Standing Tall

About 1,800 amputation surgeries are performed each year in Oklahoma. More than 1,600 of those — about 90 percent — are lower body amputations. So every day in Oklahoma, four people lose part or all of a leg. These are the stories of four people living in Oklahoma — a mother, a senior, a Marine and a student — all living life on at least one prosthetic leg.

William "Spanky" Gibson

It was May 2006, and William "Spanky" Gibson was leading a team of Marines, Navy Seals and Iraqi special forces through the streets of Ramadi, looking for a target.

They were moving in on a house, preparing to call a team strike. Spanky Gibson's job was to get positive IDs on high-priority targets, evaluating collateral damage and possible civilian casualties.

These were the days before the surge, when Ramadi was the Wild West of Iraq.

"We walked into a hornet's nest," Gibson said.

He was focused on the target. He didn't see the sniper on the roof of an adjacent house, he just felt a bullet pierce his knee. He kept fighting.

"It was either fight or die," he said.

His troops dragged him to a courtyard so they could stop the bleeding and get him to safety. Four of the men were shot in the attack, but none died.

Medics put two tourniquets on his leg, threw him on the back of a Humvee and gave him morphine. He was transported by helicopter to the nearest hospital, then on to Balad, Iraq, to catch a transport to the military hospital in Landsthul, Germany.

By the time he woke up stateside at Bethesda Naval Hospital, his leg was gone.

William "Spanky" Gibson puts on his military dress at Tim Bonea Photography in his hometown of Pryor. JEFF LAUTENBERGER/Tulsa World

He had lost too much blood, and there was no way to save it.

"Life or death is really the only thing you think about," he said. "I never wondered or cared if they could have saved it."

Gibson always wanted to be a Marine, and he always wanted to fight. His grandfather was a Marine, his father a Navy man.

Gibson, who grew up in Pryor, enlisted in 1989 and spent his 18th birthday in boot camp.

He earned the nickname "Spanky" for being a "precocious smartass," he said. It stuck.

Gibson served in the first Gulf War and in Somalia in 1992. Service became his career. He deployed to the Persian Gulf again in 2006, to Iraq.

The weeks after he lost his leg to a sniper's bullet are somewhat of a blur. He doesn't remember much about his time in the hospital or his 11 surgeries (save for some flirting with the nurses).

Gibson also doesn't remember getting his Purple Heart two weeks after he was injured, but he's seen the video. He left Bethesda on his 35th birthday and went to Walter Reed Army Medical Center for several months of inpatient rehabilitation.

There, he got his new leg. He promptly informed his therapists and commanding officers he intended to return to active duty, prosthetic leg or not.

Photographer Tim Bonea photographs Pryor assistant police chief Derek Melton and William "Spanky" Gibson. The pair first met when Melton arrested Gibson, then 14, when he was part of a group of a kids throwing eggs at cars. JEFF LAUTENBERGER/Tulsa World

"I told them, 'Let's not put a cookie cutter around me. Those kids were blown up, I'm not,'" he said.

He transferred to Brook Army Medical Center in San Antonio by the fall, and he started running. He petitioned to be returned to active duty. As an above-the-knee amputee, he knew the likelihood was rare, but it was worth the fight, he decided.

The Marines eventually agreed to let him return to Iraq in 2008, but on limited duty with stipulations. His case drew national media attention.

"I never thought it would become this big deal," he said.

What he saw in 2008 was a transformed Iraq, "worlds different" than the country plagued by insurgent violence in 2006, he said.

"I got to see what I saw guys sacrificed their lives — and some, their body parts — for, and that it wasn't in vain," he said.

He also found a new mission: He could bring positive light to the wounded warriors who had sacrificed for their country, as they tried to move on with life-altering injuries.

Spanky Gibson walks through the bleachers of a practice field at the ASA complex in Oklahoma City. Gibson is the oldest player on the Wounded Warrior Amputee softball team. JEFF LAUTENBERGER/Tulsa World

After another 11 months in Iraq, he accepted a congressional fellowship and moved to Washington, D.C. He joined the Wounded Warrior Amputee Softball team and began speaking on behalf of Paralympianscq and combat veterans returning home.

Before he retired recently from the Marines and moved home to Oklahoma, Gibson worked for the assistant secretary of the Navy to encourage U.S. companies to hire wounded veterans returning from Iraq and Afghanistan.

