Category: Patient Profiles
1 July 2017,
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 FROM SUMMER 2017 ISSUE

When Jim Davis learned he had diabetes, he didn’t take the news very seriously.

He was a young man of 21, applying for his first job with the phone company in 1987, when their standard drug test revealed that he was spilling ketones in his urine. This could indicate that the body is dangerously low on insulin—and in his case, it did.

“Diabetes doesn’t hurt,” he reasoned then, confident that he was too young to have major health issues. But, because he didn’t take early measures to correct the situation, he went from initially controlling it with his diet, to pills, then to insulin, within 12 months—and, ultimately, to more serious consequences.

“I still didn’t ‘get religion’ until I lost my kidney function in 2000, and I was forced to actually acknowledge I was a diabetic,” he admitted.

Although his mother donated a kidney and he started to take better care of himself, the diabetes had already made inroads into his body. He had problems with his eyesight, his kidneys, and his extremities.

“Every little cut that I got took an amazing amount of time to heal.”

For years, Davis said, he battled with diabetes and it battled with him.

“I was always large; always overweight—and I had two congestive heart failures. During the second one, it took me 45 minutes to get from my bedroom down to the truck—out of a standard house. My wife took me to Abington Hospital, where a triage nurse told me, ‘Mr. Davis, you should be dead! I don’t know what you need to do, but you need to do something—because the next time I see you, you’re going to be horizontal!”

So Davis decided to undergo gastric sleeve surgery, which he credits with saving his life. It was not without its trials, however, he pointed out. Although the surgery went well, an infection threatened his stomach, and caused him to lose his gall bladder.

While he was hospitalized from the sleeve surgery, he began having problems with an infection that developed on his right ankle.

“True to form, it just didn’t heal,” Davis recalls. “So I went to the foot doctor and assumed he was going to give me some kind of antibiotic—and he told me I had mersa, and the only way to deal with it was to amputate it.”

Shortly after the 2013 amputation, the donated kidney from his mother quit functioning.

“That was a rough three years,” he admits. “I lost my leg, I went back on dialysis, I still had another infection on my left side that I was dealing with.”

Meanwhile, there were complications from the gastric sleeve surgery and the liquid diet his digestive system was unable to tolerate, so at one point, he was being fed intravenously.

Drastic and unpleasant as his situation was, the results precipitated a major change in his attitude—and his life. Over a 6-8 month period, he went from 300 to 180 pounds. “I lost another person!” he jokes. “The weight came off like crazy, but I had been big all my life—I didn’t know how to be thin! As it turned out, I lost too much weight, and at 180, I was sickly. I had to regain 20 pounds. I’m at a nice, even 200 now, and I’m happy.”

It was during this period when Davis claims that he “got religion”.

“I came out of my amputation surgery and said, ‘Okay, this is enough. Someone is trying to tell me something and I think I’d better listen!’” In anticipation of his prosthetic fitting, Davis began rehabilitation in the Moss Rehab prosthetic pertaining program on an out-patient basis. When his kidney failed and he entered the hospital, his prosthetic training proceeded on a more intensive inpatient basis, also including general rehabilitation, explained Alba Seda-Morales, PT, DPT, a physical therapist in the O&P Amputation Program at Moss Rehab-Elkins Park.

“It’s been a long journey,” Seda-Morales observed. “Hehas had every single secondary effect of diabetes: he’s blind in one eye, he’s missing digits on his hands, he’s on dialysis because his kidneys are failing, he did have a kidney transplant that failed. He’s missing toes on the side he has the short brace on. Everything that can go wrong with diabetes, he has it!”

She stresses the importance of goal-setting and motivation in achieving Davis’ successes in therapy.

“Unfortunately, I’m not so much of a cheerleader as a tough love kind of person,” she noted, pointing to other team therapists who also supported and worked with Davis, each with their individual approach to therapy.

“It’s all about setting goals. If you tell me what your goal is, we’re going to work on that and we’ll make it happen, with each of us doing our 50% of the effort to get there.”

Because of Davis’ healing issues, there was a delay before his leg had healed enough to be fitted with the socket to which his below-knee or transtibial prosthesis would be attached.

Learning to put on the socket was a challenge. “It’s a very weird feeling,” he

noted.

“Lawall treated me very well—they are real craftsmen and consummate professionals who gave me realistic goals about what to expect with my prosthesis. It was just that I had to get used to the whole idea of a prosthesis.

“And because my ankle is very weak, due to the swelling from diabetes again, I have to wear a brace to support my other leg.”

Traci Romano, CPO, one of Davis’ prosthetists, explained, “With a secondary condition like diabetes, it is not uncommon to need a brace for stabilization when a lower-limb prosthesis is used on the other side. Due to neuropathy or a stroke, patients can experience lower leg weakness on the contralateral side.”

