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Louis Stokes Cleveland VA Medical Center

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Veterans standing with protestic legs

Joe Gross, who lost part of his right leg while in Iraq, is an avid outdoorsman, and has a variety of legs for the different sports he likes. He holds a rock climbing leg and a biking leg. In front of him is a golf leg and a running leg.

By Diane Suchetka, The Plain Dealer
Monday, November 1, 2010

CLEVELAND, Ohio -- Joseph Gross tells people he has more legs than some people have shoes.

He's not kidding.

On the days he runs, he pulls on his running leg. On the days he bicycles, he attaches his bicycling leg. When he golfs, it's his golfing leg. And then there's his everyday, getting-around leg. He has three of those, in case one's in the shop.

The Iraqi war veteran counts on his collection of prosthetic limbs to help him live the life he would've had if half his right leg hadn't been blown off by a suicide car bomb in Baghdad in the middle of the Iraq war.
One week from today marks the fifth anniversary of the day Army Staff Sgt. Gross rounded a corner in his Humvee while driving bomb technicians out of the Iraqi capital to disarm explosive devices. In a blink, everything went black. Then he landed on his back, about 100 feet from his Humvee.
Instantly, he began patting himself down.
Everything was OK until he got to the middle of his right shin. Nothing. The rest of his leg was lying beside him.
Gross unzipped the medical pouch on the front of his flak jacket, pulled out his Army-issue, high-speed ratchet tourniquet, wrapped it around the stump and slipped, unconsciously, into the most sophisticated medical system the military has ever offered.
Comforting or not, the war in Iraq, where the U.S. just ended its combat mission last week, leaves a legacy of medical advances that soldiers and civilians will benefit from for years to come -- just like other wars before it.
It will be some time before we know how many new medical devices or treatments or therapies this war gave rise to.
But two things are certain.
Ohio's playing a major role in the innovation.
And Gross -- from the tourniquet that saved his life, to the medical plane that got him back to the United States within 72 hours of being injured, to the help he provides other vets through his work with the Wounded Warrior Project -- is a walking display case of many of them.
Start with his legs.
Every one that he owns now was built at the year-old prosthetics lab at the Stokes Cleveland VA Medical Center.
Sophisticated computer system
A year ago, the VA built the $1.25 million lab so it could make its own limbs instead of paying others to do so. It's one of the newest and most sophisticated in the VA system. And it has cut the cost of making limbs by a third -- so much that the VA has already recovered its cost.
With the lab came a sophisticated computer system that allows technicians to build artificial limbs that come within 1/1000th of an inch of the body part they need to fit. The computer can make adjustments, too -- in seconds.
"Stuff like this never existed before this generation," says Tom Teklinsky, chief prosthetist at the VA in Cleveland. "This is the ultimate body shop."
There's the running leg made of carbon steel that doesn't just absorb the impact of a foot pounding the ground, it returns energy too, like a spring that helps the runner push off the way a real leg does.
There's the bicycling leg that allows for serious knee movement and clips right onto the bike's pedal.
There's the golfing leg that pivots, mid-shin, like a human one.
And the rock-climbing leg -- the latest Teklinsky has built for Gross -- with a foot so tiny and pliable it fits into crevices and helps him grip rock.
There have been dozens of other advancements in prosthetics in recent years, some so sophisticated they sound like science fiction. The DEKA arm is a good example. Under development now, the bionic arm, as it's sometimes called, can be controlled by thought.
Testing and development are being funded by the Defense Advanced Research Projects Agency and the VA to help wounded vets.
"We've achieved more in the last 10 years than we probably have in the last 30 years," Teklinsky says. "And the war in Iraq had a very big role in these advancements. It's this population that has generated all this -- this Iraqi generation."
Just as impressive is some of the new technology the war is giving rise to at the Cleveland Clinic.
New institute fosters research
In 2008, the U.S. Department of Defense announced that the Clinic, along with Rutgers University, Wake Forest University and the University of Pittsburgh, would take a lead role in the brand-new, federally funded Armed Forces Institute of Regenerative Medicine, AFIRM for short.
