, Problems

Osseointegration is a surgical procedure in which a titanium rod is implanted into bone. It has been used for some time in dental and facial prostheses, and efforts are not underway in Europe to perfect the technology for trans-femoral, above-the-knee amputees.

Titanium implants are so promising because the human body almost never rejects one as a foreign object, as sometimes happens with other implants and transplants. As the bone heals, it integrates fully with the titanium rod screwed into it. As a result, a prosthesis can be attached easily without the need to fabricate a custom socket around an amputee's residual limb.

Over the past several years, advances in prosthetic science have enabled prosthetists to make sockets that fit much more comfortably than in the past. Still, a few amputees have a difficult time wearing their prosthesis because of chronic pain or decreased circulation. For them, osseointegration offers a big improvement. However, the procedure has been most successful in younger, healthier people whose bones heal best.

The two greatest barriers to the complete success of osseointegration technology seems to be loosening within the bone cased by the stress of walking, and infection at the site where the implant protrudes through the skin. Efforts to overcome these problems look promising.

Amputees Rehabbing in Skilled Nursing and Out-Patient Facilities

A gradual shift in Medicare policy has greatly affected amputees and rehab facilities in the St. Louis region. Until recently, most amputees qualified for rehab with their new prosthesis in an acute care setting.

Within a hospital, they benefited from the care of experienced therapists and the camaraderie of other amputees. In the past several months, however, it has become increasingly difficult for new amputees to qualify with Medicare for such extensive rehab care.

While some remain in an acute setting, most amputees are now doing their therapy in skilled nursing and out-patient therapy facilities. This means that instead of being concentrated at a few specialized locations, St. Louis amputees are spread throught the region.

Area rehab organizations are working to get their best therapists into the settings where amputees now find themselves. Prosthetic companies like P&O Care are scrambling to educate more therapists in more facilities. Mroe than ever, amputees and their rehab team need to make sure they get the best care available.

Nothing Slows Down Janetta

Janetta Rogers is one of the most vibrant and active eight-year-olds you could ever meet. And the fact that she wears two prosthetic legs has never slowed her down. Janetta enjoys strolling the mall, winning summer camp relay races, and even ice skating! Her YouTube videos below have already been viewed over 10,000 times. Her newest venture is playing on a third grade girls basketball team.

Born with a rare condition known as PFFD (Proximal Femoral Focal Deficiency), Janetta has worn a right above-the-knee prosthesis and a left below-the-knee prosthesis since she was one year old. Her prosthetist, Dan Luitjohan, sees her more often than most patients ot make adjustments as she grows.

The Amputee Coalition of America reports that roughly one out of every 200 Americans live with limb loss, with 82% due to diabetes and peripheral vascular disease. Comparatively, congenital-related limb dificiencies happen in only 26 out of every 100,000 births. In the US, this rate has remained stable over the past thirty years, while the rate of trauma-related amputations has decreased and the rate of dysvascular amputations has risen considerably.

Bizarro Cartoon

We Want Your Stories!

Please lest us know if you have an interesting story about a person, event, or trend that would be interesting to people who wear prosthetic and orthotic devices, or their doctors, nurses, and rehab therapists. Contact Bill McLellan, Blog Administrator.

The P&O Care Team and their spouses held their Christmas party at Soulard's Restaurant