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The Prosthetics and Orthotics Podcast
The Prosthetics and Orthotics Podcast is a deep dive into what 3D printing and Additive Manufacturing mean for prosthetics and orthotics. We’re Brent and Joris both passionate about 3D printing and Additive Manufacturing. We’re on a journey together to explore the digitization of prostheses and orthoses together. Join us! Have a question, suggestion or guest for us? Reach out. Or have a listen to the podcast here. The Prosthetic and Orthotic field is experiencing a revolution where manufacturing is being digitized. 3D scanning, CAD software, machine learning, automation software, apps, the internet, new materials and Additive Manufacturing are all impactful in and of themselves. These developments are now, in concert, collectively reshaping orthotics and prosthetics right now. We want to be on the cutting edge of these developments and understand them as they happen. We’ve decided to do a podcast to learn, understand and explore the revolution in prosthetics and orthotics.
The Prosthetics and Orthotics Podcast
Valves, Sockets, and Creating Consistency in Prosthetic Care With Matthew Doering
Matt Doering shares how Cypress Adaptive came to fruition.
• Entering the prosthetic industry through an unexpected path from Coast Guard service to selling cars
• Building Cypress Adaptive with a focus on superior valve technology using spring and diaphragm systems that work even with debris present
• Designing components with replaceable parts that prioritize patient convenience over planned obsolescence
• Introducing the Symphony Aqua system that captures limb shape under weight-bearing conditions
• Creating a repeatable "recipe" for successful socket fabrication that bridges the experience gap between senior and junior practitioners
• Addressing industry challenges of consistency and knowledge transfer as new master's-level practitioners enter the field
• Enabling practice owners to maintain quality standards across all clinicians through systematized approaches
• Fostering collaboration between traditional fabrication methods and new technologies like 3D printing
• Emphasizing patient-centric care while maintaining business sustainability
To learn more about Cypress Adaptive's products and the Symphony Aqua system, visit cypressadaptive.com or reach out directly through their website.
Special thanks to Advanced 3D for sponsoring this episode.
Welcome to Season 11 of the Prosthetics and Orthotics Podcast. This is where we chat with experts in the field, patients who use these devices, physical therapists and the vendors who make it all happen. Our goal is to share stories, tips and insights that ultimately help our patients get the best possible outcomes. Tune in and join the conversation. We are thrilled you're here and hope it is the highlight of your day. Hello everyone, this is Brent and Yoris with the Prosthetics and Orthotics podcast, but, as you can probably hear, yoris isn't doing the introduction here, so he is actually at a trade show, so you only get me today, but that's okay because we're going to have a good time. We have Matt Doering from Cypress Adaptive here with us.
Speaker 1:One really neat thing that I know about Cypress is they want to come alongside of you and help you create a prosthesis. That's the right thing for your patients. The things that they're known for are their valves and other components that go along with it, but they're also known for sockets. A lot of people haven't heard of the Symphony Aqua system, which we'll probably get into a little bit, but it's using water pressure to create trans-tibial and trans-femoral sockets with amazing success, and so the neat thing about that and, as you know, I love recipes to get patients great outcomes, so we'll also hop into that as well. So, matt, welcome to the show. Thanks, brent, I appreciate it. Yeah, man, well, our first question to you is always how did you get involved in the prosthetic and orthotic field?
Speaker 2:I don't think I've ever told you this story. I don't know. It's a little bit interesting to me. It's not your traditional way and you'll understand what I mean in a few seconds. I was in the Coast Guard when I was a younger man. But yeah, so you know, I was in the Coast Guard when I was a younger man, it's. It's funny how in this industry, it doesn't take long to look back like, wow, I'm like, I'm like one of the older guys in the industry. Like, quickly, I've been in this field 26 plus years now. So, anyway, I got out of the Coast Guard.
Speaker 2:I didn't know what I wanted to do. My wife had got accepted into veterinary school. She's a veterinarian and so I moved back across the country. She was already in school, she graduated, I graduated. I didn't know what I wanted to do. We moved down to Tampa and I got a job building boathouses in the middle of summer in Tampa, moving from a northern climate, moving from a Northern climate. And just to fill time and figure out what I wanted to do, well, I blacked out on a roof of a boathouse. After, within the first couple of months, I'm like, okay, I, yeah, I'm not, I'm not doing physical labor in the summer down in this environment. So I didn't know what I wanted to do.
Speaker 2:I got a job at a Ford dealership. It was like a big marquee Ford dealership thing. Just till I kind of got my feet settled and figured out what direction I wanted to go. Well, I went through a training program at the Ford dealership and then we had like one of those offsite sales like Sunday, sunday, sunday. You know, come here, buy your car, all that. So I'm like if I'm going to do this, I want to understand it, I want to get good at it, that's how you're going to make money. So it's funny. People in my little class, my education class for the dealership, they were judging cars as they pulled into the tent sale, like I'm not going to help them. I was like I'm going to help everybody, cause the only way I'm going to learn is just to help everybody. Make my mistakes, look like an idiot, all that fun stuff. And this green Nissan I remember this so vividly this green Nissan Pathfinder pulls into this offsite sale with Tasmanian devils painted all over it and no one's. They're like oh, I'm not taking that. I'm like I'll take them. Well, fast forward.