Davis’ custom-made metal and leather AFO (ankle-foot orthosis) brace provides that needed support.

“In the beginning,” Romano noted, “Mr. Davis did not have a strong motivation due to his other medical conditions, which could have been a deterrent to his progress. As he began therapy and could see his potential, his attitude completely changed. He became more motivated and had a strong desire to walk independently so as not to depend on his wheelchair in and about the community.”

“He’s a very determined person,” said Seda-Morales. “He was able to find that internal motivation—something that was very important. External motivation doesn’t matter, if you don’t have your own. He saw that certain things were possible if he put his mind to it.”

Every step forward in therapy is a victory that is remembered and celebrated as progress toward a goal.

“Each time, we’d remind him, ‘We stood up today without any help,’” said Seda-Morales. “‘Do you remember when you needed five people?’ –reminding him where he was and where he is now, helping him to realize that that was more important than trying to look at what he’s not able to do right now, but focusing on where he wants to be. That was a lot of his own motivational determination.”

A psychologist is available to provide support to Moss Rehab patients, “…but a lot of it, we do as therapists, and the prosthetists do it, too.”

Seda-Morales points to a device she credits as a key element in his rapid improvement—the AlterG® or antigravity treadmill. Developed by NASA to help astronauts returning from space re-adjust to Earth’s gravity, the treadmill incorporates a bubble in which the air pressure can be adjusted to allow the patient to practice weight-bearing at levels as low—or as high—as the therapist determines.

“The AlterG is one of the main interventions that we used to get him up and moving. With that treadmill, he was able to get more repetition on steps, and to get used to standing up. He started on the wheelchair and we got him up onto crutches, and the journey continues.”

Davis remembers his early days in the Moss program: “The physical therapists there told me ‘Look, you are going to exercise, you are going to learn to walk again, and it’s going to take some time and a lot of work, but as long as you are willing to put in the time and effort, we are going to guide you to where you want to be’ —and that’s exactly what happened.”

He identifies his first therapist, Dave Nutt, as “the first person to kick my tail and make me smile!”

He learned that if his attitude wasn’t right, his body was going to follow that attitude—whether good, bad, or indifferent. “The rehab was really for my mind first, not my body.”

He has now been in the Moss program—as both inpatient and outpatient—for nearly four years since his amputation. A ‘graduate’ who has achieved his personal and functional goals and been discharged into the community, Davis now works with Seda-Morales and her maintenance group—for people wishful to maintain their prosthesis’ functional status while working on their endurance and their strength.

Davis shared a childhood memory of an attempt to befriend some boys, shortly after he had moved to their neighborhood, by joining them for a bike ride.

“These kids on my block decided that I was too fat to ride with them,” he recalled. “So they decided to take me for a very long ride and dump me. I tagged along while they took me from Overbrook High School to West River Drive, then from Montgomery Avenue up to Falls Bridge and down to the art museum—twice!”

Although the trip was about 14 miles, Davis, at age 12, was determined not to be tired out and left behind, for his parents to come and get him.

“I am stubborn!” he admitted. “The short story is that I kept up with them, and actually ended up enjoying myself. It’s a very nice ride if you’re not trying to race it!”

That early love of biking stayed with him; a favorite part of his therapy was practicing on some recumbent bikes in the parking lot, which sparked childhood memories of wind blowing through his hair, and made him happy as a kid. The center also added a hand bike—a tricycle driven by hand power—which Seda-Morales incorporated into his rehab program, so he got to ride often.

So it was natural for Seda-Morales to invite him to join a Moss Rehab team preparing to participate in the Tour de Cure—a fundraiser bike ride to benefit diabetic research, sponsored by the American Diabetes Association (ADA).

The original plan was for Davis to use the hand bike to ride the minimum distance—three miles. Other Tour de Cure courses challenged teams to ride 12, 30, 65 and even 100 miles, leaving from and returning to the same starting point. “One of my attributes is that I sometimes shoot for things that are outside of my reach,” Davis mentioned. “I like to shoot for the stars and accept the moon. So when Alba told me I could do three miles, I went for the next longer course—which was 12 miles. I asked her if she thought I could do it, and she said that, with training, she thought I could.”

Unfortunately, in the weekends prior to the ride, while Seda- Morales was training hard with the other three amputees preparing for the event, Davis’ father was unexpectedly hospitalized and gradually declined and passed away just two weeks before the Tour de Cure, and those important family matters prevented Davis training with the team.

“What I should have done is backed out or at least taken the three-mile ride. But a month earlier, I had ordered a mountain bike which they equipped with stabilizers (adult training wheels), which I could ride in an upright position, and could also carry my forearm crutches along. And just before my father died—in one of his last conscious moments—I told him I wanted him to see me ride my bike—and told him I was going 12 miles.

