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Stand tall

Thanks to prosthetics and a strong attitude, a grateful amputee can again live fully

By Bob Sylva - bsylva@sacbee.com
Published 12:00 am PST Sunday, December 16, 2007

In an examination room equipped with hand bars, a full-length mirror, a few inspirational posters, Don Harway sits in a chair. He has on shorts. He usually wears shorts. He has nothing to hide.

His right leg is gone, cut off just below the knee, the result of a motorcycle accident. The stump, called the "residual limb" in polite medical terms, looks a bit pinkish and chafed. The muscles in his thigh are still in the process of atrophy and change.

Harway, 36, sits in the chair and rubs his exposed stump. He can move it back and forth. Admittedly, it's an odd spectacle – this completely responsive, functional knee, attached to nothing, kicking air. Even so, in his mind, in the phenomenon known as "phantom limb," Harway can still feel the kinship, the majesty of his toes. There is no pain, just an aching regret.

Now he slips on a gel-lined sleeve over his stump. The bottom of the sleeve holds a metal locking pin. His prosthetist, Bryan Hayes, hands Harway his new prosthesis, which consists of a plastic socket, a leaf-spring ankle, a splayed, carbon-fiber foot, now snug inside a khaki-green Nike running shoe.

Harway slips his stump into the prosthesis. There is an audible "click." Now he stands like a man.

This is the story of Don's leg.

On another afternoon, Bryan Hayes sits in his office at Hanger Prosthetics & Orthotics, which is at 1248 32nd St. He is holding a foot in his hand. Not a real foot. But a graphite composite foot, a marvel of stability, pace, clad in soft foam flesh.

Attached to a pivoting, piston-driven hydraulic ankle, this foot puts measurable spring in the step.

Hayes is 37 years old. He's a certified prosthetist. He's sturdy, laconic, with blue eyes and a reddish goatee. "As a kid, I was always fascinated by the human body," he says. "And I always liked to work on cars. So, this field is the perfect combination. I like to help people. I like to build stuff. Building a leg is like fine-tuning a race car."

Hanger is a historic company. It was founded in 1861 by James Edward Hanger, a Confederate veteran who lost his leg in the Civil War, the Golden Age of amputation. Hanger, unhappy with the quality of artificial limbs at the time – think peg legs and broomsticks – whittled a shapely leg from a barrel stave. His popular leg became known as the "Hanger limb."

(The art of prosthetics, of course, goes back centuries. The oldest limb ever discovered, made of copper and wood, circa 300 B.C., was untombed in Italy. The first articulated knee was made out of metal in the 15th century, by the same medieval tailors who hammered those bespoke suits of armor.)

Today, Hanger, with 660 offices nationwide, is the largest provider of prosthetics in the country. Hayes, a graduate of the University of California, Davis, who has a degree in prosthetics/orthotics from Northwestern University, is the practice manager of the Sacramento office.

Sacramento is Hanger's busiest office on the West Coast. Each year, it fabricates, in house, upward of 200 lower- extremity prostheses, 60 percent of which are limbs for below the knee. Surgeons, whenever possible, strive to save the knee. It usually takes two weeks to make an average leg, and, depending on range of motion, prosthetics can cost $6,000 to $60,000.

In a seemingly prehistoric age, which wasn't that long ago, prosthetists made leg sockets from carved willow, cast residual limbs using plaster. Modified the fittings with files, chisels, intuition.

Today, Hayes uses a laser scanner to measure a perfect, three-dimensional image of the stump, which he can then digitally shape and alter on his laptop computer. Once satisfied, he e-mails the image to a carving machine, which, using a block of high-density foam, cuts the block to size as if it were a Chippendale leg.

From there, using the whole spectrum of Space Age materials – titanium, thermoplastics, composites, Kevlar, fast- setting resins, hydraulics, myoelectrics – technicians can then build a prosthetic device with almost lifelike function and flexibility.

But technology can only go so far.

Scientists have not been able to replicate a positive mental attitude. Or heart.

"That's everything," says Hayes. "Especially in the beginning. Some people get depressed. They never get over the loss of their limb. Others see it (loss) as another challenge to conquer."

New ways, old dedication

Augie Sequeira is sitting in the employee break room at Hanger. Sequeira, in prosthetics circles, is something of a legend. He started in the industry 40 years ago, carving legs out of wood. He has witnessed all the major steps in the industry.

Sequeira is 73 years old. He is a prosthetics technician. He is a polite, dignified man, with courtly, Old World manners, glasses, a trim mustache, his scrupulousness buttoned up in a flowing blue laboratory coat.

"A lot of the old technicians are gone now," says Sequeira of his longevity. "I think I am the oldest one still working."

Sequeira is a native of Nicaragua. As a boy, he went to an industrial school and learned auto mechanics. Then, in 1966, at age 32, he immigrated to San Francisco, and got a job with a prosthetics company. In the beginning, he made hands out of foam, which were painted with natural skin tones and blemishes.