Speaker 2:That was the owner of Euro International. It was a pretty well established company at the time where, just kind of starting, they were starting to get a name. They used to be a subsidiary of Autobot. That's literally how I learned that our industry even existed. I sold them a brand new car. He happened to live near me and they messed up his paperwork, so I brought him his paperwork. I was at his house and I flat out asked him. I said hey, you know, I see you import, export, mike, do you have any opportunities in your company? He thought about it and after a couple of weeks he called me and said why don't you come in? And I started working there part time at Euro International and working the Ford dealership and I ended up traveling all over the world with this guy and learn this industry and never really looked back.
Speaker 1:So Wow, that is an amazing story and I think it goes to show, though I love the kind of the attitude or wherewithal like hey, we're going to help everyone, and I think that kind of attitude can take you a long way, especially with you know, in the prosthetic and orthotic field, not only are we a niche industry, but we also serve a niche subset of patients and doctors, subset of patients and doctors, and word gets around quickly if you're not doing the right thing or helping the right thing or what have you. So that's pretty cool.
Speaker 2:So yeah, it was a neat experience to just looking back and reflecting on that to now. So it's quite a journey on that to now. So it's quite a journey.
Speaker 1:Well, let's talk about now. Where are you at now? Tell us a little bit about your company, and then we'll kind of dive in from there.
Speaker 2:Yeah, and I'm not knocking anyone that has done it, but we all know if you've been in the industry a while, you know people. I always lovingly and jokingly refer to our industry as Hotel California, because you could check out anytime you like. But you can never really leave, especially once you get a certain level of experience and knowledge, because it's such a nuanced industry. We've all seen it. People that have come in from pharmaceutical companies or venture capital companies tend to fail a lot trying to buy patient care, or they did early on. It's changed a little bit but it takes time to learn and once you learn you have a very valuable skill set. Even on my side the manufacturing, supply, sales side of things you really have to understand a lot about it and it's great, I love it. It's a very, very rewarding field.
Speaker 2:But some people in our industry have jumped from job company to company, the company, the company. I've been fortunate where I have not. You know I started at Euro International. Then I went out on my own as an independent rep type person and I represented Endolite. I was literally the first independent sales rep at Endolite. Before they didn't even have sales reps.
Speaker 2:And that's before Blatchford even existed. So I repped Endolite. Who else did I rep ESP? I repped ESP so and then I repped a brace company called Hope Orthopedic and then I eventually bought my own foot orthotic lab I was partners with. We used to make all Dr Comfort's custom orthotics before they made their own. So you know, I kind of just started really diving in. So my track record after Endolite I became a full-time salesperson at Endolite and dropped the ESP lines, hope lines. I sold my interest in the footer thought of company and I just focused on Nendola. I really liked the prosthetic side of our industry so I really focused on that. So I was there 12 years and then I transitioned from there to ESP. I was at ESP for two years and then it wasn't necessarily the direction I wanted to go. You know, after kind of being there and I was reevaluating, so I wanted to start my own company. So in 2016, I started Cypress Adaptive and um and once again, never kind of looked back.
Speaker 2:Just shortly after I started Cypress Adaptive I met Andreas, who you've met. Andreas Ratschmiller is the founder and developer of the Symphony Aqua system. I met him at the Boston show, aopa, boston show right shortly after I started Cypress Adaptive. They were at the Medi booth and Medi was showing the systems and Andreas and his other partner was there demonstrating the system. Well, that was the show that Oser bought Medi and they did a great job. Because you know our industry, word travels real, real fast and they did a great job and no one knew anything about that. That was one of the best acquisitions. That was kept quiet because it was a shock to everybody when that happened. Long story short, that system I got introduced to Andreas after word got out that they were bought by Oser and Andreas was also kind of introduced to myself and my partner Lynn and people know the name Lynn Lynn's been around the industry a long time. She is my business partner.
Speaker 2:I'm always reluctant on how I say this, brent, but the reason I do I like making the correlation with her name just to validate that we know what we're doing when it comes to manufacturing valves. We have a lot of experience and a lot of knowledge in how to manufacture valves the right way. My partner Lynn is Lynn Lynn Valve. Lynn Lynn Valve was named after Lynn. She helped really brand that and get that to what it is today. So that's the only reason. I like making that correlation just, uh, just to validate.
Speaker 2:Like I, you know, we're not just trying to throw a valve out in the industry. We designed our valves a very specific reason for a very specific you know because we know functionally that spring and diaphragm concept is far superior than anything else that exists. And what I mean by that specifically is you can get a fair amount of debris in that spring and diaphragm setup and that valve will still function totally fine, whereas if you have a duckbill valve or an umbrella valve or something like that, you get a little piece of lint in there and it's going to leak. Ours don't. Plus, you can replace parts in our valves like you could buy a new diaphragm for like eight dollars and keep that valve functioning even longer. We would like you to buy a new valve, but this ultimately helps the patient and the practitioner.
Speaker 2:So our philosophy from early stage going into it was, if we can make these parts replaceable for low cost to keep the functionality going and not inconvenience patients because they can quickly get it swapped out not be an inconvenience in time and money and everything else, then in the long run we felt like we were going to get a good portion of that business in time and the volume would be high enough where it would sustain ourselves by not selling a new valve every time, because our whole world is planned obsolescence. You know, your washing machines last five years and they break and they want you to buy a new one. That's a horrible model and we didn't want to do that. So that might have been a little long-winded as to explain that, but no, well, I think that's interesting.
Speaker 1:So you really have a you know a couple um diversified products. You've got the the valve lineup and some of the accessory side of things, and then you have the symphony aqua stuff. What would you say is your philosophy around valves? Um, like, what makes a good valve? You mentioned a couple different the spring and diaphragm duck bills. Can you take us into the weeds a little bit and then kind of why you landed on where you're at? And then also from the patient side? I'm sure Lynn you know exactly how she feels about valves as well. From the patient side, what is important?
