A new review by Kirkus Reviews – now celebrating “80 years” reviewing books!

Here is this very important new review provided by Kirkus Reviews:


A heartwarming debut memoir about finding meaning in the face of loss.

In Garrison’s debut memoir, he recounts his experience with amputation and how it led him to devote his life to the study and production of prostheses. At 17, he was diagnosed with an aggressive form of cancer in his right foot, and his doctors told him there was a “ninety-five percent chance” that amputation would be necessary—a pivotal moment in Garrison’s life that he recreates with vivid feeling (“The effect of those words as I tipped my head back, looking directly at the blinding bright lights above, shocked me in a way that I had never experienced before”). Three months after this fateful appointment, surgeons removed his foot and ankle. To any teenager, losing a limb might seem like the end of the world, and particularly to the athletic young Garrison, who admits that before losing his foot, he was uncomfortable around people with physical disabilities. Thankfully, his intrepid spirit helped him adjust to his prosthesis; however, he was underwhelmed by his device’s quality, and his desire for a better prosthesis spurred him to pursue a career path he’d never considered before—one that began with a minimum-wage job at a prosthetic manufacturer and ended with Garrison making a living as a certified prosthetist. Garrison is a proficient writer with an inspiring story, but his self-awareness and insight into disability give weight to his memoir. His sly sense of humor, meanwhile, provides a good balance to his heavier material, as when he reflects: “I was such a wild youth, before I lost my foot, that if I had ever gone into the military, I probably would have gotten into a lot of trouble….I would be hiding from the military authority way up in the mountains somewhere with two beautiful Asian women who loved me.” Overall, this book would likely be a valuable resource for anyone learning to embrace life with a prosthesis.

A quick but moving memoir of resilience.

Pub Date:Dec. 7th, 2011
Page count:160pp
Program:Kirkus Indie
Review Posted Online:Sept. 23rd, 2013


Lower Extremity Prosthetics: Proper Management, Uncomplicated Results Kevin S. Garrison, C.P., L.P. and Gary Saff, MD

As seen in: Case In Point • www.dorlandhealth.com • December 2012

Lower extremity prosthetics are improving all the time. An amputee qualifying and participating in the Olympics is a true testament to this fact. These very complicated devices can now be provided with lighter weight yet stronger construction.

Electronic automatic vacuum suspension systems and microprocessor-controlled knees and ankles are now available as well. These advancements offer a natural ambulatory experience, especially for the bilateral amputee as never obtainable before. The relatively new prosthetic knee joint offers the amputee less thinking while standing, ambulating and sitting. It senses the absolute position of the foot and automatically tightens appropriately to prevent any loss of control or balance quite unsurprisingly. The electronic ankle actually lifts the toes of the prosthetic energy-storing foot.

This most natural automatic motion prevents us from catching the toe and falling as we walk. This ankle also automatically adjusts for different heel heights as the amputee casually chooses to change shoes. Angular changes required for ascending and descending ramps, unusual slopes and steps are easily accomplished within milliseconds. These microprocessor systems correctly offer reliable, smooth, controlled and confidence-building ambulation on the most challenging surfaces, offering another truly great advancement.

Upper extremity hands, wrists and elbows have advanced as well with similar electronic technology. Specifically, the hand has taken a leap forward with the availability of all-finger natural proportionally controlled motion. Seeing my veteran patient hold a water bottle with his new hand and then screw the top off and on with his existing hand, stating, “I can help my wife now with the baby bottles,” tells us just how important prosthetic care is.

Gauging Pressure Points

I would first like to explain what happens when an amputee lifts up their existing limb and puts all their body weight on the new residual limb. As you might guess, an enormous amount of pressure per square inch is forced on the remaining limb tissues. Knowing this, one can then begin to understand that as the residual limb may be of a shorter length, getting shorter as demonstrated by the different classified levels of amputation: very long, long, mid, short and very short, that as the limb is made shorter there rapidly becomes less peripheral weight bearing area to spread out the great pressures.

This impressive force must be properly disbursed through the prosthetic socket. The perfect fit will prevent pressure points that can lead to pain and eventual skin breakdown of varying degrees, even from abnormal gait patterns. This relates especially to the trans-tibial levels, as the trans-femoral levels are not as much at risk due to the different boney anatomy at this level.