Under the bureaucratic name lies an extraordinary collection of research designed to provide injured service members with dramatic new ways to repair burns, heal wounds without scarring and reconstruct and transplant faces and limbs.
It's been called The Manhattan Project of Regenerative Medicine, after the government project that raced to create the atomic bomb. Like that, the AFIRM brings together great minds from prestigious institutions. In this case 35 scientists from the Clinic, the Massachusetts Institute of Technology and 26 other institutions are working together. And they're working fast.
The Department of Defense wants the innovations, which would have taken 15 or 20 years to develop, by 2013, says Dr. George Muschler, an orthopedic surgeon at the Clinic and a co-director of the AFIRM.
Muschler is overseeing one of the Clinic's two leading roles in the AFIRM: helping the human body grow missing bone.
The work has similarities to the construction field.
What scientists hope to do is implant scaffolding -- made from a polymer or cadaver bone -- where the original bone is missing. They'll also implant cells from the patient's own bone marrow that will grow more bone inside that scaffolding.
"Our charge is to take advantage of the best available science and materials to determine what works best and bring the best possible treatment to the aid of the wounded warrior by 2013," Muschler says.
"It's a tight timeline.
"But we are on schedule."
The Clinic plays another major role, too.
Face transplant doc involved in work
Dr. Maria Siemionow, famous for leading the team that conducted the first face transplant in America, is working with the AFIRM to identify soldiers for the same surgery.
In addition, she's working on a new antibody that will allow the body to recover faster and with fewer side effects after a transplant.
"We are hoping that within one or one and a half years, we will be able to use these new therapies in a clinical application," Siemionow said.
"And that is really the dream of every scientist."
University Hospitals Case Medical Center is giving birth to new treatments, too, because of the war in Iraq.
Congress awarded $13.9 million to University Hospitals along with the University of Toledo Health Science Center, Columbia University in New York and the University of Michigan to find better ways to understand post-traumatic stress disorder.
The research subjects are 3,000 Ohio National Guard members who served in Iraq and Afghanistan, who will be studied once a year for 10 years.
One early finding is that PTSD doesn't travel alone.
"You typically do not see a pure case of PTSD," says Dr. Joseph Calabrese, the psychiatrist who directs the mood disorders program at University Hospitals and helps coordinate the research.
"When you see PTSD, it's almost always accompanied by something else."
That something else can be depression, generalized anxiety disorder and alcohol dependence, the researchers report.
"And when you add those to PTSD," Calabrese says, "you ratchet up the frequency of suicidal thoughts sevenfold.
"As more psychologists and psychiatrists become aware of these findings, more will look for and treat these accompanying disorders, not just PTSD," says Calabrese, "which should ultimately lead to fewer suicide attempts and completed suicides."
That's the hope.
A future goal of the study is to explore the genetic cause of these disorders.
"The most compelling, curious thing is that more than 80 percent do not develop PTSD," Calabrese says. "And we believe this is because they're genetically resilient and cope well with the stress of war."
The findings are already helping the Ohio National Guard, says its director of psychological health Jeremy Kaufman.
"What we've learned from Dr. Calabrese's group has opened our eyes," says Kaufman.
It's helping the health and well-being of members of the guard, he says, allowing them to continue to serve their communities and their country.
"And it is saving lives."
There are quieter, low-tech innovations that have come out of this war. And Gross has a role in those, too, in his work for the Wounded Warrior Project. The nonprofit organization was founded in 2003 by veterans of previous conflicts who wanted to do more for this generation of warriors than was done for them. One way they're doing that is by providing support without using the old-fashioned support group that can be off-putting.
Instead, outreach coordinators like Gross take fellow vets out skydiving, to dinner or fishing. Then they sit back and watch them tell each other their war stories.
"I've had guys at the end say 'Thanks for bringing me out -- I haven't talked about that in over a year and I feel so much better now,' " says Gross. "And that's from a Browns game.
"All they did was go watch football and they come out feeling better. That's good stuff.

For additional photos and video, see the full article here.



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