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Firsthand Perspective

Francisco Pinedo was sick of politicians and entertainers. He'd had enough of them dropping by his room in Ward 57 of the Walter Reed Army Medical Center. "They weren't going to do anything for me," he said. "I didn't want to see them."

With each passing day after an improvised explosive device in Iraq shredded his right arm below the elbow, the young staff sergeant felt his future shrinking. His dream of a career in the U.S. Army was gone. Before he deployed to Iraq, he had passed the tests necessary to get into the San Diego Police Department academy, as a backup plan. That was no longer going to happen.

Pinedo, a father and husband, was now a disabled veteran who would spend the rest of his life without his original right hand. He was stewing about his situation when his mother and wife announced that another visitor had come to see him. "I was adamant that I didn't want to see anyone else," Pinedo said. "They said, ‘You really need to see this man.'

"I told them I didn't want to meet anyone. I didn't care who they were or where they were from. They said, ‘No, you're going to meet this man.' I am fortunate that my wife and my mom were so adamant."

The man was Fred Downs, a Vietnam War veteran whose left arm had to be amputated after he triggered a "bouncing Betty" mine during a 1967 combat mission. Downs was 23 when he lost his arm near Pleiku.

Pinedo was 25 when he lost his hand in Mosul.

At the time, Downs was national director of VA's Prosthetic and Sensory Aids Service. He talked to the young veteran that day, one combat amputee to another. Pinedo listened as Downs suggested that he look into a special VA training program and learn the field of prosthetics. "He totally changed the trajectory of my life," recalls Pinedo, now chief of prosthetics at the new Las Vegas VA Medical Center. A member of Post 76 in Las Vegas, he recently spoke with The American Legion Magazine.

Describe your introduction to the Army.
I joined the Army in 1997. I was living in San Diego, my hometown. I really didn't have the means to go to college, so it was a good opportunity for me to get away from home, mature as a young adult and earn some money. I went through basic training at Fort Benning, Ga., and after basic training I went to airborne school. I was assigned to the 82nd Airborne Division. We literally hit the ground running there. Every day was a training day. Before I knew it, I had been there for three and a half years. I deployed to Saudi Arabia during Operation Desert Fox. We were there for six months. I came back to the States and was selected to be a part of this new program, a corporal-recruiting program. You had to be a sergeant, E-5. We were the first people to pilot that program.

You decided at that point to make a career in the Army?
After being in for three and a- half, four years, I decided this is exactly what I wanted to be doing with my life.

Where were you when the war began?
During 9/11, I was actually stationed at Fort Lewis, Wash. I was part of another new program the Army had: the Stryker Brigade. We were the first unit to have the Strykers (high-speed armored combat vehicles) and train with them. So when 9/11 happened, we were getting ready to deploy to Fort Irwin, Calif., which is a desert training facility for the Army. Once we finished that deployment, we went back to Fort Lewis, got our bags ready, and deployed to Iraq in October 2003. I was there almost a complete calendar year. I got injured in September 2004.

How did you get hit?
When I was in Iraq, we were not only the local police – at the time, government functions were disbanded – but we were also doing operations at night. During the day, we were handling a lot of domestic issues. We were in the northern part of Iraq, the city of Mosul, working with several different people chasing down high-value targets. During one of these missions, we were traveling through an area where there are a lot of rolling hills. It was on one side of the Tigris. On the other side was the Mosul airfield, where a lot of the friendly forces were stationed. In these rolling hills insurgents would set up and fire rockets into the airfield. Our mission was to go out there at night, set up an ambush and capture these guys in the process of trying to fire the rockets. As luck – or fate – would have it, they caught us as we were heading out.
We were in a four-Stryker formation. I was usually the second or third in the formation. This time, I was the lead vehicle. We had a relatively new lieutenant who was unfamiliar with the area, so he asked if I would take the lead. No problem. I got up in the front, and as we were traveling down one of the main roads in Mosul we were hit with an IED.

And you lost your lower right arm.
I did. I was riding on top of the Stryker. I was exposed, waist-high. I had my weapon up, at the ready. A big piece of shrapnel came through the back of my wrist, went through my vest and lodged in my chest. As soon as I woke up, I saw my arm basically shredded. My hand was hanging off of my forearm by just a couple of pieces of skin. There was blood flowing. My immediate thought was, I have to stop the bleeding. We all traveled with a first-aid kit. I immediately grabbed my tourniquet and put it on there. The blood wouldn't stop, so I had to put it on tighter. I knew I was going to lose my arm, but at that point I was more concerned with just staying alive.

What was the journey like from there?
At first, I was treated locally at the Mosul airfield. It was nothing more than a tent with some IV poles and a few doctors. They worked on my hand, trying to repair it, for about 10 hours. It just so happened that when the explosion came, it was a shift change for the surgeons, so the ongoing surgeon was there, and the offgoing, and the supervisor. So all three of them were working hard to try to save my hand. They weren't able to, so they had to amputate. During this process, I had lost so much blood that I wasn't able to fly right away. So it took a couple of days before I got on a plane to Kuwait, and eventually Landstuhl, Germany.

