Erik Quist ’99 is up and running.
Thanks to a high-tech carbon-fiber prosthetic recently developed by the military, the Marine Corps captain, whose feet, ankles, and spine were severely damaged in a bomb blast in Afghanistan in August 2011, can walk, jog, sprint, and jump. Eighteen months after he was airlifted from Helmand Province, Quist drives (though he warns passengers that the ride may be a little jerky). One of his goals is to run the Marine Corps Marathon in October. Another is to redeploy and again command Marines in combat.
And once he was fitted with the device, his mobility returned in a matter of days.
It’s a remarkable recovery considering that Quist, after multiple surgeries, was told repeatedly that amputation of his left foot might be his best option. That, he said during rehab training at an Army medical facility in San Antonio, “was never really an option for me. I didn’t want amputation, period.”
Had this happened five years ago, Quist might not have had a choice. That was before the wave of catastrophic injuries to American soldiers from explosives set off under Humvees and other military vehicles in Afghanistan and Iraq. The bombs sent thousands of wounded soldiers into military hospitals back home, where medical teams set out to salvage their shattered limbs.
For many, salvaging injured limbs proved impossible. The Center for the Intrepid at Brooke Army Medical Center, where Quist was training in December, is a special facility that rehabilitates hundreds of amputees. The state-of-the-art gym is where many of those soldiers, sailors, airmen, and marines, fitted with prostheses, undergo weeks and months of physical therapy.
“The whole gamut,” Quist said, during a workout there. “Single amps, double amps, triple amps. In October there was a guy who had both arms amputated. Talk about inspiring.”
The scene that day was one of determination and courage, as dozens of combat wounded worked to regain their strength and abilities. In years past, amputees were inspiring to other wounded. They often represented the best outcome possible for those whose with limbs severely damaged by roadside bombs, land mines, mortar rounds.
“We were salvaging the limb and we were telling them, ‘You’ll probably get back to walking. Being able to play with your kids some. Go at at slow pace. But you probably won’t run, and you won’t go back to duty,’” said Johnny Owens, who heads physical therapy at the Center for the Intrepid. “Young guys don’t want to hear that. They say, ‘Why can’t I run? I want to get back to my unit.’”
In many cases the decision was simple. Modern prostheses offered far more physical independence and athletic potential than, for example, Quist’s shattered feet.
But amputation carries a number of liabilities: risk of infection, repeated and complicated surgeries in some cases, and degeneration over time. “We needed something,” Owens said. “A big innovation to make a drastic change.”
The answer came from Ryan Blanck, a prostheticist at the center, who had a patient ask if there was a way he could run, like the amputees he saw. Blanck, who five years ago interrupted a successful civilian career in prosthetics to contribute his skills to the military, worked with Owens and Lt. Col Joe Hsu, an orthopedic surgeon, and came up with a device born out of prosthetics technology.
The result, designed in 2009 for Army Special Forces, is the Intrepid Dynamic Exoskeletal Orthosis, a custom-made carbon-fiber footplate and strut device. The IDEO (pronounced i-DAY-oh) provides power through the flex of a carbon-fiber rod. Users have to relearn how to walk and run using the balls of their feet and their quad muscles. Fitting and training take weeks, but the results often are dramatic.
“I had a guy who was injured in Fallujah in 2003,” Blanck said. “He hadn’t run or walked comfortably in seven years. He was a three-hundred-pound guy, all rough and tumble. He gave me a hug and was weeping.”
As of December, about 340 military personnel had been fitted with the IDEO. Eighty percent had seriously considered amputation, Blanck said. Fifty-five patients had been redeployed with their units, including Navy Seals, Army Rangers, and Delta Force. That day Blanck had an appointment with a patient who had just returned from 15 months of high-level combat duty. He was coming back to Blanck for two new devices, custom built in the center’s lab.
Due to demand from active-duty wounded, the device isn’t available to civilians, and retired veterans are put on a waiting list, though Blanck said he hopes that the IDEO will become more widespread over time. While he hesitated to characterize the importance of the invention, the medical press has called it one of the most significant medical breakthroughs to come from the two recent wars.