Nearly 1,300 amputees have returned from the wars in the Middle East, Gibson said.

"They might have a physical limitation, but if you give them a chance as employees, you will get amazing loyalty," he said.

Gibson, 40, is living in Lawton with his two sons and studying to become a psychologist, so he can counsel fellow veterans returning from war.

Every day in the U.S., about 500 people lose a limb.

It's a number that has grown during the past decade, due to rising rates of diabetes and vascular diseases, as well as thousands of war wounded returning home from the wars in Iraq and Afghanistan.

Unless prevention strategies are put in place to reduce rates of the diseases causing the bulk of these amputations, Americans can expect the average number of daily limbs lost to double by 2050, according to the Amputee Coalition's Limb Loss Task Force.

Most recent data collected by the Agency for Healthcare Research and Quality show the southern region of the U.S., which includes Oklahoma, leads all regions in the annual number of amputation surgeries.

Nationally and in the south, the most common procedure is toe amputation.

In Oklahoma, however, below-knee leg amputation is the most common, followed by above-the-knee leg amputation.

About 1,800 amputation surgeries are performed each year in Oklahoma, according to hospital data collected by the state Health Department. More than 1,500 of those — about 83 percent — are lower body amputations.

Every day in Oklahoma, four people lose part or all of a leg.

Amputation changes lives dramatically, but not necessarily in the ways you might imagine.

Jeff Waldmuller

The day Jeff Waldmuller nearly died started out so ordinary.

He was 24, attending the University of Houston on a music scholarship, and home in Wichita Falls, Texas, for a few days.

He was riding his motorcycle, maybe a mile and a half from his parents' house in December 2008.

An 18-wheeler rolled through a stop sign, so Waldmuller waited for the driver to pass, then caught up to the rig in the right lane. The truck moved suddenly to the right lane, trapping Waldmuller's motorbike in a construction zone with a cement wall. There was gravel underneath and no room to brake. He tried to speed up and escape, but it was too late.

The rear wheels of the rig sucked him under and trapped him between the tires and the cement wall.

His right arm and leg were crushed, the rest of him mangled around the bike and tires.

His only stroke of luck was that the first driver to stop and help was an emergency room nurse who had just gotten off her shift from the local hospital. She kept him calm and alive.

He bled out and had to be resuscitated several times. He remembers a trauma surgeon telling him he was lucky to be alive.

It took days for Waldmuller's body to stabilize in the ICU, just so he could survive surgery.

When they finally unwrapped his bandages, he saw a blue line drawn all the way across his thigh, and another one on his bicep.

After his accident, Jeff Waldmuller was originally determined to keep his leg but was frustrated with being unable to be physically active. After a visit to Scott Sabolich Prosthetics, he changed his mind. JEFF LAUTENBERGER/Tulsa World

"Is that what I think it is?" he asked the doctors.

Amputation was a highly possible option, they said.

But he couldn't bear the thought of losing his arm. Waldmuller had been a musician since age 7, playing guitar and trumpet.

So doctors operated, using pins, screws and skin grafts to reconstruct his arm and leg.

His arm improved. But 20 surgeries later, his leg was as good as it was going to get. He could walk, but only with intense pain.

His heel was ripped off in the crash; it would never grow back. Special shoes, braces and pain would always be part of the equation.

Family members were opposed to any talk of amputation, but Waldmuller couldn't walk more than 30 feet without intense pain. He started researching amputation on his own. He told his parents he was going to Oklahoma City to see a foot specialist.

In reality, he went to Scott Sabolich Prosthetics & Research in Oklahoma City, at its futuristic-looking campus off Broadway Extension.

There, he learned about all the things he could do on a prosthetic leg that he wasn't able to do on his fragile real leg.

Walk without pain. Run. Ride a mountain bike.

He met Paralympic sprinter Roderick Green, who told him: "There's nothing you can't do on a prosthetic leg."

Waldmuller returned to Texas that Friday night and called his surgeon: "Take it off. I'm ready."

Jeff Waldmuller mountain bikes on the Bluff Creek Trail near Lake Hefner in Oklahoma City. Waldmuller has been able to secure sponsorships from several paralympic programs to buy equipment and participate in events. JEFF LAUTENBERGER/Tulsa World

They scheduled surgery for the following Wednesday.

The evening before, he and his friends went to a Buffalo Wild Wings, and he let his friends sign and write on his leg, below his knee, with a Sharpie: "Take this one, not the other!"

