WHEN COSI TALKS, HEALING BEGINS Cosi Belloso

[00:00:00] Welcome back to the AMPD UP211 Podcast. Today, I'm joined by an extraordinary guest, Cosi Belloso, a physical therapist with over 23 years of experience and a true champion for the amputee community.

[00:00:14] From founding her own clinic to helping countless individuals regain mobility after limb loss, Cosi's passion and dedication shine through in everything she does.

[00:00:24] She's also the host of Cosi Talks, a live weekly show where she answers questions about recovery and life after amputation.

[00:00:33] In this episode, we'll dive into her journey, her work, and how she's changing lives one step at a time. Let's get started.

[00:00:48] Good morning, Cosi. Good to see you.

[00:00:51] Good morning, Rick. Thank you for inviting me.

[00:00:53] Look at you getting ready to have something to drink. I'm going to follow one of your little protocols. What are we drinking today, Cosi?

[00:01:01] Oh, we've got an espresso double shot because it's just that kind of a day and I need that kind of energy right now.

[00:01:07] Really? So caffeine is your jam in the morning?

[00:01:12] It's totally my jam. It is my one addiction and I'm just not going to apologize for it. It's in my genes.

[00:01:19] I do not drink coffee at all. I know.

[00:01:22] How do you survive?

[00:01:23] I know. So this is my guilty pleasure is my zero sugar monster.

[00:01:33] Okay.

[00:01:34] Which I know is terrible for you.

[00:01:40] And very often people at work will say, what are you drinking? And I turn to them and I say, poison.

[00:01:47] Yes. Yes. That stuff will make you glow in the dark.

[00:01:52] Caffeine, just see, for me, the coffee just makes you do stupid things faster. So that's kind of my...

[00:01:58] Yeah. So today's a day that I needed a little kick in the pants. Thank you for being here, of course.

[00:02:06] And when we started the Amped Up to 11 podcast two years ago, I was jamming on who do I need to get on this show?

[00:02:18] Because I was in a very ambiguous space at the time and I knew I wanted to get all kinds of people

[00:02:25] in the limb loss and limb difference community involved.

[00:02:30] And I didn't want to reserve that just to amputees, which is a healthy amount of the guests that we do engage.

[00:02:39] But I really, really wanted to get with people like yourself, people that are in the community,

[00:02:45] dedicated to the community, our practitioners, clinicians, people in technology.

[00:02:51] But your particular endeavor, Cozy Talks and your video blog and your clinic, which I read up on,

[00:03:02] really jumped off the page for me. Like, wow, here's someone that's dedicating our life to people like me.

[00:03:10] And I reached out to you and look at us. About a year and a half later, here we are.

[00:03:19] We're doing it. We're doing the interview, right?

[00:03:24] Yes. No, it's nice to be on the other side of the interviewing table. So yes, looking forward to it.

[00:03:30] Yeah. I would think because, you know, I've done a couple, you know, like articles and different things

[00:03:37] where I've been asked questions, but I've yet to do an actual like podcast or this sort of format

[00:03:46] where I'm on the other side. So it's interesting for me to sort of engage you knowing that you sit in my seat

[00:03:56] most often. And I feel like you're very bold in this space because you do so many of your talks

[00:04:06] are live and you're streaming. And very often you can tell it's, it, it can be challenging.

[00:04:14] And anything goes.

[00:04:17] But I feel like your temperament, your humor, and just your light as a person, you just roll with it,

[00:04:26] man. You're just like, Hey, this is just how it is. Let's just go. Let's just do it.

[00:04:32] And I tend to struggle in those situations. I just, I get nervous and I think I'm going to be

[00:04:41] tongue tied or I'm not going to know what to say, or maybe I'm not going to react, you know, the way,

[00:04:48] because I feel like when I prep for our podcast, I, you know, of course I develop questions. I do all

[00:04:56] my, my reading and, you know, I was always, always pretty good about homework when I was a kid.

[00:05:02] And in business, I'm, I'm always prepared for a meeting. Like I never come unprepared.

[00:05:07] So I, I like to feel this, maybe it's a illusion of control that I have in, in, in that we are not live

[00:05:17] and we can fix things later because so, so rarely, I mean, Brian, Brian, our producer, Brian, we don't

[00:05:25] fix all that much when you think about it. I mean, we've done plenty of episodes that are really almost

[00:05:33] live in the sense that you don't have to change a whole lot. Right. Yeah. Yeah. That's Brian.

[00:05:41] You get to hear Brian.

[00:05:42] Well, I have a, I have a funny story. So some people don't know I'm, I'm outside of the world

[00:05:47] of PT. I'm actually a semi-professional violinist and I participate a lot in community theater.

[00:05:53] Why did I not know that?

[00:05:55] Yeah. I, I'm a strange bug. I'm a strange bug professionally in person and in my personal

[00:06:00] life. I don't fit into any kind of peg or any particular shape. Um, but I was cast as the

[00:06:08] wicked witch of the West in the wizard of Oz really crazy fun role. And we had a live dog Toto

[00:06:15] and every night we had eight performances to sold out house of about, you know, 150 to 200 people

[00:06:21] audience. And every night that damn dog would do something different. So the first night opening night,

[00:06:29] I've got all the special effects with the broom shooting fire, whatever, whatever. And all of a

[00:06:33] sudden this dog just takes off and runs off the stage into the audience. So how to do improv there.

[00:06:38] Another night, the dog comes and attacks me during the show.

[00:06:42] We are the wicked witch. Of course it attacked you.

