Local surgeon brings hope, limbs to wounded soldiers (11/26/04)

Local surgeon brings hope, limbs to wounded soldiers

By Hal Bernton
Seattle Times staff reporter


ELLEN M. BANNER / THE SEATTLE TIMES
Dr. Doug Smith checks patient Larry King's leg at Harborview Medical Center. King's leg was amputated below the knee in 2000.


Dr. Doug Smith is a Harborview Medical Center surgeon who performs amputations on injured loggers, fishermen, construction workers and others.

That expertise has pulled him into the frontlines of the U.S. military effort to treat soldiers wounded in Iraq and Afghanistan. Every few months, Smith flies to Walter Reed Army Hospital in Washington, D.C., the nation's major military center for amputee care. There, he advises on patient care, visits clinics and occasionally assists in surgery.

So far, more than 200 U.S. soldiers have undergone amputation of all or a portion of a major limb, including at least a dozen injured during the last few weeks of fierce clashes in central Iraq. These amputations typically result from blast wounds, which create large areas of dead and dying tissue at risk for infections that can complicate healing.

"Amputation is not glamorous surgery, and when there's no war, there aren't very many people talking about it or trying to teach it," said Smith, an orthopedic surgeon. "Now there is a lot of interest, and people really want to learn how to do this right."

Smith gained his skills here in the Pacific Northwest, where accidents on rough seas or rough terrain have helped make the region a major hub for amputation surgery.

Last year, Harborview reported 166 amputations, many performed by Smith.

"It's very painful surgery, involving tissue, bone, muscle and nerves. And emotionally, it's pretty tough to look down and see part of your body gone. Our limbs are not only vital for function but also of our body image."

Smith, 46, is very active outside the operating room. He serves on the University of Washington faculty, directs a Seattle-based research center that develops prostheses, and works with a national coalition to improve the long-term care of amputees. He also has co-edited a medical atlas on limb surgery, prosthetics and rehabilitation.

Smith first visited Walter Reed in spring 2002 as the first wounded soldiers returned from Afghanistan. He then joined a Walter Reed hospital board to help advise on patient care, and last year gained hospital privileges to occasionally assist in surgeries.

"He is a recognized authority on amputee care, and we certainly value his advice," said Col. William C. Doukas, chairman of the Walter Reed department of orthopedics and rehabilitation.




The loss of limbs has been a grim result of insurgency warfare, and some of the wounded do not show up in U.S. government tallies of the war. Many are civilians who may have been targeted in a terrorist attack, or wounded by errant gunfire, and likely to end up in Iraq or Afghanistan hospitals, which often experience a shortage of medical supplies and modern prostheses.

The U.S. casualty count is tallied by the Pentagon, and updated each week. The most seriously injured soldiers move through military field hospitals, then to a U.S. military hospital in Landstuhl, Germany, and finally return stateside to Walter Reed.

Many of the military amputees suffered horrendous injuries that may combine the trauma of limb loss with burns or other war wounds. It may take weeks for the full extent of the limb damage to become clear, and several months to a year before the limb stabilizes enough for a prosthetic fitting.

It can be a tough task to know when to try to save a limb, and when to amputate it. The salvage effort can involve numerous surgeries, and bone and skin grafts, but may eventually yield a limb of little use. The amputation is a more severe surgery but can sometimes — with the aid of a prosthesis — yield a better result, according to Smith.

"I try to remind people that amputation isn't always a failure," he said.

According to U.S. Defense Department statistics, the more than 200 war amputees include 47 who have undergone below-the-knee surgery, 37 who have undergone above the knee surgery, and at least 14 who have lost portions of both their legs.

The rehabilitation of these patients poses a huge challenge for Walter Reed, which earlier this month broke ground on a new center that will include a wide range of programs to help those who have lost limbs regain their strength, retrain for military skills and be fitted with new prostheses.

So far, Smith said he has been impressed with the quality of the care at Walter Reed, and the soldiers' drive to overcome their injuries. An Army Special Forces soldier who lost a foot last January was outfitted with a prosthesis in March. By May, he was jogging five miles every other day.

"[More than] 90 percent of these soldiers have asked to try to stay, and continue to serve," Smith said. And the Army increasingly is willing to keep amputees on active duty rather than funneling them through military retirement.

But for many soldiers, the path to recovery is long and frustrating.

Army Sgt. Trevor Phillips has undergone about a half dozen surgeries to help him heal from the loss of a part of his right arm in Iraq in May. Though satisfied with his medical care, Phillips, of Onalaska, Lewis County, has struggled with life at the medical hold unit at Walter Reed.

Soldiers are assigned to the hold unit during recovery. Phillips says he has been unable to get enough help to guide him through the paperwork bureaucracy that envelops a wounded soldier. More importantly, he says, he failed to get respect from the soldiers in charge of the hospital's medical hold unit.

Phillips' anger is stoked by a major paperwork mistake that he says unexpectedly cut his pay for several months this summer. This caused serious financial hardships that forced his wife and two daughters to move out of their rented home in Onalaska.

And he says that the unit's leadership was slow to respond to his concerns.

"The way we have been treated, it's a disgrace," Phillips said.

In October, Phillips was allowed to return home to Onalaska, where friends and others in the community raised money to help his family. Phillips said he dreaded his return to Walter Reed. But on Nov. 17, he flew east to rejoin the medical hold unit.

Smith said he was disturbed to hear of Phillips' situation. "I can understand how the bureaucracy is frustrating, and it's horrible that someone feels like that," he said.

Smith's advisory group includes soldiers who have gone through rehabilitation. The group is seeking to improve the long-term support for amputees who often undergo a lengthy and difficult period of readjustment.

But Smith said he has not heard widespread complaints about patient treatment at the hospital.

"On the medical side, I have seen the staff show amazing respect and dignity for the patients," he said.

Hal Bernton: 206-464-2581 or hbernton@seattletimes.com



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