On Sept. 11, 2004, Brian Kolfage was injured at Balad Air Base in Iraq, leaving him with a left hip disarticulation, right transfemoral amputation and a right transradial amputation. By November of the same year, he was trying to walk.
Though the journey has been a long and painful one, he never let his injuries stop him from moving forward.
Kolfage does not remember the rocket hitting the ground next to where he was walking, but for a few moments after the explosion, he thought he might be dreaming. He had been on his way to exercise before work and then all of a sudden, he was on the ground with sand in his mouth and everyone around him was screaming.
His friends began stuffing his wounds with towels to try to stop the bleeding.
“I tried to look at my legs — I sat up a little bit — and they just put their hands in front of my eyes so I wouldn’t see,” he said.
The ambulance truck scooped him up and rushed him to the hospital on base. Medics refused his repeated requests for pain medication but quickly sedated him. When they rolled him into the hospital, he lay on the table and looked up at everyone’s horrified faces.
“That’s the last thing I remember from Iraq,” he said.
Kolfage was at Walter Reed Army Medical Center 36 hours from when he was injured in Iraq — the fastest person transported back to the United States, he said. Doctors kept him in a medically induced coma for a week. When he awoke with family and friends by his side, he knew his legs were gone, but was ready to deal with his situation.
“I was in a lot of pain for a few days,” he said. “But once I started seeing other injured people missing chunks of their heads and people not knowing their families’ names, [people who had] different brain injuries, I was just glad that I had my head and everything was in tact up there. I could care less about my limbs.”
Full speed ahead
Determined to move past this tragedy, Kolfage began working with his therapy team right away, first learning to sit up and regain balance.
“It was pretty much full-speed ahead from the moment I was awake,” he said.
For the next 7 months, Kolfage worked with the team at Walter Reed on his overall mental and physical recovery and his ability to walk. When he left the hospital, the only skill lacking was his ability to walk.
Although he worked with the recovery team and prosthetists at Walter Reed — and did fairly well — he was unable to progress past the parallel bars, or using a walker with assistance. He attributes this to the severity of his case.
But as difficult as it was for him to walk, Kolfage never thought he would not be able to.
“I kind of always believed I could walk from the get-go,” he said. “I think seeing other people who were going through the same stuff as me, who had similar injuries, and they were walking. It gave me hope.”
Intense prosthetic care
When he finally left Walter Reed, he relocated across the country to Arizona. That is where he found Hanger Prosthetics & Orthotics.
Kevin Carroll, MS, CP, FAAOP, vice president of prosthetics for Hanger, flew in from Orlando, Fla. to evaluate Kolfage — who was in a motorized wheelchair — and soon after, they went to Oklahoma City, where he received his first set of sockets and stubbies.
On the first day, Kolfage set a realistic goal for himself: to walk. Not to complete a marathon, or to run, but just to be able to walk from his house to his car, and into work, a store or a restaurant. Once he achieved this, then he could begin to think about building his endurance for longer distances.
The Hanger team realized how difficult this would be for Kolfage because of the lack of any significant length in his residual limbs and the existence of bony prominences. On one side, he was left with a hip disarticulation and on the other, a residual limb ending just 3 inches below the trochanter. On both sides, Kolfage suffered from severe heterotopic ossification, making it difficult to fit him with any sockets or prostheses that would be comfortable.
Carroll assembled Kolfage’s prosthetic team. which included Chad Simpson, LP, and Randy Richardson, RPA, in Oklahoma City, Jeff White, CPO, from Hanger’s Tucson, Ariz., facility, volunteered to be the 24-7 person, available at any time, by phone or in-person if necessary, for all of Kolfage’s needs.
“When you’re dealing with these type of challenging cases, you’re looking for all of the clinicians to step up to the plate,” Carroll said. “Not every patient is going to demand that type of a commitment. But when it’s called for, we have to ask ourselves, ‘Am I the one to do this?’ In this particular case, Jeff said, ‘Yes, I’m the one to do this.’”