Speaker 2:Yeah, so both, both. It goes hand in hand for both practitioner and patient. You know the, the reason we approached. We kudos to you, know esp, and we know how the sausage is made and we know where, where, where it truly came from, where the designs and and the concept truly came from. You know it isn't. You know it isn't. You know it isn't 100% proprietary. But we felt strongly, like I said, because it's a superior methodology.
Speaker 2:But the key on a good valve is just you have great airflow, automatic airflow expulsion, so as little as a half PSI, no matter what you get a little leak in your sleeve or something, that air is being pushed out with minimal effort all the time. So it's always working. It's kind of quietly working in the background, but if you have a leak it can't fully keep up with it. You're always going to, but it's always pushing air out. You need very smooth airflow and functionality. Operation has to be smooth, very little effort and there's obviously there's a lot of dexterity issues with people with multiple limb loss, digit loss and everything else. So you also have to take into consideration that for design, if it's a valve that has to be unscrewed from the socket or a button push. Well, some people don't have that ability, especially upper extremity that are multiple extremity loss, if they only have one arm and they're trying to doff their prosthesis and they have to push a button like that, that's very, very challenging.
Speaker 2:So, you know, a good valve will be thinking of these different things and that's why our valve line is kind of expanded as well, because there is no black and white in prosthetics. It's always gray, it's always nuanced. There's always going to be someone that has a, you know, a situation that's slightly different than the norm, and so you have to be able to accommodate these patients. They have to be able to function and live their life, you know. So you, you always are trying to approach it from that, from a, from a patient perspective, like how can we make this easier?
Speaker 2:You know, and in the early stages, like anything, you have your trials and tribulations like all right, we need to improve that. But a good company and a good product will evolve and just drive more and more efficiency and and smooth this into it until the point you know where it's like all right, this is pretty dialed in and we we've gone through those iterations of our valves and we're very confident where we're at now. It's I mean shit, we're coming up to what I started january 2016, so we're, in essence, in our 10th year, or gonna be starting our 10th year how that works, but yeah, you know. So we've, we've been around enough and we've evolved it. I I would put our valves against anyone for sure.
Speaker 1:So so, um, yeah, let's let's take a look like 2016 to now. I mean, you've done some evolving, not only as a company but in some of the uh, the manufacturing and that sort of thing. And so, from what you've explained to me before, there's there's like to prevent leaks. Air is very sneaky, right, it can get in pretty much anywhere and somehow you have to seal that off. Can you take? I mean, you don't have to share, like how it's done, but like that's right. What is important when it comes to manufacturing and things that that you know some of our listeners may not even think about, when it comes to manufacturing these very precise bodies, essentially to make sure that you don't have the leaks?
Speaker 2:Well, so manufacturing from the prosthetic side, manufacturing and fabricating into a prosthesis, or manufacturing from our side, from design.
Speaker 1:Well, I guess I didn't think about it from the prosthetic side. I'm guessing that's probably the weakest link is our manufacturing for?
Speaker 2:Those are your words, man.
Speaker 1:Hey, I'll poke at us all the time you know, but so let's, well, let's talk about, you know, making sure that your product's good, right that side of things, but then let's, then we can talk about the challenges of, like, the customer service side of troubleshooting this. So I think that would be a good segue, service side of troubleshooting this.
Speaker 2:So I think that that would be a good segue. Well, from the manufacturing side, you know, to make it function properly, you're working with very small tolerances, like a sheet of a piece of paper, sometimes less, sometimes two sheets of paper, and a slight difference in those tolerances can decrease the functionality of it. And so that that's very challenging, especially because you, especially because we started with machining all our valves and we still machine a fair amount but because of our volumes, hit a point where it made sense. Molds are as you probably are aware of. Molds can be very, very expensive. But we started smartly investing in some molding, especially for a lot of our valves that have similar parts, because it's a smarter way to do it. But you don't even have to know what it is exactly. But a vent spool, right, the vent spool is a very important small piece in all of our valves. We have two different, three different types of vent spools Between the three types. They're pretty much across the board in a series of different valves.
Speaker 2:Well, that gets tricky. Like I said, those tolerances, if they're off a little bit, that can really make something not work or be problematic. And to the practitioner side, you don't hear about. If people are having issues with our valve, they don't necessarily are going to call us like, hey, I tried this valve and this didn't work. It's a commodity product. They're just going to move on and say I tried it and they're going to go right back to what they were using before. That's very difficult from a manufacturing side because you work really hard to build some confidence for someone to try you and then, if they try and you have an issue, that's very, very hard to get their them to come back and be willing to give it another try, especially if you have a problem. So, whereas a knee or something else a more higher end product, if something doesn't function properly, you are absolutely going to call the manufacturer and say, hey, I don't know what's going on with this, but software's glitching or this is functionally, this mechanically, this isn't working. And we don't hear that as much. We do occasionally still, but you don't hear that as much, like I said, Brent, because they're just going to go back to what they were doing before.
Speaker 2:So that's one of the challenges from the manufacturing side. That's why it's so important to both think about it from the patient side and what they have to deal with, but also the practitioner side in their manufacturing process. And this is where the chuckle comes in a little bit. And even when my 12 years at Endolite you really have to. That's not the right word. You have to word things in a way and make things easy for people to digest. And the reason being it isn't not, it isn't picking on practitioners.
