I have an IDEO!

I’m back! Lost my website for a little while, but thankfully I was able to get all the kinks worked out and the blog has returned.

The biggest news I need to relate is my trip to Medicine X at Stanford University. It was as mind blowing as ever, and again, the best conference I have ever attended. Med X is not your typical medical conference; it is a life changing experience.

I started my week by participating in the IDEO Challenge. IDEO is an absolutely amazing designing firm that has worked on many of the products we use every day. The purpose of the challenge is to change the way we view problems that patients face and look for new ways to fix these issues.

The problem I presented was with the prosthetic socket. Prosthetic technology continues to grow by leaps and bounds, the issue we have is there is no good way to attach a prosthetic to our bodies. Let’s face it, sockets are uncomfortable. No matter what suspension system you use, you are still strapping a machine on to your body and in my case, bearing weight on bones that aren’t use to bearing weight.

The group I was with was absolutely amazing. The beautiful thing about IDEO is all problems are looked at from a “How might we…” viewpoint. For me, it was How Might We deal with the multitude of problems associated with wearing a prosthetic socket. These problems include skin issues, pain from wearing the socket, volume fluctuations throughout the day, and proprioception (where your limb is in space)

No idea is a bad idea, just throw your ideas out on a post it note and work it through. Photo credit to @BonKu


I can’t say enough about my time at Stanford this year! It was bittersweet knowing that this will be my last year going to Medicine X, but I am excited to see where the next class of ePatients will push medicine and the provider/patient engagement.



Medicine X: You Belong Here

That blur of a weekend in the California sun has came and gone. With it came tons of laughs, learning, and stories of learning to live with life’s hurdles. The big theme this year was empathy. A topic I’m honestly not very good at.
You see, while in paramedic school you are taught to disregard your empathetic leanings and act according to the instinct that is drilled into your head for the next two years. Don’t get me wrong, empathy has it’s place in emergency medicine. I’ve held the hand of many a patient who were at their worst the very moment they met me. The difference is that in the moments of a true emergency it’s easier to treat a disease process or injury than it is to treat a person. Sure, I may be working to save your wife’s life, but to me she isn’t your wife, she’s the head bleed from a car wreck. It may be your grandfather, but to me it was the cardiac arrest and the accompanying rhythm I was treating. It’s a harsh way to look at the world, but it allowed me to do my job. Clear the hospital and pick up the next patient in the quickest time, without dwelling on the life that is in my hands. There were times where empathy got in the way. The pediatric patient who happened to be wearing the same shoes I had just bought my son made it impossible to not realize I was working on a child. I was able to resuscitate him, but it interfered with my ability to return to work immediately. In the world of Public Safety that can be construed as a sign of weakness. Yes, in the “Hero” business of saving lives, caring too much can be viewed as weakness. Then came my accident. I traded places with the many patients I have treated over the years. I was now the one lying on the backboard getting a guided tour of the sky and ceiling of the ambulance. I now had first hand experience of the fear of being a patient. Empathy now had a permanent place in my heart. 
