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Amputation is no longer a surgery of last resort

He walked into the lodge like any of the other skiers and snowboarders. A little nervous. A lot excited.

This is what the first day of heliskiing is like for anyone, and Tyler Burdick relished the momentary inconspicuousness. For the moment he was just another first-timer. Just another adventurer who would be joining other bucketlisters in one of the most incredible backcountries in the world.

Then he took off his legs.

On that snow-drenched day in January, everything changed — but only for a moment. Sitting on the fireplace hearth in the Ruby Mountain Heli-Experience lodge, in the northern Nevada town of Lamoille, Burdick slipped down his pants to adjust his prosthetic legs, chuckling at the surprised gasps of his fellow skiers. Then, as he has grown accustomed to doing, the 34-year-old lifelong snowboarder turned to addressing a barrage of polite but personal questions.

Yes, he was injured in Afghanistan. Yes, it has been tough at times. Yes, he relishes the opportunity to be an inspiration to others. And no, he wouldn’t take it back; not for anything in the world; not even for his old legs.

That last answer took some time to get to. Burdick does not mention it to the other backcountry adventurers he met on that day, nor to many people for that matter, but there was a time in which he felt ready to take his own life.

As it happens, though, that day came and went before his legs were amputated.

The roadside bomb that sent Burdick home from Afghanistan exploded on July 22, 2010. After doing all he could to rehabilitate his body, the Utah native decided in late 2014 have each leg cut off at about mid-shin.

In doing so — the left leg came off in late September of that year and the right leg followed about three months later — Burdick joined a small but growing group of people who have been able to save their natural limbs following a major injury, but ultimately decide to amputate, even in cases in which they’ve seen significant improvement in their salvaged limbs.

These decisions come in defiance of hundreds of years of medical history. In the past, amputation was almost always a surgery of last resort. Today, technological advances in prosthetic limbs and shifting social stigmas have created a world in which a once unthinkable choice is growing so common that doctors and patients now have a clearly marked path of ethical and medical precedent to follow when making the decision to remove a semi-functional limb.

“Elective amputation is still not something most people have heard of,” Burdick said. “But I know a lot of people who are doing it, and they’re happier for it. And when you explain it to other people, they get it. It doesn’t take long for them to say, ‘well, of course you decided to take off your legs — and good for you.’”

From surviving to thriving

Joe Royer had only heard the basic details of Burdick’s story when he decided to invite the retired Navy corpsman out to the Rubies.

Royer’s only worry: Would Burdick be able to get in and out of the helicopter — on soft snow and in areas where one wrong step could be catastrophic? Burdick assuaged that concern the moment he walked into the company’s lodge, his prosthetics hidden under snowboard boots and pants, his gait betraying nothing of the missing bones, muscle and flesh below.

It had been just over a year since he first slid into a prosthetic leg, but Burdick looked as though he’d been walking on them his entire life. Only when he took them off did any of the other skiers and boarders know.

And when, for the first time, he stepped out of the helicopter, strapped on his board, perched over the precipice and let gravity do what gravity does, any remaining doubt was erased.

“You look at that guy,” said Joe’s son, Michael, the Ruby Mountain ski guide who led Burdick’s tour group, “and it’s hard to remember that he doesn’t have legs.”

And that’s the idea for more and more people who face the daunting decision of whether to amputate.

Emily Harvey, the co-founder of LIM359, an activities-based support group for people with limb loss, said she has seen a tremendous shift in post-amputation expectations in recent years.

“It’s made it so that we can get beyond surviving and get to thriving,” said Harvey, a triathlete who has worn a prosthetic since the age of two. “That’s become the expectation.”

Harvey, who worked with amputees at Walter Reed National Military Medical Center before becoming a staff attorney with Disability Law Colorado, credits Iraq and Afghanistan war veterans like Burdick for “pushing the limits.” These are young, healthy and athletic men and women, Harvey said, who expect to be able to do everything they did before their amputations — and even more.

And that outlook, she said, is beginning to filter into physicians’ offices.

“We’re starting to see a movement toward not seeing amputation as a failure,” Harvey said. “We’re starting to move toward a world in which doctors see amputation as a good alternative to keeping a non-functional biological limb.”

That’s in no small part because of the advances in prosthetic technology that have come as a response to the nation’s most recent wars, which have cost more than 1,600 American service members one or more of their limbs. Supported by millions in research and development grants from the Department of Defense, today’s prosthetics are personalized, specialized, tech-centric marvels of modern engineering. New surgical techniques are even offering some amputees the option of prosthetics that can be directly connected to an implant in the owner’s skeleton.

Bryant Jacobs, a 35-year-old Army veteran originally from Tracy, California, first learned of that option from the surgeon who amputated his right leg, above the knee, in March of 2014. Jacobs, who was wounded in Iraq, had spent nearly a decade working to rehabilitate his leg before the amputation. He spent another year and a half getting used to his traditional “socket” prosthetic before undergoing two surgeries to set an implant in his femur earlier this year.

He said it was exciting to be part of the small vanguard of amputees trying out the osteointegrated prosthetics.

“I just want to move forward and progress,” he said. “And I feel like I am. Every day gets a little better. Every day I feel a little stronger.”

Jacobs said he knew his decisions to amputate, and later to pursue the implant, would mean plenty of pain and having to learn to walk over and over again. But he wouldn’t go back.

“I have absolutely no regrets,” he said.

Jacobs’ implant is connected to a microprocessor-powered mechanical knee-joint with shock absorbers, stability control, and even Bluetooth connectivity.

