Milestones

Our 4 year old son Finn achieved a childhood milestone yesterday. He successfully rode his two-wheeler!  He was so excited and beamed with the satisfaction of accomplishment. He can't wait to show Daddy this weekend.
For me, this was the first child of our 6 whom I was able to help with this milestone. Duane patiently helped all 5 of our other children. I just could not run along with them. It was a milestone for me as well. I am so appreciative of these seemingly small things, but the shining eyes of our son were all I needed to know that this was really no small thing. I could not have done this a year ago. I feel that with this (new to me) prosthetic technology, I am 20 years younger than I was with my old prosthesis.

IT IS FINISHED!

Well, it may have taken 6 months from start to finish, but it was well worth the time! It is finished!

The new cover in place. First one like this Dennis has ever made. Pretty good!

A final photo of Dennis and the family with me on the left.

I will unequivocally recommend Metro Prosthetics to anyone needing a prosthetic device. They are professional, great listeners, patient, with a creative and can-do mindset that didn't just get the job done, it literally changed my life. Thank you a thousand times Dennis and Metro Prosthetics!  

Anyone know a good place to take ballroom dancing lessons near Annapolis, MD?

Making the Cover

As long as I've had a prosthesis, I have expected it to look something like my unaffected leg. Because of the shape of my residual limb, it cannot be exact, and that's OK. It is what it is. But I've come to realize that there is a different expectation in current prosthetic fabrication. The emphasis, and rightly so, is on fit, function, and comfort and not so much on the cosmesis (the way it looks). While there are amputees who can afford to have more than one prosthesis (as in one for sports, one for life-likeness), most probably fall into the category with me of having one prosthesis to fit every occasion. So, this brings me again to my very awesome CPO Dennis who is trying something for me for the first time. He is fashioning a hard cover to slip on over my socket which will be shaped as closely as possible to my left leg.  I will then have the choice of wearing my prosthesis with or without the cover. As I explained in a previous post, prosthetics has an element of artistry to it. Here is an example of that.

Dennis starts with a hollow-center styrofoam cylinder

Next, he inserts my socket into the cylinder

After looking at my left leg, he uses an electric knife to carve the styrofoam into a leg shape.

Michelangelo

The shape after carving....pretty good.

The result after final carving and 'sanding', trying to get the ankle as small as possible.

Plastic goes on before wrapping the limb in plaster to make a mold.

Plaster mold after cutting it away from the socket.

Finished plaster mold which will be used to fabricate the cover.

....to be continued 

Swimming and an Explanation

Swimming? Yes, you can. I have always had some sort of swimming leg. And over the years, they have evolved. My first swim leg was simply my every-day prosthesis with a rubber sleeve covering, then taped at the top with water-proof tape to keep out the water. A previous post explains how that was a fail (see "A Few Vignettes"). After that, a special "swim leg" was made for me and was solely for swimming. That worked great and had a "Kingsley Beachcomber" foot molded right onto the end.

Aunt Alice...............Bertha.............Christy...............Destiny
The kids insisted on giving them names.

In the photo at right, that swim leg (Aunt Alice) is shown on the far left. You can see the "P-Lite" liner that went on first, then slipped inside the exoskeleton. I don't recall exactly, but I think that swim leg was made for me in about 1988 (update: after talking to Duane, we determined that it was probably more like 1991). It has been rather uncomfortable to wear for about the last 10 years, so I have not really enjoyed swimming or, especially, the beach. The fit is no longer good, which is the source of the discomfort, but at the beach add to that the sand that enters the prosthesis from the top when one wades into the surf and then grinds into one's skin when walking.... well, I go to the beach for the kids not for myself. The prosthesis to the right of that, Bertha, is my old every-day, exoskeletal prosthesis with the Seattle foot.

 Next, Christy is my new swim leg.When we were discussing with Dennis what I could use for a swim leg to replace the old one, there were a couple of options, but then when he had to go back to re-fabricate a lighter socket, we decided to use the first final socket (now Christy) as the new swim leg. It fits exactly like my lighter final socket (Destiny) and has the Venture foot, it is just heavier. Perfect for use every now and then for swimming. Swim-Christy is pictured at right after I took her out for a swim yesterday at a local swim center. This was so superior to old Aunt Alice.
1) It was completely comfortable.
2) I could wear it to walk in and swim in, so I did not have to bring an extra leg in my swim bag.
3) The knee sleeve kept the water from entering the gel liner, so my leg inside the prosthesis stayed dry. This will be awesome at the beach for keeping out the sand!
4) I was able to towel-dry the knee sleeve after our swim, and change into my jeans without getting wet.