Fast forward to this years Medicine X conference. I had just sat down for breakfast in the ePatient lounge and it happened. A pop. Just loud enough for me to hear. I quickly scanned my prosthetic leg and noticed a missing screw. The screw to my rotator had broken, this allows the socket to rotate left and right to be centered to the prosthetic knee. It’s a piece that I never think of, because I have rarely had to use it. In fact, I had never heard of anyone having this piece break. And now here I am, struggling to walk, each step I had to fight my prosthetic to keep it remained centered. I had to use my hip and back muscles to constantly, all while keeping an eye on each step to keep from falling. I explained my issues to one of the physicians who helped get me to Medicine X Dr Kadra (sorry Bassam if this is spelled wrong). Immediately, the Medicine X support staff began finding me a prosthetist to get the problem fixed. The difference here is that they all had empathy. No, there were no other amputee’s at this conference. Yet, each person there pictured what it would be like to be in the position I had just found myself in. That’s the difference empathy can make. They only wanted the best for me, and although they had never experienced my fear, they placed themselves in a position where they understood. They worked tirelessly to find a solution, and thanks to one of the staff, found a prosthetist that was willing to come to me and try to fix the problem. Although we weren’t able to find a permanent solution to my broken screw, we managed a temporary fix that would get me through the day. This fix gave way as I stepped on stage to give my Ignite Speech. I was panicked as I delivered my speech. I had planned to walk around the stage, show my advanced prosthetic in action, instead I was left to stand front and center and face a crowd of faces. 
As I looked around, I was shocked to notice so many of my fellow ePatients staring up at me. Wanting nothing but for me to succeed and deliver the message I had prepared. The speech went off without a hitch. I was able to get my point across, although not as I had planned. It was a spiritual experience. That’s the only way I can describe it. 
In fact, that’s a great way to describe a weekend spent on the Stanford University campus; Spiritual. It’s a utopia of sorts, no, you aren’t going to get along with everyone. You won’t connect with each person, but there will be a group that you do connect with. You will feel at home. You will be welcomed. No matter what is going on with you. If you’re a diabetic, have Rheumatoid Arthritis, MS, Cancer, or a disease so rare that you are the only person in the US with a documented case…YOU BELONG HERE! You will be welcomed with open arms. You will be taken care of, no matter what that may mean. They will help you overcome your problems and help mold you into a better version of you. Even if it’s only for a weekend. 
Medicine X’s tagline is that “This is where technology and medicine intersect” and to a point that is true. More true is that Medicine X is a place where You are more than a sum of your parts, you’re more than your disease, and they want to help you celebrate that. Don’t believe me? The next round of applications are coming up this winter. Apply, prove me wrong. Last year, Medicine X taught me the power of the Patient Narrative, and how your words can change how medicine is practiced. This year, I was able to learn the power of embracing who you are as a person. How powerful it can be to say My Name is Joe Riffe, I am a Left Above Knee Amputee, and I want to change the world for other Amputees. I am more than my situation. I am more than my physical malady. I AM JOE RIFFE, THE PROSTHETIC MEDIC, AND I AM A HUSBAND, FATHER, SON, BROTHER, FRIEND, AMPUTEE, PARAMEDIC, AND I CAN HELP YOU, BECAUSE I WILL BE EMPATHETIC TO YOU AND WHATEVER YOU BRING TO THE TABLE. I have been on both sides of the stretcher, and can honestly say You are more than the sum of your parts, you are not your disease or injury, or pain…NO, you are You and there are no other you’s out there. Celebrate that! I will help you as much as I can along the way; and if I can’t…I know someone who can, just let me call on my fellow ePatients. We will welcome you as you are. You Belong Here!

