Jon D. Wilson, Prosthetic and Orthotic Leader in St. Louis and Beyond

John D. Wilson, CPO, LPO, helped found P & O Care just over six years ago with Jim Weber; since then he has served as its Clinical Director, being both a prosthetist and an orthotist. Jon has a total of over 16 years experience in the field. He graduated from the Certificate Programs in Prosthetics and in Orthotics from the Northwestern University Medical School and then earned his ABC Certification in Prosthetics in 1996.

Later, after working as a prosthetist in St. Louis for a few years, Jon went back to Northwestern for his Orthotics certification and completed his residency in the fall of 2003. Whereas the State of Missouri does not require licensure in the O & P field, Jon is currently a Licensed Prosthetist and Orthotist under the State of Illinois Department of Professional Regulation.

Besides leading P & O Care’s team of nine prosthetists and orthotists here in St. Louis, Jon has been recognized as a national leader in the field of upper and lower extremity prosthetic care. In 2004, he was awarded the prestigious Howard R. Thranhardt Lecture Honorarium for his abstract “A New Concept in Prosthetic Interface Design for Hemicorporectomy Amputees Utilizing ROHO Compression Therapy.” Jon’s new invention, which utilizes a matrix of ROHO cushions inside a custom fabricated “bucket” prosthesis, enables people who have literally been cut in half to float in a seated position. With their weight and body fluid evenly distributed, they are able to lead active, mobile lives without worrying about skin breakdown. Users can get around on their own in a wheel chair (or skateboard!), and some have even driven long distances alone, instead of lying in bed.

Reference Guide: Custom Prosthetics and Orthotics in St. Louis

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Congratulations Shawn!

Congratulations to Shawn McAdams, C.P., for passing his board exams and becoming an ABC Certified Orthotist. The American Board for Certification in Prosthetics and Orthotics offers the highest certification in the profession, requiring a four-year bachelors degree, training in the fabrication of prosthetic and orthotic devices, a graduate certificate like the one Shawn earned from Northwestern Medical School in Chicago, and finally a year-long residency each for orthotics and prosthetics.

While most states require professional certification and licensure for doctors, therapists, nurses, and hairdressers, currently only eleven require that prosthetists and orthotists get certified and licensed. Illinois does, but Missouri doesn't. Still, all of P & O Care's practitioners on both sides of the river have graduated from Northwestern University, and our residents work under proper supervision until they pass their boards.

Practitioner Profile: Shawn McAdams, ABC Certified Orthotist

Shawn McAdams 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. He completed his residency in orthotics with C. H. Martin Co. in Macon, GA before joining the care team at P&O Care in St. Louis, MO, in July 2007.

Shawn got into the P&O field to help people just like himself. "In November of 2000, I fell and broke my back so that I could no longer do a laborers job. Through a vocational rehabilitation program, I was able to get retrained, so I went to school to become an orthotic and prosthetic technician. I knew that I wanted to help people directly with their needs rather than in an indirect way with fabrication, so I went back to school for my bachelors degree and then on to Northwestern University to become a CPO.

"First, I became a technician because I wanted to make the tools for people to have a better life. Then, I became a practitioner because I wanted to see the smiling face of the patient using the tools that I had designed. I like to help people achieve peace of mind. When someone is hurting, they tend to focus on that hurt. If I can help relieve that hurt, then they can focus on other things in life that make them happy and fulfilled."

St. Louis Prosthetists Get Accredited in iHand and Proprio Foot

ABC Certified Prosthetists from P & O Care have become the only accredited providers of the new iHand in the St. Louis Region. Dan Luitjohan and Manny Rivera attended a course April 2 in Chicago put on by iHand's manufacturer, Touch Bionics, from Scottland. The iHand is the first prosthetic hand with individually moving digits, so it can hold a penny or a business card, turn a key in a lock, munch cell phone keys, or pick up a mug of coffee. Plus, it looks and moves much more naturally. The only downside: it costs a lot and is not covered yet by Medicare or private insurance.

