Category: Patient Profiles
1 November 2017,
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FROM FALL 2017 ISSUE 

Even a brief conversation with Baltazar Rubio will convince cynics that you can’t keep a good man down. Especially not if his sights are set on higher altitudes.

Before the 2012 motorcycle accident that cost him his left leg, Rubio’s passion was mountain climbing; he had recently summited Mt. Rainier and was planning a trip to tackle even taller peaks in the Peruvian Andes, preparing for an eventual assault on Mt. Everest.

A high-energy, cut-to-the-chase problem solver, Rubio was active as trial advocate, litigator and negotiator on behalf of clients at his law practice in Upper Darby, PA. He was physically active, too, with his favorite activities including rock climbing, skydiving, whitewater rafting, and cycling. Just-married (17 days), he was on his way to his obstetrician/gynecologist wife’s graduation ceremony when everything changed in an instant: A negligent driver strayed from her lane and crashed into Rubio’s motorcycle (then into another car and the guardrail), sending him airborne. He sustained multiple serious injuries that left him in a coma for 13 days, awakening with virtually no memory of the accident or its aftermath.

Ironically, Rubio recalls, “I hadn’t started riding until I was deep in my 30’s and a friend gave me a motorcycle. The bike that I was on when I was hit was my second bike—the Harley-Davidson I had been dreaming of since I was a kid. But honestly, I drove it like a little old man—I never really went fast. I was not into taking that kind of risk on motorcycles; they always scared me a little—so I was driving really slow when I got squashed that day.”

Unable to move his 800-pound bike out of the way fast enough, Rubio was hit on the left side, hard enough to bend the bike and throw him into the oncoming windshield with his left elbow before he flipped over the car and landed hard on the guardrail, breaking his neck and nine vertebrae in his middle back. His left leg was severed above the ankle, both femurs were fractured with bones exposed, one lung was punctured, and his left elbow was salvaged only through the exceptional efforts of University of Pennsylvania surgeons he calls “geniuses.”

Since then, there have been “lots and lots of surgeries” on the nerves in his arm as well as revision surgeries on his residual limb; and he anticipates more to come.

“I’m trying to exercise more—trying to get back to doing what I had done before—and that’s causing its own problems: skin lesions and things like that. It’s not the prosthetic socket’s fault so much as the amount of pressure I’m putting on the socket as I try to get back to being athletic again,” he explains.

His favorite activities prior to the accident were those that required nerve, confidence, and courage—qualities that have recently fueled his determination to return to his former life as the same active participant and high-achiever he has always been. So it’s not surprising that after his early rehabilitation, Rubio proactively took charge of his own therapy, and started bicycling again.

In top physical condition before the accident, he had gained weight and lost muscle tone during his recovery. With limited mobility and strength in his injured left arm, and still adapting to his below-knee prosthesis, he was unable to follow his previous routine of weight lifting and running at the gym; but he discovered that biking—a former favored activity—now offered an ideal exercise solution.

“My brother asked me last year if I’d like to do the American Cancer Society ride with him in June 2016. I wanted to, but I was scheduled for surgery on my stump that summer—and the real problem was that, since only one part of my left bicep is operational, I do everything with my right arm—and I overdid it and wound up with a ‘tennis elbow’ injury. Because I had to have repair done on the elbow and it was unstable, I couldn’t train for the race, so that burned my whole summer,” he fretted.

This year it was a different story, however: he told his brother in January 2017 that he was going to join the ACS team and ride with them on their June fundraiser this time.

“Can you DO that?” his brother worried.

“I don’t know,” Rubio replied, “but let’s find out!”

“It turned out to be a lot easier than I thought it would be,” he reflects. “I just started riding.”

He acquired an old 2009 Trek Madone race bike and started pedaling and calorie counting. He lost 30 pounds during his training, and he plans to continue his routine in order to trim off another 15 pounds.

On June 11 he completed the 66-mile ACS ride from the Benjamin Franklin Bridge in Philadelphia to Atlantic City, and, not content with that personal victory, on September 23, on a new 2015 Trek Domane bike, he crossed the finish line of the Bike MS: City to Shore Ride 2017 with his team at the end of a 74-mile course.

Works in Progress

 He speaks with enthusiasm of addressing the challenges of adapting his prosthesis and his bike to perform effectively and efficiently:

“The bike is a work in progress,” he explains happily. “My first race bike was like a Tour de France bike—racers ride with their posteriors high and their heads really low. In order to make it work I had to increase the stem size and make it ride like a mountain bike, but the handlebars were higher than the seat, and my left arm can’t sustain my body weight for very long. So I set it up like a triathlon bike; that lets me ride in a laid-down aerodynamic position on my elbows.”

His second bike, the 2015 Trek Domane, has an electronic shifter that compensates for his left hand weakness from nerve damage.

To accommodate the prosthetic leg he wears clip shoes that trap the foot onto a special LOOK brand clip pedal.

“It’s really easy to ride; all I’m doing is what I call ‘squashing grapes’ as I pedal.”

His prosthesis is also a work in progress; Rubio continues to benefit from the evolutionary adjustments and improvements to his current (sixth) leg, with its ever-better customizations based on previous incarnations.

“I’m a pretty high-maintenance customer,” Rubio laughs. “I’ve presented Dave (Lawall, his prosthetist) with a series of challenges.”

From his perspective, Lawall was immediately impressed with Rubio’s attitude: “From the get-go he was super positive, super energetic, and was determined to do all the activities he was doing before the amputation. He told me that he wanted to get back to karate or martial arts—that was his number one thing when I first met him! This is a guy whose arm was all busted up—he had multiple surgeries on his arm, sitting on a bed with his amputation, and he was just extremely positive. At no point was he ever depressed or negative about the process. Even though it was the fault of somebody else who did it to him, I didn’t see any anger or bitterness.”