Then it was gone. And in a few months, when his stump had healed and his prosthetic leg was finished, he celebrated by in-line skating down the hallway of his dorm.

He hasn't stopped moving since.

Waldmuller, now a student at University of Central Oklahoma in Edmond, rides mountain bikes and competes on Paralympic track and volleyball teams.

Also, at 27, he's decided on a career change: Waldmuller plans to go to graduate school to become a certified prosthetist.

The Ertl procedure

In 1920, a Hungarian physician, Janos Ertl, was searching for a way to help amputees return to the work force. Pain and difficulty with prosthetics were common obstacles.

Ertl noticed that in the months after amputation surgery, there was a tendency for the cut end of the tibia bone to grow toward the cut end of the fibula bone.

Why not assist the natural phenomenon by encouraging bone growth between those cut ends, via bone grafts, he thought. A graft builds a bone bridge that provides a stronger base to which below-knee amputees can attach prosthetics.

Janos Ertl eventually had three grandsons who all became orthopedic surgeons, all working with the Ertl procedure. One of them, Dr. William Ertl, performs the procedure regularly at University of Oklahoma Medical Center in Oklahoma City, where he lives.

He's had patients from all over the U.S., Australia, England, Canada and Sweden.

Though various modifications have been proposed over the past decades, the basic principle of the procedure remains the same. It would be difficult to get an accurate count of Ertl procedures performed worldwide since his grandfather pioneered the procedure, William Ertl said.

His grandfather cared for an estimated 13,000 amputees during his career, he said.

Juan Lopez

When 77-year-old Juan Lopez was young, he worked at a steel forge making railroad wheels. Lunch was frequently a sandwich and 16-ounce Budweiser.

When he got away from drinking, he couldn't pass a pastry shop without indulging. Apple pie, ice cream, salt. New vices replaced old ones.

He developed poor circulation, and he had a family history of diabetes. His future was written.

Nationally, Hispanics and blacks are at higher risk for amputation due to diabetes and vascular disease.

After a colon operation several years back, doctors told the Tulsa resident he was diabetic and needed to make changes.

He didn't. No diet changes, no lifestyle modification, no blood-sugar monitoring.

"I didn't believe all that," he said. "I thought I could beat it. I'm just hard-headed, that's all."

By the time his toes on his left leg started becoming gangrenous, it was too late.

Doctors had to take part of his leg, below the knee.

After that, he changed his lifestyle — but not his attitude.

"I never let it get me down," he said. "I can't see me being dependent on anyone."

His positive outlook sometimes frustrated his youngest son.

"My boy got a little on the hot side and told me, 'Don't be surprised if you have a wheelchair waiting for you after surgery," Lopez said.

Juan Lopez has a below-knee prosthetic on his right leg caused by diabetes. Since his surgery, Lopez has tried to watch his health, and frequently takes walks with his wife. JEFF LAUTENBERGER/Tulsa World

"Michael, I don't see no wheelchair in my life," Lopez told his son.

He got sent home in a wheelchair, but he got out of it as soon as he could.

The first thing he did was try to ride a bike in his backyard.

"I'm not going to sit down," he said. "That's not for Juan."

He likes to be free, to drive his red truck where he pleases, or to the Corner Cafe, where he's a regular.

"I'm always doing something, running the streets," he says. "I don't know what I would have done if it had been my right leg."

There was less pain after the surgery than there had been before. Afterward, he felt the odd sensation of missing something.

"It's a strange feeling," he said. On stairs, he always lands on his prosthetic leg first, otherwise it feels weird.

He exercises now and plays pool regularly in senior tournaments to stay active. He eats healthier.

But he's still diabetic, and soon he was battling stubborn sores that wouldn't heal on his right foot, too. This time, he didn't ignore them.

Doctors at St. John Medical Center told him they could possibly save his other leg and foot using hyperbaric chamber therapy.

Juan Lopez almost lost his other leg to diabetes. But doctors were able to save it through hyperbaric oxygen therapy. JEFF LAUTENBERGER/Tulsa World

"I call it the tank," Lopez said.

Basically, patients spend extended periods of time in a chamber breathing 100 percent oxygen at increased atmospheric pressure. It increases oxygenation within your blood plasma, which aids the healing process in your body.

A vascular surgeon first repaired two dead arteries in Lopez's right leg, and then Lopez spent a few hours every day in the tank. The tank saved his other leg and spared him from becoming a double amputee.

