October 2007 NEWSLETTER Vol. 4 Issue 10 Patients in the News Mt. Kilimanjaro Climb On September 14, Sandy Dukat (AK) and Kati Rooney (BK) along with 3 other athletes with disabilities successfully climbed Mount Kilimanjaro. This was the first fundraising project for Disabilities without Boundaries, a non profit organization dedicated to raising funds for athletes with disabilities. Mt. Kilimanjaro is the highest mountain in Africa at 19,340 feet above sea level. The following is an excerpt from Sandy’s report on the climb:  “One of my favorite moments during this hike was watching the sunrise below me. At Gilman’s point (18,000 ft.) we were blessed to see the sun start to rise. It was like being on an airplane looking down on the sky. From this point we had 2 more hours to Uhuru Peak (19,340 ft.). I remember looking into the distance to see where this peak would be and knew at this point we would do it.
Ten years ago Kati lost her leg and I watched her first steps on a prosthetic leg. Now 10 years have passed and I got to watch Kati summit Kilimanjaro. As we approached the summit sign I remember telling Kati don’t cry, we cannot have our tears freeze on our faces! As we stood at the summit sign, we pulled up our right pant legs to expose our prosthetic legs and took a photo.” Kati said, “I'm thrilled to have had the opportunity to do this climb! It was all very short notice for me, but I was sure that the training base that I had from summer combined with my kick ass prosthetic would enable me to reach the summit without too much trouble.” 
Congratulations to Sandy, Kati and the 3 other athletes on their amazing journey. To read more about their trip and view more photos go to: www.disabilitieswithoutborders.blogspot.com.
From the Billing Department Yes, it is that time of year again, summer ends and fall begins. It is also insurance options time for many people. It is time to check your insurance coverage to make sure that you are optimizing your prosthetic coverage. So check your options and your insurance coverage. If you have any questions about your current insurance coverage or any changes in coverage call the billing department or email us at janet@astepaheadonline.com
Technology A Step Ahead will be testing a new microprocessor knee. Freedom Innovations is releasing on a limited basis the Agility MPC Knee. This fall, A Step Ahead will be testing this knee on current users of microprocessor knees to evaluate its effectiveness. The knee uses Accel Control Technology, incorporating advanced hydraulic engineering and an optimized microprocessor program which measures inputs from the pylon 1,000 times per second and reacts within 10 milliseconds to changing gait and environmental conditions. We will provide an update on this testing in future newsletters.
Amputee Support Groups The next meeting will be held on Wednesday, September 31 at 6:15 pm at the Hospital for Special Surgery located at 535 East 70th Street, NY. For more information about this informative monthly meeting contact Charlie Steele at charlieatl@aol.com or (212) 877-7050 The Long Island amputee support group that meets the first Saturday of each month at South Side Hospital, 301 East Main street in Bayshore. If you are interested in joining this group contact Jodi Adler at 631-968-3330
A Step Ahead in the Merck Manual The latest edition of the Merck Manual Home edition is now available online featuring a full section on prosthetics authored by Erik Schaffer, C.P. The Merck Manual is the most widely used medical manual used by physicians and other health professionals. The comprehensive online home edition written in everyday language is available free of charge. To read the section on prosthetics go to the Merck Manual Home edition website: http://www.merck.com/mmhe/sec25/ch307888/ch307888a.html
Virtual Consultations A Step Ahead now offers the ability to do live video consultations with our prosthetists and perspective patients around the world. Through the use of this technology we can demonstrate prosthetic design and components using photographs and direct visualization. Using any computer with high speed internet access will allow you the ability to take advantage of this very convenient, cost effective technology. In addition, this allows us to more accurately assess a new patient before they travel to our facility in New York. For more information and details about how to set up a virtual consultation, contact our office or go to the following page at the A Step Ahead web site: http://www.astepaheadonline.com/video_consult.html
Tilite Wheelchairs  A Step Ahead has become a dealer for one of the leading manufactures of custom lightweight wheelchairs. Tilite wheelchairs are exclusively made of titanium, one of the lightest and strongest materials available. The Tilite philosophy is based on the idea of developing manual wheelchairs that would combine orthosis-like customization with the most advanced materials. These attributes in a wheelchair help users remain independent longer, reduce body stress and incur fewer posture related problems.