Seeking the Perfect Fit

Creating the achievable “perfect fit” by the prosthetist is only possible through the use of sound biomechanical principals designed into the lower limb prosthesis. The use of diagnostic sockets made of high-strength plastic facilitates an ability to visually observe the illusive, important balance of pressure. With special tools the clear plastic can be precisely adjusted, adding or removing pressure anywhere within the socket. This enables the development of a properly balanced socket relative to the environmental needs of the residual limb. Biomechanical principals can also be tested as the patient ambulates on the clear check socket, thus ensuring they have been properly included in the entire socket design.

One example of proper biomechanics for the trans-tibial residual limb can be found in the relationship between the anterior patella tendon and the posterior proximal tibia. If the posterior wall is not high enough, the residual limb will not be held in an appropriate position while ambulating, which will prevent unwanted motion within the socket. The remaining limb will drift in a distal direction in short time causing undue pressure on the distal end resulting in pain. The tibia can also drift in an anterior direction repeatedly while ambulating causing anterior distal pain as well.

Another example of sound biomechanical principles being addressed in prosthetic design would be the use of proper suspension. Suspension is what keeps the prosthesis from falling off. Suspension is what keeps the prosthesis from slipping up and down causing unhealthy motion while ambulating. Suspension does directly affect the residual limb, balance, and ultimately comfort. The patients’ energy level is absolutely compromised as they actively struggle to try and use the improperly designed prosthesis allowing this unwanted and uncontrollable motion. Skin breakdown and pain will occur over time with this piston action. A high risk of falling can also develop if proper suspension is not maintained. The amputee should feel like the prosthesis moves with them, without any unwanted motion. This is proper suspension and it feels good.

Elevated vacuum (suction) suspension systems used today can actually eliminate all motion within the socket as weight is applied and removed during ambulation. The amputee truly feels one with the device, with a genuinely new level of comfort and control. These systems are said to relieve moisture within the socket as well, which is another healthy benefit for the amputee.

Now we have an excellent socket fit determined by the use of clear check socket fittings. Proper suspension has been determined through careful visual evaluation of the ambulating amputee and observing the skin, removing the prosthesis and looking for developing irritations. What else can cause pain through unwanted socket pressures? The answer is alignment. Where do we put the prosthetic foot under the amputee? Where do we put the prosthetic knee relative to the amputee, the prosthetic foot and ankle?

Without proper alignment the patient is at risk of falling, developing lower back pain, hip pain, knee pain within the sound limb and residual limb. How can this happen? One example is the prosthesis being short; this will strain the sound knee causing pain and contracture over time. If the prosthetic foot is positioned forward relative to the residual limb, the amputee will feel like they are walking up hill all day, wasting energy and contributing directly to residual limb pain. All other inappropriate alignment configurations will only com¬pound the affects listed above.

If not created with the greatest of care and consideration, the lower limb prosthesis can become a destructive force. Those that practice in pain management are well aware of how chronic pain syndromes, especially myofascial and spine-based, have their origins in a gait disturbance. Even slight pain and gait disturbance stemming from seemingly minor toe nail injuries and infections, to the more bio¬mechanically unfavorable gait disturbance from chronic arthritic pain or a poorly fitted prosthesis, can result in the toll of chronic diffuse pain complaints if proper gait and biomechanics are not restored. Lumbar and cervical disk degeneration resulting in spinal stenosis, nerve impingement, scoliosis and chronic pain are an often unfortunate result. Many chiropractic approaches to maintaining health and wellness are based upon this need for proper alignment. An attempt to treat the spine, without addressing the lower extremity issue, is often futile and frustrating both for the patient and clinician. An analogy often told to my patients is that you can’t expect your car to drive smoother, no matter how many times you adjust your seat and steering wheel, unless that very important flat front tire is fixed.

Prosthetics, these very complicated devices when created properly, sincerely contribute to a restored active life for many patients. It is genuinely a gift to receive a proper device. The amputee should feel no pain while using their new prosthesis, only optimism.

