Amputee Prosthetist

Amputee News- Ricks Babblings

The last couple of entries have been segments written by my patients without any editing on my part. This was what they wrote about getting a new leg made. It is one thing for me to go on about how good I am at making prostheses but I believe it is more powerful when it comes from the end user.
I have been trying out new nylon sheaths to try and find one that would last longer than my standard Knit Rite sheaths. I use them on the outside of my insert and inside of my socket. I have a no ply fit but sometimes without some type of sock there will be an air noise from my socket. When I add the nylon sheath the noise stops. Typically I would only get a couple of weeks out of a sheath before the runs would destroy it. I would have holes all around the back of the sheath where it articulated against my back wall. I also use a sheath to fold over the edge of my socket so that my suspension sleeve doesn't get cut by the graphite edge. At the Academy meeting last Spring, I obtained sheaths from several manufacturers and started my own highly subjective test.
Here's what I found. Knit Rite does make a more durable sheath that has silver threads in it to aid in fighting infection. That sheath seemed to last about three times longer than the regular Knit Rite sheath. There is another sock manufacturer that makes the most durable sheaths. Comfort sheaths lasted over three times longer than the Knit Rite ones but did cost a bit more. The most durable sheaths were the DAW sheaths but they are so expensive that they are best used next to the skin rather that as a spacer.
Comfort Sheaths were the clear winner as the best prosthetic sheath.

Amputee Experience- Ray Gumm's new leg

Ray Gumm’s Blog-
It is time for a new leg! Now that is a statement not everyone can make. At least I know where to get a very good one. Rick does a bang up job in every instance, and that's a fact.
It does take some time and a few visits to get a perfect fit. This procedure cannot be performed with a cookie cutter approach. Each new limb is extremely individual in its fabrication. On day one I came in for an evaluation of the changes that had taken place since the last leg was fashioned for me several years ago. I don’t look the same as I did several years past and neither does my leg stump which must be in perfect harmony with the prosthetic’s socket.
Rick made sure the skin tissue was healthy and ready to receive his attention. We discussed what could be done and the new advancements in technology that had taken place in prosthetic feet and ankles. It is amazing how flexible and life like the designs are.
On the second visit he made a perfect impression cast of the distal end of my leg that would fit into the socket made of a durable material. This is one of the most important steps in the whole procedure. I could feel the calm pressure and assessment going on as he wrapped and formed the cast, rubbing and pressing delicately on the exact confirmation of my stump. This is not something that can be acquired from a book it has to be learned from years of practice doing it. Making a prosthetic is not just a technical/scientific job, it is also an art. Through all of this I had a feeling of confidence generated by Rick's basic professional demeanor that is just under the surface of a jovial, friendly and caring attitude.
On the third visit the trial socket made of a clear material was placed on the stump and evaluated for exact fit and any pressure points were noted and marked and adjustments made.
On the fourth visit the permanent socket mounted on the adjustable support and foot was dispensed for my wearing for couple of weeks. A shake down cruise so to speak. If I had any problems during that time I was to report them for solutions. The next visit was to have the new leg put in top finished condition.
Eureka! I have a new appendage that works. I feel like dancing! ~Ray Gumm
Ray is an 84 year old below knee amputee who lost his leg in an automobile accident ten years ago.

Amputee Experience- Dan's new leg Day 6

Day-6 (Thursday)

Woke up & yet another beautiful morning. Go through the typical AM schedule...wife calls at approx. 5:15AM...get a status on the household and what is scheduled for the day back at home. This will be my last full-day here in Washoe Valley, NV...yes, I miss being home but let me tell you, it is hard leaving such a place like this to go back to the congested east.

After all of the activities yesterday (1/2 mile hike, Virginia City, etc) my limb is expected to be a little sore but it is not painful, just a little sore. You have to understand, with my previous prosthesis that I have been using for 3-4 years, if I did not put the prosthesis on immediately after the shower, and waited a couple of hours, it would begin to swell tremendously. To the point where it would take me 45 minutes to an hour to get the swelling down...I believe this is all due to the skin affliction that I developed by wearing the prosthesis.

So, I am in this habit of waking up really early (which is my nature anyways), taking a shower and putting my prosthesis on immediately. With the prosthesis that Rick has created/designed, I can walk immediately after putting it on...I mean inserting my limb into the prosthesis and walking IMMEDIATELY. No 'limping' around for 10-15 minutes (or longer)...I go right downstairs at the motel room and out to the rental car.

