South Florida Hospital News
Tuesday April 23, 2019
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September 2007 - Volume 4 - Issue 3

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The Preservation-Amputation Care and Treatment (PACT) Program at the West Palm Beach VA Medical Center

The image of a soldier or veteran with an amputation epitomizes the sacrifice a person made for our Nationís freedom. The Veteranís Administration (VA) places high priority on providing preventive care and treatment to these wounded warriors to restore function and improve quality of life, because life does not end with a disability.

Veterans who are at risk for or who have suffered limb loss are able to participate in a proactive multidisciplinary program focused on team oriented care, treatment, and prevention. In 1993 the Preservation-Amputation Care and Treatment (PACT) program was developed in the Veterans Health Administration (VHA). The program is intended to prevent or delay amputation through proactive identification of patients at risk to lose a limb. At the same time, the program intends to capture patients who have already lost limbs due to medical disease or trauma and maximize their function.

The key to the PACT program is compassionate team work. Cheryl Chana, ARNP, PACT Coordinator, at the West Palm Beach Veterans Administration Medical Center (WPB VAMC) acts as a conduit between Medical Center staff and the Amputee Clinic team physician, Nick Potochny, D.O. Chana tracks every amputee and patient at risk for limb loss and places priority on not letting any fall through the cracks. Dr. Potochny utilizes his specialty expertise and team membersí skills, including those in prosthetics & orthotics, rehabilitation, social services, and mental health as examples, to prescribe, direct and maximize the care of each patient in the program. Dr. Potochny and other team members are also certified in bionic prosthesis care and management.

Historically, prior to the PACT programís implementation, approximately 9000 veterans nationwide required amputation each year. Since the programís implementation, less than 5500 veterans suffer an amputation annually. During the most recent years, the rate of amputation has decreased by more than 50%, standardizing for age and maximum amputation at discharge. The estimated cost of care associated with amputation is roughly $40,000 to $75,000. Therefore, prevention of amputation and cost-effective treatment planning is important during the long term care of patients.

The PACT program represents a model of care to prevent or delay amputation. Early identification of a patient at risk for limb loss is essential. A majority of amputations are due to diabetic and vascular neuropathies and complications. Commonly, a patient develops a foot ulcer due to underlying medical problems. If this ulcer does not heal, it often progresses to bone involvement, necessitating lower extremity amputation. However, more recently due to Operations Iraqi Freedom and Enduring Freedom, the VHA is faced with increasing numbers of patients with traumatic amputations from the battlefield. As these soldiers leave the military and come to the VA for medical care, the team of medical providers will guide the PACT program to adapt to these changing needs, and optimize their health care.

The West Palm Beach VA Medical Center PACT Program supports national events such as the Wheelchair Games and The National Disabled Veterans Winter Sports Clinics. Dr. Potochny, Chana, Douglas Tuttle, RKT and the multidisciplinary team members assist patients so they may participate in adaptive sports activities such as wheelchair racing, shot put, javelin, bowling, wheelchair basketball, swimming, billiards, wheelchair softball, sled hockey, alpine skiing, scuba diving, shooting events, Nordic skiing, curling, adaptive gold and fencing just to name a few. Often, advanced prosthetic devices, such as swim legs, myoelectric arms, or bioelectronic leg components as well as custom wheelchairs or hand cycles are prescribed for these patients. Likewise, sport-specific medical care and rehabilitation may also be required. Through such supportive and complementary settings, the amputee is able to connect with fellow amputees, engage in unique activities, and train for competition and fun. Ultimately patients find that "Öit is not the disability but the ability" that should be their focus.

For more information about the program, contact Cheryl Chana at (561) 422-5497.
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