Kevin S. Garrison C.P., L.P., the author of It’s Just a Matter of Balance: You Can¹t Put a Straight Leg on a Crooked Man, is a certified and licensed prosthetist. Contact: kevinsgarrison@att.net

Gary Saff, MD, a licensed anesthesia pain interventionalist, independent medical examiner and acupuncturist at Integrated Pain Solutions of South Florida, is affiliated with Healthsouth Sunrise. Contact: saff@whatapain.com


Prosthetic Limb Problems

The use of a prosthetic limb can literally expand ones functionality to a beautiful degree or level. Restoring function or getting back to normalcy is everyone’s dream. When you have an artificial limb that is functioning properly this dream approaches reality and normalcy comes within your grasp for sure. This is your goal and your goal is shared by all the healthcare professionals involved in your prosthetic care!

What happens if the prosthesis is not the best type or design for you? What happens if the prosthesis was not constructed properly? What happens if your general health contributes to conditions that further complicate the successful limb fitting process?

What happens is, that your optimum outcome is compromised? I’ll tell you what it can lead to; it leads to the real possibility of all out rejection of the prosthetic limb, sadness and anger swelling up inside you.

In order for you to be able to approach normalcy, making your dreams come true, you must understand two things: The first is to get proper prosthetic care as you might guess! The second would be the developing of an understanding that you are the motor that makes it all work. So don’t think this all happens by itself in a vacuum so to speak. You must participate in your prosthetic care 110%, with great consistent determination, always working hard to achieve your goals!

Proper prosthetic care begins with a very skilled prosthetist. It is the responsibility of the prosthetist to get you comfortable. This means no pain at all while using your device, and excellent balance as you walk, stand and sit. For this to happen the prosthetist has to design your limb and assemble it properly then ”follow up” with you, to insure as your body changes the prosthetic limb keeps up with those inevitable changes. If you have pain issues then your prosthetist has to work with you and your doctor until you get comfortable. (I speak of this in; “It’s Just a Matter of Balance”, as I personally had all these issues to deal with from day one.)

You must be physically fit – meaning this: As you build strength – you develop control, as you develop more control – you then can develop “confidence”. When you have achieved confidence, you have achieved your goal, you’re now getting back into life as you once new it.

Make your dreams come true!
Please let me know how you’re coming along in your quest for normalcy, getting your active life back. If I can answer any questions for you please just ask!


Search for Reality – Art Work by an Amputee

I have been asked many times to explain the relevance of putting a copy of my freehand abstract india ink drawing in the book “It’s Just a Matter of Balance” – You can’t put a Straight Leg on a Crooked Man, found on page 107. Explaining why I put it in the book and also explaining what’s in the drawing I think will make for a brief bit of interesting reading.

In 1979, 8 years after my right foot amputation I was obviously still very upset because of my unfortunate and very necessary surgery. This can be easily seen in studying this drawing that took me more than a year to complete. The details are very revealing and after giving a lithographic copy to Veronica Noboa-Pantuso, MS, Psy-D, she made that very clear to me. She said “Kevin, you were so very angry when you drew this.” As she spoke in a very convincing way, Veronica went on to explain how I was expressing myself as she so easily continued interpreting the drawing.

I put “Search for Reality” in the book because I wanted to bring out, show and prove how hanging on to anger can deeply affect us, even 8 years after the event occurred. Creativity comes from a deep place within us and when truly set free, can only be a reflection of how we feel inside. Becoming free of anger is worth all the effort you can muster because the reward for that great effort is so beautiful. For me it was an opening of space in my mind as I let the anger go finally after 10 years. This enabled me to become unstuck from an unhealthy state of mind, causing an opportunity to open, allowing for growth and development to occur within me.

The drawing shows me, depicted at the bottom just to the right of a white hole, the largest white space in the 18” X 24” work of art. The drawing shows me looking into the white hole searching for reality that is within it, as what’s all around me is my world of pure fantasy, sadness and feelings of dread.

This is a link to a video of a Chinese man “Huang Guofu” that has mastered the art of drawing with his feet and mouth!


(Just copy and paste this in your browser bar. His message is beautiful and one that is very important to all disabled people and worth seeing.)

Please share other interesting art you may have seen or created yourself, I am truly very interested!!!

If you might be interested in getting a lithographic copy of “Search for Reality”, it is available only here, at our website:


Let the creativity flow!