Why Stanford Medicine X is Better than Your Conference

I’ve had an absolutely terrible day. Honestly, today has been one of the worst days I have had in a very long time. My bad day started last night when I fell in my hotel room. I had taken my leg off, as usual I didn’t bring my crutches with me (they’re too bulky to travel with), I decided to take my clothes for today into the bathroom so I could just get dressed in there. I hopped my way into the restroom. Here’s where the bad day starts, I had forgotten to take my sock off, this resulted in me trying to hop into the bathroom on the tiles with a sock…you can see where this is going. I slid and fell, striking the end of my stump against the hard rim of the toilet, then the ground. You know that feeling you get when the end of your femur pushes down into the muscles that have been stretched over the end of the cut bone? No? Well, it’s excruciating. Imagine the worst toothache you’ve ever had and put it into bone. That’s the best way I can describe it.

Now I know what you’re thinking, what does this have to do with Med X being awesome? I’ll tell you. Last night, @ChronicCurve came to check on me. Just to make sure I was OK. This led to me being checked on by @AfternoonNapper. I convinced them both that I will be fine and called it a night. Honestly, I lied. I wasn’t OK. I was in immense pain every time I moved. I pushed through a sleepless night and got ready for the pre-conference course I had signed up for.

Now, here’s where things get worse. Kate, my wife, messaged me from Louisville with a health issue. One that could possibly end up with her being hospitalized. This poses a problem. If Kate get’s hospitalized then who will take care of the kids? What if a surgery is needed? I’m literally on the other side of the country and feeling quite helpless. I explained to @AfternoonNapper and @HurtBlogger everything that was going on. They were more than helpful; offering to move my presentation so that I could leave if need me and still complete my requirements of the ePatient Program. Kate refused me leaving early. She’s a trooper and knows how important this conference is to me. All was going well, Kate had gotten in touch with her mother and worked out that if something happened she would come down to take care of the kids until I got back Monday. Once again, things seemed to be looking up. With all the stress I suppose my PTSD triggers were just waiting for the slightest reminder to go off…that reminder came in the peaceful (for most) form of a clear blue sky, a slight breeze, and the sounds of water crashing against rock. Instantly, panic set in. I had one of the worst panic attacks of my life. It ranks up there with the first one I ever had inside an MRI machine with a fixator attached to my leg. I was in a tailspin. The leg pain coupled with the issues at home that are beyond my control had sent me into a PTSD anxiety attack that had no mercy. @AfternoonNapper and @HurtBlogger went out of their way to make sure I was ok. Hooked me up with a set of headphones, a quiet place to gather myself, and even went as far as bringing my lunch to me, away from the crowds where I could attempt to regain some form of composure.

This is where MedX outshines all other conferences. It’s OK to not be OK. It’s OK to be a patient, to take off that mask of wellness we all wear everyday. You know what I mean, we all do it from time to time. Convincing everyone you’re fine when on the inside you know it’s not true. Be it a psychological issue like I had today, or as simple as working through a bad headache. Here those masks aren’t necessary, you’re surrounded by patient and providers alike. They understand that sometimes life happens and it’s beyond your control. I’ve never seen another place like this. Not just a medical conference, but in general. It’s a nearly Utopian ideal. Be who you are; sick, stressed, healthy, or a mixture of them all. It doesn’t matter…That’s why this conference is better than yours…It’s not just a place where the patients finally have a voice. It’s a place where the patients can finally drop their guard and be themselves and allow others help them cope; and with this environment the providers can finally see what patient life is really like and leave changed by the power of the patient life and narrative.

Introducing the Medicine X Global Access Program

As most of you know, I will be returning to speak at Stanford University’s Medicine X conference this year. What if I told you that you can watch my speech and the entire conference for free!?! That’s right, you can get all the education and information that those in attendance receive from the comfort of your own home. It doesn’t get any better than that now does it? Learn all about the emerging technologies on the healthcare front…all while kicking back on your couch, lounging in your pajamas.

Think you’re too busy, going to be on the go and can’t sit around looking at your computer for hours, even though you want to get all this awesome education….this year Stanford Medicine has brought back the Global Access Program. All you have to do is register for the site and you can enjoy a live stream of the conference, photos of the speakers and guests, and best of all its Free!!!

Medicine X Global Access Program

From the Medicine X website

The Global Access team is led by Emmy-award winning television producer Bita Nikravesh Ryan and 2013 Stanford-NBC Global Health Media fellow Hayley Goldbach. Our photography team includes Academy Award-winning documentary filmmaker Theo Rigby, speaker portrait photographer Christopher Kern, and our special venues photographer Yuto Wantanabe. 

Medicine X is an amazing conference, not only for the in depth look at the emerging technologies that fuel healthcare and healthcare innovation, but because it’s a conference that truly does put the Patients First! This is ground zero of the ePatient movement. I highly recommend you sign up for the Global Access Program and see what I’m talking about. Last year, the Medicine X conference was a life changing event for those in attendance. I’m so happy that now you can watch and learn from the amazing presenters and ePatients from anywhere you have an internet connection (4g counts).

So what are you waiting for? Go own…get registered and get your learn on! Remember to watch your very own Prosthetic Medic speaking on September 6th at 4:20pm PST (7:20pm EST)

Grief Mops

I realized a sad truth very early into my career in EMS. It can best be summed up by a quote from the movie “Bringing Out the Dead.” Nicholas Cage’s character is describing his role as a paramedic

 I realized that my training was useful in less than ten percent of the calls, and saving lives was rarer than that. After a while, I grew to understand that my role was less about saving lives than about bearing witness. I was a grief mop. It was enough that I simply turned up.”

