Your First Appointment in the New Year

QUESTION:

My next appointment is scheduled in your office after the first of the year.  Do I need to bring anything with me?  Is there anything new I should know before coming to my appointment?

 - Karon M.

ANSWER:

Thank you for the great question!  The first of the year can be tricky for medical offices, as it is when most insurance policies renew. It is also the time of year when brand new insurance plans go into effect.  Unfortunately, a change in insurance can sometimes cause problems for patients since not all medical providers participate with all insurance plans. 

For example, we often see patients who were previously enrolled in traditional Medicare who have signed up for a Medicare Advantage plan during the open enrollment period.  Changing over to a Medicare Advantage plan can potentially affect coverage with your current healthcare providers, as some providers may not participate with a particular Medicare Advantage plan.  This means you would no longer be able to see that provider without having an out of pocket expense.  This is one reason we encourage our patients who have made any change to their insurance to contact our office prior to their appointment to let us know of the change.  At this time, we can also confirm whether or not we are an in-network provider with your new insurance plan. 

Speaking of out of pocket expenses, since most insurance policies run calendar year (Jan 1 – Dec 31), deductibles and out of pocket costs also renew the first of the year - so there may also be a possibility you will have a share for a service early in the new year.  We will certainly let you know of any financial responsibility you may have prior to providing the service.  Also, please don’t forget to bring any new insurance cards with you to your appointment! 

One last thing, so we may have the option to effectively communicate with you in regards to the care you receive from us, we will be asking for your current email address, as well as your permission to use it as a method of contacting you regarding the medical care you are receiving from us. 

 Happy New Year!

 - Kristin Boswell, Director of Patient Services and Billing

 

Do you have a question you would like to Ask Us? Email us at info@dankmeyer.com.

End of Year Benefit and Scheduling Planning

This is question that comes up close to the end of the year, so we thought it was worth reposting.

QUESTION:

Hello, with the holiday season quickly approaching and winter just around the corner, I’m concerned my prosthesis will need repair or I will need supplies and I might not be able to get an appointment.  Do you have any recommendations to ease my concerns?

 - Peyton K.

ANSWER:

We certainly understand your concerns, Peyton, and highly recommend scheduling an appointment with your practitioner prior to the holiday season and end of the year.  Many insurance policies renew January 1st, which may translate into your annual deductibles and out of pocket costs starting all over again.  This is something you certainly want to keep in mind as the end of the year approaches.  We are more than happy to review your benefits and provide you with the anticipated cost difference for services you receive prior to January 1st compared to after January 1st.  Just give us a call and one of our patient service coordinators will be happy to verify your benefits and answer your insurance questions.  In most cases, receiving repair to or supplies for your prosthesis prior to the end of the year will help keep cash in your pocket!  Make your appointment now for November or December.   We look forward to hearing from you soon!

 - Kristin Boswell, Director of Patient Services and Billing

 

Do you have a question you would like to Ask Us? Email us at info@dankmeyer.com.

What is 3D printing about in O&P?

QUESTION: 

I keep hearing about 3D printing in orthotics and prosthetics. How does that work?  - Paul W.

ANSWER:

Paul, what a great question! This is a very exciting time for 3D printing in Orthotics and Prosthetics and one of our favorite subjects.

The start of 3D printing
Most people think that 3D printing is relatively new. The truth is that it was started in 1980 when Hideo Kodama first described a layer by layer approach to manufacturing. About four years later a French team filed a patent for the stereolithography process (later to be re-named as 3D printing). They later abandoned their efforts, saying they just couldn’t find a viable market for this process. At about the same time, Chuck Hull filed his own patent for a stereolithography fabrication system. Through the ’80s, with much work and experimenting, 3D printing moved from its infancy and childhood to its adolescence. Though there are certainly others, three main printing methods have emerged: SLA - which uses a photo-sensitive liquid polymer; SLS - fuses material in a powder form; and FDM - deposits heated filament on a build plate to create objects layer by layer.