Speaker 2:Practitioners are burdened with a lot of stuff, as you know. They have many, many hats they have to wear and very little time, and so to be able to shift gears when you're trying to be productive now like now, I got to troubleshoot this. I have to trouble, I have to learn how to do this. I have to learn how to do that. Our industry, the practitioners, are creatures of habit, it's, it just is. So it's hard to convince them like I. This is slightly different than what you've been doing, but there's an upside to it. That's very hard. So it isn't because you know they don't pay attention or they don't care. They do, but they're limited in time. So you have to try to make things as easy as humanly possible to make those types of transitions to new products. So I don't know if that kind of answered the question a little bit.
Speaker 1:Well, no, I think I think that's important.
Speaker 1:I think you touch on, you know, even talking about how you got involved with your first position and then moving on. I mean, and then you talked about the, the vcs, you know, sometimes coming in with some you know a lot of money and they thinking that they can take over this industry with a lot of money, um, but what you're explaining is, you know, you've been around for a long time, but this industry and we have a lot of other vendors and people listen to the podcast to find out how to better serve our industry. But I think the key to this is relationships, relationships, relationships and picking up the phone. And so I'd love for you to just dig in a little bit on your philosophy at Cypress about that, because it is so important, because we see people come and go very quickly. Money comes in real quick and gets burned up pretty much, and then they move on, and there's not a big appetite for that in our field either. So people, yes, they're creatures of habit, but they're also creatures of those that will stay and reinvest their money.
Speaker 2:Yeah, I mean I think that's a very good point and that's one of the things I'm proud of as well. They, you know I referenced 26 plus years and I started at 98. My partner, lynn, has been in the field Same. I actually have maybe a year longer than me, 26, 27 years. We have another partner who does a lot of our design work and our technical and troubleshooting aspects of our product line, not just the valves. He's been in the field 20 plus years. He has, like I mean geez, between his time in prosthetics and before prosthetics he's got 30 plus years working with silicone, like he used to be, you know, do a lot of the silicone design and manufacturing for ESP back in the. So he is a great asset to have and so we've all been in this a long time and we feel very fortunate.
Speaker 2:Yeah, there's frustrations in our industry. There's challenges. There's a lot of dynamic shifts going on, you know, with the onset of manufacturers getting in more and more into patient care. There's some of the regulation issues. You know there's a number of things going on but at the end of the day it's a very rewarding field. To's a number of things going on but at the end of the day. It's a very rewarding field to be a part of, where you can truly help individual people and get them functioning and very much participating in society.
Speaker 2:I'm going to go off on a slight tangent here, but one of the most rewarding things that I've been a part of, that I love about this industry is seeing and it doesn't happen with everyone and once you're going to realize where I'm going with this in a second. But when you have a patient that goes through that they just lost their limb for whatever vascular reasons, trauma, who knows? There's a whole psychological rollercoaster that they're going to go on as well to my life is over. But when you get them surrounded with good peer support of people that have gone through the process, I love, love, love. Seeing someone that feels like their life is over to now. Like, tell me I can't go ride that bike 200 miles. Tell me I can't go hike that mountain, and they do more without their limbs than they did when they had all their limbs, more without their limbs than they did when they had all their limbs. I mean, how cool is that? I mean that's what I'm saying.
Speaker 2:I love that aspect about the field that we're in being able to help people. Not a lot of people get that opportunity. Yeah, doctors and all this stuff. There are other things, but man, just the uniqueness of our industry, it's. It's been the best thing in my life for sure, being a part of it, no doubt about it. And, like I said, that comes with its fair share of frustrations as well. But at the end of the day, if that that'll pass, those frustrations are fleeting, they come and go.
Speaker 1:So yeah, well, I know we've talked before and I'd love for you just to share a little bit about it. I mean, the reality is is, uh, you could sell into any industry, like you personally you've been. You've been in a lot of things and you've chosen this because you've seen the life change of the things that you can do. I think that's the interesting thing that I see. This is maybe we can touch on this a little bit is, you know, with the education changing to a master's level program and you know who knows where it's going to go from there, you have a large population of people coming in for that feeling, right, the feeling of, hey, I'm making a difference in a patient's life. But a lot of times, uh, obviously feelings don't pay the bills either, um, but they so a lot of.
Speaker 1:There's a lot of engineers that come into our field and they, they want to make a difference in people's lives and they're doing it, they're doing it and then, but they're seeing their friends that are engineers make way more money, right, and? And with that master's degree, you can, just because you, by nature of you, have an extra piece of paper it doesn't matter that it's in prosthetics or orthotics extra piece of paper, it doesn't matter that it's in prosthetics or orthotics. You have the ability to bail on the industry, essentially, and go make more money. And so I think it's interesting for those that are looking. Can money be made in O&P?
Speaker 1:Yes, sure, can more money be made outside of O&P, selling into the automotive space, dod, that sort of thing? Yes, very much so from an engineering or even a clinical standpoint. But there is something special about our field and what we're able to. Obviously, along with the patients, empower people to do and make a difference. Obviously, along with the patients, empower people to do and make a difference. I'd love for you just to share some of your insights on that aspect. I've been in the field.
Speaker 1:Actually, we probably started about the same time, matt, I was like 1996.
Speaker 2:It was actually when I first got into the field. Damn Brad, you're way older than.
Speaker 1:I thought. But what's interesting is, now that I'm on this side and I've been through, you know, some different jobs, I probably hopped, when I wasn't supposed to hop, you know, to another job. Right your freedom and also chase, you know, a group of leaders, a business, or start your own place, but don't chase the money, chase the freedom.