[00:06:44] Well, yeah, yeah. But he wasn't, he was really coming after me because I, you know,

[00:06:48] I was kind of scary looking. Right. So I was just like, you know what, if I can handle this dog

[00:06:52] and then, you know, the flying monkey was being played by a six-year-old. So he was just being

[00:06:56] rambunctious. And at one point I'd just pick him off and throw him off the stage. You know? So if I was

[00:07:00] like, if I can handle that, I could figure out how to do a live show on a.

[00:07:04] Yeah. Well, I, I, I, I admire you in, in that regard. And of course I just gobble up your content

[00:07:14] because, you know, so, so often we take this approach of, you know, talking about the personal

[00:07:22] stories of amputees or people in this community. And I, you know, so highly recommend if you haven't

[00:07:31] to our audience, you know, you know, cozy does this incredible series of videos you can see on YouTube.

[00:07:39] Um, you know, these cozy talks where, I mean, she, she drills very deep into so many different,

[00:07:48] very, very relevant and important issues for, for new and old amputees. So whether you are struggling

[00:07:59] in the prosthesis space or you're struggling in the nutritional space, or you just need inspiration,

[00:08:06] um, it's, it's, it's just a fantastic series. And, um, I've been, you know, very much a listener and a

[00:08:15] watcher and it's, it's very, very fun to have you here and have the opportunity to ask you some more

[00:08:23] specific questions because, you know, me developing the podcast really just had a lot to do with my

[00:08:31] curiosity. And it was initially for me was a very self-serving kind of idea, which was, man, wouldn't

[00:08:42] it be cool if I could talk to some of these people that I'm following, that I could actually engage

[00:08:48] them, get to know them and feel as if there was a connection point there because I mean, let's face

[00:08:56] it. You see a lot of people in social media and that's sort of one dimensional to a certain degree,

[00:09:04] but I want to go a little deeper and understand a little bit more about what makes people tick

[00:09:10] and what brought them to this place. And I want to share that and shine a light on it and bring it to

[00:09:16] a community because I'm sure you can appreciate given your background, uh, medically that, you know,

[00:09:24] information is power. It's, it's this massive empowerment tool. Um, you know, being that you're in

[00:09:33] physical therapy, what would you say, you know, give, give us, you know, give us the narrative on,

[00:09:42] you know, what brought you to the amputee space as a physical therapist?

[00:09:47] Um, I say this a lot. It was actually just dumb luck. Uh, so when I graduated from PT school and

[00:09:53] dinosaurs roamed the earth, uh, you know, I put myself in a hospital setting where I was rotating

[00:09:59] through all the different specialties of physical therapy. And at that time there were about 15 to

[00:10:04] 20 different specialties. So every six months I felt like I was basically starting a new career,

[00:10:09] getting rotated around. It was at the Jackson Memorial hospital in Miami. Uh, it's a world renowned

[00:10:14] hospital with a level one trauma center, uh, tertiary care facility, huge. Uh, we had people being flown

[00:10:21] in from all over the world. Um, and because I was low man on totem pole, I got the rotations that

[00:10:28] nobody wanted. So nobody wanted trauma. ICU. Nobody wanted the burn trauma rotation. Not very many people

[00:10:34] wanted spinal cord. And so I got these fantastic opportunities and to learn from amazing mentors.

[00:10:39] Um, and then I got put into the amputee rotation. And I remember coming home that day to my newlywed

[00:10:48] husband and saying, babe, I think they're finally going to figure out that. I don't know what the heck

[00:10:53] I'm doing and they're going to fire me and I'm going to lose my license and the world is going to collapse.

[00:10:58] Right. So just, just, you know, total drama moment because I had not received a lot of education on

[00:11:04] amputees. Most PTs don't, it's, it's a failing in our education system. Um, but that's another soapbox.

[00:11:10] So I went in the next day and I just was just like, okay, you know, this is it. And my senior PT and

[00:11:17] amputee, his name, um, was Curtis Clark. And not many people know his name because he's a very quiet,

[00:11:24] humble man, but he wrote the book on a lot of amputee protocols for physical therapists. And he's

[00:11:30] the guy who trained Bob Gailey and everybody knows who Bob Gailey is. Yep. So he comes to me that first

[00:11:36] day and he says, look, I know you don't know the difference even between a below the knee and above

[00:11:40] the knee. And I'm like, oh my gosh, he knows. And he said, and I'm going to sit with you and we're

[00:11:45] going to train you. So he blocked off a full week and he just gave me all of the educational

[00:11:53] literature that I needed to know. And then he sat with me with every single patient as if I were a

[00:11:58] student. Um, and he just taught me and we had some of the most amazing cases come in during that time.

[00:12:04] So it was hard not to fall in love with, with the field in my patient care when, when I just,

[00:12:09] just by having, you know, uh, someone else who was so passionate about it and wanted to teach me.

[00:12:15] Um, and that was just something that really lit a fire under me. Um, so as the years went by and I

[00:12:20] worked in so many different settings and I started my family and I moved to Tampa, um, I really just

[00:12:26] had a desire to continue to serve amputees. Um, and so that, that's kind of what lit the fire under

[00:12:33] me at that time. Yeah, that's, that's fantastic that you had, uh, a mentor in that situation. I

[00:12:39] spent, I want to say I spent about six weeks in rehab after my amputation, uh, at a place called

[00:12:46] Marion Joy and, um, in Illinois. And, um, I have to say that it was, uh, such an incredibly empowering,

[00:12:58] you know, validating kind of experience for me. It was really, uh, the launch pad that put me on the

[00:13:07] right trajectory. Had I been sent home, which I hear sometimes through other, yeah. Through other

[00:13:16] amputees, I'll say, okay, you're post-op. Like what's going on? Oh, I'm going home tomorrow.