Since 1971, working for the then R.E. Hauck Co. in San Francisco, Sequeira has specialized in legs. Back then, he would hollow out a limb socket from a stump of wood, using chisels and drills. Ankles, feet, even hinged knees, were constructed of wood and dowels. It was puppetry.

Still, there are plenty of amputees walking around today on a simple, low-tech wooden leg attached with leather straps.

"Not too long ago, we repaired a wooden socket," says Sequeira. "It was cracked. We put in some acrylic resins, which made it stronger."

Sequeira ushers a visitor into the Hanger workshop, where he works with three other technicians. There is the sound of hammering, the smell of glue. The work stations are littered with tools, parts, metal braces and orthotic footwear. Legs, contoured, muscular, balletic, are held in the jaws of bench vises.

Sequeira is a proud man. He is proud of his work. His ability to impart mobility, stature.

"I love it," he says of his job. "I have seen people crying when they get their prosthesis for the first time and they are walking. When I see that joy, there is no way I can explain the feeling."

Adjusted mechanics, emotions

On yet another afternoon, the late sun casting elastic shadows, Don Harway is sitting outside of his favorite Starbucks, at the corner of Broadway and 65th Street. His right leg is propped up on a chair.

"I'm real happy with it now," he says.

Two weeks before, Harway was in the fitting room with Bryan Hayes, trying on this leg for the first time. This is not Harway's first leg. It's his second leg, third socket. Since his stump will continue to change, and given the wear and tear on the prosthesis, the likelihood is that Harway will need a new leg every five years, along with periodic tuneups.

Thus, he and his prosthetist, Bryan Hayes, have commenced a long waltz through life together.

Harway is big, balding, affable. He works as an advertising salesman and has a house in nearby Tahoe Park. Even now, he loves to water ski, play softball, skateboard. Single, he and his pals make the downtown club circuit. Young, active, in genial spirits, he is the perfect candidate for prosthetic success, for a normal recovery.

This was certainly evident in the fitting room, where Harway, slumped in a chair, stump exposed, was unembarrassed, candid, cracking jokes. At one point in the session, his cell phone rangs. He quipped, "Hey, I'm getting my new leg attached. I'll call you back."

The fitting was a fascinating process. Harway very much like a NASCAR racecar; Hayes the ace mechanic. With his new leg on, Harway stood up. He walked, he stooped, he shuffled. He stopped. He walked. Hayes, sitting on the equivalent of a mechanic's stool, watched every step. He made various adjustments with a wrench.

Literally, it's like doing a front-end alignment. Trying to get the cant, the toe-in, the ball joints, everything in sync with his normal leg.

"How's it feel now?" asked Hayes.

"Better," said Harway, beaming.

Now, sitting outside at Starbucks, the sun in his face, Harway looks a little different. Must be the long pants he's wearing, extra roomy. Given his appearance, his unimpeded gait, unless he lifted his pants leg, you wouldn't know he was wearing a prosthesis.

Harway grew up in Glendale and later Los Altos. He served in Desert Storm as a military policeman. All his life, he wanted a motorcycle. So, when he was released from the Army, he bought a ATK 605, a dirt bike.

On March 9, 1999, scrambling along a fire trail on Cow Mountain, near Eureka, Harway went airborne and came crashing down, suffering a high-compression fracture of his foot, ankle, tibula and fibula.

"It was like crushing a cigar," says Harway of his limb.

Over the next eight years, he had eight surgeries to repair the damage. The leg never healed. Says Harway, in a rare moment of bitterness: "I was dragging my ass around for eight years on crutches. I was in pain. I was miserable. There was no ice, no painkiller you could put on that sucker."

Finally, he developed a staph infection, which invaded the marrow of his shin. Sick, his ankle grotesque, Harway was hospitalized. He recalls the surgeon coming into his room, saying, "Sorry about your leg. You're going to have to have it amputated."

His response? "Cool. When?"

The leg was taken off Sept. 25, 2006.

"I was walking by Christmas," boasts Harway.

Asked his reaction when he first woke up and realized his right leg was missing, Harway says, "It hurt bad. It felt like my (missing) toes were stuck in a Coke bottle. But I didn't feel sick anymore."

Asked when he knew he was home free, he laughs, "I could walk to the refrigerator and get a beer! I could go to the bathroom without a pair of crutches."

Still, understandably, he misses his leg.

"You can't believe it's gone forever," he says, massaging his thigh, looking wistful. "But it is."

His dimmed mood quickly rebounds.

"I've always loved machinery," he says, flexing his prosthesis. "This is my machine. Before, there was carbon fiber in my dirt bike. Now it's in my leg."

And what a machine.

"When I have my leg on," says Harway, proud, grateful, standing tall, "I am no longer an amputee."


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