As he prepared to graduate with a biological engineering degree from the University of Georgia nearly a decade ago, William Fletcher was in a bit of a quandary.
The Jackson, Ga., native simply didn't know which career path he wanted to take. Should he enter medical school? Or was the seminary his calling? Perhaps he should stick with pure engineering?
"I had figured out I didn't want to sit at a computer all day and end up doing mathematical modeling and engineering work all day long," Fletcher said. "So I decided it was either going to be med school or something where I could use my hands and my mind to help people, and to be able to see the fruits of my labor."
Then he ran across a couple of brochures on the industry that cares for people who have had amputations. That led to him hanging out as a volunteer with the Hanger Prosthetics & Orthotics office in Athens, Ga.
Fletcher finally realized the direction he should take and hasn't looked back, eventually landing a job seven years ago with Hanger, a publicly traded company that is a leading player in the artificial limb and braces sector. He's been in Columbus six years now and runs the Hamilton Road office and a staff of five, along with satellite offices in Opelika, Ala., and Newnan, Ga.
The operation includes a workshop in which artificial limbs and braces are custom made using digital scanners, plaster casting, ovens, grinders and materials such as carbon fiber, fiberglass, resin and plastic.
The Ledger-Enquirer talked recently with Fletcher, 32, about his job, what it entails and why he enjoys it. The interview has been edited for length and clarity.
What's a typical day for you?
It's a mix of doing the fabrication, of seeing patients and a little bit of management, as well and seeing what's going on at the different offices.
What do you enjoy most about your job?
I like the patient care the best, the interaction with the patients. It's real gratifying to see a stroke victim get back up and walk or see an amputee who has lost a limb get back up and get going again. Being able to transition them through that is really exciting.
The technology also is huge for us. For instance, there's a computerized foot and ankle system that's new this year. It's only been out a month or so. We've fit three so far in this office. We're one of the first offices in the country to provide that foot. We've got some patients who didn't do well with their old system, and the new technology is making it where they can be a whole lot more active.
Are there steady advances in technology in this area?
There are advances all of the time. Historically all of the major advances have come at some point during a war. The Civil War was a big deal. James Edward Hanger, who started our company, was the first Confederate soldier to live through such an injury; he lived as an above-knee amputee. There was nobody making artificial limbs at that time. He opened the company because there was nobody else doing it.
Since then, with World War I, World War II, Vietnam, in each one of those eras the government put money into research and you can see each one of those times there have been huge advances. Even with the most recent deal in Iraq and Afghanistan, the same thing has happened.
Your clientele is both civilian and military?
We do see some soldiers that are active duty. We also see veterans, and we see patients that range anywhere from birth up to our oldest patient, who was 105. She was a below-knee amputee, and she still walked around pretty well with a walker.
The military has their own treatment facilities?
They start out a lot of times at Brooke Army (Medical Center), what was Walter Reed, and they get their first prosthesis there. If they're going to stay active duty and they get stationed at Fort Benning, we end up seeing a lot of those. If they decide to get out, we see them through the (Veterans Affairs) system.
What's the general cost of an artificial limb?
It's a huge spectrum. A below-knee prosthesis could range from the low end around $4,000 and on the high end $30,000. The big thing that adjusts or changes the cost is the foot or knee system that's going into the device. The reason for that is the more active the patient is, the more advanced the foot needs to be.
Does insurance cover this?
Most of the items we're doing are covered under insurance. There are a few things that are brand new on the market that maybe don't have coverage yet, but those are items that companies producing them are working to have (covered) and I'm sure they'll fall under the insurance umbrella eventually.
Are there more people with artificial limbs and braces than we think?
There are. One of the things related to the growth in our industry is the Baby Boomer generation. I worked at a children's hospital for a little while and 100 percent of what we saw was congenital or trauma situations. Probably 80 percent or more of our patients are actually Baby Boomer generation patients that have diabetes, that have dysvascular complications. They may have had a sore that wouldn't heal and they ended up with amputation.
A large portion of our patient population is out there. You don't realize they're there because we get them back up and walking well. We cover the prosthesis and hide it really well. And with pants on, you just can't tell what they have.
What about the need for braces?
The big increase in brace wear is probably more on the stroke level and cerebral palsy. There have been some advancements in that as well. Sometimes instead of fitting a brace, we fit a thing called a 'walk aid.' It's a functional electrical stimulator. It basically uses a computer to shock the nerves in the foot and ankle, which gives the patient the ability to pick the foot up. Somebody that has foot drop -- which is what a stroke victim or a cerebral palsy patient would typically have -- uses that device to pick the foot up as they walk. The advantage to that is over time, those patients are starting to see some return of function that we typically wouldn't have seen until now.
Do you have any unusual cases?
We have a guy at Fort Benning right now who's an above-elbow amputee, and we're working on setting him up to do the Tough Mudder competition, which is a 12-mile run and 30 or 40 obstacles. He's going to have to be able to do monkey bars and climb a vertical rope and do several things like that with his prosthesis. It's going to be harder than it would be for me and you, but it's going to be possible.
How long does it take from start to finish to craft an artificial limb?
It really depends on what the patient needs. If I had all the parts here, I could do it in a day -- if you were willing to hang out for eight or 10 hours. The big thing is that each step requires cure time and requires fabrication time between steps. For instance, a patient that's getting a below-knee prosthesis, I would see them three or four times.
What's the general attitude of folks coming in for a prosthesis?
It's a broad spectrum. When you've lost a limb, a lot of times the patients are mourning the loss. There's a psychological thing that they have to get over and get going again. But sometimes there's nothing to it; they hop up and go and don't thick twice about it. I think it helps to introduce them to other patients who are doing well, to be able to see somebody else who's gone through the same thing.
After the limb is installed, what's next?
We provide the device and then we work hand and hand with the therapist to train them. Depending on the technology, we may have to train the therapist on how to use it before they can train the patient. We pretty much work with all of the therapists in town.
What's the next step in your career, moving up the corporate ranks?
The downfall to that is at some point you get out of clinical care, and the whole reason that I decided to get into this field instead of doing the engineering was so I could see the fruits of my labor. A good example I like to give if I was still an engineer I could design the feet, I could design the knees that we use, and I could design the hands. But I would never see a patient get up and walk again.
I've been given an opportunity and found this little niche where I'm not designing the foot, but I'm able to use physics to help somebody walk again and see their face when they leave here, to see that excitement and see somebody who wants to go to the ballfields and watch their grandchildren play, and be able to get them there, but not with a wheelchair.