[00:13:23] And I'm thinking what, like how, how, right. And I reflect on my own experience and feel very,

[00:13:33] very fortunate, very blessed that I had professionals like yourself, you know, in PT and OT

[00:13:41] that were guiding me. And I remember the, the, uh, physical therapist that I worked with

[00:13:50] in the gym post-op. And I, I remember going in to see him the first day and he's talking,

[00:13:58] you know, he's kind of walking me through, okay, you know, here, here's all the resistance training

[00:14:03] we're going to do. And this is where we're going to do all this other stuff. And, you know,

[00:14:07] they got all the mats and the tables and all this stuff. And I remember him saying, do you have any

[00:14:13] questions? And I said, well, I don't know if this is really a question. I said, I need you to really

[00:14:19] push me. And he goes, oh, we're going to push you on. Never tell a PT, you never tell a PT,

[00:14:27] go ahead and push me more. Or that wasn't hard enough.

[00:14:31] Yeah. He goes, oh, we're going to push you. And I, and I just recall coming out of surgery

[00:14:38] and you're in this weakened state. I mean, you're just not, you're nowhere near a hundred percent.

[00:14:45] And I, I remember like for the first week, just telling him over and over again,

[00:14:51] man, you're strong. I just kept telling him that he's like, he goes, well, maybe he goes,

[00:14:58] I think you're just really weak right now. He goes, we're going to get you strong. And by the time I

[00:15:04] left, yeah, we were definitely, you know, kind of, you know, matching, matching each other strength

[00:15:11] wise where he'd be pushing, I'd be pushing back and he'd be like, okay, that's, that's the Rick.

[00:15:17] That's the real Rick right there. And it was a phenomenal experience and something that I'll

[00:15:24] always just reflect on as such a huge, you know, starting point, putting me in that mindset of,

[00:15:35] I need to find my best self now, and this will not define me. And I talked to so many amputees

[00:15:44] that will speak of how they found their best self through an amputation. And when I get a little

[00:15:55] deeper into that conversation, it usually has to do with who they surrounded themselves with and who

[00:16:02] was their team, who, who were the people that enabled that mindset. And I would imagine that for

[00:16:12] yourself, you must have, you know, some stories that you feel like, you know, there was such a huge

[00:16:23] connection in what you provided, you know, for that patient. I would think so, right?

[00:16:29] Oh, absolutely. And just even pulling from my own personal experience, you know, it's who you're

[00:16:35] surrounded by because it takes a village. But then it's also how are you going to take this trauma and

[00:16:40] this horrible crisis that happened to you? And you have two choices. You either play the hand you

[00:16:45] were dealt or you fold. And when it came to, you know, for example, I have a history of breast cancer

[00:16:52] myself, and that was the catalyst that started a lot of my work for the past six years. But at that

[00:16:57] time, getting that cancer diagnosis with four young children at a young age, you know, for me, it was,

[00:17:05] it was the realization of, okay, there is a plan in my life. And for me, God was directing that plan.

[00:17:09] And I had the choice to follow his plan, put my trust in him, or to fight it, be angry, become

[00:17:17] resentful, become bitter, become scared and become anxious. And it's not to say that those feelings

[00:17:21] don't emerge because we're human. But ultimately, it's, you know, for me, and I've seen this also

[00:17:27] in many of my patients, the mindset of there is a plan for me in this life. And I have a path to take,

[00:17:33] and I can either fight it, or I can embrace and accept what's happened and see how I can

[00:17:40] make the best of it and move forward with it.

[00:17:44] Yeah. And being a cancer survivor, which, you know, when I was researching for the interview today,

[00:17:53] you know, I picked up on that somewhere, whether it was, it was an article or, yeah,

[00:18:00] there was something floating around on the internet. And I thought, whoa, okay, well, that's,

[00:18:07] that's an interesting ripple. I mean, that, that is part of your backstory that I would think

[00:18:13] created some components for you to certainly you're, you're, you're not an amputee. However,

[00:18:21] being a survivor, being a survivor, and my mom is a breast cancer survivor, being a survivor of,

[00:18:29] you know, such a serious illness can sort of lay some foundation there for you to be able to relate

[00:18:38] to that.

[00:18:40] Oh, absolutely.

[00:18:40] Yeah, to that struggle, you know, managing ideas of mortality, managing ideas of, of loss,

[00:18:47] and being able to, like you said, get yourself surrounded by the right kind of energy to be

[00:18:55] able to overcome those things. So how long, how long ago was that, that you, that you had cancer?

[00:19:05] So it'll be on December 4th, it'll be nine years since my diagnosis. And then it'll be not,

[00:19:14] yeah, nine years since my diagnosis. And I'm going on eight years being cancer free. Thanks be to God.

[00:19:21] So, you know, I say this a lot, a lot of my, thank you. A lot of my lectures, especially when I lecture

[00:19:26] to a group of amputees and family members and caregivers, I always start by saying, you know,

[00:19:30] I will never be able to relate in the sense that I didn't lose a limb, but I know what it's like to

[00:19:36] have my world turned upside down from one minute to the next and to have to spend the lifelong

[00:19:40] process of healing. And that's exactly what that is. And I say this on my show a lot, you know,

[00:19:46] I'm not a mental health counselor or professional, but I've had to do a lot of mental health with my

[00:19:50] patients over the years. And I've realized healing is a physical, emotional, and spiritual

[00:19:55] process. And you have to address all three, despite, regardless of what your beliefs might be,

[00:20:00] you need to address all three to have a good outcome, in my opinion.