3D printing and prosthetics
One of the things that make 3D printing so appealing is the possibility to design, alter and customize objects. This has led to manufacturers using it to create prototypes in a much more efficient and timely manner. In the world of prosthetics almost everything is custom built for an individual patient - making 3D printing a very useful tool. 

In the last decade, groups like e-NABLE began creating, through open-source collaborations, hands for people who were missing fingers. This has sparked the hope for customizable, lower-cost prosthetic devices.

Often when a prosthetic leg is made, the patient wants a shape that resembles a real leg. This is most often done by encasing the metal tube that connects the foot to the rest of the socket with a foam material and sanding it to a leg shape. It can then be covered with a stocking or an artificial skin. This is known as a cosmetic cover. 3D printing has given rise to a market for personalized cosmetic covers for patients who aren’t as interested in natural-looking devices or really want to have an artistic way to express themselves.  

Dankmeyer’s involvement in 3D printing
Dankmeyer began their adventure in 3D printing in 2013 with the purchase of their first printer. Several people began the process of learning to design 3D objects as well as run the printer. That year also saw a number of staff members participated in an e-NABLE sponsored event where a number of pre-printed hands were assembled. 

The first real foray into creating a 3D device was for a patient who was less than pleased with the prospect of needing to wear a “traditional” prosthetic hand. We designed and produced an Ironman-inspired hand for him. The movie was in the theaters at the time and he was definitely a fan. We later made him a Batman version as well.

The next hand we produced was for a baby born with a defect to his right hand. He was beginning to crawl and his parents thought it was important for him to become used to wearing a prosthetic early enough that it would just be normal as he grew up. You can read more about this device and see pictures on our 3D Printing page. Click here.

If you are interested in seeing a video we made as an introduction to 3D printing, just click on the video link below.


Thank you for your question!  - Art Ross and Shawn Ross, Fabrication Technicians

Do you have a question you would like to Ask Us? Email us at info@dankmeyer.com

Back to Class with Orthotic and Prosthetic Devices

This is an encore posting of some Back to Class questions!

We have three questions about returning to school with orthotic and/or prosthetic devices.

QUESTION: 

The start of school is approaching and I am about to start my back to school shopping.   I wear both a prosthesis and an Ankle Foot Orthosis.  Is there anything I should be aware of for my brace or prosthesis?  - Tammy V

ANSWER:

Hi Tammy,

Before going back to school, it is a good idea to do a thorough inspection of your orthosis and prosthesis.  If there are any cracks, creaks or abnormal movements with either device be sure to schedule an appointment with your orthotist or prosthetist to have the devices checked out.   Also, if any of your liners, socks, sleeves, straps or buckles are ready to be replaced, it is better to schedule an appointment before school starts.  This way you won’t miss any classes.

As for your personal shopping, it is important to pay attention to what shoes you purchase for both your prosthesis and orthosis.  Typically, with an AFO we recommend that patients purchase shoes ½ size longer.  It may also be important to purchase a wide shoe in order to fit the device into the shoe.   For both your AFO and prosthesis, it is important that the new shoes also have similar heel heights to the shoes you brought to your most recent appointment with your orthotist or prosthetist.  

QUESTION: 

I want to try out for a school sport this fall.  As a below knee amputee and prosthetic user is there anything specific I should know before trying a sport and are there any restrictions?  - Derek Z

ANSWER:

Hi Derek,

We never want a prosthesis to limit a person’s potential activities.  We have patients who play or have played many of the common fall sports, such as football, soccer, volleyball, cross country and more!  That being said, here are some things to think about when starting a new sport.  1) Before going through a large change in activity levels it is always a good idea to contact your prosthetist.  Different prosthesis setups are intended for different levels of activity.  If your current prosthesis was not built with the expectation of high activity it has a higher chance of malfunctioning or holding you back.   2)  In whichever sport you decide to participate, it is important that you regularly inspect your residual limb for wounds or bruising.  Especially in the beginning, new, unfamiliar movements can change how your limb contacts the prosthesis.  Changes can be made to your prosthetic socket if this becomes an issue.   3) Be ready to sweat!  Prosthetic users almost always deal with the issue of sweating in their socket/liner.  With increased activity, it is very normal and expected.  It may be helpful to remove your prosthesis during breaks in play in order to air out your limb.  Bring extra prosthetic socks to practice and games.   As you sweat the size of your limb may shrink throughout the day, if this is the case, socks can help improve the fit and can assist in preventing unwanted limb movement within the socket.  Also clean your socket and liners daily.  Mild soap a damp cloth and rubbing alcohol can help with personal hygiene, component longevity and odor!  4) Have fun!  

QUESTION:

I am a fairly new above knee amputee.  My limb is very sensitive and I struggle to wear my prosthesis for more than a couple hours at a time.  Any recommendations to help get me through a day of school?  -  Julia D

ANSWER:

Hi Julia,    

Never feel like you have to keep your leg on during an entire school day.  It is common for amputees, especially new amputees, to limit the wear time of their prosthesis.  Schools want to help students who may need accommodations, so rather than struggle, take your time and do what you need to get through the days.  Talk to your prosthetist about writing a schedule down to help you gradually increase your tolerance.  Bring your prosthetist’s recommendations and contact information with you to school. Speak with your school counselor and ask for a meeting with your parents, teachers and the school nurse about your necessity to take breaks with the prosthesis throughout the day.  Your school will help you develop a plan that works for your needs and they can call your prosthetist if they have questions.

We also recommend that you do some work to help desensitize the limb.  First, become aware of issues that create stress for you. Trying to control stress is very important.  Relaxation techniques have been shown to significantly help with residual limb pain.  A second recommendation would be to start desensitizing exercises.  A common exercise is to lightly touch and rub hypersensitive areas of your limb with different textured materials. At first the materials should be extremely smooth and soft, for example silk.  You can do this for about 2-5 minutes, or to your tolerance, several times per day.  Once your limb can handle the silk material you can gradually use more coarse materials.  A common progression in material would be silk, cotton, corduroy, then wool.  If there are any open wounds on your limb do not rub it with any material. Never hesitate to give us a call if you have questions.

Thank you all for your questions!  

Do you have a question you would like to Ask Us? Email us at info@dankmeyer.com.

How often should I follow-up with my practitioner?

QUESTION:

How often should I follow-up with my practitioner?

Nancy W.

ANSWER:

In general, when you have any skin problems (for example, redness that does not go away in 20-30 minutes after using your orthosis or prosthesis) or pain while using your prosthesis or orthosis, you should follow-up with your practitioner. If you notice that your device is not functioning properly (ankle joints not operating well, prosthetic knee is not bending appropriately) we also recommend that you call and follow-up with us.

Prosthetics

If your prosthesis is fitting and working well, it is still a good idea to come in about every 6 months. We can inspect your prosthesis for signs of wear as well as look at your liners, sleeves, and socks to make sure they are in optimal condition for use with your prosthesis. It's a great idea to follow-up with us regularly so we can catch any problems early.  At the beginning of the process, when you first receive your prosthesis, we may see you more regularly for follow-up, as your limb may be changing quickly. However, over time these changes usually slow down and less frequent follow-ups may be more appropriate. We will normally call you to follow-up with you about every 6 months to see how you are doing.

Orthotics

We recommend an annual follow-up for orthoses. This is especially important if you have an orthosis that uses ankle or knee joints that may need maintenance or replacement. We will normally call you once a year to check in and see how you are doing. 

In all cases, if something does not fit or function well, please contact our office at 410-636-8114. We may be able to resolve issues over the phone, and if not we look forward to seeing you in our office!

Thanks for your question! - Nina Bondre, CPO

Do you have a question you would like to Ask Us? Email us at info@dankmeyer.com.