Bringing Out the Dead is a perfect example of a paramedic who is “burnt out” in public safety terms, in medical terms Frank Pierce (Nic Cage’s character) is a classic, albeit highly dramatized for the film, case of PTSD. He had ran too many calls, had tried to wring out that grief mop one too many times. The years of hiding his feelings coupled with the lack of that adrenaline rush that comes with a save to give his life meaning, he is left to battle his demons. His particular demon was named “Rose,” an asthmatic he was unable to save, becomes the standard barer for all those perceived losses he is unable to mourn. We call it being “Burnt Out,” the inability to have any empathy. It’s not that we don’t care about our patients, we just simply cannot take any more, our mop is soaked and there is no way to wring it out.

The role of Public Safety falls into this category all too many times. The combined amount of human suffering and tragedy that we are exposed to is only compounded by the perceived machismo of the position. Showing emotion is often viewed as a sign of weakness and is preyed upon by the collective group. As always, there are exceptions, most often pediatrics. It seems to be the only time when emotion is not weakness, but expected. The same isn’t true for the countless other tragedies, for those you are expected to “suck it up and move on.”

For years, I followed this formula. Pushing all the fear and guilt of the “lost” saves into a dark recess of my mind. I would find outlets where I could, dark humor and nightmares were my two normal weapons to combat the feelings when they crept up. Insomnia became constant, only to be quelled by medication (both self and prescribed).

My “Rose” came in the form of a 10 year old boy. He happened to be wearing the same shoes I had just bought my son. Prior to this run, I had been comfortable as seeing my patients as their respective conditions. I could trick my brain into seeing a broken bone, a stroke, a heart attack as just that, the person who had suffered these ailments didn’t exist. That wasn’t your father, that was a full arrest who needed to be intubated and medicated. I followed my protocols and treated each problem in order of it’s severity and life threat…until this child. I jumped into my normal role, he was a cardiac arrest that was more than likely caused  by a respiratory problem. I needed to get him intubate and oxygenated…I inserted my laryngoscope blade and looked up to get my tube, that’s when those Thomas the Tank Engine shoes came into view…I continued on my mission. I had been successful and had a return of circulation. I was walking on air…I had a save. One who had an actual chance of walking out of the hospital. Yet, his shoes stuck in my mind, I would relive this run over and over again, every night he would meet me in my sleep. I thought if I went to see him, to see that he was getting better it would help quell this temporary problem. I met his mother, I saw him on the ventilator with my tube still in his trachea, providing that all important oxygen. Yet, this only worsened the nightmares. It all came to a head when I heard the news of him dying. He was to be released, and suddenly took a turn for the worse. His death marked my first experience with that flood of emotion breaking loose from the dam I had built. Years upon years of tragedy I had held in broke loose with a force I had never experienced.

I took more and more ambien, trying to knock myself out and patch this hole…and it worked for a little while. The problem is, self medication never works. We need to change this broken dynamic. We need to realize that in our field there are no walls, we are alone in a sea of human suffering. We have been called to be islands of refuge in this storm, and we need to let their be strength in showing emotion.

I’ll end this diatribe with this thought. We all have a calling. For those of us who chose to run towards the chaos instead of away from it, we have to realize that it comes with a price, more often that price is our own piece of mind. So take on that grief, be the mop, but before you become saturated, turn to your friends, your coworkers, and show that their is untold strength in empathy and emotion.

Update on Life…Glad to be back

Well, after a long hiatus I’m finally back online. We have been having some issues with our internet connection, so after several phone calls AT&T finally got the issue handled. I just wanted to stop in and give you an update on things around the Prosthetic Medic household.

First things first, I’m very excited to say that the schedule for 2014’s Stanford Medicine X conference is out, and I will be speaking Saturday Sept 6th. I’m still working out the speech and trying to decide between the two topics I’ve been writing on. I’ve got a few more days before my initial outline has to be turned in, so I’ve got to make a decision soon.

Next up, Kate has taken a job with Bullitt County EMS and couldn’t be happier. She loves working in a 911 system and I’m very excited for her to finally find a service that feels like home to her.

Lastly, I have taken a job with Amazon in Sheperdsville, Kentucky. I am so excited to move to my next step in this crazy experiment of life. I will be working there as an Onsite Medical Representative. Basically, I’ll be providing basic medical care and helping to manage their  cases. I’m very excited to be joining the Amazon team and try my hand at Industrial Medicine. It will be quite the change from working on the ambulance, but after proving that I can still do that job, I think working in this setting will be better for me physically. I will probably try to find a part time job on a truck somewhere, just to keep my skills up, but I’m ready for the change.