Even though the prosthesis has enabled me to go and 'do my thing' immediately, I noticed today (Thursday) that the prosthetic socket is not getting to the point where I am 'really' comfortable...the fit is remaining fairly tight.

I head to a store down the street (US395) and then proceed to Mt. Rose ...the highest mountain in the local area. This tightness is beginning to irritate me to the point that I have to pull over and stand/walk a little bit. Yes, it is distracting me to the point that I am beginning to analyze the fit itself...where is the pressure on the residual limb, where is/are the area(s) within the socket that may be causing this discomfort.

After completing the trip which took approximately 1 and 1/2 hours, I head to Rick's shop. The discomfort is still there BUT is diminishing...now I do not know whether an adjustment should be made or not. I know as the day moves forward, I have been placing a 1-ply sheath to avoid the slight 'pistoning' that occurs. This is a 'norm' routine for myself and other amputees.

I arrive at Rick's shop/office and explain the sensation that I have been experiencing and wonder whether a socket adjustment should be made in a couple of areas. Rick proceeds to explain why the socket areas that I pointed are there (in detail). Rick asks me to take the prosthesis and gel liner off of the residual limb and we both notice that there are no scrapes, cuts, or discoloration. We both notice that there is more moisture on the liner than usual. Especially where I really have not walked a great distance or have done any extranuous work this morning...I'm somewhat on vacation.

Rick then adds a term I have never heard of...Adema (a-dee-ma). I'm not sure if the spelling is correct (cannot google right now the hotel's router is down and I'm now) but Adema is this... When the body is trying to disperse fluids that it cannot temporarily figure out.

The new prosthesis is placing pressure on the skin condition that was created from the other 2 prosthetic sockets that I have been wearing over the last 5-6 years. Rick's socket is making total contact with these areas, this is needed to rid this very irritable skin condition. I have been told this not only by Rick BUT also by a dermatologist; of which, the prosthetist(s) in my area have been trying to do over the last year.

The discomfort that I have been experiencing this morning disappeared after a few hours. I could walk normally during this period, it is just the sensation/discomfort that is bothersome.

EDUCATION..it is so important..Rick has all of this...he is an amputee...we are 'generally' all of the same mold...we are humans...yeah, some are taller, some are smaller, some may sweat more than others, and yes some of us, may be a little more sensitive to certain conditions than others. BUT without knowing what an amputee is experiencing, how can a correct prognosis be given.

You see, Rick is on both sides of the fence...he has years, oops...I can now say decades (boy are we getting old in prosthetic years) of experience as a prosthetist & an amputee. And talk about pushing the limits, he has all kinds of medals (Gold, silver, bronze) from snow skiing tournaments. He is a very successful individual...
as a human being, husband, father, very very active within the community that he lives in.

DO NOT interpret this man as one who has a personal goal of raking the system through the coals using his business. He is sincere in getting YOU up and going. Can you figure out why this is? Because, he at one point in his life, was like you and I, at the mercy of a prosthetist...hoping that they could ENABLE yourself to go about your 'day-to-day' routine as effortless as one could imagine. This is WHY he got into the business...to ENABLE himself to carry on with his life in this manner. Once he mastered this using his greatest pupil (himself), he transcended the concept onto those who see him.

Can you figure out why I am doing this? He is the only individual that has enabled me to do the things that I want to accomplish in my prosthetic life of 31 years...twice. I better not lose contact with this guy again. I got to stop here with this ...

After we review the topic of Adema, Rick then begins to finish the plastic support that is used for my good foot. Remember the previous day, when we talked about how amputees generally have an arch because of the way we walk? When the support mechanism is completed and I start walking I can notice how my heel on the good foot (non-amputated) is more level with my arch...I never had an issue with the good foot as far as walking BUT this does seem more natural.

We then head to Reno to stop at some other 'authentic' Mexican restaurant...this place was fabulous. The food, atmosphere, and location was great. As usual, the company I was with surpasses all of this. Not once have I went to a casino, I'm not a gambler, nor do I wish to even see such places. Don't get me wrong, I'm not strongly tied to some religion, I'm not to the far-left (or right) in politics. I just rather spend time and surround myself with amazing/unique people...Rick, Bill, Chris, Heinze...yes, they are all amputees...yes, we do have something in common, NO, each one of us have a story to tell, a service to provide, an experience to explore.

