Lynn Budde: One Step at a Time
August 2012 Issue
High Technology Helps Toxic Shock Victim to Walk Again
Just over two years ago, Lynn Budde was living a normal, happy life with her husband in Nancy, Kentucky.
In the fall of 2009, she started to feel as though she was getting the flu. Her husband took her to the hospital. That's the last thing Budde, 52, remembers about that day. She woke up from a coma six weeks later after having bilateral transradial and bilateral transtibial amputations, as well as losing a portion of her upper lip and nose. She learned from one of her physicians that she had contracted toxic shock syndrome (TSS), which is often associated with using superabsorbent tampons. TSS is a rare but potentially serious disease that can be fatal. It is believed to be caused by toxin-producing strains of the staphylococcus aureus bacterium, according to tampon manufacturer Tampax.
Budde says it was a "blessing" to learn what had happened to her the way she did. "I was never really freaked out by it. It wasn't a rude awakening because I came to the realization in a gradual way," says Budde, who is undergoing plastic surgery to reconstruct her lip and nose.
Nonetheless, it was quite an adjustment for a woman who had quit smoking three years earlier, enjoyed swimming and boating, and loved working in her "big, beautiful yard," to no longer have the independence she once had. One thing Budde knew immediately, however, was that she had no plans to sit in a wheelchair for the rest of her life. As soon as she was fitted with upper- and lower-limb prostheses, she started to focus on becoming as independent as possible.
A Unique Set of Challenges
Often, just creating prostheses for a client is not enough to give that person his or her life back, says Budde's prosthetist, Rick L. Riley, CP, owner of Prosthetic Consulting Technologies (PCT), Washoe Valley, Nevada. Budde says she found Riley after conducting a nationwide search for a new prosthetist because the one she had in Kentucky didn't meet her high expectations. While she did have prostheses for each of her limbs, they were unstable and rotated so they were not very functional for her. Additionally, her prosthetist at the time did not have previous experience with a client who had quadrilateral amputations. One thing that appealed to Budde about Riley and his team of seven employees at PCT was that almost everyone there has an amputation.
When Budde first came to PCT, she had already been provided with multiple prosthetic devices, says Riley who lost his right leg in a motorcycle accident in 1974. In addition to the problems she was experiencing with the prostheses, as a woman with quadrilateral amputations Budde had another small problem: she was not able to don any of them on her own. Though Budde's former prosthetist had provided her with prostheses, there was no follow-up to see how she was doing, Riley says. "This was a failure of what was necessary to give her back her independence," he says.
Riley began to work to improve Budde's quality of life. Because PCT's first step in working with someone who is missing multiple limbs is to find out what things are like at home, Riley made a trip to Budde's Kentucky home. He took pictures of her bedroom, bathroom, stairs, and the front yard. During the visit, Riley and Budde discussed her aspirations and desires as well as her fears and frustrations. One of Budde's big concerns was getting up at night to go to the bathroom and having to wake her husband to help her put on her prostheses, Riley remembers. Budde also feared not being able to leave their home in case of an emergency without someone to help her don her prostheses.
"These were unacceptable situations for her," Riley says.
Riley returned to PCT and went to work. The staff built Budde new sets of prostheses that included regular walking legs, aqua legs, and a pair of aqua arms with interchangeable terminal devices for specific activities of daily living (ADL) such as washing or grooming, as well as another set of terminal devices that she uses to swim and play ball sports. While these devices allowed Budde to accomplish ADLs more easily, she still could not don or doff her prostheses on her own. The biggest challenge they encountered was creating a solution for a patient with no hands to don a locking liner. The PCT team decided that a custom donning station would solve a lot of her problems. They built the customized station, which included mounting the storage cones that come with Silipos® liners on an angled rack.
"She could just get her below-elbows stumps to unroll the locking liners from the cones and don them while lying on the bed," Riley says.
Budde says she pre-positions her lower-limb prostheses next to her bed so she can easily don them without help. The PCT team placed a wedge-shaped piece of wood in her custom donning station that hooks above her ankle to hold her prostheses while she disengages the shuttle locks and removes her prostheses.
Not only did Budde master the donning and doffing of her prosthetic devices, she progressed at a far greater pace than her prosthetic legs allowed. Although the PCT team had switched her from rigid feet with no ankle action to much springier feet that were a compromise in terms of ankle action, they still did not allow her to navigate the long driveway of her home, which was built at a roughly 45-degree angle.
A Bionic Solution
When the PCT team made Budde her new prostheses, they used locking liners and a supercondylar socket design for increased stability. But Budde had heard about new powered ankles that might help increase her mobility and asked Riley to look into iWalk's BiOM powered lower-limb system, originally developed through the Massachusetts Institute of Technology (MIT), Cambridge. PCT then duplicated her sockets, which took into account changes in her residual limbs, for her BiOMs, Riley says.
"They gave her ankle motion and stability that she had not been able to achieve with the typical energy-storing feet," he says.
Budde took to her new BiOMs as though they had always been a natural part of her body. "They just lifted me and took me places," she says of the BiOMs, devices that mimic a person's anatomical feet and ankles and produce forward propulsion with each step. Though Riley says he is not a proponent of high-technology prosthetic components, the BiOM certainly captured his attention. "This one produced a big wow factor for me when I tested it," he says.
The BiOM ankle reduces the energy consumption of a person with an amputation by up to 20 percent, about the equivalent to a person with biological limbs, according to Tim McCarthy, iWalk president and CEO. What makes the BiOM different is that it allows for a more natural gait, he says. "There's nothing wrong with the carbon brands on the market, but the carbon technology is only providing 50 percent of the energy required for normal ambulation, where the BiOM has proven to normalize level ground walking." The BiOM replaces plantarflexion, so the user has a more natural step, which, as a result, puts less wear and tear on the body and less pain in the back, hips, and knees in the long run, he says.
Perhaps none of this would have been possible were it not for Budde's husband's years of working as a United States Postal Service employee, his health insurance coverage, and Darla Fox, who has been a clinical case manager for the Anthem Blue Cross and Blue Shield Federal Employee Program for the last three years and a registered nurse for 27 years. Funding for BiOM's development came via the federal government, and until lately the device had only been available for Iraqi and Afghanistan veterans. However, some private insurance companies have started to cover the cost of the system. Such was the case for Budde, whose BiOMs were covered completely by insurance and who became the first woman in the United States outside the military to be fitted with BiOM prostheses.
Most insurance companies have a case manager for their members, Fox says. To secure a case manager, there has to be a need, and it is just a matter of asking if your carrier has one, she says. In Budde's case, her nurses contacted Fox to help with her outpatient needs because they were going to be so extensive. "We really had to think outside the box on Lynn's case because she had all four limb amputations," Fox says.
Fox reached out to a number of agencies including the U.S. Department of Veterans Affairs (VA) for help with training a patient to use BiOMs. "Most therapists aren't trained in bionics, so that made it even more of a challenge," Fox says. Fox says despite Budde's situation, she always remained positive and upbeat. "If Anthem ever had a poster child, it would be Lynn," she says. "It was always 'okay, I can do this.'"
Betta Ferrendelli is a freelance writer based in Denver, Colorado.