[00:20:05] Um, and it's, it truly is lifelong for the amputee. Obviously you are faced with your mortality

[00:20:10] and complications down the line that can arise from amputation and for cancer patients. You know,

[00:20:15] once you're a cancer patient, you're always a cancer patient for the rest of your life. Right.

[00:20:19] Um, and having to acknowledge that mortality and the complications there too. Um, so, and it was

[00:20:25] definitely for me, the cancer was certainly the catalyst. It was certainly the catalyst for

[00:20:32] everything that I've done in the past six years. Yeah. It's, it's, it's an incredible story. I mean,

[00:20:37] it really is when you, when you consider, you know, how that sort of put you in that pointed you in

[00:20:43] that direction and then, you know, to stumble into that amputee space and go, well, wait a second.

[00:20:52] I, I, in many ways, I kind of feel like some of these patients are describing, you know, I kind of went,

[00:21:00] I kind of went through this process and those, those types of situations, um, very complex and

[00:21:09] very different for everyone. I've mentioned this on the show before where, when I went through my

[00:21:16] amputation, I was just in this sort of, let's just keep moving forward kind of head, kind of head

[00:21:30] and I don't know what it was like for you, especially having children. Ooh. Um, I felt

[00:21:36] like I was doing it for everyone else because I saw the pain around me, right? Because your family,

[00:21:44] your friends, and everyone kind of receives serious illness in a different way. Some people have sort of

[00:21:55] an understanding of it where it's like, okay, you know, my mom, this, or my, you know, my aunt that,

[00:22:01] or whatever, and others amputation, like, oh no, it's this terrible thing. So I was just moving

[00:22:13] forward, moving forward. And I've commented often now, you know, moving into my seventh year,

[00:22:23] I go through fits of depression now, years later. Yeah. Oh yeah. Where I look down. It's,

[00:22:32] yeah, I look down and I'm just, and it hits you. Oh yeah. Just hits you. It just, you're like,

[00:22:37] it's not there. Oh yeah. It just, it just kicks my teeth out. Like, wow. Wow. That's, that's really

[00:22:44] bad. And it's, it's, I feel like my emotional set is sort of recalibrating and allowing me to

[00:22:56] feel some of those things now as if, well, now I'm safe. People see me around me as safe and well,

[00:23:08] and doing well and thriving all those, all those positive things that people who love us want to

[00:23:14] see gives them comfort. And now I have that permission from like my subconscious to go

[00:23:24] just cry, man, let it out. To mourn, to mourn. Yeah. Just mourn. Just grieve it. Yeah. Feel it.

[00:23:31] It's, it's again, I am no psychologist. I had the, I had the, the privilege of working with some of

[00:23:37] the best darn trauma psychologists in the country at the trauma center. And I learned a lot. And,

[00:23:42] but you know, going through it myself, it was like you said, you, for me, it was during the chemo,

[00:23:47] you know, got to get through it. Got to get through it. I have four kids. I've got a husband. I've got a

[00:23:51] life. I got to get back to it. And then when all of that was said and done, I was expecting to feel

[00:23:57] this huge weight lifted off my shoulders and it didn't, you know, all was said and done. And I go,

[00:24:02] why am I still feeling this way? And I'm, and I was realizing, I was like, okay, I'm, it took me a

[00:24:07] while to kind of pick up on it, but I'm like, I am having the post-traumatic stress that I see my

[00:24:13] patients have. Why? Because cancer is not normal. Amputation is not normal, right? These are not

[00:24:19] normal things that are meant to happen to the human body. Right. And we are normal people trying to

[00:24:24] deal with an abnormal situation. Yeah. Right. So, and, and just trying to acknowledge that and get

[00:24:30] the help for that. And then realizing that yes, cancer, my, my oncologist calls it canceritis,

[00:24:36] where, you know, a little hanger, a hangnail, right. We'll send you over the roof. Sure. Right.

[00:24:42] And you have your triggers, you have your things, your days. For me, it was my, my children's

[00:24:48] birthdays that were definitely very difficult those first few years. And you've learned that,

[00:24:53] you know, in my case, again, you know, I have less of those days than I used to have. But when I do

[00:24:59] have one of those days, it's saying, you know what, for whatever reason, I need to just have a day,

[00:25:04] let myself have that day. Yep. Whether it's a pity party, whether it's a, every, everything is wrong,

[00:25:10] you know, but then I go to bed that night, say my prayers and the next day I start again.

[00:25:14] Yeah. No, and that's so wise. And I, and I, I feel like it's, it's great advice because

[00:25:22] if you don't allow yourself that, if you stifle, push that down, um, it's going to build and it's

[00:25:29] going to, it's going to affect you on a more of a grand scale where, Hey, we can, we can sacrifice a

[00:25:36] day to the emotional gods. We can say, okay, well, this is just, that's what's happening today.

[00:25:42] And it is, it is what it is. And tomorrow's a new day. And I think that's the best way to approach it.

[00:25:49] The thing I want to talk to you about in your work with amputees, you know, as a physical therapist,

[00:25:57] I want to talk about fitness level. I want to talk about people finding that, you know, reaching

[00:26:06] milestones with their fitness coming back, you know, we call it the comeback and the challenges

[00:26:14] that people face because so often I get to speak to amputees. I'm very fortunate like yourself to

[00:26:22] have, you know, this platform to be able to get things out. And then you're more of an expert than

[00:26:29] me. So, so people kind of come at me like they're talking to you. Like, um, like I know what, uh,

[00:26:37] and what should I, I'm like, I, you're going to have to call cozy because I can't give you that advice,

[00:26:44] but please hold, please hold messaging you cozy. Uh, can you talk to this person this morning?