The only downside that I have to figure out is that the foot cover holds water and it was awkward trying to get the water out without taking off my socket. I may have to decide between awkwardness and the inconvenience of removing and replacing the socket. Also, the foot cover is very hard to remove to allow the whole thing to dry properly at home. This is very important to keep the parts from rusting and getting moldy. I need to find a tool. Note to self: ask Dennis about a foot-cover-removal tool.

The Final, Final Socket

OK, folks, after much fitting, fabricating, testing, and tweaking, I have my final socket! And let me tell you, it was worth the wait. This socket is so much lighter than the first-final socket, which in its turn was so much lighter than the test socket. My knee is so happy! I believe my theory was correct, you know the theory in which my right leg essentially had a 4-pound weight strapped onto it while using the test socket and so I was strengthening the leg the entire time? And then the weight was reduced to something more like a 2-pound weight with the first-final socket. Now, this final-final socket feels as though it hardly weighs anything at all. As a matter of fact, the gel liner and knee sleeve together feel heavier than the socket. My knee feels good nearly all of the time. I can still over-do and end up with a sore knee, but that's just life.

First the gel liner and stocking go on

It fits!

Sliding into the new socket....

But, it is not finished yet. Dennis now goes back to work to make a cover for all of this, so I can look good in my dress when Duane takes me out to dinner..... although, I may be starting to embrace this whole socket-and-tube look.

Victories

   

Victories come in different packages. Some victories are small, some are huge. This orchid is very nearly ready to bloom. This is a small victory. I have been watering it and looking for the perfect spot to provide just the right amount of warmth and sunshine so that it desires to bloom. It has taken months. But look! The effort and patience have paid off, and possibly tomorrow it will show us the loveliness of an orchid flower.
A victory necessarily implies some obstacle, something that must be overcome. In this case, it was simply the right amount of water and sun.








Other victories are bigger, with more at stake. More effort, more time, more emotion, more investment, more sacrifice. As I chronicle a part of my journey as an amputee, my heart aches for those who have lost loved ones and those who have lost limbs following the bombings at the Boston Marathon. I can't imagine the pain, but know that I have been praying for patience in your tribulations as you strive for your own victories. I remember that I cannot do it in my own strength, but "I can do all things through Christ who strengthens me (Phil. 4:13)."



So, today my bigger victory pales in comparison to the mountains others have to climb.

If you have read along with me, you know that in recent years, many things I have been accustomed to doing I have had to modify or curtail altogether because of pain. Well, my victory today is that I AM PAIN-FREE! In November, December and January, I had to apply a lidocaine patch to my knee 12 hours per day so that I could function. Now, I am able once again to comfortably take walks with my kids. On a recent camping trip, I was able to almost effortlessly walk up and down the side ramp on our travel trailer. This was something that a few months ago I could not do. So? I can help move the bicycles to and from the trailer. I do not like watching while others do the work. I am now able to walk up and down (most) stairs step-over-step. When my 4-year-old still wants me to pick him up....I can! Walking in the sand used to be intolerable after a couple dozen steps. Now? I spent my stroll on the beach marveling at the beauty of God's creation, soaking in the sun and the sounds; the surf, seagulls, the kids playing. When you have pain, it is difficult to think about those things.

Next post.....the final (final!) socket is finished.

Why the delay?

April 22, 2013     At last check, Dennis was back in the workshop fabricating a second permanent socket with the goal of making it more lightweight than the first one (which I am currently using). I need to back up a bit and explain another ongoing issue I've been experiencing. As I've shown, this prosthetic system has 3 parts, 1) the gel liner which is applied over the limb, 2) the socket that goes on next and to which the foot is attached, and 3) the knee sleeve, applied over the top of all which is the final 'lock' on the suspension. I will be receiving 2 gel liners and 2 knee sleeves, one to wear and one to wash, so that I always have a clean set. The first gel liner I was given worked perfectly with not a single problem with the fit or any skin issues. When we were sure the liner was working, the second one was fabricated from the same mold as the first. So, no problem. Well, not exactly. For some reason, the second liner was too tight. After a few minutes of wear, it felt as though it was strangling my leg and my leg felt tingly and began to become numb. Sure enough, when I removed the liner, my leg was bright red and I felt 'pins and needles' for about 15 minutes. After discussing this with Dennis a new, second liner was made. I have had this one since April 2, nearly three weeks. This one is not as tight as the one that was replaced, but I did continue to have some milder tingling and tightness, making it difficult to wear for longer than 4 or 5 hours. After talking to Dennis, we came up with an idea to relieve this problem. We drilled a 1/4" hole at the base of the socket. This allows air to escape as I slide my leg into the socket, relieving some of the tightness of the liner. This has made the difference and I am now able to wear the second gel liner comfortably all day.

A tiny change that made a huge difference.