After lunch, Rick had a few errands to do, so I went and explored a few areas again. This never ceases, eventually, you start going into the woods and looking at the different wildlife within the locale. It is amazing how nature changes throughout the USA...I have no need to ever leave this continent...this place that has made me who I am today, and will be tomorrow.

Well, again, there is so much to add here but I must keep it shot. Yes, as the day wore on, the residual limb got comfortable. I had to eventually add a 1-ply, this is the norm because my residual limb is bony. I wore the leg approximately 14-15 hours today...this is the 3rd day in a row. I realize that there is going to be some pain in the very near future as I get back to a 'normal' state with both the residual limb and my hip...remember the 'Leaning Tower of Pisa' did affect my hip...this has not started yet...but I believe this will come within the next couple of weeks.

I will not add the final blog until I get back home...I really hope anyone who reads this will contact me; daniel.nault@gmail.com ...it has been a pleasure/experience once again and I will be back within the following year.

Amputee Experience- Dan's new leg Day 5

Day-5 (Wednesday)

It is another beautiful morning and the schedule today at the office seems to be not as intensive with the socket. I get up to the usual; wife calls, gives me the update for the day..after all, I still have 3 of 5 kids living at home (18, 16, and 3). Jump in the shower, and then place the prosthetic limb on.

By the way, Rick does make a shower leg. I have not requested to have one made, yet. It seems like a good idea now because of the new mannerisms with the care/cleaning of the residual limb. Meaning, I use to apply a white cream on my residual limb before placing it into a gel liner, then into the socket. So wearing a shower leg puzzled me in the fact that the shower is where I clean my residual limb. How can this be done when I am wearing a limb.

I now, per Rick's recommendation, just place the residual limb into the gel liner, then into a pelite liner, lastly into the socket. If I start sweating, I just take all of this off and use the "hand-sanitizer"; of which, requires no water. I also use this process when I take the prosthesis off for the night before bed. NOW getting a shower leg seems more appropriate.

This socket is so much more attached to my residual limb. I can tell by looking, feeling, and more importantly, wearing the prosthesis. There is still some soreness, but look at my situation; verrucous hyperplasia, grafted skin, and a socket that was designed to not rip the gel liners that I was using.

As the day goes on I feel pretty comfortable. I get over to Rick's shop and was greeted by a gentlemen named Heinze (I do not know if you spell his name in that manner). Heinze also has a prosthesis, he is 70 years old and gets around as a typical 70 year old man...not one with a prosthesis as you would think...pretty good at that. He drove over to see Rick for an adjustment. He also brought over some german onion pie...I believe he came from Germany when he was younger. His company was appreciated and the pie was awesome...I know I will never have a pie like that again. Yeah, Rick took the other 3 of 4 pies and stashed them away... oh well, I'm still here for 2 more days. Realize I'm playing around here, Rick will always share what is available for food rations within the Sierras.

So, Rick and a previous coworker (Chris); of which, is a pretty big guy... I do not mean as in over weight, but as in BIG... someone I would not ever think of messing with (it is not my nature to begin with) present me a proposition...

How about if we make a support mechanism for my good foot. You see, most amputees develop a really high arch. The arch is moreso on the 'good' foot because of how amputees walk. You know, strike on the heel, and push off from the toes of the good foot...it is just something we tend to do more than the average bilateral homosapien.

I'll give anything a try at this point...if it hurts or causes problems, then I just don't have to wear it. So we proceed to place my good foot (no shoe) with my typical footsock into this rectangular box that has this blueish foam in it. Obviously, they (Rick & Chris) took a capture of the foot and made a plastic insert out of this that goes into my shoe.

They have me walk around a bit, I describe some sensations that I would like to see corrected. They fully understand transposing this into medical descriptions of the situation amongst themselves and go make the adjustments. Place the plastic molding back into the shoe and voila, I'm off and walking with no problems found.

Now Rick wants to really test the prosthesis and plastic foot support...lets go for a hike up on the hillside. I have only done this a couple of times back east at the 3 sister mountains in New Hampshire. I have no problem with this because I am curious. So we go out, Rick had a couple of errands to do, then headed for the hillside.