“I don’t think any of this could have happened as fast as it did [had it happened] in the civilian world,” Blanck said. “The support within the military for its patients is pretty big. You have a situation where there’s a need, you fill the need.”
For Quist, the situation was this:
After multiple surgeries his right ankle joint had been fused. His shattered right heel was in 15 pieces. The heel bone in his left foot was in the center of the sole of the foot, where the arch had once been. The bone protruded in a large lump, covered by a thin layer of skin.
“I had been doing physical therapy, but I couldn’t walk. Well, I could walk, but I was hobbling,” he said.
Blanck has a plaster cast of Quist’s foot and calf in the lab at the center. The cast is used to produce the IDEO and it is continually revised—shaved down here, material added there—based on the patient’s input about where the device may be chafing or inflicting pain.
But even in its first draft, fitted to Quist in August, the IDEO was a success. “That Friday I walked two miles,” he said. “That Saturday I walked a quarter. That Sunday I walked another two. … On Monday, my first day of training, I was running.”
In December Quist was back in San Antonio at the Center for the Intrepid to get a new device. He’s cracked several in strenuous workouts. “He’s worked super hard,” Blanck said. “A lot of patients do, but he’s worked extra hard. Very diligent about what he does. That makes my job easier, or harder, depending on how you look at it.”
That morning Quist joined a group of about a dozen IDEO users for a two-hour workout. Some had been using the device for weeks. Others had recently been fitted. Some had one device, others two. One young Marine had a prosthetic on one leg, an IDEO on the other. One man used the device to replace the calf muscles on his right leg, blown off in combat.
They sprinted against elastic tethers. They ran an obstacle course and raced up two flights of stairs. They were told to land on their toes, not their heels. Lean forward. Keep those arms up. “Which leg?” one soldier asked. “My dead or my good?”
It could have been boot camp exhortations.
“It’s your last one, make it count!”
“Go, go, go. Move, move, move.”
“I beat these two. This guy’s running his mouth and he’s got the worst time.”
After the stair run, Spec. Kevin Logue, a burly guy from Fort Bragg, said he’d had his device for a week.
“How does it feel?” he was asked.
“Different,” he said, smiling. “I can run.”
The workout ended with weight work in the gym on the first floor. The equipment was first rate, with flat screen televisions on the walls and a two-story climbing wall.
Most of the people working out were amputees. Some were new to their prostheses, taking cautious steps while therapists stood close. Others removed their prosthetic legs to do core exercises on mats. One guy, a double amputee, tossed a ball against a mini-trampoline, catching with his left hand. Another had a blade-like foot on his prosthesis.
Most were young, college age, wearing baseball caps backwards, sweatshirts that said ARMY or USMC. The IDEO crew lined up to drag a weighted sled down the floor; one by one, down and back. Afterward they scattered to the various weight machines.
Quist paused as he did leg presses at 225 pounds. “You look around,” he said softly. “You count your blessings.”
In January Quist was back in the hospital, the same hospital, the Walter Reed National Military Medical Center in Bethesda, Maryland. This time it was for surgery on both of his feet. Bone was removed from his left foot; toe tendons were clipped in his right foot, allowing his toes to straighten for the first time since he was injured.
After an overnight in the hospital, he was back home in Virginia, where he would spend a month in a wheelchair.
It was all very familiar, the latest in a long line of surgical tweaks and fixes. “You alleviate pain and you have new pain coming into focus because other ones were so dominant,” he said. “I don’t think it’s going to be too much of a setback. I’ll get right back into the IDEOs and back to what I was doing.”
For Quist’s wife, Liz Czernicki Quist ’98, it was a flashback to 18 months ago, when she waited with family members for word about her wounded husband.
“Same surgical waiting room,” Liz Quist said. “Same waiting for the doctor to come out.
She said she can tell “a first-time family” outside the O.R., and watching them takes her back to those first traumatic days. “The chaos and the doctors and people in and out of the room all the time. It either feels like yesterday or it feels like it never happened.”
Those recollections, Liz Quist said, are a sharp reminder of just how far her husband has come. “It’s really miraculous,” she said. “I saw the video of him running in San Antonio before I saw him running in person. To see him running, it brought tears to my eyes. It was awesome.”