Dennis needed to wait until we solved the liner problem before starting the new socket because the alternative would have been to start from square one with a new original cast/mold. We are both extremely happy that we did not have to go there.

I received a call today that the newest socket is ready for a fitting, so next week I will give that a try.

A Few Vignettes

I have been reflecting a good bit on why this blog has been hard for me to write. Actually, with each entry it has become decreasingly difficult, so I think the exercise has become therapeutic. I have felt very resistant to being candid about the fact that I have no foot. Why? Well, it's different. Most folks have two feet and I have one. I've never enjoyed being singled out for anything and have always preferred the behind-the-scenes jobs when I've had a choice. But, writing about my experiences has given me some freedom from the fear of what others may think. Anyway, I thought I would share some mostly-humorous vignettes of experiences I've had over the years related to being an amputee.

When our 9 year old son saw this, he exclaimed, "Is that YOU in there?!"  No, but that was the point we were trying to make to the county roads division. They repeatedly filled in this sink hole on our street with asphalt and it repeatedly eroded away. So, we set up this photo by placing my unoccupied prosthesis in the sinkhole and sent it along to the county to make a point. They did finally repair the hole properly.




My sister Mary reminded me of this story. She and I played high school field hockey together. Field hockey is a fall sport and in the summer, in order to swim, we had to apply a rubber sleeve over my prosthesis to keep it from getting wet. So, the rubber sleeve was still in place as we competed in a field hockey game one fall afternoon. Good thing. The rubber sleeve was not a perfect system and over the summer, the moisture must have corroded the bolt that attached my prosthetic foot to the socket. As I ran down the field during the game, I felt something snap in my foot. I knew immediately that my foot had snapped off of the socket, but because the rubber sleeve was still in place, the foot remained in place. I couldn't continue in the game, so I had to call for a time-out, telling my coach that my foot had fallen off! We did have a good laugh over that, though I think the other team was a bit confused....

Somewhere in my 'tweens, I was priveleged to be invited on a Florida family vacation with my good friend Melissa. We traveled in their RV. One day after a swim, I briefly left my prosthesis upside-down in the tub to dry. Melissa's brother Scott later opened the bathroom door, and had quite a shock when he first spied a leg sticking out of the tub!

After I moved to the Chesapeake Bay area, some friends and I decided to take sailing lessons. After completing our lessons, my friend Jean and I borrowed my then-friend's-but-future-husband's day sailer for an afternoon of sailing. We were having a great time until we tried to come about with the jib too tight and the boat almost capsized. Jean, being a more experienced sailor than I, released the jib in time to right the boat, but it was pretty well swamped. Having no instrument with which to bail the boat, I looked at Jean and said, "Wait! We can use my prosthesis to bail!" So, I took off my prosthesis and it worked like a charm. We had her bailed and were on our way back to the dock (we'd had enough sailing for that day) in no time.

One Step Closer...

April 3, 2013     

Yesterday I received my permanent socket, but it's not really my permanent socket. The one on the right is the test socket which I've been wearing for the past several weeks/months. The one on the left is the new socket. Dennis is not happy with the result, so he is going back to the workshop to make a new one.
I am now wearing the new socket and he is keeping the test socket to use as his mold. Why is he not happy with the result? He feels that the new socket is too heavy, and when we compare it to my old prosthesis, is does feel slightly heavier, BUT it is much lighter than the test socket, so walking is easier and my knee is happier.
Without going into too much detail, Dennis used some materials for the socket that he hoped would increase the ease of donning and doffing, but that he feels resulted in the socket wall being too thick and therefore too heavy. So in the re-do, he will use some alternate materials which are lighter and thinner to create an overall lighter socket. Then, if issues arise from too much friction during donning/doffing, he can create relief using other methods.

Life does not stop for my prosthetic appointments. Here the kids are doing their school work during my fitting.

P.S. and the Next Phase

March 8, 2013     Post Script notes on my previous post. I had made a checklist to show that I am ready to move on to the final phase of this prosthesis-fabrication journey, but I glossed over one item which needs a bit more attention: my skin. I want the reader to try to understand when I write "zero skin lesions" how enormous this really is for me. I have battled skin lesions on my knee for probably 25 years. If you have ever had a 'corn' on your toe which has developed from shoe pressure or toe misalignment, you have some idea of the type of pressure sores I am talking about. They are thick, calloused areas which are painful even to touch, let alone to bear all the weight of one's body. Over the years, I have had to deal with these in different ways: have a doctor remove them and use crutches for several days until I could wear my prosthesis again; have the prosthetist grind out the prosthesis in the affected area (not very effective); use a scalpel a couple times a week to shave off the built-up callous; avoid weight bearing on 'difficult' surfaces (uneven, hills, stairs). All of these I have done and still over the years the pain I have had from these lesions has grown until (in the past 3-4 years) it had become quite severe. That was what finally brought me to my orthopedist and ultimately, to Metro Prosthetics and Dennis Haun. So, all that to say that I really, really wish I had pictures of my knee with its lesions before....and after. It is amazing. I never thought I would see the skin on my knee look like it does now. It is smooth and has absolutely no callous, even on the large tibial prominence in the front of my knee which caused me the greatest pain. I have no pain from pressure points. At all. Thank you a thousand times to Dennis! This gel liner and suspension system is awesome! Oh, and the foot....the foot. Today I walked all around at the park with the kids, up and down hills, over bridges and across fields without feeling like a knife was stabbing into my knee. This Venture foot is crazy good!