A new clinical Book Review

A more clinical Book Review for the:
American Academy of Orthotists & Prosthetists

Title: It’s Just a Matter of Balance -You Can’t Put a Straight Leg on a Crooked Man
Author: Kevin S. Garrison, CP, LP
Publisher: iUniverse; Number of pages: 136
Reviewed by: Elizabeth Peterson, resident prosthetist, board eligible orthotist

It’s Just a Matter of Balance-You Can’t Put a Straight Leg on a Crooked Man is the story of the author’s journey from smug high school jock to certified prosthetist with his own practice. Garrison discusses how a minor foot injury interrupted his innocence in the late 1960s. As the story continues and a Desmoid tumor is diagnosed, Garrison takes the reader on a journey through his teenaged denials and emotions. His late high school antics are comical, yet laced with a touch of self-loathing.

Garrison manages to pull himself out of the depths of self-pity when he develops a curiosity about his very ill-fitting Symes-style prosthesis. A mechanical-minded tinkerer, he becomes motivated to explore a career in prosthetics and pursue a quest to fabricate “properly designed limbs.”

On his path to adulthood and throughout his education, Garrison is led to different parts of the country. The opportunities that present themselves to him can only be seen as compliments to his talents.

In summary: This book is ideal for those looking to get into the field. Garrison touches on the requirements that he needed to attend prosthetics school and gives insight on what current students can expect (from patient models to the dreaded critique).

Featuring a humorous but sincere forward from Academy President-Elect Mac McClellan, CPO, LPO, FISPO, FAAOP, this is an enjoyable, quick read that can easily fit into the “inspirational” section of a personal library.

Well, I am happy to say that I’ve gotten over my self-loathing. On a more serious note, I am so very proud to say that “It’s Just a Matter of Balance – You Can’t Put a Straight Leg on a Crooked Man” is recommended reading by the Academy!!! WOW

This review can be found here at the AOPA web site:



A Lecture Before Going on a Long Vacation

It’s very unusual for me to take a nice long vacation, from it all. I remember being in private practice as I am, and having a difficult time justifying taking a lengthy vacation for 7 years one time. I never want that to happen again. I am writing to you now from Israel, here visiting with my beautiful extended family and visiting all the ancient sites we can, taking allot of pictures!

I just spoke to Nursing students on the 4th and 5th at Chamberlain College of Nursing in Miramar Florida. I was asked to speak by Dr. Linda Gettinger-Dinner. She was providing an incredible level of insight to her students instructing them on the subject of adolescent psychology. She honored me by asking me to speak to the students about my personal struggles as a teen relating to my most challenging confrontation with permanent disability.

I spoke in detail about my experience, my extreme sadness and anger as I struggled to get my life back. The mistakes I made and the unbelievable need I had to feel normal again. I read from “It’s Just a Matter of Balance”, pages relating to my initial shock after amputation, my psychological denial and introversion.

I read the students a passage in the book where I honor their career so to speak as I reminisced how my most helpful healthcare worker during my ordeal at the hospital was a “Nurse”.

The lecturing experience was mutually enjoyed and I look forward to the next opportunity I will be given to speak to the students at Chamberlain College. I invited the students to check out this Blog. I hope they do to learn more about permanent disability, as they work very hard toward becoming excellent future nurses!


Why put so much time and effort into writing a book?

Are you passionate about life? That’s reason enough in my most humble opinion, to write a book. Here are few more reasons:

Do you have something to say?
So you have something to share?
Do you want to contribute to the creation of something that’s even greater than yourself?
Do you want to help in strengthening the human condition by telling your story or possibly clarifying something that needs to be, or should be clarified?
Bring out the truth in a situation that has been corrupted over time.
Help create laughter.
Help to create a pleasant escape from reality.

This little list could grow longer and longer until it would wrap around our planet a dozen or so times. If you’re going to give it a try, writing your book, I can offer some simple advice if your interested.

One thing I quickly discovered as I started the process is, that you need to direct your story to someone, create a reference point. Like in “It’s Just a Matter of Balance”, I directed my attention to those that I felt would be very interested in reading it. In a way, I was telling my story to them as if they were sitting directly in front of me. Your choice should be based on the subject matter. I chose to speak to several groups of people:

The general public just interested in a good inspirational story
High school students especially those interested in healthcare
College students especially those interested in healthcare
Professionals very involved in the care of permanently disabled people
Permanently disabled people
The family members of permanently disabled people

They were all my focus as I organized and wrote my story. I actually started with a Palm held computer, punching away one letter at a time as I waited for my son Gabe to finish his gymnastics program. Boy was that boring, to wait. It was boring only because you couldn’t even see the children as they were taught to bounce, swing and tumble repeatedly. I eventually had so much information stored in my hand held computer that it took a bit of time to boot up. I finally decided it was time to get it into my desktop computer.