With the assistance of William Lehr, long time wheelchair athlete in many sports and the regional representative and manager for the New York metro region, A Step Ahead can now provide the highest quality wheelchairs for it patients. For more information about TiLite wheelchairs contact our office or go to their website: http://www.tilite.com/
World Congress & Expo on Disabilities Phil Kreuter, P.T. along with Shlomo Nimrodi, Michael Laforgia and Amy Palmiero-Winters will be presenting a lecture at the World Congress & Expo on Disabilities entitled, “Maximizing Function in the Lower Extremity Amputee” The presentation will be on Friday November 16 at the Washington Convention Center in Washington D.C. The theme of the presentation is the cooperative effort of the prosthetist, physical therapist and coach in assisting the lower extremity amputee to live life without limitations. For more information on the World Congress & Expo on disabilities go to their website http://www.wcdexpo.com/
A Step Ahead is a Provider of Prosthetic Care for Federal Employees A Step Ahead has been asked to become a provider in a federal program that will give employees in over 40 federal agencies the opportunity to receive the complete services of our facility. Based on A Step Ahead’s many years of experience in providing prostethic care to disabled veterans, we will now be a provider for prosthetic & orthotic services in the New York metropolitan region. Incorporating a 100 mile radius from our facility, employees of agencies including the Department of Veterans Affairs, Department of Defense, Coast Guard, the Army, Navy & Air Force Department of Transportation, the FBI, the Secret Service, Department of Homeland Security, Health & Human Services, Department of Transportation, will now be able to benefit from all of the expertise and experience of A Step Ahead. We are very proud to be selected by the federal government to provide the highest quality prostethic and orthotic care for its employees.
On September 9th, Tommy Koehler, Amy Palmiero-Winters, Brian O’Sullivan and Kelly Bruno posted the fastest time ever for the ambulatory physically challenged division for the 50 mile Ocean to Sound Relay Race. With each athlete running 2 legs each of the 8 leg race, running from Jones Beach to Oyster Bay the team finished with a time of 6 hours 19 minutes and 29 seconds. Averaging a 7:31 pace per mile Team A Step Ahead placed 20th overall out of 87 teams. The athletes were supported during the race by Phil Kreuter, P.T. , Erik Schaffer, C.P. and Chris Kort, C.P.O. On Sunday September 23, five team members competed in the Westchester Olympic Distance triathlon in Rye New York- Tommy Koehler (BK) and Shlomo Nimrodi (AK) both finished with personal records in the Olympic triathlon distance, Tommy w7ith a time of 2:26:47 and Shlomo with a time of 3:28:28. The relay team of John Tartaglio (bilateral hip disarticulation) swim, Michael Laforgia
(BK/partial foot), bike and Amy Palmiero-Winters (BK) run, finished with a time of 2:48:31 with Amy running a blistering 38:18 (6:10/mile pace) 10 Kilometer leg of the relay. Amy Palmiero-Winters broke another record in road racing for female amputees at the Philadelphia half marathon. On Sunday September 16 Amy completed the half marathon in 1:25:56 (6:34/mile pace) placing her 6th in her age group out of 888 women.
On September 24 Kenny Bontz (AK) took first place at the 8th annual Copper Hill / Paul DesChamps Memorial Classic EAGA golf tournament at the Copper Hill Country Club, Flemington, NJ. In only his second tournament since his amputation, he shot a 77 for his second straight first place.
Congratulations to all of the athletes of Team A Step Ahead for their amazing results this month. Upcoming events for October include Kelly Bruno’s big challenge at the Ironman World Championships in Kona, Hawaii on October 13, Amy Palmiero-Winters return to the Chicago marathon on October 7, and the Challenged Athletes Foundation ½ Ironman on October 28 where we will be sending 4 relay teams consisting of the following athletes; Marcos Corti-Maderna, Ralph Greene, Amy Palmiero-Winters, Kelly Bruno, Michael Foresto, Tommy Koehler, Sandy Dukat, Shlomo Nimrodi, Brian O’Sullivan, John Tartaglio, Michael Laforgia and Dr. John Ahrens.
Seasonal Changes Affect Prosthetic Fit The change from summer to fall may affect your prosthetic fit. Ideal prosthetic fit is dependent on stability in weight and shape of your residual limb. In the warmer summer weather your residual limb may respond to the heat and humidity with swelling which will result in possible discomfort and pain. The cooler fall weather may also bring changes to your prosthetic fit.