All of P & O Care's five prosthetists, including Jon Wilson, Greg Doerr, and Maggie Ware-Smith, have become accredited in the new Proprio Foot by the manufacturer Ossur. The Proprio offers is the first "bionic" ancle, with computerized sensors and a tiny motor that adjusts the angle of the foot to the angle of the incline on which a person is walking. Clinical Director Jon Wilson jokes, "Now, I can give you a foot that you can get up with in the middle of the night, and if you stub your toe, you can say, 'Ouch!'"

That's going a little too far, but the Proprio enables below-knee amputees to walk much more naturally up and down ramps and hills or over uneven terrain than they could with even the best traditional non-bionic foot. Unfortunately, the Proprio is also expensive and difficult so far to get third party payment for, but that may be changing soon. It's also heavier than most feet, a little over two pounds, which means it would not be the best option for a lower-activity level individual.

Prosthetic Parity Hearings a Huge Success!

Members of the Limb Loss Coalition and amputees from across the great state of Missouri showed up in Jefferson City Tuesday to support the Prosthetic Parity Bill before House and Senate Committees. Representing P&O Care were Jon Wilson, Clinical Director, Mark Woodson, Director of Fabrication, Bill McLellan, Director of Sales, and Suzi Schumacher, a young working amputee and active member of the Coalition.

Around 2:00 p.m., four witnesses testified before the Senate Small Business and Insurance Committee, chaired by Senator Lowden. Dr. John Rush, Medical Director for Hanger Orthopedic and a national expert on prosthetic parity, flew in to testify on many of the more technical issues. Then Mark Wilson, President of Prosthetic and Orthotic Design, Inc., in St. Louis testified that as a small business owner, he was not given the option of purchasing health insurance that did not include ridiculously low caps on prosthetic coverage. Next, Jeff Damerral, Chairman of the Missouri Coalition for People with Limb Loss, testified about his personal experience loosing both his legs below the knee to meningitis while a freshman at Truman State University. Damerral said that while he had good insurance through his father at the time, he is fighting for everyone who doesn't. Now that he is on his own and working as a lawyer for a small firm, Damerral must pay approximately $16,000 every 3-5 years to have his two legs replaced.

Finally, AK amputee and Secretary of the Coalition Jean Freeman brought the whole room to the verge of tears, telling how caps on her prosthetic coverage force her to hope that the various parts of her prosthesis don't wear out at once. "As an amputee, I am being discriminated against," she said.

Several registered lobbyists for the insurance companies spoke briefly against the bill, saying they opposed prosthetic parity for the same reason they have always opposed every other "mandate" the state has passed, such as those insuring coverage for mental health, women's health screenings, and wigs for children with cancer. They believe on principle that policies should be able to exclude coverage for any condition, provided that policy can be sold to a customer or employer. On being questioned by Senator Day, one gentleman did not know that some plans include once-in-a-lifetime clauses for prosthetic devices. "Do you mean that a person is expected to wear the same leg at 18 months as 18 years?" she asked incredulously. "I'll have to get back to you with that information," he replied.

The hearing in the House of Representatives began around 7:00 p.m., and since it was after business hours, many more supporters showed up. The bill sponsor, Rep. Dr. Wayne Cooper, introduced it to the committee, and Dr. Rush, Jeff, and Jean testified again. This time Jon Wilson, Clinical Director of Prosthetic and Orthotic Care, Inc., represented the state's prosthetists. "Surgeons often ask me to speak with patients before they loose their limbs, often to convince them that it's worth an amputation to save their life. I tell them I can help them walk again," Wilson said. "But later, when they're ready for the prosthesis, I have to be the one to tell them that their insurance won't pay for it. When they need health insurance the most, it isn't there."

Wrapping things up was Bill Brannan. He told how good health insurance has enabled him to live a productive life for ten years since he lost his leg at age 65; but he also told about meeting a young mother in a grocery store, juggling her kids and her cart and trying to get along in a wheelchair because her husband's insurance would not pay for her to get a prosthesis. The fine individuals who had to get up and represent the insurance companies after Bill sat down seemed like they were just going through the motions, stating rather plainly that they always oppose mandates, even inexpensive ones that seem to make all the sense in the world like ours does.

The representatives seemed to understand our case, and members from both parties told us the hearing had gone extremely well. It's always dangerous to get over confident, but here is what Dr. Rush thought comparing the parity effort in Missouri with other states where he has testified: he said that whereas elsewhere most of the real work gets done behind the scenes and hearings are just window dressing, we could have actually won our case in one day on hearings alone! We'll wait and see just where things go from here.