[00:26:51] Um, I know you would, I know you would, but I very often find that some amputees, let's face it,

[00:27:03] have a long road ahead of them. And I want to talk about that group specifically because

[00:27:13] it's, it's, it's a very, very complex set of feelings, especially when someone's mobility

[00:27:19] was very challenged previous to their amputation. And now they are tasked with donning a prosthesis,

[00:27:33] trying to get mobile again, all of these things that are very hard to digest. And I feel very deeply

[00:27:41] for these people. I feel a tremendous amount of empathy towards these people because let's face it,

[00:27:52] you know, we're in this world of toxic positivity now, and these folks are looking, you know,

[00:28:00] at the cool blades and the Paralympics and, you know, all the, you know, slick, sexy, you know,

[00:28:09] amputees and they're saying, seriously, like, this is not what I'm going through. This is not my life.

[00:28:19] This is not me. And I bring that up only to find out when you sort of embark on that journey with a patient

[00:28:29] that let's say is dealing with some serious odds against them, what's your, what's your approach?

[00:28:39] Uh, first of all, I love having someone who has, not that I love that they have these challenges,

[00:28:44] but for me as a, as a clinician, I say, let's do this because I've seen in my, I've been a PT for 23

[00:28:52] years. I've been working in healthcare for 30 years and I've seen some stories of people who have

[00:28:57] no business walking and I've seen them run. And then I've seen people who should have been doing

[00:29:04] cartwheels after their second session and they never make it out of their chair.

[00:29:08] Um, so I don't really look at those statistics anymore. And I actually embrace those challenges

[00:29:13] as a clinician saying, okay, we've got a long road ahead. And if you've listened to my show,

[00:29:18] you know that I have no filter. I don't sugarcoat things. And I will be very blunt with people saying

[00:29:23] you've got a lot of stuff that we need to work through. Um, and it has to come from them.

[00:29:28] It really does. And that's another mind shift as a clinician over the years, where in the beginning,

[00:29:33] I thought I would be enough to get any patient out of the situation. And I've learned that

[00:29:37] unfortunately that's not the case. My enthusiasm, my passion for wanting to help a person is not going

[00:29:42] to be enough if that person is not truly motivated. Um, and a lot of this was reinforced and, you

[00:29:48] know, a couple of trips I took to Guatemala, you know, um, in the past couple of summer with my

[00:29:52] children working at the amputee clinic there, where seeing people who are in the worst of

[00:29:58] poverty situations in a country where there are no resources, right. And they really have every

[00:30:04] single odd stacked up against them. And I see them whizzing around on crutches in some of the worst

[00:30:10] situations. Um, so when I have a situation like that, I, you know, I assess the patient's mentality,

[00:30:16] you know, where are they at right now? Are they in a place where they're ready to work and they're

[00:30:22] ready to accept the cross that is being given to them in terms of what they have to get through to

[00:30:27] get successful. Um, if they're not there yet, then I gently let them know like, this is going to be

[00:30:33] a lot of work and you are going to need this support and try to connect them to those resources.

[00:30:38] Um, because it does take a village. It does take a village. Um, and you know, especially connecting

[00:30:43] them with amputee peer support. I love the coalition certified peer visitor program, connecting them to

[00:30:49] support groups. Um, that's a huge thing that I try to do for a lot of my patients because many of

[00:30:54] them have never even met another amputee other than themselves. Right? So when it comes to these

[00:31:00] challenging cases, I think providing them with that support system and being very upfront and saying,

[00:31:05] this is what it's, this is the reality of what your journey is going to be. And part of that also

[00:31:09] includes, there's going to be two steps forward, one step back in the progress. Um, I find that

[00:31:15] patients who are consistent are successful. Yeah. And I have a lot of patients, you know, so my practice

[00:31:22] right now, it is not, um, insurance based. It is a cash pay private practice. Um, and you know,

[00:31:29] there are some challenges for patients being able to get to my clinic, but the patients that are truly

[00:31:33] vested in their, in their success that are coming and showing up, even if it's only once a week that

[00:31:39] they can afford to come, those are the ones that have the success. Yeah. Um, all the other obstacles,

[00:31:45] the clinical obstacles, we can find a solution. We can find solutions between technology,

[00:31:49] clinicians, you know, fancy equipment, whatever needs to happen that part. We can, we can find

[00:31:55] solutions for that, but it really, really starts with the mentality of the patient. Yeah. I've,

[00:31:59] I've always felt like, uh, showing up is, you know, for me anyway, is a big part of it. You got to show

[00:32:07] up. Yeah. Uh, yeah. I so love when you said consistency, consistency is, it can sometimes be

[00:32:16] the, the X factor. It's what creates forward movement. Even when there is a setback shortly

[00:32:23] after I got fitted for a prep, um, I, uh, developed a, uh, I have a, uh, uh, uh, bony prominence,

[00:32:35] uh, right below my knee on my residual limb. And, uh, I, I was in a prep that, you know, maybe wasn't

[00:32:47] the best fit. And, you know, I was doing my, you know, headstrong, you know, stupid guy thing of,

[00:32:57] I'm just going to walk through the pain. I'm just going to walk through the pain.