He sees others in walkers and wheelchairs, and he is grateful for his prosthetic leg and cane.

"God's the one who gives me strength," he said. "He puts it before me, and I'm the one who's got to use it."

Hyperbaric oxygen therapy

When Juan Lopez came to see Dr. Lam Le at St. John Medical Center's Wound Center, the 77-year-old had already lost one leg below the knee and was in danger of losing the other.

"His other leg was starting to get a wound," Le said. "He didn't want to do hyperbaric therapy; he didn't see the point."

More than half of Le's patients come to see her as a last resort before amputation surgery.

Hyperbaric oxygen therapy may sound like voodoo medicine or space-age technology, but it's really just using oxygen to heal wounds, Le said.

Patients spend extended periods of time in a chamber breathing 100 percent oxygen at increased atmospheric pressure. It increases oxygenation within your blood plasma, which aids the healing process for diabetics with dangerous wounds.

"It's been around for a long time," Le said. "I think that it's starting to get used more, and people are starting to know more about it."

More than 3 percent of the population over 65 has wounds that potentially lead to amputated limbs. More than 86,000 foot amputations are performed on diabetics each year in the U.S.

Wounds occur when diabetics let their blood sugar get out of control and get ulcers or lesions, commonly on their feet. Poor circulation in their lower limbs decreases blood flow and slows healing, and the increased blood sugar makes these wounds attractive to bacteria and prone to gangrene.

"There's a perfect storm of factors that contribute to it," Le said.

Some patients arrive at their clinic with black, rotting feet and exposed bones after letting wounds go untreated for too long.

Because amputation surgery tends to decrease mobility in older diabetics, doctors try everything they can to avoid it. Decreased mobility is ultimately terrible for diabetics, Le said.

"After amputations, within one year, 22 percent are dead," she said. "Within five years, it's 71 percent are dead."

In Lopez's case, a vascular surgeon first repaired two dead arteries in his right leg, then Lopez spent a few hours every day in the tank. His wounds healed, and he avoided becoming a double amputee.

"Good foot care is important," Le said. "Prevention is the best treatment."

Maria Greenfield

The 1987 car accident that took both of Maria Greenfield's legs never stopped her from living the life she wanted.

She was only 19, a year out of Booker T. Washington High School, and studying physical therapy at Oklahoma State University.

Driving on the Broken Arrow Expressway in the rain, her Ford Mustang hydroplaned and hit a guardrail. She got out to check the engine.

She doesn't remember the other car hitting her. The two weeks after the accident are also a mystery, the gaps filled in by family members.

Her pelvic bone was crushed. Both legs were nearly severed, neither could be saved.

She was in the hospital for almost three months. The only bright spot was a guy who visited her a lot at the hospital, her brother's best friend, Greg. A few years later, he became her husband.

Greenfield has a serious stubborn streak.

A year after her accident, she found a Mustang just like her old one. She persuaded its owner to sell it to her. She put her old car's engine in it. She still owns that car.

While she was still in the hospital, Greenfield's occupational therapist told her she shouldn't expect to be able to go back to college anytime soon.

Greenfield went back to school the next semester and eventually became an occupational therapist — so she could help people learn to do the things they wanted to do, instead of telling them they couldn't. She lives and works in Norman, at the J.D. McCarty Center for children with developmental disabilities.

Maria Greenfield works in therapy with Kaydyn Buckley, 2, a down syndrome patient at the J.D. McCarty Center in Norman. JEFF LAUTENBERGER/Tulsa World

Prosthetic limb technology has advanced greatly in the quarter century since her accident. As someone with one above-the-knee amputation and one below-the-knee amputation, she's had nearly every kind of prosthetic leg available.

The early sockets were wood, and the leg joints were a clunky combination of wood and metal parts.

"They were terrible," she said. "Compared to now, it was like walking on sticks and bricks."

She became a patient at Scott Sabolich Prosthetics & Research in Oklahoma City around 2001. She went to several different prosthetics clinics for her legs over the first decade. Many of the early models couldn't keep up with her.

Greenfield frequently fell, cursing in frustration. A lifelong swimmer and "water baby," she wanted to get in the pool but didn't have the right legs for it.

"The first time I ever got in water without legs, I flipped over and floated like a buoy," she said.

