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September 2015 Newsletter

Clark & Associates | September 1st, 2015

September 2015

The Beginning of Change

While “death and taxes” are given the credit for being life’s inevitabilities, there is at least one other: change. Businesses change, people change and times change (Bob Dylan wrote a song about the last one).

The hardest part of any change is the beginning. While you know what the benefits of the end goal are, starting the transformation is always the most difficult. It is easy to get discouraged, to say “this is too hard” and convince yourself that your current life is good enough to get by. However, a life that is “just good enough” isn’t full of much living at all.

Life is always changing, and a good example of that is this month as we begin the transition into fall. Use this time to think about what in your life – small or large – you would like to change. Whatever it is you want to change realize this: it won’t be easy, but it will definitely be worth it. 


A reminder that October is Breast Cancer Awareness Month.  In addition to participating in several community activities, Hope From Jillians will be hosting events at the Waterloo and Mason City office locations.

Monday, September 28  (9 a.m.-4 p.m.)     American Breast Care open house

Introduction and fitting of new products

Mason City Office

RSVP to Cindy     (641) 422-1423

Tuesday, September 29 (9 a.m.-3 p.m.)                 American Breast Care open house

Introduction and fitting of new products

Waterloo Office

RSVP to Jill      (319) 233-8911

Tuesday, October 6 (9 a.m.-3 p.m.)                  Radiant Impressions Custom Breast Prosthesis Event

Custom molded breast prosthesis scanning

Waterloo Office

RSVP to Jill      (319) 233-8911


9/2         ONR PT Dubuque in-service

14           Physiotherapy Associates Marshalltown in-service

15           TLC Meeting, 2:00 p.m., Covenant Hospital Cafeteria

28           Kirkwood Community College PTA Program in-service

30           Manchester ONR PT in-service

Patient Spotlight: Kaily Ramage

Kaily RamageMost of the patients we see have lived parts of their lives – short or long – without the need for a prosthetic or orthotic device. However, in some less common cases, we work with those who haven’t known life without the need for assistance from a brace or prosthesis.

Kaily Ramage is one such case. While still an unborn child inside of her mother, her doctor noticed she didn’t have a fibula in her left leg , along with a club foot. At five months old, Kaily had an amputation on her left leg.

Kaily RamageAt six months old, she received her first prosthesis, followed by a revision at 3 years old. Now, after working with Clark & Associates’ Pat McTaggart in our Dubuque office, Kaily is on her seventh prosthetic leg. However, none of this has put a stop to her level of activity or her dreams. She’s so active that Pat actually had to make a patch for her liners because they get worn down from her playing soccer and T-Ball and doing dance and gymnastics.

As for her future goals, Kaily has is all figured out. She wants to be a teacher and a baker, as well as get back into gymnastics to work on doing a back flip. She also wants to run faster than the other kids, and also teach her baby brother how to play games.

With her attitude and the help of Pat, we believe anything is possible for Kaily to achieve!

Medicare Proposal Update: SUCCESS!

The Amputee Coalition is happy to report that the public meeting about the recent Medicare proposal on lower limb prosthetics was a great success!

We are thankful to all of the individuals who spoke out against the recent proposal. Those in attendance and on the phone communicated effective, passionate, personal stories and experiences to express their opposition to the draft proposal and without the support of the many amputees and professionals who participated, we wouldn’t have had the impact that we did to show Medicare the depth and breadth of the opposition to their proposal.

After the Medicare Contractors (DME MACs) were forced to expand the meeting space to accommodate the huge number of people that registered, amputees and their families filled the meeting room. In addition, prosthetists, physicians, physical and occupational therapists, and others provided vital comments in opposition to the proposal to ensure their patients are able to receive access to appropriate prosthetic care.

Dan Berschinski, chairman of the board for the Amputee Coalition, presented our serious concerns with the proposal and encouraged the DME MACs to rescind the proposal and make significant changes in accordance with our formal comments.

It was inspiring to see so many members of the limb loss community come together to share their concerns and make sure amputees’ voices were heard. The comments made by the speakers at the hearing overwhelmingly centered on the issues that were identified by the Amputee Coalition shortly after the draft proposal was published:

  • Proposed changes to patient functional levels:
    • Concern about eliminating potential in determining an amputee’s functional level
    • Concern that assistive devices like crutches, canes and wheelchairs would automatically limit an amputee’s functional status
    • Concern that amputees would be required to attain a “natural gait” in order to get a prosthetic device
  • Proposed changes to the rehab process for new amputees:
    • Concern that the proposal would make new amputees rehab on out-of-date technology before being able to receive an appropriate prosthetic device
  • Proposed changes that would limit foot and ankle options for patients
  • Proposed changes that would eliminate elevated vacuum socket systems for all amputees
  • Proposed changes that could make it more difficult to receive a custom fabricated liner

With more than 400 attendees on the teleconference, and a packed room, this was one of the largest attended public comment meetings in recent memory.  This is a testament to how seriously the limb loss community takes this issue and how powerful we are as a community.  We made the point that prosthetic devices are not a luxury and amputees must be able to receive the most appropriate device at the most appropriate time.

After the conclusion of the public hearing, a special meeting was organized by Sharon Lewis, senior disability policy advisor to the secretary of Health and Human Services (HHS) and Administration for Community Living (ACL). Susan Stout (president & CEO), and Jack Richmond (board chair-elect) represented the Amputee Coalition at the meeting. In addition, representatives from AOPA, the Academy, and the O&P Alliance attended to express concerns about the proposal with those at the meeting. From the government, those in attendance included Acting CMS (Centers for Medicare/Medicaid Services) Administrator Andy Slavitt, CMS Deputy Administrator Patrick Conway and Senior HHS Counselor Kevin Thurm. Acting Administrator Slavitt acknowledged that the concerns of the group had been heard loud and clear, and that our views would most assuredly be taken into consideration by CMS. He invited representatives of the groups in attendance to submit further comments about the proposal and provided a mechanism to deliver them directly to the medical director of CMS.

Even with this success it is still vital that everyone submits formal comments to the DME MACs about the concerns you have with this issue by the August 31 deadline. Use the Amputee Coalition’s prepared letter, or create your own and send it to:  

Misconceptions About Amputees- Part 1


Andy Steele, CPO, LPO

At Clark and Associates, we work with amputees of all ages, genders, and activity levels.  Some of them come to us after a traumatic incident, others come because health issues such as cancer or diabetes have necessitated amputation, and others are drawn to us after unsatisfactory treatment from other facilities.

While most of our patients reside in Iowa, we are treating more and more patients from bordering states as well.  The point is that every person we treat has their own story, their own goals and aspirations, and their own set of circumstances that sets them apart.  Keeping this in mind, we thought it would be interesting and informative over the next several months to address some common misconceptions that people have about amputees (and that many recent amputees may have about their own future).

Misconception One:  We don’t want you to ask about our prosthesis.

Truth:  This is a personal choice to talk or not talk about our prosthesis.

While it’s certainly not okay to stare or to bombard a stranger with personal questions, what you will often find is that many amputees proudly wear their prosthesis and are very willing to answer questions about their device.  In fact, a large portion of our patients no longer choose to enclose their componentry with cosmetic/protective covers.

“I’m always glad to answer questions about my prosthesis.  Kids are usually the ones that ask the most.   I’m happy to take time to talk with them and explain why I wear a prosthesis.  Hopefully this helps them understand that people with physical challenges can still be as active as everyone else.”

-Andy Steele, MBA, CPO, managing partner of Clark & Associates