“He smiled and encouraged me, ‘You go, son!’

“After he passed, I got it in my head that I had to keep that promise to him, and thought I could manage to do 12 miles around a track.”

But what Davis didn’t know was that the Tour de Cure courses led through neighborhoods—very hilly neighborhoods, with a lot of traffic on the streets.

And he didn’t know that the bike wouldn’t arrive until two days before the event—so he had no opportunity to practice or train on the new bike—or any other.

Seda-Morales was riding with a few therapists and prosthetists in the 30-mile group; all the remaining therapists, who had not trained, were in the 12-mile group with Davis. Several of them suggested that he might prefer to take the three-mile ride, instead, but Davis was committed.

“He is a very determined person, and stubborn at times,” said Seda-Morales. “That’s why we get along, because we are both so stubborn!”

Because Seda-Morales launched early with the 30-mile  group, and was focused on watching for the incoming three mile group, she wasn’t aware till later that Davis was riding with the 12-mile group, and was in trouble.

“My team is the only reason I completed the 12 miles,” he confessed. “Once I hit the first hill, I just could not do it on my own. So the seven members of my team—all but one of whom have been my former therapists—got off their bikes and took turns pushing me! One would scout the next hill, park their bike at the top, run back to the bottom and push me up to the top of the hill, then ride back down the next hill—and they alternated and that’s how we got through,” he marveled.

“Alba met me at the finish line, and I thought she was hugging me, but I think she was really trying to choke me!” he joked. “She was not happy with me, but she was proud of me at the same time.”

He reflected soberly. “I could not have made it without my team,” he repeated. “I was on an emotional high trying to impress a person who was no longer on this side of the life fence; and my team made sure that that happened. I love those guys!”

Davis’ appreciation is shared by others:

“I am fortunate to work so closely with Moss Rehab,” notes Jack Lawall, CPO. “Dr. Wu, Alba and the whole rehabilitation team always work to push patients to their fullest potential. No one ever gave up on Jim. He should be very proud of what he has accomplished!”

Davis’s wife and extended family—multiple cousins and in-laws who are truly ‘family’—were there at the finish line to cheer him, as well.

“One of the reasons I was able to be so stubborn and persistent in rehab in general was because of my family. My wife in particular has been my best friend, my caregiver—every hat fits!—my nurse, and my disciplinarian when necessary. She has pushed, pulled, cajoled, and done everything you can possibly think of to keep me in the right frame of mind and the right attitude. And the rest of my family is right behind her!”

So what lies in Davis’ future now? What new goals has he set for himself?

“My next challenge is to find a job and to get back into the  work force. Right now I’m officially retired after 30 years with Verizon, starting out as a repair technician, and ending in the office, maintaining some very expensive switching equipment. Since that door is closed, now, I’m not sure what I’m going to do, but I feel that I am able to work if I can find something that works around dialysis, since dialysis is part of my life.”

Another goal is participation in next year’s Tour de Cure event, for which he plans to train appropriately, well in advance, this time!

Seda-Morales agrees that, with training, Davis can surely manage the 12-mile course.

“There are so many new rules, thanks to him: ‘If you don’t train, you don’t ride!’ We had a long conversation about that,” she laughed.

As far as his prognosis, she is equally optimistic; “For this population (diabetic amputees), it’s very hard because of all the complications and medical issues; but all you need to do is have a goal and we’ll get you there. So if he continues to stay active, if he continues to actually do what he wants to do and ride all the time, I think he can live a very successful life—including being able to get rid of those forearm crutches, too.

“It’s all about being able to just continue with life. Life doesn’t end after an amputation,” she concludes.

Davis has learned that lesson—and another of his goals is to share it with others who may be helped by his example.

“There are amputees who do triathlons and stuff, so I consider myself just ‘Joe Average’,” he said. “But I’d say I’ve gotten back 90% of my independence since I lost my leg and all the related challenges. If I could do what I have done—and I haven’t done that much!— and if I could make it this far—anybody can!

“I can go wherever I need to go, I’m not stuck in my house. I don’t consider myself unable to do almost any job I could have done before; I’m not going to be climbing up any ladders or stringing any phone lines, but I wasn’t doing that, anyway! I was sitting at a desk, and I can still sit at a desk with the best of them!” he quips, laughing.

Inspiration—and humility—come from the examples of others around one, as Davis knows from experience:

“I saw a person in rehab who has no legs, he has no arms. He doesn’t speak English—and he was the most inspirational person I’ve ever seen. This man could out-exercise, out attitude anybody! I don’t even know his name—but just to watch him go from station to station and see the enthusiasm he puts into everything he does, motivates me to do what I do. I figure if this man with no arms and no legs can do sit-ups, push-ups and whatever else he has to do, surely I can get up and walk five steps!”

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