When your body weight changes or fluctuates, you will notice that your prosthetic socket may not feel right or fit correctly. You may notice pressure areas and discomfort in specific locations on your residual limb. With minor and gradual changes in weight and shape your prosthetist can make changes to the prosthetic socket to accommodate for these changes. If your body weight changes drastically or quickly either up or down your prosthetist may need to completely fabricate an entire new prosthetic socket.
If you notice that you are not fitting properly in your prosthesis or there is discomfort or areas of pressure that feel uncomfortable you should not hesitate to contact our office to schedule a follow up appointment. If you wait too long to address the issue of weight and shape changes with a prosthetic socket that is not fitting well, you will potentially have major changes in your prosthetic socket which could be time consuming and potentially costly.
 New Innovations in Above Knee Prosthetics  A Step Ahead is continuing to create new innovations in customized prostheses. Through modifications in socket design and fabrication, alignment, knee joints, custom attachments to the bicycle pedal, the cycling prosthesis allows the athlete to distribute more direct application of power and force to the pedal while using their musculature in the most effective and efficient way possible. Both of the prostheses in the photos are built with the lightest weight carbon composite materials, incorporating aerodynamic design, custom knee components and custom built pedal adapters. For more information about having a prosthesis designed and fabricated for you for any type of custom application contact our office and speak to our prosthetists.
Skin Tones Options A Step Ahead’s Skin Tones department will work with you to customize a silicone skin covering for your needs. The Skin Tones System is customized to each patient’s unique anatomy, appearance and lifestyle. Many options are available to you with the Skin Tones System. Options include split toe allowing the wearing of sandals, full or partial skin covers for above knee amputees, and custom tattoos. The Skin Tones staff works closely with you to determine your skin tones and the exact details needed to match your individual flesh tones. To view the Skin Tones photo gallery on our website, click HERE. Mobility Clinic Join Dave Balsley, P.T. and Phil Kreuter, P.T. for their monthly mobility clinic on Sunday October 21 at 10 am at the Jericho High School track on Long Island. They will provide instruction in gait training and running techniques as well as advanced mobility skills. Dave and Phil have extensive experience working with amputees of all ages and activity levels. Come work out with world class athletes and learn from experienced coaches and physical therapists. The setting is relaxed and enjoyable. There is no pressure, come and learn and see what you can do to improve yourself or just watch. For more information and directions to the mobility clinic, please call the office at 516-681-3484.
Update on Parity and Federal Initiative In 2006, the Amputee Coalition of America launched a state by state campaign to push for coverage of prostheses. Much progress has been made, but it's clear that the ACA must continue the fight for prosthetic care. In an online survey during June and July 2007, the ACA found that insurance coverage was reduced for 29 percent of respondents and eliminated for 8 percent of respondents. Sadly, the situation has become worse for so many of our members. The ACA is happy to report, however, that coverage had increased for 5 percent of respondents. As more and more states step up to introduce a bill for parity, companies are being made aware of the importance of covering prosthetic care. This is certainly increasing the public's awareness of this important issue. In addition, many of the people who are working with the ACA's National Limb Loss Information Center to appeal coverage denials are not only winning their own personal battles, but are also helping to push companies in the right direction. The recent data gives the ACA cause to celebrate, as well as the fuel to keep up the fight until every amputee has the care they need! In fact, the Amputee Coalition of America is preparing to launch a federal bill.
The ACA is working with a number of partners in our efforts to secure congressional protection. Meetings have been held with several key leaders including Senator Arlen Specter (R) of Pennsylvania to discuss the federal effort. Specter sits on a number of important committees including the Veteran's Affairs Committee and the Appropriations Subcommittee on Labor, Health and Human Services, and Education. Launching a national bill is an important step towards meeting the ACA's goal of ensuring access to prosthetic care. While the ACA remains committed to the state legislative campaigns, there are certain insurance plans that fall under federal jurisdiction. The ACA needs to pass a law at the federal level in order to impact the coverage available in all private insurance plans. For more information on the ACA’s fight to secure parity in prosthetic coverage in every state and nationally visit their website at: http://www.amputee-coalition.org/advocacy/take-action.html
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