Rick got a couple of ski poles to use for balance...this makes it easier when hiking. We do not have to concentrate on what is on the ground as much when walking (pine cones, sticks, etc) when using these poles.

We headed up the side of a mountain...this was NOT some cliff...it was a nice walk... the slope./grade was not sharp...I don't know. maybe a half mile all together maximum (Back and forth). I had some pressure but no pain, if need be, I will look at this the next morning and address it with Rick if need be. The beauty of the Sierra is really something you have to see. Rick is also a great tour guide...he will inform you of your surroundings in great detail...certain trees, plants, the history of why certain landscapes look as they are (fires, forestry control mechanisms, etc).

I would not have done this with any of my previous prosthesis(s) without knowing that when night falls, I will be dealing with some definite pain at the end of the day. Something I have been accustomed to because I have to do what I have to do...that is how we amputees think when there are responsibilities (family, work, chores, projects, and this list goes on).

So we get back from the little hike that we took and then proceed to go out for dinner with Rick's kids. We headed into Virginia City and stopped at an authentic Mexican restaurant...not a 'tex-mex/taco-bell' type of restaurant. The company and food was great. We then took a walk around the town..very western-like back in the late 1800s...wooden planked side-walks, small 2-way street with saloons, fudge-shop, jewelry & stone shops...too much to list. Virginia City is a remarkable place to experience...the city takes you back in time...it was an old Silver mining city. Too much history to relay in this blog BUT a place that must be seen. Just the right to & from this city via a 'Pass' is amazing and is worth seeing.

Well, the day was challenging in the fact of the hike, then going to Virginia City and walking around. I must admit I am a little sore BUT after taking my prosthesis off, washing the residual limb and gel liner w/ the non-water hand-sanitizer, a physical inspection of the limb shows no redness, or breakdowns on the skin. I believe it is just a matter of time before my limb truly heals and days like this will be a breeze.

There is so much more I could add to this blog...if more details are needed, please email me at daniel.nault@gmail.com

Well, lets see what tomorrow brings us in Day-6 (Thursday)

Amputee Experience- Dan's new leg Day 4

Day-4 (Tuesday)

I awoke to the phone ringing...ah, my wife back home (8:00AM EST) calling about inground pool vacuuming issues. Talked her through this, and got off of the phone. Jumped into the shower & noticed that my limb was a 'little' sore but nothing major. Got dressed and headed out to the store.

The initial walk and feel was alot better...tremendously different and inspiring. I felt good, the socket at this time was not too tight and was not pistoning. Got into the car and made my way to the store that was approximately 1 mile away down US395 South. I got to remember that RIck stated he does NOT want me to go any place far..sight-seeing ride and walk off into the woods. If something pops-up and I get into trouble with the limb, this could be a difficult situation...I'll just go back to the motel room and hangout...see if something arises.

Leaving the store I got back in the car, and upon starting it, noticed the 'check engine' light was on. The rent-a-car had the manual in the glove compartment and sure enough stated that emissions may be having an issue. Well, I got to wait until they open; it is only 5:35AM PST.

As I am riding back, my limb begins to hurt, you know when you have that PAIN that just starts pinging...kinda makes you want to crawl out of the hole that you are currently in...trust me, right now I'm in a hole...wife calls all upset w/ the pool, mind you, I'm an early-bird and no one gets up as early as I do...I got the phone call on the 3rd ring in my sleep. Then this damn rent-a-car 'check engine light'...yeah, yeah, I know, its an 'idiot light' BUT not now!!!

Lastly, the new test socket prosthesis is driving me nuts, I have to go back to the hotel room to take it off...its too early to call Rick ...yes, I have respect for the man. So, I gotta not let the day crumble so quick, what is causing this within the socket? Concentrate Dan, what area seems to be giving this painful sensation?

This is hard, most of my limb is bony, I have probably 4-5 inches of limb from the knee down. There are some sensitive nerve areas also...the pain is different and does not seem to becoming from any of these areas. AHA!!! the back of my residual limb (the calf) as small as it is...it is used as an area to apply pressure...why not, the skin is not grafted (natural skin)and defintely can take alot of pressure. Obviously not as much as being applied by the modified 2nd test socket. I get back to the motel room, take off the prosthesis and comfort slowly comes back into my life...WHEW.