[00:33:00] And I ended up with a, uh, really serious, uh, you know, pressure wound. And I ended up,

[00:33:08] you know, taking several steps back and ended up in wound care and got very close to a revision

[00:33:16] that would have taken me from below the knee to above the knee. So yeah. So that was one of those

[00:33:27] lessons in consistency, certainly, but also patience. And like you said, there's going to be a lot of

[00:33:39] challenges with this and my, my, my, my, and I know you, you've promoted, um, adjustable sockets,

[00:33:48] which were a godsend for me. Um, yeah. So initially I, like a lot of new amputees, I had,

[00:33:59] you know, massive fluid shift throughout the day. I mean, it was way beyond, uh, ply socks.

[00:34:06] It was just like, how many, how many of these socks can you wear? You know, I'm like online asking

[00:34:11] questions. Like how many of these can you put on 30 people are like, no exclamation point.

[00:34:17] Um, but I've seen that and it's scary. Yeah, exactly. So when I ended up, you know, with an

[00:34:23] adjustable, that was a game changer. First of all, they did a cutout on my bony prominence.

[00:34:34] Hey, let's take the pressure off of that one area. Right. And then I had an adjustable. So

[00:34:41] throughout the day, not only could I manage my, my fluid loss and losses and gains, but I could also,

[00:34:50] uh, acclimate to a prosthesis well, because when I was moving, I was fine. Cozy. I was fine. I could

[00:35:00] walk around. I felt pretty confident still. It wasn't a hundred percent where I could pivot and turn

[00:35:07] and do all the normal movements that I was used to. But for the most part, you know, I wasn't like

[00:35:13] gimping around or anything. And when I sat still, all bets were off. I was in so much pain.

[00:35:23] I just, it was, it was almost unbearable. I would just sit in my chair at work and within five minutes,

[00:35:33] yeah. Like my leg was just, yeah, it was no, no, no, no, no, no, no, no. And I can't even tell you

[00:35:41] how fortunate I felt that I could just, you know, loosen it up. Just let all those tissues relax while

[00:35:51] I was sitting, I was pain-free. And then when I was ready to get up and get mobile again,

[00:35:56] I tightened myself back up and go about my business. So that was wonderful. That was probably,

[00:36:05] you know, three, maybe two to three years of acclimation, getting active, doing all those

[00:36:13] things. And, you know, now I'm in a rigid socket and I'm comfortable 20, I'm comfortable 24 seven.

[00:36:22] I don't even know, I don't even know what it would be like to go back to an adjustable. I don't need it.

[00:36:27] Right. And I very, very rarely, if not at all, ever even have to add a sock. So my limb-

[00:36:37] So one of the unicorns.

[00:36:38] Well, yeah.

[00:36:39] Unicorns that I talk about on my show.

[00:36:40] Yeah. My limb doesn't really do a whole lot anymore as far as fluid exchange. It just,

[00:36:49] it is what it is. And I think my prosthetist said it's matured. It's kind of like, you're good to go.

[00:37:01] Like you're not going to be-

[00:37:02] It's mature and it's stable.

[00:37:03] Yeah. It's stable.

[00:37:05] Yes.

[00:37:05] Yeah. Which is wonderful that I can sit for long periods of time, never bothers me. You know,

[00:37:13] you can make it through an entire movie without taking your leg off, you know, all of that stuff,

[00:37:18] which is great. And I really appreciate that, Cozy, because, you know, when I do watch Cozy Talks,

[00:37:27] it's just chock full of all those little tips and tricks, you know, and real-time sort of,

[00:37:35] you know, experts kind of weighing in and, you know, giving us amputees really, really valuable

[00:37:44] information. The thing that I was wondering when I was, you know, watching, I went on a binge the

[00:37:53] other night and probably watched like, I don't know, like 15 different episodes. And yeah, it was

[00:38:01] like my Game of Thrones, you know, Cozy Talks. I was like, wow, you must've had a lot of monsters

[00:38:07] that day because I talk way too much. That's a lot of hours. No, I really enjoyed it and learned

[00:38:14] a bunch. The thing that kept pinging in my head was, how do you procure guests? I mean,

[00:38:21] walk me through that process. Meaning how do I, I'm sorry, you cut out on that one part.

[00:38:26] How do you procure guests? Like, what is your process? How do you get people to come on?

[00:38:30] What, what's your qualifiers? Like, what are you, what are you thinking of when you reach out

[00:38:36] to someone and say, yeah, I need to get them on because?

[00:38:41] Well, in the beginning, cause when I first started the show, it, I really had no intention of doing

[00:38:47] what I do now. It was just, I would go live on the amputee peer and support group and on the amputee

[00:38:52] help and support line. Those were the only two groups that would allow me to go live. So I'm still

[00:38:57] eternally grateful to those admins of those pages, but it was basically just like, I'm going to go

[00:39:02] and give the information that I keep hearing in these Facebook groups that people are just constantly

[00:39:07] asking these questions that I can just answer for them. Um, and so I did that for well over a year,

[00:39:13] uh, twice a week, every, every, every Wednesday and Thursday evening. Um, and then finally college

[00:39:19] park had been apparently listening in on my talks and they were the ones who first approached me and

[00:39:24] said, we would like to sponsor you. And I'm like, I have no idea what that means. And I'm not interested

[00:39:29] in selling anything. And they're like, no, no, no, no, no. We just want to support your educate,

[00:39:33] you're educating the community. And so when I started working with college park and then shortly

[00:39:39] afterwards, freedom innovations and limb innovations, I was, I was learning myself. So I

[00:39:45] really got to have the behind the scenes look on prosthetic feet, which is what college park really

[00:39:49] is an expert on. Um, and I would say, you know, you know, I have so many questions related to how

[00:39:56] do I choose a prosthetic foot? What am I getting myself into? What do I need to tell my prosthetist?