I have been wearing the new (test) socket full-time now since February 16. That marks another milestone; I no longer want to wear the old prosthesis because the new prosthesis is more comfortable. The new socket is now mine. The old prosthesis continues to be useful first thing in the morning before my shower. Because it takes fewer steps to don my old prosthesis (pull on socks, then slip on the limb), I use it to walk to the shower. After my shower, I don the new prosthesis (apply lotion, pull on gel liner,  smooth out air pockets, pull on sock, slide into socket, apply knee sleeve). More steps, but well worth it once it's in place.

Now for the fun part! Today's appointment. Today, Dennis "poured" the final socket and he allowed me and the kids to watch as he and his team worked. It is quite fascinating the way it is done. I have been an amputee for a long time, but I have never watched the prosthetic fabrication process up close. This is a science and Dennis has it down, but it is so much more. There is an art to the process. Each limb is unique because each person using it is unique. Her skin, his residual limb shape, her activity level, his knee, her hip, that one's job, this one's stubbornness. It all has to work. That is the art. The choice of a correct 'medium' to capture the exact needs of the individual. The reason Dennis is so good at what he does? He listens to the needs of the individual and he has the skills to give them what they need. He knows how to choose the correct 'medium.'

First, the jig is set up to hold my test socket in place using a thick pipe and clamps.
Dennis builds up the walls of the socket a bit with tape to prepare to pour the moulding material.










He mixes up the moulding material which he explains is the same material that dentists use to make dental moulds. When it 'hardens' it is a rubbery solid.

Jonathan getting into the process.

He pours this into the socket to make a mould of the adjusted test socket. This is actually an extra step that is not required for all prosthetic fabrications. Because my limb has a bulbous-shaped end (my ankle), the first mould has to be pliable. You will see why in the next step.



The delicate part here is removing the socket from the mould with out breaking or cracking the moulding material. Dennis pulls the socket slowly and removes it with the mould intact.



On the right is the first positive mould of my socket.















Next, Dennis sets up another jig to hold the mould in place while he applies a hard plaster to the mould.  This will be used to make a second (harder) mould. The plaster is applied to the soft mould. The plaster hardens quickly while the softer dental mould material begins to shrink, allowing the mould to be pulled out of the hard plaster mould. This is the extra step needed. Otherwise, the mould would become stuck by the bulbous end of my residual limb. Pretty cool. 

Getting ready to apply hard plaster

Applying strips of plaster

Smoothing the plaster mould

That's all for today's visit. Dennis returns my test socket for my use while he and his team fabricate the final socket over the next week or so. They will use carbon fiber and resin which is very light weight. The carbon fiber alone is black, but they can add layers that are mixed with resin and pigment to resemble flesh tone. This will be fabricated over the final mould made from the plaster in the above photo.

Plaster mould sitting on jig waiting for next phase

Amelia helping clean out plaster residue

OK, I'm Ready Now

March 6, 2013     Since this new prosthesis is very different from any previous limbs I have used, I have wanted to be very conservative and take my time to be sure everything is right before the final "pour" to fabricate the permanent limb. Here's my checklist:

_most importantly, the socket is comfortable
_zero skin lesions or pressure points
_gait is natural
_increased ease of movement on stairs and inclines
_height is right
_knee function is maximized
_BONUS: I can balance for a short time on my RIGHT leg and am working on increasing the time