Speaker 2:So I'm just kind of curious on your input from I love that you said it that way, A hundred percent've. I've had very similar conversations over the years to younger people. Older people do when we're just kind of you know spitballing about, you know getting nostalgic and stuff. If you do the right thing by the patient and you are consistent with that over time, just like any investing, you're investing in yourself. The money will come. Like you said, even if the engineers that come in and if they went into automotive and that's a great example yeah, they could most likely make more money. But then it's the quality of life issue and fulfillment issue as well that yeah, the money might seem great initially, but then eventually, what am I doing? Why am I doing this? But even to digress further, this is a new phenomenon within our industry. Once the education side of things started getting on par with what it should be and I truly believe I think a master's degree is the right level. Yes, you can expand on that. Some people are just made for academia and they will always stay in that crack, which is fine. We need that, um.
Speaker 2:But we have such an influx of younger people coming in because historically, you know this, like the way people came into our industry is they. They knew someone their neighbor or uncle, relative, whatever was an empty. They met this place and they started working in the back. They started sweeping the floors in the back right. Then they liked it. It's kind of neat, you know, it's very artsy, hand crafts. Um, then they start standing on some foot orthotics right. Then they start to get to observe and work on some bks and then most of the time at that stage they either go become a tech or they eventually go to school and become a practitioner. Well, that that's still exists, but that's not the predominant way people are coming into this field. They're learning of this. Orthotics, prosthetics, like huh, you can get a master's degree in this. I can work with patients, I can, you know. So you have so many people that are coming into the field with no real hand skills, no real experience. They're gaining that you know, but they don't. They don't have that. And how historically our system was working, and I'm not saying one's better than the other, that's just a reality. That's just that's where we're at now. That's what we're, that's where our industry is.
Speaker 2:But this, this is why the 3d printing side of things that you've been on the forefront of, a pioneer of and there's several guys you know that I follow. I don't I'm not well-versed in the 3d printing space, other than what I've kind of learned from you and some of the other people just from observation or conversations that you and I have had. I'm a fan. I'm not anti-3D printing. You and I talked and I don't know if I should talk about this but, as I told you, Cypress Adaptive wants to work with your community and I'm saying your community, but you are a figurehead in the 3D printing space, so specific in our industry. We want to work with you. You and I already talked about some cool ideas and concepts that we could share and try to make something very unique for that.
Speaker 2:It's not going away. It's very much a part of our industry. It's going to continue to grow. It's going to continue to find its place. We want to help foster that. We want to be a part of that. You know as much as possible. So how do we blend our technology you know in our valves and what we do into what you do and we have some more specific details. But you know, I'm excited at that prospect. It might not go anywhere but I think it can.
Speaker 1:I think we've talked about some pretty cool things that we might be able to do, and you know, let's, we'll see where that goes, yeah no, I think it's, I think it's great and I think, uh, and before we get into the, uh, symphony Aqua, you know the the this idea of the recipe for manufacturing. How cool would it be that you knew that your valves were going in something, the way that you specified them to go every single time you know for the manufacturing side.
Speaker 1:I mean, it would be a win-win-win, Win-win-win For everybody, and so I think that's. The neat thing that is really at stake here is, you know, with 3D printing, the vendors, manufacturers, get to specify exactly the way they want, how their valve or whatever component they want is to be used, how their valve or whatever component they want is to be used. And you know that is via files, that's via instruction. But the reality is right now, for those that are doing traditional FAB is, almost every application of the device is an off-label application, right? It's like everything is unique.
Speaker 1:Well, I just was going to move it this way and I'm saying that to poke fun at our industry, but that's really the way it is and so you can say, till you're blue in the face, like, hey, that's probably not the best idea to do it like that, and here's why and this is the 26 years of experience that we have and people are going to do it anyway. And then it's not going to work, and they're going to call you up and say, hey, it didn't work, your valve's no good, or your component's no good, and it's like, well, we'll get the blame long before someone will take the blame on themselves.
Speaker 2:That any, every, not just cypress, but every manufacturer, yeah yeah, well, and I always have the this.
Speaker 1:So I was a technician before I became a clinician, and so if anything went wrong, it was the technician's fault. If everything went right, it's. The clinician is the most amazing person ever so, uh, but anyway, that's just well, the clinical side shit rolls downhill and the manufacturing side shit rolls uphill.
Speaker 1:So yeah, well, I'd love to to hop in the idea of what you, what you have going with the symphony aqua system. Uh, you know some of our listeners may have heard of it, some of them have not, but I'd love for you to just dive in on uh, on the why, and then uh just talk about how it works. And, um, even if you can share some stories about successes, even from shows or from patient things, because you have a lot of those as well.
Speaker 2:No, absolutely. Thanks, Brent. So in my tenure in the industry, the Symphony Aqua system by far is the coolest thing I've ever been a part of and that's simply and I'm saying that simply from the reaction from the patients after being fit with a Symphony Aqua. You know the shape capture that the Symphony Aqua provides and that's all it is. It's the shape capture that it provides. It's just another tool and I tell people this often it's just another tool in your arsenal, but that doesn't limit your method of suspension, the type of liner you use. It's just ensuring the most intimate shape capture out of any system that has ever existed in our industry to date. Now, that could change in time. It might, but it's been incredible.