I’ll be back in a night or two to write about something with some more substance, so for now, that’s all thats going on in our little corner of the internet.



I’ll give you a hand….just need an XBOX Kinect and a 3d Printer

While mindlessly browsing Facebook today I came across a very interesting article. For the low price of $45 we are now capable of printing a mechanical 3d hand that is, according to many users, better than any mech hand on the market made by the major prosthetic companies.

This got me thinking…With the push in 3D printing technology, the ever strengthening materials, and the constant battle to obtain a prosthetic from insurance companies…Why aren’t the big prosthetic companies making a huge push for Insurance Fairness for Amputees? With the lack of access to reliable and high performance prosthetic equipment, mankind is doing what it has always done when faced with a problem…We are adapting. Now with the Open Hand Project, and countless others, hand amputees have more options than ever.

To add to the dilemma, 3D printed sockets are now available for upper extremity and below knee amputees, how long till every class of amp is included. With very little knowledge in the AutoCAD program and a Microsoft Kinect camera from an XBOX, you can now 3d scan in your own limb, design a socket to fit, and soon, attach this socket to your own home printed limb….It boils down to this. The Apathy of the manufacturers is going to put them out of business. They are too blinded by their own success to look down and see the patients on whom their limbs reside, and rely on. Why would I jump through the hoops and red tape for a prosthetic, when I can design one just for what I want it to do from the comfort of my own living room? Unless this lack of response is reversed and pressure placed on the correct sources (ie Congress, not the people designing the limbs they couldn’t receive through traditional means) then they are going to put themselves out of business.

Most people putting their prosthetic designs on the internet for 3D printing aren’t doing so to make a quick dollar, no, they are doing so because they can see the insanity of denying a person a limb that could give them back a quality of life that is similar, if not better, than they had prior to their amputation. We need to join forces, there are 2 million of us in the United States, not to mention the tens of thousands of employees that are working for the big name prosthetic makers.

If you are reading this, please send this to your prosthetist, your doctors, your prosthetic company, whomever you think may benefit from prosthetic parity. The time is now…

Stanford Speech and Steampunk Prosthetics

If you missed it, above is the link to my Ignite Speech and QA at Stanford Medicine X’s School for Design Course. David Ruthven and I had the opportunity to speak about Designing for the Physical Environment. I focused my ignite speech on Prosthetic design. The biggest problem is lack of Patient Centered Designs. For a refresher:

Patient Centered Designs are generally customizable and retain some patient individuality. In the Prosthetic world you need to look no further than the Socket. The patient interface that connects to the prosthesis itself. These are designed for each patient, molded to fit their limb, and often some form of individual design added to make it feel like “mine.” As an example:

 This is my first socket. Notice the “Jackass Jolly Roger” a great way to individualize a socket
In Contrast, the prosthetic itself is a cookie cutter design that is the same for each patient. No options on colors or exterior design. Otto Bock has helped with making the individual settings customizable to speed up or slow down, add resistance or take it away, or preset settings for specific sports and activities. However, for appearance you, have no options. 
Until Now…I was forced to eat my words by the guys at Digital EFX Wraps 
( http://www.digitalefxwraps.com ) 
They have taken the idea of wrapping a car with a vinyl design and applied to prosthetics. I am the second person to have the opportunity to have my prosthetic customized to a design I chose. I went for an Industrial/Steampunk look. It fits my personality…the great part is they can do anything. I’ve already been dreaming up my next cover, probably a mixture of anatomy and machine.

I’m so excited at what this will do for amputees and bringing amputation to the forefront of peoples minds. I love that my prosthetic is a piece of art. Let me know what you think. If you want one…message me and I’ll get you in contact with Dallas at Digital EFX. Lets get this viral…spread the word!!!

Dancing with the Amputee Star…

I’ve avoided watching Dancing with the Stars. I have successfully avoided watching not only this season, but most seasons. Sure, I’ve seen an episode here and there, but for the most part, I’m simply not interested. That being said, tonight there’s not much to watch and I found myself watching Amy Purdy’s dance. She was amazing, for those who aren’t familiar. Amy Purdy is a Paraolympian Snow Boarder who happens to be a bilateral below knee amputee. What struck me the most was the buildup to her dancing, and her decision to perform the quick-step with her “blades.” Blades are the running legs most people are familiar with seeing, and for some reason the image most people associate with prosthetics.