You knew then that your career in the Army was probably over.
Yes.

And your contingency plan was finished, too.
Prior to deploying to Iraq, I actually went down to the San Diego Police Department and took what they call the out-of-town testing. You can actually do your physical exam and your written exam – all that is required – in one long weekend. I was already planning for a just-in-case or backup career, depending on what happened in Iraq. My wife was also pregnant with our first child, so I was basically keeping my options open. Right before we left for Iraq, I got the letter from the police department saying, "Congratulations... you passed everything. Once you get back from Iraq, if you're still interested, we will set you up with an academy date."

How did you deal with losing both of your career choices at once?
It was during my time at Walter Reed when I met a gentleman by the name of Fred Downs. When I first met him, I was actually surprised to see an older gentleman with a prosthesis who looked to have the same disability I did. He presented himself very professionally, someone with a career. All of the information or counseling that I had received up to that point really didn't register. It had come from able-bodied people, people with both arms and legs, who really didn't have a disability to overcome. When this gentleman came and started speaking, I started listening. It started registering that there is life after an amputation. And it just so happened that this gentleman was the national director for VA prosthetics nationwide.

So you decided at that point to follow a similar career path?
I wanted to have the impact that this gentleman had on my life. I wanted to pay that forward to other veterans.

But you don't just jump off a Stryker and land in a prosthetics career.
I actually joined an internship program that VA has. It's a two-year on-the-job training to learn to do my current job, which is a prosthetics representative. So we're on the business side of the operation. We manage the day-to-day operations of the prosthetics department.
I started with VA in San Diego. I was an intern there for two years. Based on my performance, they offered me the assistant chief job there, which I happily took. I was very happy in San Diego and very happy with the opportunity. The only problem or issue I saw was that veterans from Las Vegas were coming all the way to San Diego for care. Being a disabled veteran, I would ask them, "Why aren't you going to your local VA in Las Vegas?" They told me there wasn't one. That stuck with me for a long time. When the chief job in Las Vegas opened up, I thought, what a great opportunity for me to make a difference. I didn't hesitate one bit.

The new VA medical center was far from done when you started your new job, correct?
When I first arrived in Las Vegas in 2008, we were working out of a 1,200-square-foot office building. We didn't offer any of the services we do now. We mainly worked through our community partners or commercial vendors. The veterans were not necessarily being taken care of by VA. We were paying the bill, yes, but we weren't providing the hands-on care. Fast-forward to 2012, and we move into the new facility. We begin to put together the state-of-the-art facility that we have now, including the prosthetic and orthotic fabrication lab. We have the latest technology available for fabricating artificial limbs. We have very qualified individuals on staff. We have come a long way from the 1,200-square-foot office building.

What technological aspects of the lab distinguish it?
One of the key systems we have is the CAD/CAM system, which allows us to digitally scan a residual limb, send that image to a carver we have in house, and actually produce (a prosthetic limb). We can begin the fabrication process a lot sooner than before – it used to take three or four days. We can do it in an hour or two.
We have different levels of cosmetic or aesthetically pleasing covers. We have off-the-shelf skin covers that we can match closely to your skin tone; or we can have a custom glove made, where an artist would come in and paint the glove to match the skin as close as possible.
We are actually very fortunate in VA that we are able to provide the latest technology. We have mechanisms in place for us to obtain the technology and try it on our patients. We are actually one of the leaders in research and technology.

Prosthetics have come a long way in a short period of time, haven't they?
One of the only benefits of war is that there are advances in the medical field. And prosthetics is one of those fields that directly benefits from the research and some of the outcomes of war, where you have more amputees to trial, test and advance the field. Lower extremities are more common, so they are a little more advanced than upper-extremity prostheses. But since the wars in Iraq and Afghanistan, we have seen more upper-extremity amputees, so that field is advancing as well.

How have advances in computer technology helped?
There is a lot that goes into fitting a prosthetic arm or leg. One of the key components is the individual's motivation level and what their intended use is, and that helps develop the prescription for the appropriate device. We have a system where it actually digitizes the image, and we are able to manipulate it where we need to, if we need to make changes, and then send it to the carver for production.
We produce artificial limbs for amputations above the knee, below the knee, above the elbow, below the elbow; and we have the capability to do custom orthotic braces, so ankle-foot orthoses, knee orthoses, things of that nature.

How can someone operate an artificial attachment like a prosthetic hand that grips and turns?
The way (my) prosthetic works is, the signal sent from the brain to the remaining muscle in the arm – there are electrodes placed on the muscle – that message goes from the brain to the muscle to the electrodes, which then go to the motor in the hand.

