Addition By Subtraction: Choosing amputation later helps some wounded warriors gain independence

While serving in the Air Force, Daniel Crane injured his right arm which caused nerve damage leading to a complete loss of function. Prior to heading to the Invictus Games he chose to receive an amputation. Crane participated in multiple events in London, including Archery, Athletics and Swimming. (U.S. Air Force photo/Staff Sgt. Andrew Lee)

An off-duty shooting two years ago took away three things in retired Staff Sgt. Daniel Crane’s life that he enjoyed. Gone was the former quarterback’s ability to throw a football. Gone, also, was his shooting capability, at least at the proficiency he was accustomed. Even his career as an active-duty security forces Airman seemed to be lost forever.
On July 28, 2012, Crane was shot in his vehicle by an anti-U.S. forces national while stationed at Andersen Air Force Base, Guam. The bullet struck Crane’s brachial artery and severed nerves in his right arm, requiring eight surgeries. The use of his forearm and hand never returned.
But as Crane reached the two-year anniversary of the shooting, he was perhaps busier than he was before his injury. Less than a month before the anniversary he calls his “alive day,” Crane had an elective trans-radial amputation that took the right arm to 4 inches above his wrist. He has now resumed his CrossFit workout while training for five sports in the inaugural Invictus Games, an international competition for wounded servicemembers, in London.

Daniel Crane competes in a 100m Men’s Ambulant IT3 race during the 2014 London Invictus Games at the Lee Valley Athletic Centre, England, Sept 11, 2014. Servicemen and women participating in the inaugural Invictus Games are those who have overcome adversity in every sense of the word. Be it either wounded, ill, or injured, these warriors have found themselves an invitation to compete in the games and represent their country, service, and comrades. (U.S. Air Force photo by Senior Airman Justyn M. Freeman)

“I never would have thought I would be involved in as many activities and sports after my injury and amputation,” Crane said. “I feel so good to really get back into competition. You know those guys that everybody is annoyed with because they are always so competitive? Now I’m that guy everyone is annoyed with, but at the same time, I also make sure the guy next to me is doing as well as he can, too.”
For eight years, another wounded warrior, Tatiana Perkins, lived with a paralyzed right arm after a motorcycle accident on May 12, 2006. She was a staff sergeant with the Air Force Reserve’s 940th Civil Engineer Squadron at Beale Air Force Base, Calif., when the accident left her with a partially torn anterior cruciate ligament and torn medial collateral ligament, shattered clavicle and complete nerve erosion in her right arm.
A doctor first suggested amputation a year and a half later. Perkins said she didn’t seriously consider it until she moved to Tucson, Ariz., and began working as an amputation rehabilitation coordinator at the Veterans Administration Hospital. There, she met a man with a similar injury who became a Paralympic athlete after his elective amputation.
While Perkins, like Crane, is an athlete who competed in the Warrior Games this year, her main motivation for eventually having her arm amputated was different – she wanted to start a family with her husband, and didn’t relish the thought of being a one-armed mother.

Tatiana Perkins practices the standing discus throw Aug. 3, 2014, at the Air Force Academy, Colo. The Wounded Warriors are conducting their final group practices prior to the up coming Invictus Games in London Sept. 10-14, and the Warrior Games Sept. 28 through Oct. 4, 2014. (U.S. Air Force photo/Staff Sgt. Tim Chacon)

“Taking care of a child is one of the things I worried about with one arm, like changing a diaper,” Perkins said. “While I know how to change a diaper with my feet, it’s not like I can go out with my child to the mall and use a public restroom to change the diaper with my feet. It’s about independence for me.”
Crane and Perkins are among the many wounded warriors who choose to have a limb amputated for safety concerns and to aid their rehabilitation. Both retired Airmen credit being around and talking to other wounded warriors with helping them make a decision they think will improve their quality of life.
“When it came time to pulling the trigger on the amputation, it made it that much easier,” Perkins said. “Here I was, thinking about what was taking me so long to make a decision on improving myself, and there were Airmen, Soldiers and others, who only a year or two into their injuries were already prospering and doing things they never thought they would do prior to their injuries. I got tired of playing in my backyard. I wanted to get out.”
Elective or delayed amputations amount to about 15 percent of all combat-related amputations, according to a Military Medicine article published in 2011. Surgeries are performed at Walter Reed Army Medical Center near Washington, D.C.; Brooke Army Medical Center in San Antonio; Naval Medical Center San Diego and Bethesda Naval Medical Center in Maryland.

Retired Staff Sgt. Melissa Coduti and Tatiana Perkins participate in a 100m sprint during the Invictus Games at the Lee Valley Athletics Centre, England, Sept. 11, 2014. Athletics is one of several sports the more than 300 wounded warriors from 13 nations competed in. The vision of the Invictus Games is to harness the power of sport to inspire recovery, support rehabilitation and generate a wider understanding and respect for those who serve their country. (U.S. Air Force photo by Senior Airman Tiffany DeNault/released)

Wounded warriors who face this decision must weigh several important factors, said Dr. (Maj.) James Bales, an orthopedic surgeon with the 81st Medical Group at Keesler Air Force Base, Miss. As head coach of the Air Force Warrior Games team, Bales talks with many Airmen and Air Force veterans who have to decide about elective amputation. When counseling them, Bales wants the wounded warriors to consider whether the benefits of amputation would outweigh the risks.
The main factors he recommends they consider are: the functionality of the limb, whether the muscles or nerves still function, how bad the limb was damaged and the location of the injury. Recovery and rehabilitation tend to be easier for lower limbs than for the hands and arms, and aren’t as susceptible to swelling, he said.
“We’ve made such huge strides in below-knee amputations, with some great prosthetics available today, that these people can pretty readily return to relatively completely normal lives,” Bales said. “For the upper extremities, the hand is hugely more needed than the foot, so to press forward with hand or arm amputation is a lot bigger deal because of what you need them for — activities with daily living. When we talk about the upper extremities, we want to see if we can save the thumb and one finger to have a pincher group, so he can pin something down with the forearm.
“The main thing is we want to focus on 98 percent of the things they can do, rather than the 2 percent they cannot.”

Tech. Sgt. Leonard Anderson and Staff Sgt. Daniel Crane go over swimming techniques during the Wounded Warrior Pacific Invitational (WWPI) swim meet at the Iolani High School’s Dillingham Pool. WWPI is a competition among seriously wounded, ill and wounded service members from the Air Force, Army, Coast Guard, Navy and Special Operations Command. The WWPI is the largest joint-service competition to take place outside the annual Warrior Games. (U.S. Navy photo/Mass Communication Specialist 1st Class Kenneth R. Hendrix)

A tattoo Crane got above the scar on his right arm near the one-year anniversary of the shooting shows his commitment to the things he can still do, even after his delayed amputation. The tattoo illustrates the words of a Bible verse, “Faith and trust in what we cannot see.”
Now that the hand that was no longer serving him as intended was removed, Crane is learning to shoot and throw a football with his left hand. He received his prosthetic hand just a few weeks after his June 20 amputation, and now even has hopes of returning to his active-duty career, though he was medically retired in February.
“The chances of me coming back into the military now that I’ve had my amputation, I think, have gone up because I will be able to do so much more,” Crane said. “Now that I have the prosthetic, I can grab things with my hand, I can do pushups, and I can still pass the fitness test.
“Now that I’ve gone through my own elective amputation, I am really very happy with it. With the prosthetic, I feel I can do more and more. It just makes me feel like I have two hands again.”

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