I then continue to feel around the socket where it contacts my limb...I believe this is the area located in the back of the socket. Apply pressure to my calf to validate this is what I am feeling; of which, aligns where the socket slightly protrudes to apply pressure. So I wait an hour (it is early), put on the prosthesis again, go for a short walk outside, wait for that pain to come back (approx. 10-15 minutes). I go through the process again of pressing on the back of my residual limb (on the calf) and have located the 'exact' location of where the pain/pressure is coming from and review the socket protrusion for pressure...God I wish I had some sandpaper!!! I feel confident though because I have clearly identified what is causing this issue. Well, I guess I'll have to wait for the scheduled time to arrive at RIck's for the adjustment. He did say to call if any problems occur...but it really is too early...I have a lot of catching up to do with work via my laptop using a VPN connection...this will occupy a couple of hours.

I shoulda' brought the 'Leaning Tower of Pisa' prosthesis as a backup...what a horrendous thought. As bad as this may seem...the fix is very obvious...you get to this point in the fitting process and I can already see the 'light at the end of the tunnel'. What goes through my mind for 'red flags' (warnings) at this point? Duration...endurance of the fit is already where I want to be with this test socket.

I have to be careful as an amputee not to jump to cause. We 1st need to address this latest issue and see if this causes another area to be affected. Rick will know what/where this may shift to IF the pressure is to shift at all to some other location.

POSITIVE NOTES:
1) I stopped using the cream I use to apply on the end of my limb...this is so much better. I use the Hand-Sanitizer to clean the limb and keep it dry. Someday I will be able to afford a shower leg... one of Rick's recommendations.
2) The socket really does feel better...not too tight, not too loose, I really need this area corrected.
3)My gait/walking ability is sooo much better...it is smooth, my strides are effortless. There is no 'swinging' around the prosthesis effect. The overall walk seems very natural. Even though it is for a shorter timeframe than I would like at this point.

I gotta remind myself that I have been working with a couple of prosthetist for a year now on another leg. We are on test socket number 4 or 5 (with modifications on some of the sockets). Here I am on Day-4 and I know where this problem is as an enduser, let alone having a prosthetist like Rick to resolve the issue. I really need to get to the 'endurance over time' part of this fitting process...PATIENCE!!!

Arriving at Rick's place I explained all of the above to Rick. Within 15 minutes this issue was resolved. He suggested that I go out for approximately 45 minutes and to test this alteration on the modified 2nd test socket. Well, I took a drive to pickup some hamburger & buns, walked around the store for a bit during this process. Came back to the shop/office and the problem was resolved. No other issues seem to have arisen during this time frame.

I explained to RIck that I am anxiously awaiting to get to some type of endurance test of the leg. You know when a prosthesis is used for fairly short periods of time and no problems are found. Then when you leave and wear the newly designed prosthesis for some longer period of time (hours, days, etc) and then an issue arises. That wouldn't be good.

I had to give the #2 test socket/prosthesis back so that Rick could go onto the next phase; of which, was to add a soft material to the inside of test socket #3. This process will take somewhere between 3 or 4 hours. IF there were any discomforts, this last step would eliminate any slight discomforts by as much as 10-15%.

I have to clarify the term 'discomforts'...this is not pain that is being experienced when using the test socket. The term 'discomfort' here is those 'slight' areas within the non-bony & non-nerve areas of the residual limb where 'good' contact pressure is being made. The 'healthy' pressure areas used to keep the prosthesis on the limb. In other words, discomfort is not referring to those extremely sensitive areas (bony or nerve).

As we get closer & closer to the final product, I have now become so comfortable. Again my walking stride is back to being normal...this may lead to some muscle or even hip discomfort...but the avenue that this will lead me down is for the better. I have already noticed better movement of my hips when walking...I am no longer 'swinging' my leg out to step like I have been doing with the 'Leaning Tower of Pisa'...if my hip begins to hurt when using the newer, wait a minute, "MUCH IMPROVED" newer socket, I will know why. This can be addressed by using some 'Ben-Gay' type of product like Mineral Ice, Icy Hot, etc for a period of time until I get my body back to a normal stature.

I must add, watching Rick go through the process of making a socket is truly inspiring. When we hear custom design...I always thought that he made a socket that would fit the residual limp comfortably...meaning, the socket has every dimple, nook, and cranny that the stump had...a mirror image. Not only can Rick do this BUT I NEVER IMAGINED all of the layers that are put into place on top of the socket design.