So, with all of these items in place, I decided to try an early morning workout over the weekend; I did a basic, total body/aerobic workout for about 50 minutes. Now, this is a workout I have used many, many times, but NOT in a few months. I haven't been able to work out due to pain (previously) and not while making all of the changes needed to fabricate the new limb.  During the workout, I felt my right leg working harder than usual (and I have noted this in daily activities as well), but I pushed through and finished the workout. Turned out not to be such a great idea. I hobbled around for the entire day with a very sore right knee, while giving this outcome some thought.
I had a theory. In the evening, I weighed myself wearing my old prosthesis and then wearing my test socket. There was approximately a 4.5 pound difference, the test socket being heavier due to the plaster which covers part of it. So, when wearing my test socket, it is like strapping on a 4-pound weight and wearing it around for the entire day.....and during an entire 50-minute workout. That probably explains the soreness, especially since my knee felt much better the following morning. I am encouraged. All of this time, I've been wearing this extra weight, so I am going to think that this has strengthened my right leg muscles and therefore, when I try out my lightweight carbon fiber permanent socket, it is going to feel fantastic. That is my theory. We shall soon see, because this Friday, I go to have the final socket poured. Then Dennis will fabricate it and sometime in the next couple of weeks, I will see if my theory is correct.
Another note: during my workout, my LEFT (unaffected) knee was less stressed than usual. How do I know? I couldn't hear or feel it making it's usual creaks and groans. Definitely a plus. It's all good.

So, I'm ready now to be done with this test socket. Time to move on!

1/4 Turn Here, 1/4 Turn There

February 19, 2013     I've been wearing my test socket now for 12 days, including the day of my latest checkup with Dennis. He increased the amount of knee flexion that is built into my socket to allow for a slight knee flexion contracture that I've had for a very long time. This simply means that my knee will not completely extend. So, as I've been walking the prosthesis has been causing my knee to extend beyond the contracture and so has been causing the posterior knee pain. Once again, it's a quirky characteristic of my knee, but after making this adjustment and walking for a couple of days, it feels much better. Dennis also slightly changed the 'toe-out' angle to keep my knee in less of a valgus position through the gait cycle.
So, that was Friday February 8. I was still experiencing some knee discomfort, but I decided that I need to just wear the new socket daily, try to push through the discomfort and see if it will work itself out. The idea being that my knee will slowly feel better with the new adjustments. No good. By Thursday, I am feeling more posterior knee pain. But I am certain we are on the right track. I decide to give my knee a break and wear my old prosthesis on Friday (the day of our Valentine's Day date). I call Dennis and after we discuss these results, he gives me instructions to slightly change the flexion in the socket again, trying to add just a bit more. Duane understands how the turn of the anterior and posterior screws changes the angle of the foot, so I let him do the adjustment using Dennis' instructions. A quarter turn each on the anterior and posterior screws and off I go to give it another try. Saturday and Sunday my knee feels nearly perfect. We are so close. On Tuesday, I have Duane turn the A/P screws 1/8 turn again. I am going to let it ride this way for a couple of days and see how it feels.

Valentine's Day Post Script: As noted above, I was wearing my old prosthesis for our Valentine's Day dinner date, so the red-dress-and-pointy-black-shoes worked just fine. We took a few pictures, and they were all lousy iPhone/Pod shots, but I posted one anyway. I will tell you though that after wearing the new socket with the Venture foot for several days, and then switching back to the Seattle foot, I am amazed at the difference! The old Seattle foot is so clunky and uncomfortable, especially with my dress shoes. The Venture foot is a drastic improvement. Like a Cadillac to a 3/4-ton pickup.

Thought for the Day....

February 13, 2013    Switching from my old type of prosthesis & socket to the new is like switching from Pilates to Boot Camp.  At first it's hard and my muscles are screaming, BUT if I persevere, there will be great benefits.

Roses Are Red.....

February 11, 2013     On Friday I decided that I am just going to wear the new prosthesis without a break (except at night) until my next appointment. If this new prosthesis is going to be mine, I have to use it.

OK, so I'm feeling really good about it. Like I can take on the world....or maybe be an Olympian kick-boxer.   Is that an Olympic sport?










Oh, then I remember that this week contains Valentine's Day. We like to go out for a nice dinner on Valentine's Day. What do I do about that?

Roses are red,
Violets are blue,
My prosthesis isn't finished yet,
So what do I do?

Well, would you go out looking like this?
And...would you wear nylons??


So, here's the thing. I want my prosthesis to be comfortable and functional and that is my priority. Really. But I'm also girly. I like wearing dresses and cute shoes. So, as much as I admire the posters of athletes running with their "blades", well the blade-and-pipe look just doesn't go well with a red dress and pointy black shoes. Maybe I'll take a night off and wear the old prosthesis. What do you think?

Weekend Results...

I wore the new (test) prosthesis all day Friday and all day Saturday. Saturday evening Duane and I took the kids for a family swim at Finn's Swim School pool for some fun. I wore my I'm-not-sure-how-old-it-is swim leg that has been uncomfortable for a number of years - but, I have only the one prosthesis which is OK to wear in the water, so I deal with it. It usually causes me discomfort after wear. We had a really great time swimming with the kids, so it was worth it. Sunday, my knee was sore when I first put on the new prosthesis, but there was no worsening through the day. I was able to wear the new socket all day once again. No posterior knee pain. So, all in all, that's good news.