Is it hard to make a prosthetic hand do what you want it to do?
There is a learning curve, but the human body is very resilient. So it's very adaptable to whatever situation is there. I was able to learn this process in about a week or two. This particular hand has to open and close, rotate right, rotate left – it can actually rotate 360 degrees.

Is it even more versatile than the natural one?
It does come in handy. Ninety-nine percent of the activities I do throughout the day, I actually don't feel like an amputee unless I don't have my prosthesis. When I have it on, the level of function that it gives me, in my mind, I don't feel like an amputee.
There is the ability to control the amount of grip. This one in particular has about 17 pounds of pressure, so if you lose control of that …

… you could break a glass or can?
I stay away from foam containers because they tend to crush very easily, and it ends up all over my shirt.

What about putting on your prosthetic every day?
It's not so difficult to learn how to don a prosthetic or to take it off. It's just getting used to the process. Since it happens early on after your injury, you're still dealing with the fact that you're an amputee and you have to put this device on to help you get through the day. But the actual process of putting it on and taking it off is really not that difficult.

How many do you have, yourself? Are they all hand-shaped?
I have three. I have a primary and a backup that's like the primary, and I have one that is activity-specific, which allows me to interchange the terminal devices or end pieces. I can put on the terminal device for whatever activity I am doing. You can attach different terminal devices, depending on what you are doing.
Some of them are pretty interesting. They look nothing like a hand. They are designed to be more activity-specific. I have one that is called a Greifer, and it helps pinch a very small object like a nail or a screw, which helps me do work around the house. It expands laterally, so you can grasp cylinder objects if you are working on your car or something like that, or something high up.

Does the Las Vegas VA lab produce prostheses for athletic uses?
We provide sports prostheses. There are activity-specific prostheses. So if they are running, archery, you name it, there are prostheses out there. There's one for kayaking. For pretty much any activity you want to do, there's a prosthetic that can help you do that.

The right prosthetic depends on the person getting it, then.
That is one of the reasons we have an amputee clinic – to address all of the issues, not just the missing limbs. A 23-year-old missing a leg below the knee is not the same as a 65-year-old missing a leg below the knee. The issues are different. The profiles are different. You really have to take into consideration all of the aspects of their lives, what they are planning to use the artificial limb for.

So any veteran who lost a limb in combat can come to VA and get the prosthesis?
We also treat non-service-connected veterans. Even if they did not incur their injury while on active duty – maybe later in life they had a car accident, or maybe they had some type of disease that required a leg to be amputated – they can still receive care through VA. We will provide the same prosthesis as we would to a service-connected veteran.

How many veterans do you help a year?
Right now, we are at around 75 to 100 amputees.

How does it help that you and others on staff are veteran amputees?
I think they develop a trust. We have been there. We use these products. We are not only guiding them through the process just to get them up and walking. You want them to thrive. You want them to go out and explore new challenges. We don't want them to just get by. We want them to excel in life. We've been able to do that. That's one of the things we try to get across. There are no limits except for the ones that you set in your own mind.
That's one of the benefits of this position, having that one-on-one contact with the veteran who is in the same situation I was a few years ago. Immediately it eliminates any barriers of misunderstanding – any "you-don't-know-what-I-am-going-through" – or any of that. Right away, they know we are here for them, are trying to provide for them the best prosthetic possible. We are not only here for their artificial-limb needs, but any psychological needs they may have, any questions in general about being an amputee, we are able to answer. Not only am I an amputee veteran, but our chief prosthetist is also an amputee veteran from Vietnam. There are a lot of small details that most people who are able-bodied can't answer. For example: how to tie a tie with one hand, or how to tie a tie with your prosthetic. Those are just some of the interactions we have with the amputees that won't show up in any report or any type of medical record.

Another interaction important to you is sharing your story with young people. Why?
I go to several schools around Veterans Day to talk about what it is to be a veteran and some of the sacrifices our veterans make for our country. I think it's important for our younger generation to understand and make sure they are not influenced too much by what they see on TV. I have found it's better to engage them directly. I have kids myself, and they ask me questions all the time about what it's like to be in the military, what it's like to serve your country.

What made you join The American Legion?
I joined The American Legion when I was at Walter Reed many years ago. I recently joined the local post here in Las Vegas. The veterans service organizations, The AmericanLegion in particular, are very active in issues. It's nice to have a voice that's speaking for the veteran, not with a hidden agenda, just looking out for the best interests of the veteran.

Was it that kind of support that you received from Fred Downs?
He is directly responsible for me being here. It absolutely changed my life. My life was heading in a totally different direction. Once I was injured, I didn't know what I was going to do. I had offers from companies, but VA's mission to "care for him who shall have borne the battle," I really identified with it. It resonated with me. There is nothing I would rather be doing right now than helping my fellow veterans.

Jeff Stoffer is editor for The American Legion Magazine.