So what was I so feverishly typing as I waited twice a week for gymnastics to be over? I was writing everything that I felt was relevant to the proper telling of my story. I was not concerned about the order of all the facts, I just wanted to get them all on paper, all my important thoughts that were extremely relevant to my purpose. The telling of my personal experience with a life-changing event that occurred in my life about 33 years earlier would make a great story. As my memory flexed its muscles, my fingers just had to keep up so nothing was lost, it all came out and flew into words strung together in somewhat legible sentences.

As the book developed I spent quite allot of time checking the time lines for accuracy, and checking my facts for clarity. I spent over 3 years working mostly late at night when it was very quite around the house. I remember one night throwing up my hands and starting to pray out loud, asking that all this time and effort would not be for nothing. I was getting very tired of reading and rereading the book over and over again. I even spent 4 weeks just going over the last big paragraph in the last chapter. I asked as I prayed, that if my book, my story helped only one person, than I would feel satisfied knowing that it was worth all my efforts!

You see, I wanted to help by strengthening the human condition! Three weeks after the book came out I received an e-mail testimonial that made it all worth it for me. Please read it here below:

Dear Kevin:
Reading your book, It’s Just a Matter of Balance, evoked a lot of memories, some good… others bad. I remember the times spent in the military hospital with my own “kind,” and how we used to joke about our situation. I was glad that the hospital I was in was far away from my family — I hated visits. Before all this, I used to exercise and had a pretty good physique. I would never be the same, I thought. I tried a half-hearted attempt to end it with pills. After I got my prosthesis, I made sure that whenever I sat next to anyone, especially girls, it would be on their left, thus avoiding any possibility of them touching my left leg. I used to own a 1966 GTO or Goat as it was called then. It had a 389 tri-power (3 carbs) 3/4 cam, posi rear. I lost a cop that was chasing me one time. I’ve had numerous accidents, my license taken away from me. My wife, (fiancé at that time) was in one of those accidents; she sustained a compound fracture of her arm. I thank God that she did not take her family’s advice to leave me.

Kevin, I have gotten past that craziness, but I still had something that made me feel standoffish. Notice I said had. God works in mysterious ways; your book was one of them. I can now say that I have come full circle.
Thank you,
Samuel Negron
Disabled Vietnam Veteran

If you have a book in you, just make it happen!!!


The Prosthetic Profession – from an Amputees Point of View

Moving like the speed of light we search for the answer to our question. We usually ask the question to our doctor first, then possibly a near by nurse or physical therapist. The occupational therapist could be a nice target for the question as well, as we start the recovery process.

Everyone has a different initial internal experience when receiving an amputation. I mean that some of us get a fair warning of sorts as to what rough treatment needs to occur to save our life. Some simply wake up to find they have lost a limb, possibly even more than one. We all ask the same question but in a different state of mind. So what is the question? “How will I be able to replace the limb-limbs that I’ve just lost?” Getting the best answer to this question I feel, will ultimately come from a “Prosthetist”, with all do respect to the professionals listed above.

We need a new limb, and it needs to replace the one lost as perfectly as possible. This becomes as important to us as breathing is! We need to feel whole again, absolutely seeing a future with as little change in our cosmetic appearance and life style as is humanly possible. The prosthetist now becomes a very central focus of our attention in our life, as we struggle to get our lives back to normalcy.

A prosthetist is someone that has chosen to be part of a wonderful ever evolving profession; the field of upper and lower limb prosthetics!

The prosthetic profession is comprised of four main organizations, and here they are listed below for your review.