So, that brings us to another problem we are trying to solve, which is, what to do about a new swim leg. We are leaning towards using my current prosthesis. Why can I not simply swim without one? Well, I could. But then what do I do when I am not in the water and how do I help the kids? It's not practical for me. Using the current prosthesis makes the most sense, but I have to figure out how it will work. The swim leg I have now has holes which allow the water to escape, so that removal is not overly hampered by water-induced suction (that sounds technical, but even with the holes, the silly thing has been stuck on my leg before and it is not fun trying to get it off). Note to self: ask Dennis about that one.

Swim Leg

What's Going on Now?

February 9, 2013     After 2 weeks of trying out both the Echelon foot and the Venture foot, we have determined that the Echelon foot is simply making the prosthesis too long. There is just not enough room for the mechanics. I'm totally OK with that. The Venture foot is an excellent alternative. Getting used to the Echelon foot for me was also a challenge because there were several new sensations happening in my gait. I think in the end, even if the height had not been an issue, I may have still chosen the Venture foot. I love the smoothness of my gait and the extra help it gives me on hills.

We checked in with Dennis yesterday at his office. The 2-week trial revealed 3 main things: 1) there is a spot at the top of the plastic socket that needs to be relieved, it is pushing on my knee and causing discomfort. 2) use of the prosthesis is causing posterior knee pain (after 10 hours or so). 3) when I walk, I feel my knee being pushed into more valgum ( my right knee moving toward my left).

After discussing these issues with Dennis, he is going to slightly shorten the height of trim lines (the top of the plastic socket that goes above my knee) to relieve the pressure. Also, he makes an adjustment which will allow less of an extension moment at my knee during the push-off phase of gait (when my right leg is the back leg). This will hopefully put less pressure on the posterior part of my knee and thus relieve the pain. To fix the knee valgum issue, Dennis uses the adjustment plate at the ankle once more and slides the foot to its maximum medial position (towards center) to give me a varus moment. Hopefully this will be enough to give me the proper balance between inward and outward movement at the knee as I walk. If more adjustment is needed, then at the next appointment, he will have to reattach the adjustment jig. Trying the prosthesis at the office with these new adjustments, everything feels pretty good. So, we'll take it home and give it a real workout.

What am I looking for at this point? When having a new prosthesis fashioned, there is a transition which occurs at some point along the journey of fittings, adjustments and trials. The transition happens when my old prosthesis stops being mine and the new prosthesis takes over; when I no longer want to put the old one on so that I am more comfortable, but I prefer the new one because it feels and functions better. There is an aspect to this which involves physical comfort and improved function, but another aspect which is purely 'psyching' myself into this transition. At some point in our visit with Dennis yesterday when we had discussed several negative points, he looked me in the eye and said something like, "Are you OK with all of this?" I very unequivocally replied that "I am not going back." There is a give and take between the prosthetist and the client. We each have our job to do. Mine right now is to persevere through this phase, to be patient as we try different adjustments, to be aware of whatever might be causing the problems and to communicate these very well to Dennis. His job is to work through possible solutions and execute them. He is very good at explaining the reasons behind each of his adjustments or fixes and gives me confidence that we will get to that point where the new prosthesis is mine.

I have some pictures to post later.....

Super Bowl Sunday

This is all we have to say today!

Ravens are Super Bowl Champions!

Day 3, Day 4, Day 5

January 28, 2013   I checked with Dennis on Monday and he agreed that it was good to give my knee a rest for a day, then to try the Venture foot. After a full day with the Venture foot, my knee is sore but not quite as sore as it was after using the Echelon foot. One additional suggestion that Dennis made was to try using the test socket and feet for a limited number of hours instead of for a full day.

Because of the difference in the length of the prosthesis with the Echelon vs. the Venture foot, we have played with foam shoe inserts to raise or lower my height as needed. The Echelon foot makes the prosthesis longer, so we take the inserts out of my right sneaker for that foot. With the Venture foot, we put the inserts back into the right shoe to allow for the shorter height.


January 29, 2013   On Tuesday, my knee is still too sore to wear the new socket so I will use my old prosthesis. The discomfort I have in my knee from the new socket is a posterior knee pain which mainly occurs on initial contact of my heel during gait. On Tuesday evening, I decide that I will start out Wednesday with my old prosthesis again and wear the new socket later in the day as Dennis suggested, trying to build up wearing time more gradually.


January 30, 2013   After a full day's activities of household duties, cooking, cleaning and homeschool, I notice that my knee and leg are feeling really good in the old prosthesis. I'm going to try out the new socket now. I put on the new socket with the Venture foot at about 5 o'clock and immediately notice that my gait is not as comfortable. Duane notices right away as well. Hmmmm. It feels like my right leg is too long. I do not have any inserts in my shoes at the moment. That is puzzling. All right, I try putting the foam insert into my LEFT shoe. Wow, that feels a lot better! Wearing the new socket with the Venture foot for the remainder of the evening feels pretty good. I think I'll try this again in the morning. Another point for the Venture foot.