[00:40:00] So, okay, let's create an educational show on this and who in college park is the expert that I can

[00:40:07] bring on the show to really answer these questions. Um, and that's usually how it would come about.

[00:40:12] I I'm, I'm, you know, I've been a student of the human gate cycle for 30 years and I'm still a

[00:40:17] student. I'm still learning. Um, so it was part and parcel, just my own education as a clinician

[00:40:22] and wanting to getting an inside look as to what all this new technology, new surgical procedures,

[00:40:28] you know, targeted muscle re-innervation. I had the guy who pioneered that surgery on my show and now

[00:40:32] with osseointegration. Um, and then my patient, my viewers asking me all these questions. So going

[00:40:38] back to the adjustable socket, everybody in the world was asking me about adjustable socket

[00:40:43] technology. And I really had no concept of it. So I was just like, okay, let me go see what's out

[00:40:48] there. Who, who is making adjustable socket technology? What does it mean? And from my

[00:40:53] viewers, what are they using and what are they liking? Um, so I would kind of weigh that against

[00:41:00] what I was reading in the literature and say, you know what, this company right here, Click Medical,

[00:41:05] I'm really hearing a lot of great stuff about them. Let me learn more about them. And if I think

[00:41:11] I'm liking what I'm seeing, then let's just see if they would like to have a collaboration together.

[00:41:15] That's great. Um, and that's how a lot of this came about. A lot of it was also dumb luck.

[00:41:20] Again, people, um, who have helped me so much throughout the years introducing me, they're

[00:41:25] saying, Hey, Kosi, you really should go talk to this person here from this company or that person there.

[00:41:29] And for me, I approach them and I go, okay, what can I learn from you? What, what is it that I can

[00:41:33] learn from you that I can then bring onto the show? Um, because for me, that's, that's the mission

[00:41:38] of the show is education, information, and empowerment. Um, and it's not just for the

[00:41:42] amputees. It's also for clinicians. I've had a lot more clinicians listening in on the show because

[00:41:47] there's so much of this that is not being presented to the PT community. Um, and that's another,

[00:41:53] again, another soapbox there. Um, so that's kind of how I, you know, and there've been some companies

[00:41:59] that they've approached me, um, that I can tell that they just kind of want me to sell their product.

[00:42:08] Yeah. We've had some of that too. Yeah. And I, and I just have to politely decline or that they

[00:42:14] have a problem with me talking about competing companies. Right. Um, and I also have to politely

[00:42:20] decline because I'm just like, guys, you know, I'm trying to present as objective an opinion as

[00:42:24] possible. And I want folks to know all of their options. Um, so over the years I've kind of

[00:42:30] narrowed things down in terms of who I partner with and, and, um, who I have on the show, but I've had

[00:42:36] some phenomenal guests on the show. Yeah. It's, it's, it's great. The content I highly recommend.

[00:42:43] It's cozy talks. It's, it's not hard to find on YouTube and some of the guests are just brilliant

[00:42:51] people. Yeah. I mean, what, what they bring to the conversation is so incredibly helpful just to

[00:42:59] understand, um, you know, on an, on an engineering level, on a clinical level, you know, what, what

[00:43:06] goes into a lot of that technology. The thing I wanted to ask you too, I mean, if you were to say

[00:43:12] in a snapshot, like what's, what's exciting you right now, um, about the future of prosthetics?

[00:43:20] I am really, and this is a completely one 80 turned from just even four years ago. I am really

[00:43:26] looking forward to seeing where osseointegration takes us. Um, when I saw my first osseointegration

[00:43:32] patient in the United States, he was a bilateral AK. He had had his procedure done outside the United

[00:43:39] States and it was a disaster. It was a disaster. It was a very poor outcome. The patient had not

[00:43:46] received follow-up care. Um, the stoma sites looked awful. And I just thought who in the world would

[00:43:55] think of doing this procedure and why in the world? Well, what I didn't know at that time was that

[00:44:00] there were different methods of OI out there, um, and they were not created equal. So, but that kind

[00:44:06] of spurred me to saying, okay, I need to figure out what this surgery is because I know people are going

[00:44:11] to start asking me if they should have it done or not. And, you know, four years later, it led me to

[00:44:16] a partnership with Integrum. Um, and just seeing the work that they are doing is incredible globally.

[00:44:23] Um, and Dr. Brandenmark, he is the, his father literally invented osseointegration back in the

[00:44:29] 1960s. So the modern dental implant that we have today comes from his discoveries in the 1960s. Um,

[00:44:36] so it was really cool to be able to have that, the origin story and to really see the progression

[00:44:41] of how this has evolved to work for amputees. Um, so I don't think it is meant for everybody.

[00:44:46] I'll just put that out there. I don't think osseointegration is, everybody's a candidate for

[00:44:50] osseointegration. I think there's a very particular criteria and candidacy for that. Um, but for those

[00:44:56] who do meet that criteria, they've had some amazing outcomes and to see where that technology

[00:45:02] is going to be in 10, 15, 20 years, I think is going to be incredible. Um, so that's one thing

[00:45:07] right there. Um, I think also the advances with targeted muscle re-innervation and it kind of,

[00:45:15] kind of also correlates with OI. We're going to start to see a lot of overlap there with targeted

[00:45:19] muscle re-innervation. Yeah. Educate me on that. Yeah. Cause I'm unfamiliar with that piece.

[00:45:25] Yes. So targeted muscle re-innervation sometimes called TMR is basically a treatment for neuromas.