Speaker 2:When we first started going at 2016, 2017, when we first started going around the country and demoing this technology, the country and demoing this technology what we would typically do is like we'd go to a facility, right, and we would say they would typically have a patient lined up. We already kind of prearranged like give us a patient, we don't dictate anything, just bring us a patient. Unfortunately for us, most people love throwing their very most challenging, hardest patients in the world at us because they pride everything and they're desperate to try to accommodate this patient. Everyone has patients like that. So here we are never don't know any history of the patient, and we're casting this patient and expecting to produce miracles. Well, what started convincing me is we were actually starting to really produce these miracles. A lot of times, and I'm like and not every time we don't claim it's the answer for everything. That will never exist in our industry. Period prosthetist or resident all right, senior prosthetist cast this patient either by hand, scan whatever you typically do in your day, and then we take the junior process same patient, use what we just taught you on the system. Both of you go make a check socket and we do a blind fitting. It becomes. It becomes very, very humbling for the golden hands, guys and girls. There's a lot of them out there and I'm not saying it's necessarily a bad thing. You need to have confidence and competency in what you're doing, but you also need to have an open mind and that's what gets short stepped. A lot is keeping that open mind. So we've started winning those battles. All of the time I'm saying like to a 95% success rate, maybe higher, I'm being generous. That was a very strong indication. Like there is real. There is something very, very real and tangible with this technology. You know, and to the point, I remember the first one of the first demos.
Speaker 2:After a while we had started getting some systems rolling out there and there was a gentleman, um, he had three patients. The first two were kind of quote, unquote, home runs, very great fittings, the wow factor from the pit, like wow, like this is, this is incredible. And then the, the third patient, not so much, and I was feeling a little bit dejected. I was like, oh man, so this particular practitioner, his name is Doug, he's like Matt, this is not a loss. He's like you don't know any history of her, you don't know that it's taken me nine months to get this particular patient where she is now and on your first attempt you're as good or better in one try than it took me nine months to get her. This is a win.
Speaker 2:And from that point forward my mentality on the system dramatically changed. I'm like I'm looking at this completely wrong. And to go back to the students coming in, in general, whether you have experience around prosthetics or you're new to it, that's a pretty decent learning curve to get to a high enough competency level where you can consistently start putting out some pretty good quality fitting sockets. There's no easy way to take what your knowledge is, brent, and plug it into me. It takes time. Well, the symphony bridges that gap a lot. You still have to be a prosthetist. You still have to understand anatomy, nomenclature, alignment, product selection. All of that stuff is still very much applicable. But as a business owner, if I have a lot of younger people in my practice and I'm looking for an exit strategy, or I want to make sure that if I'm gone, I know that the level of output that we're putting out across every practitioner is going to be much higher. That's what the symphony aqua system does. It just it. It gets your starting point at a much higher level.
Speaker 2:You know, less remakes, satisfaction of patients, less time for patients to have to reschedule, come back, reschedule, come back, reschedule. That's a massive burden on a lot of people that are, you know, working and we all, most people I know. I know some very wealthy people, but the vast, vast majority of people I know are just regular working people like myself just trying to do what you have to do. So, as a patient, to have to, and you get your hopes up right, Like, oh, I just got fit with my like. Hopefully I get my leg, you know, next week or in a couple of weeks, and they're waiting patiently. They want to get their leg, they want to start living their life Well. This also shortens that cycle of being able to deliver a very high quality, very intimate fitting socket, and we talked about that.
Speaker 2:As far as, like, we have enough systems out now. I think we're in the US. We're probably between 170 and 190 systems that exist in the U? S and not all of them are being utilized to the level that some are. Um, we have, we have some outfits that if I threw out names, you would know them. Most people would know them. Um, they run systems every single day. Every office has them. They run their whole operation based off the symphony aqua system, and it not exclusively, but the vast majority, like it is a high percentage of what they do.
Speaker 2:You know we had a, we had a scenario last year. Time goes by so fast within the last couple years. Um, I'm trying to think how to politically correctly articulate this, but we were told that we don't want a demo where, because something happened that was out of our control, it was from a different company and we kind of pleaded like Andreas was 10,000 miles traveled into from Germany. I had other people that were there, so we begged and pleaded and they kind of like fine, you can use our room. And I was like, all right, let us just train ourselves. If you want to be a part of it, you're more than welcome. Like thank you so much. Well, now they mandate it, they own six systems and they encourage all the practitioners to like unless the patient's a transfer patient and doesn't need that level of intimacy, everyone goes through the system and that's very rewarding when we run into those scenarios and it just proves the validity and the efficiency that these systems can drive into an organization. I don't you're muted, I think, or I can't. I lost sound.
Speaker 1:Yes, I was on my mute button. So I think the idea of the recipe is very interesting, and now that I'm a part of a, I would say, a larger company especially on the trans-tibial side of things like the last thing you want to do is come in on somebody's prosthesis that you don't know what happened as far as in the recipe goes. So I think that's an interesting point. I think it's also an interesting point looking at the future when you're talking about additive manufacturing and how that correlates to the recipe of getting the shape. So, um, you know, there's a myriad of ways to capture the inside, uh, shape of the cast. But I mean, with, with what you have going, you can probably use some of the, um, you know, single thickness, sock type things or or what have you have you? I mean you may not suggest that, but anyway, all I'm saying is that you can scan the outside and probably still get very close to the shape and then let automation go from there, whether you go 3D printing or carving or whatever, but a lot of times you would never have to touch plaster, and so I think that is also very neat, because where people struggle is this idea of scanning. So you scan somebody that doesn't have any compression on, and then you're saying, okay, I need to reduce a certain amount of ply to get the tightness, but then you'd end up too short or whatever. And so this is, I think, where the Symphony Aqua system, or something that is similar, is really great, because you're actually getting the anatomy under pressure, under load, the way that it's supposed to be, and you're not guessing anymore.