...Now for the Hard Part

January 27, 2013  Or, "The Honeymoon is Over." And honestly, I mean that in the best way. It is actually a pretty good analogy. After the honeymoon there is the hard work of marriage; learning to communicate well, to build one another up, to serve, talking about common goals and arriving at them together, learning what works and what doesn't work; sometimes there is pain, sometimes there is joy. It requires patience, diligence and faith.

Not unlike bringing a test socket from the trial phase to the final phase. This is the hard part. Each new prosthesis I have ever had made requires adjustments, testing, discomfort, adjustments, testing, ....until finally it is right. And every time, they get it right. But it requires patience on my part to persevere when there is discomfort, diligence to communicate the problem, and faith that we will get it right in the end. Communication is crucial. I have to be able to communicate well to my practitioner what I am feeling in the socket, at my knee, at my ankle, walking on the different surfaces.

I used the Echelon foot for several hours on Friday after my appointment and then all day on Saturday. My knee joint was very sore when I took off the prosthesis Saturday night. Usually, if my knee is sore at night it feels better after resting through the night. It was more painful Sunday morning. My husband Duane and I decided that it would be better for me to use the old prosthesis for a day, then apply the Venture foot to the new prosthesis to try on Monday. That will give me a fair comparison after using the Venture foot all day. If my knee is comparatively sore with the Venture foot, then there may be an alignment adjustment needed. Either way, I'll call Dennis Monday for suggestions and to see if he agrees with our assessment. I have no discomfort at all resulting from pressure or friction, so that is really great news. In the past, that has always been a problem when trying out a new prosthesis. At the end of the day on Sunday, my knee feels fine again, so we need to do some detective work to determine the cause of the knee pain.

Chronicle of a Prosthetic Limb....PART FIVE

January 25, 2013  Today I was able to test out the Echelon foot. At the time we arrived for our appointment, snow began to fall in Baltimore, which is an infrequent occurrence. When I stood up on the Echelon foot, Dennis made a couple of adjustments to align the foot properly, then I walked up and down the hall. Ambulating on this foot has a different feel because of the hydraulics. On a level surface,  it feels like I am walking over a hump with my right foot. This foot has more adjustment possibilities than the Venture foot that I tried on Wednesday. The stiffness of the plantarflexion and dorsiflexion (pointing and flexing of the foot) can be adjusted. Mine needed some adjustment, so after this was done, my gait was a bit smoother. I tried taking a spin outside on a set of stairs. Great! Step over step with no problem, just like when I was 25. Functionally, it's feeling much like the Venture foot did on Wednesday. It is snowing, but I've got this four-wheel-drive set of wheels, so I try out a steeper grassy incline. Wow! This is where the Echelon foot really shines! When I take a step down the hill, the foot plantar flexes along the incline taking all of the impact instead of my knee. It is awesome! I can descend the hill so easily. With my Seattle foot, descending hills is a painful chore and I try to avoid it whenever possible because my knee takes all of the impact and results in my hobbling about for the remainder of that day. With this Echelon foot on, I feel like taking a jog around the parking lot.

The top video shows me using the Venture foot on the hill.

The bottom video shows me using the Echelon foot on the same hill.

Back inside, we replace the Echelon foot with the Venture foot so I can make an apples-to-apples comparison on the same stairs and hill. With the Venture foot back on, one thing I notice is that on level surfaces this foot feels more natural - it does not have the extra roll that I noticed with the Echelon foot. On the stairs, the function is great and comparable to the Echelon. On the grassy incline, I do notice a bit more stress on my knee with the Venture foot than the Echelon foot. The hydraulics of the Echelon foot are outstanding on the incline surface. I also notice that I can balance on my right foot alone with the Echelon foot. That is a first. I've never been able to do that.

So, my assignment for the next two weeks is to take both of the feet home and test drive each of them. Then, I have to make a decision about which one I want to keep. I will have to weigh the pros and cons of each. This is what I have so far:

Venture Foot:
Pros:
-natural gait on level surfaces
-ease on stairs and inclines
-with shell on, the foot is narrower, allowing more shoes to fit :)
-height more accurate, allowing comfortable gait with all shoes
Cons:
-steeper inclines less comfortable

Echelon Foot:
Pros:
-ease on stairs and inclines
-outstanding on steeper inclines and uneven surfaces
Cons:
-extra "roll" in gait on level surfaces
-wider foot may not fit into my shoes
-extra height requires removal of inner shoe linings (ideal for athletic shoes)

So there you have it. I'll be trying these out and may have some more pros and cons to add to the list before my two weeks are up.