[00:45:31] So the quick background to that, when a surgeon does an amputation, they will typically take,

[00:45:37] after they cut through all the tissues, they'll take the nerve, pull it slightly, cut it, and then

[00:45:42] tuck it back into the tissue. And I like to say idle hands make devils work. So that little nerve

[00:45:49] ending has nothing to do, but cause trouble. So it'll form scar tissue, which is called a neuroma.

[00:45:54] If it's a motor nerve, meaning a nerve that used to control muscles, not a problem. If it's a

[00:46:00] sensory nerve, that's where you start having some severe pain and can trigger a lot of really bad

[00:46:05] phantom pain. So targeted muscle re-innervation was pioneered by Dr. Dumani in about 30 years ago.

[00:46:12] And what they discovered was if they take that nerve ending and essentially plug it back into a muscle,

[00:46:18] you're allowing that nerve to do its job and it makes it happy. And they've had some fantastic

[00:46:24] outcomes with phantom pain. And now they're using targeted muscle re-innervation also in the upper

[00:46:30] extremity for myoelectric. So for mind control prosthetic devices and kind of rewiring the nerves

[00:46:35] to function that way.

[00:46:37] It's incredible.

[00:46:38] It's kind of like the Luke Skywalker. It's a Luke Skywalker, you know,

[00:46:42] handsome scenario. And I think it's very cool.

[00:46:45] And I, you know, it's funny because I, I'm always, I'm a kind of a ferocious reader and,

[00:46:52] uh, I've always been curious about, you know, how science fiction genre, whether it's, you know,

[00:46:58] literature or film, you know, where do they get these ideas from? Like, you know, like who thought

[00:47:06] of that Luke was going to have this, you know, uh, robotic hand that, you know, looked and acted and,

[00:47:14] and did all these things. And I did, I did a deeper dive on it and I got into all of this

[00:47:20] different literature on what's referred to as futurists and futurists are these people from the

[00:47:28] scientific and medical communities that essentially theorize on what we're capable of as a species

[00:47:38] in terms of technology, in terms of what they believe is coming, not just in theory, but in

[00:47:45] practical application. And so I just, I get excited because so much of what you're talking about right

[00:47:52] now, you know, reminds me of, you know, like old sci-fi and I, and I think, you know, I guess I'm

[00:48:01] bummed because cars aren't flying yet. Although we'd have the technology, we can't, you know,

[00:48:06] we've got the, we can't get them up in the air. If I'll really wave my nerd flag high, I just thought

[00:48:12] of this, um, I love Star Trek. I love Star Trek. I'm a total Trekkie. Yeah. And there's this, one of

[00:48:19] the movies that, um, it was at the next generation and it was data, you know, the robot and he was being

[00:48:25] fit. He was being grafted with human skin and you see the robotics underneath and the human skin on top

[00:48:31] and how he was able to now feel the skin. Yeah. Um, and I remember that, that movie came out,

[00:48:37] it was with a cyborg queen or something crazy like that. So that came out like probably 15 years ago

[00:48:43] or more. Yeah. Um, and we're starting to see whispers of that now. Right. Um, so it's, it's kind

[00:48:49] of cool. Yeah. And any, anything that, you know, even in theory that could suggest that some of that

[00:48:57] phantom pain, um, um, I'm fortunate it's, it's not some, you know, I, the, the phantom pain, uh,

[00:49:05] you know, uh, demons visit me, however, not that often. So I'm very fortunate in that regard,

[00:49:13] but I know that there are plenty of patients, plenty of our community that are really struggling with

[00:49:22] that on a daily basis and my, my heart goes out to them. So, you know, those advancements very much

[00:49:29] excite me because if there is something that can be done just, just to get that whole situation under

[00:49:37] control, um, yeah, would be fantastic. Again, pushing us forward into a more comfortable space

[00:49:46] to wear a prosthesis, to get active, to get more mobile, because let's face it very often,

[00:49:53] you know, phantom pain is just another roadblock in that process. And if we can, we can remove that,

[00:49:59] we would, um, we'd see a lot better outcomes, you know, across the spectrum and some of those folks.

[00:50:06] Yeah. No. And it's, it's, we could, we probably should do another show together just on phantom pain,

[00:50:11] but there's still even just now so many of the conservative methods and actually last Wednesday,

[00:50:16] today's Friday. So two days ago on my show, I, I got into it a lot because people were asking me

[00:50:20] questions about the phantom pain. Um, there are so many conservative methods that are available

[00:50:26] that are very, um, effective that again, it's, it's finding the clinician who understands that

[00:50:32] and is willing, able to educate the person on consistency with those conservative treatments

[00:50:37] and how to present them with the different options and how to just fine tune. So if they do

[00:50:42] have to resort to a medication, you know, how they can, you know, use the smallest dosage of

[00:50:48] medication in conjunction with those, those, uh, conservative methods, but yeah, that's a whole,

[00:50:52] we can do a whole show on that alone right there. Yeah, for sure. For sure. And, you know,

[00:50:57] I feel like we just scratched the surface today. And of course, I, I want to thank you for being here,

[00:51:03] um, with you and our goes by like a blink of an eye. Um, and you know, I, I so appreciate what

[00:51:11] you bring to the community. Uh, cozy below. So is, am I saying that right? Yes, you are. Yes.

[00:51:18] Okay. Cozy, you can catch her on YouTube. Uh, cozy talks is streaming on social media and, uh,

[00:51:27] it, I would highly recommend that you check it out again. Cozy, thank you for being here.

[00:51:33] My name is Rick Bonkowski. This is the amped up to 11 podcast,

[00:51:36] and I want to wish everyone health and happiness. We'll see you next time.