A prosthetist built her a pair of swimming legs with ankles that could be locked into kicking position, when not walking. If someone tries to swim with legs that have feet fixed at 90-degree angles, kicking will pull them backward instead of propelling forward.

Maria Greenfield is helped out of her pool by husband Greg after she damaged the foam heel on her swimming legs. JEFF LAUTENBERGER/Tulsa World

There's been a lot of trial by error. Several expensive legs were ruined after it turned out they were not truly waterproof. One is at the bottom of Lake Thunderbird after an inner tubing incident.

When Maria and Greg Greenfield signed up for scuba school in 1997, she conveniently omitted from her application the fact that she was a double amputee.

The instructor called her right before the first class: "Is there anything you want to tell me?

She proved she was as strong a swimmer as anyone else in the class and received her certification. She and her husband went on a cruise to Cozumel, Mexico, and reached 100 feet on their first ocean dive.

Insurance does not cover most specialty recreation legs, so Greenfield's adventures can be expensive.

For the everyday walking legs that insurance helps pay for, her portion of the tab is 20 percent.

The computerized portion of her above-the-knee amputated leg, which helps it move like a natural knee? That's $30,000, as much as a new Ford Mustang.

And that's just one part of one leg, they don't last forever. A whole set of new legs for Greenfield costs $100,000, every few years.

Donning her scuba gear, Maria Greenfield goes under in her pool to look for a lost earring. JEFF LAUTENBERGER/Tulsa World

When you lose your legs, the nerve centers directing them in your brain are left behind. So the phantom pains and sensations never really go away.

When she lies in bed, she can still feel the sensation of wiggling her toes, in her mind. The phantom pains only come occasionally, but feel like someone is stabbing her with a dagger.

Back when that car hit her in 1987, she had two questions when she first woke up. She had to write them down to ask her dad, because she was intubated from surgery.

"How's my car?" and "Can I still have babies?"

Yes, it turned out. Her daughter, Nicole, is 18 now, and son Cody is 17.

Greenfield, now 44, lets them drive her old Mustang, once in a while.

Scott Sabolich Research & Prosthetics

Scott Sabolich built young amputee Jeff Waldmuller three different legs: one for sprinting, walking and mountain climbing.

He built Maria Greenfield bilateral diving legs, so she could become a scuba instructor.

Once, he built an artificial leg for a prized breeding llama.

"We fitted him in the parking lot," Sabolich said.

There's no room for a llama in the bustling lab at his prosthetics practice and research facility in Oklahoma City.

It smells like an auto body shop, and the setup isn't much different.

Here, they churn out more than 500 limbs a year. Each requires a two- to three-week process of fitting, molding, adjusting and painting customizing.

Amputees can opt for painted nails, cobras, bald eagles and more to adorn their prosthetics. The facility hired an airbrush artist who used to work at West Coast Choppers, the famed California motorcycle customization shop.

Sabolich is a third-generation master of artificial limbs, or what the industry terms a "certified prosthetist."

His grandfather, Lester Sabolich, helped pioneer the field back when limbs were made out of wood and aluminum. His father ushered in the era of plastic prosthetics.

"Every time there's a war, you see a major bump in the technology," Sabolich said.

The wars in Iraq and Afghanistan are no exception and have created an estimated 1,200 amputees, many of whom rely on high-tech, computer-assisted artificial limbs for everyday mobility.

The Sabolich practice started in the 1920s in a small shop on 10th Street and Western Avenue in Oklahoma City. Ninety years later, it has been touted as the "Mayo Clinic" or "Silicon Valley" of prosthetics.

Specialty activity limbs and difficult-to-fit amputees are the clinic's bread and butter.

Of the veterans and war wounded that Sabolich treats, two-thirds are from the surrounding region, and the other third come from all over the country.

Collectively, Americans are losing more than 3,000 civilian limbs a week, Sabolich said.

About 80 percent of his patients are amputees due to vascular illness and diabetes complications.

Traumatic-injury victims make up about 10 percent of his patients, and the remainder are born with congenital defects or missing limbs.

The average age of an amputee is 65 years old — which not coincidentally is the top range of the aging baby boomer population. There are 3,000 certified prosthetists in the country.

Soon, there will be a serious lag between baby boomers in need of limbs and prosthetists who can provide them, Sabolich said.

Patients fly in from the coasts and foreign cities. So many patients come from north Texas that he's opening a second facility in north Texas. He's also planning a Tulsa location soon.