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MEDICINE IN
SAN ANTONIO

providers, are crucial to the solution for am- thetic limb. Some individuals simply cannot who lose a limb but have no financial means
putation prevention (often viewed as a simple use a prosthesis, regardless of access, due to of paying for a prosthetic limb. did you
solution). As all of us have witnessed that this mental or physical problems such as demen- know that Texas is ranked #1 in uninsured
“simple solution” is full of cracks through tia, paralysis, stroke, contractures, and/or residents and has a poverty rate of 16%,
which many people fall. overall debilitated state. The fact that many which is higher than the national average? In
life as a new amputee presents a maze of these unfortunate individuals actually ob- Texas, Medicare covers prosthetic limbs for
which would humble even daedalus and the tain a prosthetic limb (which they will never persons age 65 and over, and Medicaid covers
half bull Minotaur of Crete. Most health use) is the topic of another day. let’s focus prosthetic limbs for children. Medicaid does
care providers, including physicians, assume on the people who lose their leg and could not cover prosthetic limbs for adults. This is
that obtaining a prosthetic limb is so fre- walk if they had two legs, even if one or both counterintuitive and surprising to most peo-
quent that the system and process is simple are prosthetic. ple. There is no state financial help for am-
and direct. On the contrary, despite the fact Amputees seeking a prosthetic limb need putees in Texas who have no insurance or
that there is no shortage of prosthetists, no help in choosing a prosthetist. despite hav- who have insurance that does not cover pros-
shortage of prosthetic compa- thetics, or who have a de-
nies, no shortage of physical ductible so large that they
therapists, and no shortage of “Amputees can resume normal lifestyle cannot afford a prosthetic limb.
prosthetic limb parts, some am- with access to prosthetic limbs: without Regardless of which group an
putees never walk again. Al- limbs is nearly impossible.” amputee is in – insured or not
though there is no actual – it is better for everyone that
Minotaur, a simple wrong turn he obtain and use a prosthetic
or missed opportunity after amputation can ing written prescriptions for prosthetic limbs limb rather than a wheelchair. For a person
lead to devastating consequences. for over 30 years, it was not until the last few to be nonambulatory due to lack of funds to
While the patient recovers physically and years that I actually interacted with the pros- pay for a prosthetic limb is illogical, irrational,
mentally from limb surgery, he/she has to thetists who perform this singular and and in my opinion, an embarrassment in a
find and adjust to a rehab facility, find some- restorative process. There are many good state as giving and compassionate as Texas.
one to modify the home, including the bath- prosthetists in our city and it is essential that Having worked with amputees for over 30
room, and look for a prosthetic company. we help our patients connect with them. years, and having served as president of The
Of course, during this time the patient has They follow Texas guidelines and best prac- Prosthetic Foundation since 2012, I can un-
multiple doctor visits, home health visits, tices and are devoted to their patients. On equivocally declare that helping a person
physical therapy sessions, plus they require a the other hand, there are many patients that walk again is the right thing to do. The im-
driver whose vehicle will transport them are not so lucky; they get no guidance and pact of investing efforts here not only
along with a wheelchair. It is during this time make their decision solely based on the reaches the recipient but also their family and
that all of the bills and insurance documents promises of a company representative. Al- the community at large. beyond statistics, the
begin to arrive. Consequently, financial con- though prohibited by Texas law, the repre- ramifications of ambulation extends far past
siderations are often a major factor in choos- sentatives will often approach the patient the obvious. As amputees regain independ-
ing a prosthetics company instead of being without a request from a doctor, inside the ent mobility, their physical health vastly im-
based upon the abilities and dedication of hospital, the rehabilitation center, or even in proves while their overall mental, social, and
the prosthetic company. The role of the the nursing home. It is of great benefit to all emotional wellness increases, and their qual-
prosthetics company is crucial. A well-fitted if the doctors personally interact with the ity of life improves. The re-integration of
prosthetic limb will allow the amputee to re- prosthetics companies. How a limb is fitted, these individuals ensures that they can return
turn to nearly normal activities and resume manufactured and maintained is of para- to a level of community engagement not
their careers, their hobbies and their respon- mount importance to the ability of the am- previously obtainable.
sibilities. Conversely, an amputee with no putee to ambulate. Acting as an advocate for
prosthetic limb or a poorly fitted prosthesis our patients in this arena is foreign to most Demetrios N. Macris, MD is a vascular surgeon
cannot walk and is confined to a wheelchair. of us, but it should be routine. at Peripheral Vascular Associates and is a member
Not all amputees will benefit from a pros- Finally, let us consider the fate of people of the Bexar County Medical Society.

visit us at www.bcms.org 27