Following his exhilarating success in completing the ACS ride, Rubio purchased his new bike, and was so excited that he jumped on it and did a fast 50 miles.

“That was a huge error,” he admits. “When you try to ride like a professional and just go from beginning to end, like crazy mileage, you cause skin breakdown. In my case, the fibular head area skin broke completely. I had a hole about the size of a quarter in my skin where the ulceration just broke through.”

After a month spent in a wheelchair, unable to train while it healed, he tackled the MS ride more conservatively, completing it in 8.5 hours because he factored in a series of 45-minute breaks along the approximately 76-mile route to prevent a recurrence of the skin breakdown.

Rubio consulted his prosthetist frequently throughout the year, and they discussed the dynamics of his problems with skin breakdown in areas of high pressure—and the bruising he was experiencing on the bottom of his stump from the torsional strain and the circular motion of the pedals.

“Dave took all that information and put together a unique leg that’s really only designed to be ridden on a bicycle, not walked around on. He cut windows in the carbon in the front, a larger window in the side, and trimmed the back to alleviate the pressure against the back of my thigh.”

Dave Lawall remembers listening to Rubio’s input, and addressing his concerns by designing the riding prosthesis:

“There are certain spots on the limb that will take more pressure when you’re riding a bicycle than they will when you’re walking—especially the distal end of the tibia, the fibular head, and the back of his knee,” Lawall explained. “When he’s walking with a prosthesis, that posterior wall needs to be high. But for riding his bicycle, we had to make the posterior wall extra-low for him so he could get the flex that he needs to ride and to pedal the bicycle.”

“I had to also modify the bike by putting on shorter cranks,” Rubio added, “since reducing the size of the circle reduces the closure of the knee on the left side—which reduced the strain and the cutting on the back of the prosthesis. We’ve been working on these improvements all year.”

Certain adaptations were also required on the prosthetic foot, Lawall remembers. “It wasn’t just me dictating what he needed, which was great. He was very hands-on in developing the design.

“Usually we take the foot and we do all the sanding, but I had him back in the shop on a grinder, sanding the heel of the foot down so he could lock it into the pedals. It was really neat!”

Does it sound like these guys are having fun, like gear heads who tinker with their cars for the simple joy of it? Rubio acknowledges the similarity and admits that he calls Dave Lawall his personal mechanic, one who maintains his bionic parts.

“That’s pretty much right,” Lawall agreed. “He’d come in and say ‘I need you to do this!’ and it was almost like a pit stop! We’d do a quick adjustment and he’d get back out there!”

“It’s cool, with mechanicals to work on. It’s kind of fun, in a way,” Rubio reflects. “I’d rather have a leg, of course, but at least you have a hobby, playing with your prosthesis, you know?”

Having such a well-informed patient, who is interested and closely involved in his own care, makes a prosthetist’s work much easier, Lawall points out. “The fitting and making of a prosthesis is supposed to be a team effort—and he’s definitely a good teammate, that’s for sure.”

Will Rubio’s life ever be the same? Well, Licette, his wife, has forbidden him to get another motorcycle on pain of divorce; and neither of them is crazy about the idea of him continuing to pursue his skydiving license. But his other passions—mountain climbing and rock-climbing—are still eminently doable, and climbing Everest is still a very real possibility.

“If Dave can put together a leg with a foot that’s basically a set of spikes (a crampon), I’m honestly thinking about it,” he says, then adds thoughtfully, already intent on the details, “I don’t think I’m going to have any problems necessarily with freezing, but I’m going to have to sort out the frostbite issue, because I don’t know what the stump’s going to act like when it gets exposed to negative temperature cold.”

Although Dave Lawall has not yet been consulted regarding the potential Everest ascent, he accepts it without a blink. “It would not surprise me if he turned around, strapped the prosthesis on, and started climbing up Mount Everest! I would not be shocked at all.”

In some ways, Rubio’s changed life has brought new joy; the family he and his wife had previously postponed were actually a result of the accident, he notes. “We didn’t know what kind of time we might have left, so we just decided to go ahead with the kids—we got pregnant, bought a house, everything changed.”

Max and Madeline, now aged 4 and 2, assume Dad’s ‘Transformer’ leg has always been and is supposed to be that way. “My only problem is that it’s hard for me to keep up with them,” he smiles.

The depression and pessimism new amputees often experience is an alien concept to Rubio, who produces his arguments with the clarity and disciplined thought one would expect from a successful lawyer: “It happened, but it’s over—now it’s time to move on. Tomorrow is coming. I’m not going to waste time thinking about yesterday. It’s not a productive frame of mind.

“I used to tell people who asked me how I felt (about the amputation), ‘I’m not dead. This can’t kill me.’”

The same forthrightness is in evidence when he counsels others dealing with traumatic amputation: “Life is not over—nothing is over. It’s just different. No matter how you got here, let it go. You have to move forward—what else are you going to do? So I lost a leg. There’s guys coming home from Iraq and Afghanistan with no limbs at all—with TBI’s. Yours is not the worst—it never will be.”

And to the world of non-amputees who stare and wonder, reluctant to ask questions or say the wrong thing, he also offers advice: “Don’t be afraid to talk to somebody that has a prosthetic. A lot of us are open to discussing it. Sometimes in social situations people are leery because they don’t know how to address it. In my personal opinion, it’s okay to ask questions. It’s just a thing we’re going to have to deal with. We are normal too, just also bionic.”

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