SAN ANTONIO — Lt. Col. (Ret) Donald Gajewski, MD, MC, shared lessons learned from what he called “the best job in the world” working with injured service members during the opening session of the American Orthotic and Prosthetic Association National Assembly, here.
Gajewski, the keynote speaker, worked in the military for 13 years and spent 4 years as chief of the San Antonio-based Center for the Intrepid (CFI), a rehabilitation center for veterans of Operation Iraqi Freedom and Operation Enduring Freedom who have sustained burns, amputation or functional limb loss. The CFI is one of three military centers in the United States for amputees. Gajewski currently works as an orthopedic surgeon for Asheville Orthopaedic Associates in Asheville, N.C.
“Not much good comes from war except for the advancement of medicine and that is the main goal at the CFI, the main goal at Walter Reed [Army Medical Center] and the main goal at [the VA] San Diego [Medical Center],” he said. “Because if we do not gain something positive from the horrible negatives of war, we have not done our duty.”
The CFI offers amenities such as a gait lab, a Computer Assisted Rehabilitation ENvironment (CAREN) system, a Flowrider therapy system — a machine that creates waves the veterans can ride with a boogie board or their bodies — and a firearms training center.
Gajewski said he learned three important lessons from working with prosthetists. The first is that “the use of the best technology is not always the best use of technology.” In other words, different technologies work best for different patients.
“Google kills us,” he said, acknowledging that patients want the latest device they see online, but that is not always the best choice for their needs.
Second is to focus less on “what you put on the patient,” or the prosthesis, but instead on “what you put in the prosthesis,” or the patient. Rehabilitation is crucial for patients so they can be healthy and ready to work with the prosthesis.
“These are not magical devices,” he said, adding that patients who are mentally healthy and physically fit will be more successful in adjusting to prostheses.
Third is that the length of the residual limb is less important than the soft tissue envelope because “comfort, not length, is the goal.”
Gajewski said each level of amputation has different advantages and disadvantages. Surgeons and prosthetists need to understand the options available for each patient to provide the optimal level of comfort, he said.
“It is not what you can do to the patient,” he said. “It is what you can do for the patient.” – by Amanda Alexander
Reference: Gajewski D. What I learned from my prosthetist. Presented at: American Orthotic and Prosthetic Association National Assembly; Oct. 7-10, 2015; San Antonio.
Disclosure: Gajewski reports no relevant financial disclosures.