Speaker 1:And so I think that's what I love about this idea of recipe, and and having a recipe, especially when you have good patient outcomes, is not a negative thing and it's not, um, something to be ashamed of. You know, it's like that's not a crutch, it's, and. And so what I love I love is, you know, you guys did a pretty neat VA study, right, it was a VA study that had practitioners over the whole spectrum and most patients preferred the Symphony Aqua capture method, and I think that just says a lot about being consistent every single time, taking some of the human factor of. Is my SureForm sharp? Did I use the new sheet of sunscreen or the older sheet of sunscreen? And you just don't know what was done.
Speaker 2:Absolutely, and I think that's important.
Speaker 2:Well, yeah, I mean, yeah, 100 percent important. You know, we learned some things early on as well. You know, because, into what you said, when you're scanning right, you're, what are you scanning? You're, you're scanning a liner, a cylindrical liner that's compressing the skin a little bit. You don't have no idea what's under the surface. You know the symphony ecosystem. That membrane will dive in as far as it can, where it can, those transitions between muscle, belly, soft tissue, bony anatomy.
Speaker 2:As a practitioner, if I cast a patient 10 times, I'll be pretty close, I mean, but they're not going to be exact. I mean they might be. Who knows, maybe I didn't get any sleep the night before, you know I was in an argument with my kid or whatever. I'm just mentally that can be, that can dictate as well. And when you know, for you and your scanning, all you did is trade a physical rasp for a digital rasp for your mouse. You still have to understand what you're taking off, what you're putting on and where you're doing it. It's still very subjective and to your point, whereas the Symphony, if you try to get fancy, you're going to mess it up. Let the system dictate what it wants, where it wants and how much it wants. For that. Each individual patient it's going to be different. Another very cool thing that we see often, as the example on the Symphony Aqua system, is it builds your accommodations, your modifications in while you're casting them right, and so everyone has a patient with a neuroma or a fib head issue right. So if I have a known patient that has a neuroma issue, I will do a trial run with the system. I'll pressurize it to what my app tells me, how much pressure that particular patient needs, without putting any plaster or any wrap on them so they can stand in the system. If I pressurize it to what the app says and they don't feel that neuroma, then I'm not touching anything. Now, if I do that exercise and they're feeling that neuroma, then that just tells me okay, fine, then I'll take the pressure off, I'll reflect the liner down, I'll pad that spot, I'll pull the liner back up and then I'll cast them and that's it. I'm not doing anything on the back except smoothing it up. If I want to put a posterior shelf on, I can, if I want to. I personally think that's a good, a better method, but whatever, or I'll just heat it up and flare it out after the fact, either way, it doesn't really matter.
Speaker 2:So, and like you said earlier, you're capturing how many amputees you know that are complaining about their socket fit when they're sitting in a chair. Not many, I mean. It happens if they're sitting in a weird spot, but most time it's when they're standing, they're ambulating, they're doing some type of physical activity. It's so important to capture the shape under a full weight bearing condition because that's reflecting of what your limb is trying to do when you're doing physical activities. It makes all the sense in the world and when you see it, when you're around it and you actually see the real time feedback like I said from early on like that's like all right, there is absolute truth and validity to this. I you know now that there's so all right, there is absolute truth and validity to this. I you know, now that there's so many systems out there, I used to have a better idea of what people were doing on a day to day basis, but I can't keep up with everyone anymore. I know people get very creative once they learn the system and they learn how to make it work for what they need and what they feel they want to do to accommodate their patient, and I love that. Like I said, that's why it's just another tool. It's a learning curve, for sure, but once you do it, you can make it sing and do exactly what you want it to do, which is an ideal situation for a practitioner.
Speaker 2:Occasionally you'll get a practitioner at a if I'm doing an education event like, well, why don't you just go put those in Walgreens then? And I was like, okay, you're, you're obviously missing the point. And there are people like that in our industry. Those are typically the people that are just trying to chase money. They're feeling slighted. They don't have that patient's interest at heart. They have their own interest at heart and those people just get gobbled up. And you know they I don't know, I'm just, I'm trying to be nice, but it's people. People like that are very, are very frustrating to me, but the vast majority are in it for the right reasons.
Speaker 2:You know you have profitability is not a bad word. You have to make profit to be able to help other people that aren't in a position to get a new leg. You know there is a lot of philanthropic nature to our industry overall, but you have to be solid in your cashflow and your money to have be able to pay your practitioners, your support staff and to be able to do these things. Otherwise you then no one, no one's benefiting at all. So I would say it's the adage of like what do you hear on a plane? Put your oxygen mask on first before you help the next person, or you're both going to fricking. You know, flounder around and struggle. I can help more people If I have my oxygen mask on first. I can reach out and start helping other people get their mask on. You know a lot more than if I'm struggling for air and trying to help everyone else. Then, you know most people suffer in that way. I don't know if that's a good analogy, but I think that way a lot.
Speaker 1:So, yeah, I think there's a couple of things to unpack there that I really liked. One is, you know, you do you cast the people while they're standing. You know, that's part of the symphony aqua system, which I love, and so one of the things that drives me nuts and I think it's still taught in school and such is this idea of you cast with the patient in a little bit of flexion. Well, I just never. I mean I did that in school but I never got that. Like, your prosthesis is supposed to be most comfortable when you have your whole weight on it, which is when you're in single limb support fully extended, and I will die on that sword that that is the right way to capture a patient.
Speaker 2:I'm with you, I will die with you on that sword way to capture a patient.