Chronicle of a Prosthetic Limb....PART FOUR

January 23, 2013  Today Dennis had the Venture foot attached to the test socket along with the adjustment jig. He also brought along my Echelon foot and when he held it up to the socket, I was able to see just how close it is going to be to fit it onto the base of the socket.

Venture foot with adjustment jig

In the picture on the right, you can see that the top of the ankle unit on the Echelon foot (in front) comes just to the base of the socket.

Today, I am walking with the Venture foot. When we have the liner, stocking and socket applied, first I try just standing to see how the height feels. It is pretty close, just a bit long on the prosthetic side which throws me a little to my left. Dennis makes a quick adjustment. The liner feels very comfortable even at the distal end, which has typically given me problems when trying out a new prosthesis. I'm feeling no discomfort distally or at my knee.

Making an adjustment

Walking feels really awesome! With the motion at the ankle, my steps are very smooth. My current Seattle foot causes my knee to be thrust forward with each step, giving me a clunky gait. The "clunk" I feel at each step is transferred to my knee, causing banging and friction which over the miles and the years is tearing up my knee. Walking with this new foot, I'm starting to think about some things I've been wishing I could do with the kids.....OK, but let's not get too far ahead of the horse. Let's try a hill. They happen to have a pretty good hill outside the office and when I give that a try it's amazing. Walking on a significant incline really feels no different than walking on a level surface. Normally I limp down hills, sometimes even turning to descend sideways in order to avoid pain. With this foot, I can descend with an even gait, going forward step over step and then ascend again the same way. I am noticing a little fatigue in my right quadriceps (thigh) muscles, but that is good, because I know that means my right leg is working along with my left. I also try walking in the grass to see how an uneven surface feels. No problem. The motion is occurring in the ankle, so my knee is happy.

Old prosthesis with Seattle foot

New test socket with Venture foot

Because of my particular birth defect, I have quite a lot of valgus at my knee, which is basically my right knee "bending" in toward my left knee. That's just the way my knee is, so we have to work around that. When Dennis adjusts the jig, he is able to compensate a bit for the valgus in my knee. So, with the adjustments made, he will take the Venture foot off and before my next appointment he will apply the Echelon foot. I will get to try it out on Friday. As good as the Venture foot felt today, I can't wait to try the Echelon foot to see how the hydraulics will improve my gait. I'm very excited! I do not remember ever having the first weight-bearing fitting go so well as it did today. When I try out the prosthesis on Friday, I will be bringing it home to use for a week or so to see how it works under stress.

Chronicle of a Prosthetic Limb....PART THREE

Wednesday, January 16, 2013    Today was my test socket fitting. This is what was fabricated from the fiberglass cast that was taken at my last appointment. I explained to my CPO that I am writing on my blog about this whole process and asked if he objected to my naming him and his business as I write. He doesn't mind. So my CPO is now Dennis (he is Dennis Haun of Metro Prosthetics in Landover). The test socket is a hard opaque plastic. To fit this, there are a few steps. First, lotion is applied to my limb which allows the gel liner (from the last visit) to slide on; next, a thin nylon sock goes over the liner so the socket will slide on; finally, the new test socket is applied. It all feels comfortable so far.

Gel liner applied

Test socket

Nylon sock

My Venture Foot

Dennis makes a few adjustments to the socket to make the fit conform better to my bony knee. He places a dense foam block under the end of my limb so that I am able to bear weight and he checks the alignment of my pelvis to see where it feels level to me. When he measures the distance from the end of my limb to the floor, the measurement is 4 5/8." I need 4 3/8" to be able to use the Echelon foot, so it's looking good for that right now. He explains a couple of things. At my next appointment, I will do some walking and he will do some adjusting. The adjustments happen using a jig which adjusts forward/back and left/right. In order for the jig to be used on the test socket, extra space is required, so for the alignment adjustments, I will be using the Venture foot. When the alignment jig comes off and the final prosthesis is fabricated, the Echelon foot will go on. So, I'll have a chance to try out both feet.

Heating the plastic

Molding the top of the socket

About the gel liner; this is made of really cool stuff ( I know, so technical but it is really cool). Dennis explained that it is urethane and the man who designed this liner is an amputee and also a prosthetist. He found a material that simulates the fat pad under your calcaneus (heel bone), which acts as a shock absorber with each step you take. This urethane material distributes pressure in a similar manner, thus reducing or eliminating pressure sores on the skin (which is a big problem for my knee).

My next appointment is in one week when I will be able to try out the test socket with the foot, do some walking and see how it all works in action.

The kids entertaining themselves with their Legos

Me with Test Socket