FaceTime, FedEx, and an Allen wrench close the distance for a rural amputee.
“I had never really done any telehealth before this,” says Sheila Thomsen. “We’ve always taken the trip up to the clinic in Rochester [Minnesota], which is a full day. But man, this was so much easier.”
Thomsen lives “way out in the middle of nowhere” (her words) at Innspiration Vines and Wines, the B&B/winery she operates with her husband, Paul, in Linn Grove, Iowa. The remote location is a big part of Innspiration’s attraction for visitors who want to drop out of sight for a while. The scenery’s gorgeous, the air is fragrant, and the stars at night are incredible. Think Field of Dreams.
But for all its beauty, this setting poses challenges when you’re a below-knee amputee who needs to install a new microprocessor-equipped Ossur foot, and you can’t make the eight-hour round trip to your prosthetist’s clinic on account of a global pandemic, and the insurance clock is ticking.
That’s where Thomsen found herself a couple of weeks ago. She’s practicing strict social distancing because of an autoimmune condition that puts her in an elevated-risk category for COVID-19. An in-person fitting was out of the question. “I wasn’t going to risk that,” Thomsen says, “and my prosthetist didn’t want me to risk it.”
Telehealth to the rescue.
Flexibility With the Foot
“Telemedicine has offered a way for our clients to get the service they need without risking exposure,” says Andrew Nelson, the prosthetist who’s worked with Thomsen since her amputation in November 2018. Nelson practices at Limb Lab, a Minnesota-based firm with five locations scattered throughout the upper Midwest.
“Internally, we’ve been using remote consultation for a while,” Nelson says. “It’s been a good way to connect with satellite offices for a second opinion or collaborate with outside specialists to ensure we’re providing the best service. Externally, it had never come to fruition until the pandemic.” (For more practitioner insights about telehealth, read our recent “pros and cons” article.)
Thomsen lost her leg to sarcoma after many years of pain and surgeries. She had the amputation done at the Mayo Clinic and began working with Limb Lab. After an initial trial with pin-lock prosthesis, she switched to a vacuum system in late 2019.
“The goal was to put me in a microprocessor,” she says, “because I’m still working and I’m very active. I walk a lot on uneven ground, and I’m usually on gravel. When I walk over to our shop, the winery, the processing building, or anywhere outside, I’m always on gravel. So I’m on uneven ground all the time. The nearest place where I can walk on cement is half an hour away. That was one of the main reasons I wanted flexibility with that foot.”
Back in December, long before the coronavirus made travel impossible, the Thomsens drove up to Rochester so Sheila could try out a demo model of the Ossur foot. “They watched me walk and made adjustments as to toe-in, toe-out, heel side, whatever. And then there was an adjustment if I needed to be more on my toe or on my heel, to have that equalized.”
Ordinarily, Thomsen would have done the final fitting at Limb Lab’s Rochester location, where Nelson could install the foot and make last-minute adjustments. Instead, the clinic input the settings from the December visit and then shipped the prosthetic foot to Linn Grove. When it arrived, the Thomsens set up a FaceTime appointment with Nelson, and he talked them through the whole process.
A Unique Case
“We started off by just taking off my prosthesis, setting it on the table, and talking about how to get the old foot off and the new one on,” Thomsen says. “I held the phone, and my husband did the work. At one point Andrew couldn’t see Paul’s hands because of the phone position, so he was telling me where to stand and what angle to show. Then Paul held the phone while I was walking, so Andrew could see the flow of the foot.”
Nelson had the Thomsens take a few measurements, guided Paul through some mechanical fine-tuning with an Allen wrench, and then had Sheila do some more walking. “He talked me through it just like he does in the office,” she says. “He was watching on FaceTime, and then he’d tell Paul what adjustments to make, and then I’d walk some more. It was mainly the alignment of the foot. There are these little screws that control toe-in/toe-out or heel-in/heel-out.”
Once the alignment was complete, Nelson shared some practical info about maintenance and proper use. The whole process only took about half an hour, about the same length as an in-person appointment would have been.
“We thought it worked really well,” says Thomsen. “Eventually I will need to go up there [to Rochester], and I’ll take my shoes with me. They can program the foot so it automatically adjusts when I wear a certain shoe. I don’t even know if there’s an option to do that remotely. For now I’m just wearing the same pair of shoes all the time, which is fine—I’m not going to church, and I’m not working a normal schedule.”
“Sheila’s kind of a unique case,” says Nelson. “I felt she and her husband would be mechanically and technologically able to do this via FaceTime and connect the componentry themselves. Otherwise it would have been a matter of waiting until she could come in person, and there’s really no telling how long that might take. We didn’t want her to be without the benefits of her foot in the meantime.”
Nelson’s excited about the potential for other patients to benefit from remote consultation in the future.
“This is only the tip of the iceberg with regard to telemedicine,” he says. “The ongoing discussion now is how to implement this in the future, after the pandemic’s gone, to reduce appointments and increase efficiency but still do things effectively. It’s going to open a lot of opportunities.”
“I was familiar with telehealth because my daughter works for the VA, and they use it a lot,” Thomsen adds. “She keeps saying it’s great for the rural areas. I guess I’m a perfect example of that.”
Postscript: Support your local vineyard
Innspiration Wines and Vines had to cancel its B&B bookings through the end of April due to COVID-19, and some concerts and other events have been rescheduled. The winery is still bottling, however, and Thomsen says retail sales have actually picked up during the pandemic. “We keep saying we need to put in a drive-up window,” she jokes. In the meantime, you can place an order here for Innspiration’s wines.