Amy Purdy on “Cheetah” running blades

What I noticed is that she had several other pairs of prosthetic feet to choose from, in addition to the running blades. I realize that she is a gold medal winning Olympian and has several sponsors who are willing to pay for these prosthesis. I found myself getting upset. No, not upset, down right mad. Not at Amy Purdy, mind you, at the fact that in order to receive the prosthesis you need to live you have to either 1.)Be independently wealthy, 2.) Be extraordinary and have sponsors who want you to wear their prosthesis, 3.) Fight tooth and nail with insurance companies to “maybe” get a prosthetic…not the best one to let you live life again, no just a prosthetic.

I nearly found myself in the 3rd category, but thanks to those of you who read this blog, and, as I was described by Dr Larry Chu at Stanford Medicine X, being persistently disruptive for a positive change in the amputee community, I was able to pressure an insurance company into covering a prosthetic they deemed “Experimental.” By the way, Experimental is an insurance term for prosthetic technology that has been around since the 1990’s, being the microprocessor controlled prosthesis. There are nearly 2 million people with some sort of limb loss currently, not everyone of these amputees would benefit from this technology, but for those that would, it is a life changing prosthetic.

Imagine this…for an insurance premium of around 5 cents per person, microprocessor controlled prosthesis would be covered for those who meet the standard. That would be possibly hundreds of thousands of people able to return to a more active lifestyle and many of them would return to work.

Now for contrast, lets apply insurance companies logic to other areas of healthcare. Could you imagine an insurance company denying a pacemaker that a cardiologist wants to implant? How about denying the hardware for a hip replacement? Yes, these happen in rare occasions, but under normal circumstance these devices are implanted and covered. Now, realize that these are also prosthetics. A pacemaker is a prosthetic that assumes the function that the heart has lost the ability to perform, a hip replacement places a prosthetic ball and socket joint that resumes function of a joint that lost it’s ability to perform the normal function. Now, why does implantation inside the body make these more important than a hand, knee, ankle, or other prosthetic device? I wish I had an answer…that’s why we need Insurance Fairness for Amputees.

Oh well,

I will step down off of my soap box for tonight and hope this has given you something to consider.

Until Next Time …PM

Happy Anniversary!!!!

Yesterday was the 3 year anniversary of my life changing fall. This week has seen a spike in my anxiety, while it has been rough, it was not unexpected. I have experienced the same problems for the past 2 years, so the increase in symptoms this year, while unexpected, were not preventable. The amazing part was that, on the actual day of the fall, I had a wonderful day. This is due to Kate and I celebrating our 1 year wedding anniversary. We made the decision to change the outlook of that terrible day into a very positive one, and I must say…it worked.

On to the updates,

I had the wonderful opportunity to speak to the Moving Forward Limb Loss support group a few weeks ago. It was a wonderful experience and I look forward to further meetings with those wonderful people. You can watch the speech here Moving Forward Speech

I spoke about one of my least favorite cliches…”Playing the hand you’re dealt.” We all have heard this euphemism before. A negative event happens, and inevitably you’re met with at least one person telling you to play the hand you’re dealt. I happen to disagree strongly with this though process. Playing the hand your dealt, leaves you in the situation. I say, instead of playing the hand you’re dealt, why not change your cards. Life is not a poker game, No, life is more a game of Go Fish. You can ask your neighbor for help, and luckily, you can help your neighbor as well. Playing the hand you’re dealt would have left me with a fused knee and ankle, and miserable.

In a few weeks, I will be travelling to Stanford University to speak to the School of Medicine. I will be giving an Ignite! style speech with a power point to back up my points. I will be posting a video of this once it’s available.

I am happy to say that, while I’m not where I want to be in life, I am finally optimistic again. It has taken 3 years, but I feel like I’m finally getting back to who I am. I have finally mourned my loss of both my leg and previous identity. I have came out on the other side with a determination I wasn’t aware I was capable of…I now understand the battles I have been through will be platform I stand on to help others either get through their battles or avoid them completely.

I’ll be updating again soon,

Until next time.