At least 11 of the survivors of Monday’s bombings at the Boston Marathon lost limbs. And some lost two of them, injuries that will forever change their lives.
Doctors who treat amputees said recovery is costly — both emotionally and financially — and will take months or even years.
There is a grieving process which involves moving through anger to acceptance, doctors said. There is a painful and difficult physical healing process, which can take several months for swelling to subside and skin to grow less sensitive.
But there is also a practical concern, of whether insurance, if it’s available, will cover the most suitable prosthetic for patients as they become more active.
“In the field of prosthetics there have been some pretty impressive advances, but these advances come at a price. When you are talking about legs, you are talking $60,000 to $80,000,” said Dr. Ramon Cuevas-Trisan, chief of physical medicine and rehabilitation at the U.S. Department of Veterans Affairs Medical Center in West Palm Beach.
His rehabilitation group has seen 18 or 20 soldiers with combat-related amputations in the past few years, he said. They have seen many more older veterans lose limbs to diabetes and vascular disease.
The VA will pay whatever is required for veterans who would benefit from the newer technologies. It will also provide physical therapy and a home accessibility assessment.
Some of the most advanced prostheses don’t just feature a customized fit, adapted to an individual’s stump anatomy. They now employ battery power and computer-controlled hydraulics, with gyroscopes and a variety of sensors to enable more natural movement. Such technology can help amputees overcome the tremendous strain and extra energy required to move without both legs.
But private insurance is typically less generous than the VA, doctors said. What type of prostheses the victims’ insurance will cover will depend on their carrier and their plan.
A spokesman for Aetna said that its durable medical equipment policy has no limits for prostheses, but does limit approval for computer-controlled limbs to those who are active and motivated, and that would include most children, according to Aetna spokesman Walt Cherniak. Someone very frail, who uses a prosthesis only for balance or moving short distances, wouldn’t likely qualify.
But for children who lose limbs, the financial strain on families is typically profound, because of how frequently their custom-designed socks and limbs must be changed, said Dr. Ahamed Mohaideen, a pediatric orthopedic surgeon on staff at Palms West Hospital in Loxahatchee and St. Mary’s Medical Center in West Palm Beach.
The Associated Press reported that one of the Boston Marathon blast victims who lost a leg is just 6 years old. Jane Richard, a first-grader, lost her leg in the explosion that took her brother’s life and injured her mother.
A child that age may have to undergo repeat surgeries as she grows into adolescence, and her prosthetic will have to be changed multiple times, said Mohaideen. There is also the day-to-day responsibility of caring for a stump, keeping it clean and free from injury. That’s tough for a small child, Mohaideen said.
“Basically it is an ongoing thing for her, a lot of things for her to take care of,” he said. “As she grows, that extremity will continue to grow. Possibly she will have to have a secondary surgery. Possibly two of them.”
Emotional support will be important for all of the amputees, said Dr. Michael Busse, acting chief of mental health at the West Palm Beach VA hospital, who has counseled people who lost limbs in battle and as a consequence of disease.
“It dramatically shifts what we thought our life was going to become, and what it is going to become,” Busse said. There’s a grieving process, he added, and some people process it more slowly than others.
“Predicting resilience? There’s no way to 100 percent predict how someone is going to respond to an immediate life change like this,” Busse said. “You are not just grieving the loss of that limb, but of what you thought you were going to be like in life.”
CLARIFICATION: The story has been updated to clarify whether Aetna covers computerized prostheses for child amputees. The insurance company’s policies make clear that most active children would qualify for the limbs.
Wall Street Journal:
At Boston Medical Center there were “a lot of amputations,” said Andrew Ulrich, executive vice chairman of the hospital’s department of emergency medicine. Five people needed either amputations or treatment for limbs blown off in the blast. More than one had both legs amputated.
Brigham and Women’s Hospital’s Ron Walls, chairman of the department of emergency medicine, said one amputation had been performed at the hospital, and two more victims there are in danger of amputation.
Dr. George Velmahos, chief trauma surgeon at Massachusetts General, said Tuesday morning that four patients there have undergone amputations and two more limbs are in jeopardy.
Tim Corcoran of Warwick, R.I., said his sister-in-law, Celeste, had lost both legs in the attack and that her 18-year-old daughter’s legs had been “ripped open” by shrapnel. Mr. Corcoran’s brother, who was standing with them, was “devastated,” he said.
Liz Norden, a mother of five, told the Boston Globe that two of her adult sons, ages 31 and 33, were standing near the finish line when the blast went off, apparently near the 8-year-old boy who died. Each lost a leg at the knee. One was taken to Beth¬Israel Deaconess Medical Center, the other at Brigham and Women’s Hospital.
Jane Richard, age 6, lost her leg in the explosion that injured her mother and her brother.
Source: Palm Beach Post wires.