It Takes More than a Shark Attack To Stop Champion Surfer

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By Miki Fairley
Bethany (second from right) receives her new bike from the Challenged Athletes Foundation (CAF). From left are her parents, Tom and Cheri Hamilton; Willie Stewart, noted amputee athlete; and Bob Babbitt, CAF vice president. Photo by Phil Mislinski, courtesy of the Challenged Athletes Foundation.
Bethany (second from right) receives her new bike from the Challenged Athletes Foundation (CAF). From left are her parents, Tom and Cheri Hamilton; Willie Stewart, noted amputee athlete; and Bob Babbitt, CAF vice president. Photo by Phil Mislinski, courtesy of the Challenged Athletes Foundation.

There was no indication of danger when Bethany Hamilton, a 13-year-old star surfer from Princeville, Kauai, Hawaii, went out on the waves early that day last October. Along with her best friend Alana Blanchard, and Alana's father and brother, she was surfing off Tunnels Beach on the North Shore of Kauai, with other surfers nearby.

Then horror struck. As Bethany lay on her board in clear water around 8 AM October 31, she was suddenly attacked by a shark that bit off her arm close to the shoulder joint. The shark pulled her back and forth, "but I just held on to my board, and then the shark let go," Bethany told the Associated Press (AP).

Holt Blanchard, Alana's father, immediately applied a tourniquet to Hamilton's arm, using a surfboard leash, a move that saved Bethany's life, according to her mother, Cheri. Alana remembers her friend as being "really calm." Doctors at Wilcox Memorial Hospital, Lihue, said Bethany's athletic conditioning aided her survival.

The shark took a chunk out of her surfboard that was about 16 inches across and 8 inches deep, suggesting the shark was 12-15 feet long, according to Kauai Fire Battalion Chief Bob Kaden, quoted by the AP. A spokesman for the state's Shark Task Force, Randy Honebrink, said it may have been a tiger shark.

Tiger sharks are second only to white sharks in the number of reported attacks on humans. Voracious predators, they are known to eat practically anything they can catch alive; the fearsome fish can grow to about 20 ft. long, with around 10 feet being average.

Would Bethany Surf Again?

Before the attack, Bethany was expected to become a professional surfer. She had already taken top honors in various surfing events and had secured sponsorships. Would she ride the waves again?

When asked by Matt Lauer on the Today show shortly after the attack if Bethany would try to return to competitive surfing, her father, Tom, said, "It will take some time for her to adapt, but she's so adaptable, and she's so strong, and she loves the sport so much, I think she's going to surprise myself and everybody else in the world."

Bethany did indeed surprise everyone. In less than a month, she was back in the water--and she returned to competition in just ten weeks, placing fifth in her age group in the Open Women Division of a National Scholastic Surfing Association meet in Kailua-Kona, Hawaii January 10. She did not allow any special treatment--she wanted to be treated just like everyone else.

The young surfing star was the guest of honor of the US Olympic Triathlon Team announcement in Honolulu, Hawaii April 14 and is now an honorary member of the team. The Challenged Athletes Foundation (CAF) gave Bethany a new bike, since she has expressed a desire to become a triathlete. Willie Stewart, noted triathlete and an above-elbow amputee, gave her guidance and instruction on how to ride a bike with one arm.

What About a Prosthesis?

Troy Farnsworth, CP, uses Hanger's proprietary Insignia technology to scan Bethany's residual limb as Randy Alley, BSc, CP, FAAOP, and Bethany's father Tom watch.
Troy Farnsworth, CP, uses Hanger's proprietary Insignia technology to scan Bethany's residual limb as Randy Alley, BSc, CP, FAAOP, and Bethany's father Tom watch.

What about a prosthesis for Bethany? The orthopedic surgeon who treated her after the attack noted that it was a clean amputation. In discussing Bethany's prosthetic management, Randall Alley, BSc, CP, FAAOP, remarked that Bethany is completely comfortable with her body image, unusual for a girl so young.  Alley heads clinical research and business development for Hanger Prosthetics & Orthotics' Upper Extremity Prosthetic Program. "Given her bone length, attitude, her age, her family support, and the culture she grew up in, which is focused around surfing and her athletic ability, her desire to wear a prosthesis for anything other than surfing may be somewhat less than the average 13-year-old girl, who is typically more concerned about her self-image," Alley said. "She immediately became an icon in the islands, and she is extremely comfortable with herself the way she is. Most 13-year-old girls would typically want a silicone restoration, but although she wears one occasionally, she is truly focused on what we can do for her as it pertains to her greatest love, the ocean."

However, Alley and Troy Farnsworth, CP, director of Hanger's Upper Extremity Program, would like to see Bethany return to bimanual usage "for her lifelong safety and ability to integrate into society," Alley said. Even a passive (Alley prefers the terminology "semi-prehensile") prosthesis, which she currently has, enables her to carry lighter objects and stabilize objects against her body.

Ultimately, they would like to fit her with an adaptive prosthesis that would enable her to swim out through the waves faster for competitive surfing. "Her ability to surf is not really hampered or aided by a prosthesis, as she has excellent balance with or without a prosthesis," Alley said. "Where a prosthesis could really help would be paddling through the waves and getting up on her board."

The length of Bethany's residual limb presents a challenge--it's extremely short, making it difficult for her to manipulate a prosthesis, Alley noted.

"We're looking at bone-lengthening techniques as an option down the road, because she could really benefit from a longer humerus bone to increase her leverage," Alley said. In this particular case, Alley and Farnsworth prefer a technique which uses a titanium fixture at the end of the bone, versus the Ilizarov technique, which requires an external fixator. In the Ilizarov technique, the bone is broken, slowly pulled apart, the gap fills in with new bone, then the process is repeated until the desired length is attained.

"How the Ilizarov technique works is very effective for specific individuals, but it is very time-consuming and is often debilitating during rehabilitation for others," Alley explained. "We don't want to risk freezing up her shoulder joint's range of motion if we were to use fixators up that high and immobilize the joint for a long period of time. She really needs a strong and mobile shoulder joint to help her propel through the water."

However, the titanium implant technique is not yet approved for use in the US, and it hasn't yet been sufficiently used for upper-extremity bone-lengthening, although it has proved successful in lower-extremity use, Alley explained. Bethany thus would need to be treated by a physician out of the country if this technique were to be used. "The shape of the titanium fixture would allow better suspension for the prosthesis and the healing time is much quicker," Alley continued.

If the bone length is there, a prosthesis with a paddle-like terminal device at the end, which expands as it goes through the water and then collapses as she raises her arm out of the water, would help her cut through the waves more effectively, Alley said. "We have to be careful, however, that any such device does not apply excessive forces to her shoulder joint and hence overly stress the area and ultimately induce injury," he continued. "This will take some careful design study and risk analysis, as well as a healthy dose of trial and error."

But, whether she wears a prosthesis or not, this "surfer girl" certainly hasn't let a shark attack and limb loss deter her from her beloved sport!