During that first visit, Kolfage also met Cameron Clapp, who flew into town wearing his own stubbies. Clapp taught him how to go up and down steps, how to get in and out of a car, and how to face other obstacles that affect a person at 3-and-a-half feet tall.
Watching Clapp, who has come so far in his own recovery, eased Kolfage into his own transition, White said.
With the basics under his belt and White by his side, Kolfage flew back to Tucson. Over the next few months, the two worked together, with Kolfage gaining the endurance and balance he needed to walk. White began to raise him up, inch-by-inch.
Kolfage said that this progress came only after “a mass amount of hours of work.”
“When I would get off work, I would go over to Hanger and we would work all night, until sometimes midnight, maybe 20 hours a week,” he said. “He put in all this overtime just to help me succeed.
“Any other prosthetist, there is no way I would have gotten all that extra time,” Kolfage told O&P Business News.
White stood by his commitment to his patient, regardless of the inconvenient hours. More than that, he was inspired by Kolfage’s determination.
“No one is more deserving than someone who loses three of his limbs the way he did, serving the country,” White said. “And it was a challenge for me as well. It drove me to make him walk.”
One year after getting his stubbies, Kolfage flew back to Oklahoma City to be fitted for his C-Legs. He worked with the Hanger team to walk — and walk and walk some more — until he felt comfortable using the full-length prostheses.
For added assistance, White created a crutch arm, a custum cane that slips over and extends from Kolfage’s transradial prosthetic socket to the ground. This device gave him the security he needed to gain more independence from the parallel bars.
White and Kolfage became such close friends, they often spend time together outside of the prosthetic realm. They also began making their work together less like work. For instance, the two would agree on a goal, and once Kolfage accomplished it, White would raise him up to the next height.
“As he got taller I told him that I will never make him taller than Kevin and me [who both stand at about 5 feet 6 inches]. I said once he was 5 feet 5 inches he was going to have to find a new prosthetist,” White said. “Well the time has finally come, and he now is taller than both of us at about 5 feet 8 inches … and he has the same prosthetist.”
He thinks that Kolfage will reach 5 feet 10 inches eventually.
White does not take the credit for Kolfage’s progress. Carroll and the rest of the Hanger team all contributed to his success.
“I was the one seeing him every day but I wasn’t the only one participating,” he said. “The whole team really made it work.”
Carroll also attributes Kolfage’s current status to the entire team.
“The driver of the team most often is the patient, and it was in this case,” he said.
Overall, he is proud of the progress Kolfage has made, and his ability to reach all of his goals — not just the basic ones.
“His vision was walking out, getting into — as he would call it — his pimped-out Range Rover, and driving away,” Carroll said. “It’s hard to pimp out your wheelchair-accessible van.”
Of all the roadblocks that Kolfage has faced, he admits that his upper extremity prosthetic device has never given him trouble. Since his left hand was in a cast when he got to Walter Reed, he had no choice but to learn to use the prosthesis quickly.
To keep himself active, Kolfage swims in his lap pool. Playing hockey and running — the other activities he participated in before his amputations — are out of his league for now, but he still enjoys surfing, although now he does it sitting down.
Thanks to the effort and hard work from Kolfage and his Hanger team, he has become more independent. With his cane and his crutch, he is mobile without depending on a wheelchair. Kolfage, who is puruing an architectural degree from the University of Arizona in Tucson, is able to walk to some classes, given that they are only a short distance without a significant incline.
He also is learning more about himself along the way, and his new goal is to be able to walk just with a cane.
White is impressed just with what Kolfage has done up to this point.
“I feel like I’m lucky to have been in this position, to be able to work with him,” White said. “Most people don’t get to challenge themselves with this type of complicated case.
“I think I’ve grown as much through this process as he has.”
In White’s mind, the biggest complication Kolfage has overcome is the length — or lack of length — of his transfemoral amputation.
“Without that 3 inches of bone, there’s no way he could walk,” he said. “The fact that the 3 inches of femur he has is what really propels him and powers everything for him … I think that is amazing.”
Stephanie Z. Pavlou, ELS, is a staff writer for O&P Business News.