This first organization is designed to have a pure focus on education, and its name is:

The American Academy of Orthotists and Prosthetists

Here is an internet link to deeper information as to this organizations true purpose-


This second organization has a focus on testing for certification of not only prosthetists but also accrediting prosthetic facilities as well:

The American Board for Certification in Orthotics, Prosthetics & Pedorthics

Here is an internet link to deeper information as to this organizations true purpose-


This third one concentrates only on our very important educational standards:

The National Commission on Orthotic and Prosthetic Education

Here is an internet link to deeper information as to this organizations true purpose-


The forth organization I am listing for your review has a focal point exclusively on business issues that are very important and directly impact the stability of the prosthetic profession in the short term and long term as well:

The American Orthotic & Prosthetic Association

Here is an internet link to deeper information as to this organizations true purpose-


These trained professionals, prosthetists, need to gain our trust quickly. We need to feel totally comfortable with them as we give them the responsibility of caring for us, attending to all our most personal prosthetic needs. They need to educate us quickly as to the realities of our most personal situation. We do need to trust them and they need to know that they are most defiantly deserving of our trust. This obviously makes for the best kind of relationship you can have, even with anyone!

With amazing determination from a highly educated and experienced prosthetist, your highest quality of prosthetic care is truly available. These organizations listed above truly empower the prosthetists that they produce and watch over.

In my humble experience, from an amputees point of view and as a prosthetist for approximate 40 years now, I have seen allot of changes in this profession to be sure. Some very positive and some not so positive, but one thing that hasn’t changed, is the need the amputee has, to feel a great confidence within that they are always receiving what they are genuinely entitled to: empathetic, professional and most competent prosthetic care!

Have you been happy with your prosthetic care?
I care, so if you dare, please share!!!


If you don’t want to bring out the worst in people (caused directly by you), then just bring out the best in yourself.

Continue reading


Adjustment to Prosthetic Use

I have a question: Is a lower or upper limb prosthesis (prosthetic device) complicated to make properly? If your answer is “yes”, you are very correct. Artificial limbs involve quite a few steps that are directly related to the final intended design. What does this mean? Depending on several factors, the prosthesis is developed, and some of these factors are: intended activity level, patient weight, length of the residual limb (remaining limb) relating to overall body height , overall body condition (weak, heart or lung issues, diabetic), patient requests relating to specific functional intended use, allergies, limb joint contractures, swelling issues relating directly to the residual limb. All the above must be taken into consideration because this will then allow the prosthetist to provide a properly considered device.

What else needs to be considered to enable the providing of a complex limb prosthesis besides all of the above? Well now were talking about the fun part, fabrication!!! Yes, for me it’s the absolute fun part. For the first step, (no pun intended) a copy of the residual limb needs to be created with great accuracy. The prosthesis suspends from the remaining limb and also, especially for the lower extremity, weight is put directly around and on it. When the person missing a limb stands on the prosthesis and walks, total body weight is loaded on the remaining limb.

The socket fit, shape and design, must be very accurate to control the great pressures per square inch that develop quickly as one stands and walks. We take our weight normally through our skeleton all the way down to our feet. When the limb is cut and we no longer have a foot or possibly a knee, we can no longer take the weight directly through the skeleton any more. The weight bearing pressure in the prosthesis must now be spread all around the residual limb in a very precise way. We must properly balance the pressure. When done correctly, there is no discomfort because the skin adjusts over a short time to the new environment it is placed in. If the prosthesis is initially used in a controlled manner, wearing the prosthesis for short periods of time and then standing and walking for short periods of time as well, the adjustment is smooth and the joy of walking develops quickly!

Second, we need to put it all together, simple, correct? No, not simple at all. Where is the best place to put the foot under the body, it can be put anywhere, and the knee as well. Where is the best position under the body? If the foot is placed improperly like to far in front the effect felt will be like walking up hill all day. If the foot is placed to far behind the effect will be like walking down a hill all day. Placed to close to the other foot under the body will cause the knee to get pushed outwardly with each step. If the foot is placed to far away from the other foot the opposite effect will occur. If the prosthetic limb is to short the other knee and hip can be strained and if it’s made to long, uncomfortable pressures will occur rapidly and nice cosmetic walking will become impossible.

Below the knee type devices have alienable systems that offer 12 independent adjustments and above the knee types offer 20 different adjustments. Artificial limbs are very complex. Correctly made devices offer restored balance and an opportunity to resume an active life style. If the prosthesis is not contributing to an improved quality of life for you or someone you know, get it fixed. Do not give up if you’re having problems, get it fixed. You are entitled to a properly fitting comfortable prosthesis!!!

This is an organization with a wealth of information on this subject: www.oandp.com
Any questions, just ask, it will be my pleasure to help.