The high-tech advances in prosthetic options cannot be separated from the shift in society’s reaction to modern amputees. Once largely treated as unfortunate souls, amputees today say reactions of pity are far less common.

“It’s not ‘I’m sorry you lost your leg,’” Burdick said. “I get that sometimes, I guess, but it’s far more, ‘whoa, that’s so cool.’ There was one woman I met who just came up to me and said, ‘That’s just amazing — you’re the bionic man.’ And I am. I’m the bionic man.”

No looking back

Erez Avramov can relate to what Burdick’s been through, even though he’s never seen combat.

After a 2010 car crash that mangled his right leg, Avramov was confined to crutches and in constant pain.

“I was disabled,” said the life-long extreme athlete, a native of Israel who now lives in Vancouver. “And that was a pretty tough position for me to be in.”

Avramov ultimately decided to amputate his leg. Now, he said, “I have regained my life totally,” so much so that he no longer considers himself disabled.

“All that is different about me now is that I have to have an artificial apparatus to walk,” he said. “I put my leg on in the morning and I take it off at night. That’s all.”

While Avramov knows stories like his can help people who are struggling with painful or less-functional limbs see the potential benefits of amputation, he cautioned that it is still “an extreme solution for extreme problems.”

“Once you amputate a limb, it’s gone,” he said. “There is no reversal process. You can’t grow it back. This is for life, so you have to be so adamant and so convinced that this is right for you.”

Burdick wasn’t, at first. Shortly after he was wounded, he was asked by military doctors whether he preferred rehabilitation over amputation. Wanting to preserve all options, he chose the former — and in the years that followed, he made tremendous progress.

With the help of a specially designed set of braces — “my magic legs,” he used to say when introducing himself to women, conjuring his best impression of Forest Gump — he made it to Sochi for the 2014 Paralympic Games, where the life-long snowboarder finished eighth in snowboard cross.

Burdick couldn’t help but admire the amputees who were competing in his event; he noted with a tinge of envy that several seemed better adapted to it than he was.

Training for that physically grueling sport — which includes jumps, high-speed turns and plenty of wipeouts — took its toll on his legs. By the time he returned from Russia, the bones in his feet and ankles were cracked, contorted, and growing together in all sorts of unnatural ways. The surgical screws meant to hold him together were falling apart.

The pain was unbearable.

The depression he had faced at times along the way was, too. At his lowest moment, Burdick retrieved his pistol from the nightstand next to his bed, set it on his lap, and sobbed. He’s not sure why he didn’t pull the trigger, but he decided that night that he wanted to live, at least for another day.

“I thought, ‘I can always take my life tomorrow. Maybe I can do just a little more,’” he said. “That’s just how it goes.”

If he was going to live, though, Burdick wanted to live well. And as the years went by, it became increasingly clear that there was something he could do to make that happen.

The military doctors were resistant at first — they wanted him to keep working with the braces. Ultimately, he found support for his decision at a veteran’s hospital in Salt Lake City.

“And after that,” he said, “I never looked back.”

One study of 22 men and women who elected to amputate after initially trying to salvage one or more limbs found that, a year later, all of them said they would make the same decision.

Oliver Ravenell, a retired machinist from Michigan, has come to that conclusion, too. He calls the choice he made to amputate his foot nearly six years ago “the best decision I ever made.”

As is the case for more than half of all amputees, Ravenell’s amputation came in response to vascular disease, including diabetes and peripheral arterial disease. Patients with these conditions often resist amputation until there’s simply no other choice, and sometimes even beyond that point, putting their lives at risk.

There are signs, though, that such resistance is starting to soften. Patients like Ravenell, for example, are increasingly engaging with the people who will custom-build their prosthetics, and are doing so long before an amputation, as part of the decision-making process.

As Ravenell’s neuropathy worsened to the point that he began to consider amputation, he had long conversations about the option with multiple doctors. His prosthetist, Heather Wood of the University of Michigan Health System, was in the operating room to make sure the process was conducive to her plans for his recovery. The result, Ravenell said, was a nearly seamless transition into his new life as an amputee.

“They had my prosthetic ready right away,” Ravenell said. “The second day I was able to stand on it. By the third day I was able to take a few steps. That really got me excited.”

Since his amputation, Ravenell has made several visits to other patients who are in the process of deciding whether to amputate.

“I tell them, ‘you can’t have a pity party,’” he said. “And I say, ‘Don’t think about what you can’t do. Think about what you will be able to do in the future.’”

Conquering the mountain

Burdick couldn’t stop smiling. Not as the helicopter took off, again and again, washing him and his flying partners in powder. Not as he drew lines on untouched mile after untouched mile of a mountain range that, geographically inaccessible in most places except by helicopter, only a few hundred people get to ski each year. Not as, in the waning hours of the day, his residual limb began to ache and his balance began to falter. Not even as he fell, several times over, turning cartwheels and somersaults in the deep white powder.

“I mean, how can you be anything but happy?” he said after the last flight of the day took him back to the lodge. “This is something I’ve been dreaming of doing my whole life. And I’m doing it… I don’t know what my life would have looked like if I hadn’t been blown up, or if I hadn’t decided to take off my legs, but this is what my life looks like now, and it’s glorious.”

True recovery, he has decided, “is when you wouldn’t trade the experiences you had afterward for what you had before — and I wouldn’t. I know I wouldn’t.”

Matthew D. LaPlante is an assistant professor of journalism at Utah State University, where he teaches news writing and crisis reporting. He can be reached at