Patient Profile: Queen Still Loves to Travel

Patricia Queen has type one diabetes, but that isn’t why she lost her leg below the knee last year. Nineteen years ago she ruptured a disk in her back that nearly severed her sciatic nerve, leaving her paralyzed below her left knee. Still, Pat was able to remain healthy and active, wearing an orthotic brace and flying all over the country for her employer, the United States Postal Service.

It wasn’t until a trip to Las Vegas October 4, 2006, that things started to go terribly wrong. Suddenly, a bone stuck out the bottom of her foot. Pat couldn’t feel the pain, but she did see the blood and went immediately to the emergency room.

Pat was diagnosed with osteomyelitis in her left foot, which is a dangerous infection of the bone, and they treated her with antibiotics. Still, after returning to St. Louis, Ms. Queen’s temperature spiked and she ended up at Missouri Baptist Hospital being seen by vascular surgeon Dr. Ricardo Rao. He removed the dead tissue, but she failed to begin healing properly. So one day he came into her room and said, “I’m going to talk to you just like I would talk to my mother or my sister. You need to have an amputation. We can heal this, but it will take time, and it’s not an issue of when the infection will come back, but when.” Later, a plastic surgeon working with the hospital’s wound care center gave her an even graver assessment. Pat says she saw his face change from concern to horror before he said, “I just pushed a cue tip through a bone in your foot. There is no way we can ever heal this.”

On November 3, 2006, Pat Queen lost her left leg below the knee. But her amputation site began to develop gangrene because of her diabetes, and on January 3, 2007, she had a second amputation, this time just two-and-a-half inches below her knee. With such a short residual limb, it was a challenge for Manny Rivera, her prosthetist with P&O Care, to create a prosthesis that would protect her tibia or shin bone. A short limb is a short lever and so requires more force to do the same amount of work, so when Pat told her therapists she wanted to walk out of the hospital unassisted, they said, “We’re going to have to work you’re butt off to do it.”

On February 22, 2007, Pat stood on both legs for the first time. After four weeks of therapy, she was able to walk on even ground without a cane or walker. Since leaving the hospital, Pat has gained even more strength and has been able to move into a new prosthetic socket that allows her to bend her knee more than at first. Nothing is slowing her down. She has traveled over 30,000 miles, crisscrossing the United States in her car from Maine to the Grand Canyon and many other destinations.

Pat says the initial shock of amputation hit hard, and she definitely had to morn her loss. At 58 years old, she retired last June after 34 with the Postal Service. But it was the long healing process was the most difficult for Pat emotionally: “Getting used to not being able to do everything I wanted to do was the hardest,” she says. “Talking with other amputees online at [the social networking site] Less Than Four has helped more than anything else, and I love reading inMotion” a bi-monthly magazine just for amputees. Recently, Pat has even been able to talk on the phone and encourage some of Manny’s patients struggling with depression.

Pat’s strangest experience since becoming an amputee has been her phantom limb pain. “I hadn’t felt my foot for nineteen years,” she says, “but all of a sudden after the first amputation, I started feeling it itch or cramp. It was really weird, and the doctors couldn’t tell me why the feeling came back even through my leg and foot had been paralyzed.”

That pain has gone down some, but it’s still there a little. What Ms. Queen doesn’t have to deal with is pain from her prosthesis: “Manny’s work has just been amazing. Never ever have I had pain with that leg.” Besides having a prosthesis that fits well, Pat says managing her socks is most important. “I start the day with 6 socks and move up to 7 or more. I met another amputee who complained so much about his leg hurting, but he hadn’t been taught how to manage his socks.”

Pat has her health insurance through the Government Employee Health Association (GEHA), who covered her prosthesis and replacement socket. But Pat has been in touch with other amputees who have been denied coverage because of hidden caps in their group or private policies. So, Pat is supporting the efforts of the Missouri Coalition for People with Limb Loss and talking about the importance of prosthetic parity legislation in Missouri on her profile at http://www.lessthanfour.org/. Just search for Pat Queen.

Introduction to P&O Care

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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.

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."

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.

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.

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.

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.