Speaker 1:I'm with you. I will die with you on that story. So, anyway, I think that's very, very important. And I think the other thing to touch on which you touched on is there's a lot of different ways to make a prosthesis and a patient outcome is good. So I think that is you know.
Speaker 1:Can the system benefit everyone? Yes, because there's a recipe. It's repeatable. All that Is it necessary for a good outcome? No, there's people that have different ways of doing things. But the key to that is is it doesn't scale Like. This actually can scale practice to practice. You can have people coming in, you get consistency, you've got clinicians that can cover for other clinicians and they know exactly what's happened. So I think that is really, I think for the listeners to take away is yes, you can have a good success doing everything by hand casting with plaster, your five degree, you know, knee flexion, three part cast, whatever it is but you being able to train somebody else to do it the exact same way that you do it and have the same outcome is going to be vastly more difficult than doing something like what we're talking about.
Speaker 1:And take a lot of time and they're actually standing for you and take yeah, and take a lot of time, like you're already there and I love the, the aspect that you talk about. You're in the ballpark right, you're very close. Minor, minor adjustments to get patients happy and pleased with that, and minimal, like this idea of like oh, we're too big, you always take a nine-ply reduction or whatever it is. That stuff drives me crazy too, but I think that's the that's. The key is that it this kind of stuff, it is clinically relevant and also repeatable and scalable, and I think that's what's exciting about it.
Speaker 2:Of that. That's a great perspective. Like it is, it's scalable. And there are the way I kind of internally view a practitioner whether I think they're a good quality practitioner and I'm not judging going to them or sending a family member of mine to that practitioner. I don't care if they have a system, I'd prefer they run a system, just because I know what the system can do. But to your point, I know there's plenty of practitioners that I hold in pretty high regard. I would very comfortably send my family or myself to get legs made or whatever arms made from them because their skill set and their knowledge, because their commitment to learning their craft and being the best they could possibly be, because they're patient centric. That's it, that's my measurement, that's how I view the quality and, like you said, there's plenty of them that can make a very, very good prosthesis without having the system. But to your point, how do you take that knowledge and get the younger generations to learn that and absorb it and be able to consistently do what you do? That's the biggest challenge, and especially in this day and age in our industry things are moving, changing very, very rapidly. So I think it just lends itself into another validation of where the system really shines.
Speaker 2:You know one of the challenges, you know from a negative aspect on the system, because we don't make any claims like it's for everybody. I wish everyone would systems, I think you would help our industry. But we're realistic. But one of the biggest aspects we've already said it it's just that level of consistency. It just bridges so much stuff. It's so important.
Speaker 2:You have to have an exit strategy at some point in your organization, right? Unless you're just going to one day sorry everyone next month it's time we're closing the doors, we're shutting shop. I'm done and that does happen. But typically, you know you sell it off to want some of your infrastructure practitioner people that have been with you a long time, or you sell to the bigger, you know the bigger organizations. So, but we've had plenty of people in the last several years buy systems simply because of that. They were viewing that as their transition strategy, because now they know that those younger practitioners, they might not have that level of experience that I have as the owner, the founder of this particular patient care. But now I know that at least we're going to be putting out very high outcome. You know a very high outcome, bidding socket basically.
Speaker 1:Well, and I would say, the clinicians that are coming into the field students and residents they want to have very clear expectations and they, they like um systems, um, I, I, you know. I look back at my residency, um, and it was a tough residency, it was grueling, um, and you get thrown into the deep end and then it's at the end it's like, okay, let's go back and make sure that you hit everything. And that's not the way this generation of clinicians are. They want to see the goals, they want to have some of the outputs, they want feedback, and I think it's great and I really am excited about this new generation of clinicians. I think that there's a lot of good things. I'm not going to get too far deep into it, but they're also not going to put up with some of our stuff. That's been historically like you talk about the academy and the AOPA meetings and how does ABC and BOC and all that? They don't have a massive tolerance for waste or kicking the can down the road, because this is their field now.
Speaker 2:I love that. I love that aspect and they're love that. I love that aspect and they're very, they're very sharp, very, very sharp, these younger generations coming into the field, which is good yeah.
Speaker 1:Yeah. So all that to say is it's not only on the clinical side, but on this on this whole like political you know our alphabet soup stuff that that's going to.
Speaker 2:Don't get me started. People are going to be like, oh you know, he seems like a nice guy, like that guy's crazy.
Speaker 1:Yeah, we won't go too far down, but anyway, that's what I love is that they're going to be involved. So anyway, matt, this has been awesome. I think our listeners are really going to benefit from knowing a little bit more about your company. Can you share your website where you're at, and then we'll close it up?
Speaker 2:Yeah, absolutely Brent. Yeah, so you can find all of our information on everything we do that we talked about. There's other things about Cypress Adaptive that we didn't talk about and that's okay, but if you go to just cypressadaptivecom and then we're on pretty much every social media platform as well, we try to put a fair amount of content out not to the level that Brent does, but we're trying. You can also reach out. Feel free to reach out to me. You can contact me through our website or through email and whatnot as well. We're very accessible. My partners and I, we're very much involved in the field on a day to day basis. We love interacting and working with guys like Brent and other practitioners that are really trying to move the needle in a positive way. We love collaboration and working with people. So you know, give us a shot, look us up. Like I said, we're harmless. We're very accessible. We want to work with you. We want to make you successful and help you.
Speaker 1:That's it. That's great. Well, thanks for coming on the show today. This was great. Thanks, brent, and thank you for listening to this episode of the Prosthetics and Orthotics Podcast, and, until the next episode, have a great day.
