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!