I mean, every amputee's limb is different, DUH, we know this. BUT Rick adds pieces of felt, and other materials in specific areas of the socket according to that individual's needs. It is remarkable how many variables can come into play just between 2 amputee's physical makeup. Let alone market your business on this pretense...and more importantly DELIVER that product to EVERY customer...this is what Rick Riley does...a remarkable talent that he has developed over the years. There is a whole separate landscape that is implemented by this prosthetist in his service. YOU WOULD BE AMAZED!!!

Well, a few hours have passed and I am wearing test socket #3. Rick made 2 adjustments to the component between the socket and the foot (pylon made of aluminum that DOES NOT act as a shock absorber...it is really basic ) and I am walking more comfortably now. My old prosthesis hurts all of the time when I wear it. I have only realized this after having/wearing/using the socket made by Rick. WHAT A DIFFERENCE!!! My limb is sore though from my other prosthesis.

I walked around for 10-15 minutes and we decided to call it a day. I told Rick that I will probably have to take the prosthesis off for the night when I get back to the motel and see how it truely feels in the morning. Giving the night off of my amputated limb because is hurts from wearing the old prosthesis. I want to get a fresh start...the old prosthesis really changes the physical makeup of my limb. We said our goodbyes and selected a time to meet on Day-5 (Wednesday).

By the time I got home my leg was starting to feel better. So I decided to leave Rick's socket on. The wife called, we spoke for a bit & I decided to go back out for a while. This is the 1st time I go out at the end of the day since being here...my amputated limb does feel better.

I got back in around 9:30PM PST and NPF (no problems found)...I left it on until I went to bed (10:45PM PST)...this is a 1st. I just started wearing this limb and I am feeling so much better. When I took off test socket #3 prosthesis my limb was a little sore BUT that was because I had to wear the old prosthesis for 3-4 hours earlier that day...I know this.

Got cleaned up using the Hand-Sanitizer cleanser and well see how I feel on Day-5 (Wednesday).

So, the wife's issue with the inground pool issue is resolved w/ some guidance, Rick, as usual has done a tremendous job in JUST 4 DAYS!!! And you know what, that damn 'idiot' light in the car went off...no, I'm not going to gamble, I'm staying in the 'Winner's Circle' for as long as I can.

Lets sign off and see how Day-5 goes!!!

Amputee Experience- Dan's new leg Day 3

Day-3 (Monday, Memorial Day)

A beautiful morning once again...before heading to Rick's place I took a ride over to lake Tahoe (South) via US395S to 50-West...
unbelievably inspiring. I will direct you to photos of this and other places later on. This was approximately 25 miles west of the office...not a bad ride for all that is to see.

We placed vasoline over the end of my stump and slipped it into the 2nd test socket. All 3 areas of pain/pressure were addressed...no discomfort whatsoever...and this is just my 'bare' residual limb in a test socket...no gel liner(s), etc. Stood there for about 10 minutes and these areas were no longer of concern.

There was 1 other/different area that placed some discomfort but nothing compared to the other 3 areas. Rick had highlighted this area and we took off the socket so that he could modify without creating a 3rd test socket. It was a very small alteration to be made; hence, no reason for a 3rd test socket. Rick also instructed me to 'press around' this new area of slight concern on my residual limb to see whether I could locate the exact area that was causing this slight discomfort. I/We found this area; of which, Rick had already 'marked'. This action was just to validate that the 2nd test socket was marked/highlighted correctly.

Burger time...today we had lamb burgers...something different and it was great!!! The chef was a guy named Bill Griffith...great guy...truely unique...he also is an amputee who lives near by. Bill does everything; sailing, kayaking, etc. He is a story within himself and you really need to speak with him...he has experienced more physical trama than anyone I have ever met in my life...I have been in every state except for Alaska and Hawaii, from lower-to-middle-to upper class societies in our caste system. Bill has a great deal of energy; of which, you can identify within the first 10-20 minutes of meeting him. I truely need another blog to just speak of his experience(s) in just the first couple of days of being around Bill. He does know how to operate the grill and definitely is great company.

Rick has now made the modifications and this time around I will attempt to wear the 2nd test socket with the liner. This process can take anywhere from 1-2 hours. Once completed, we went back into the GAIT room placed my limb (w/ liner) into the socket and started adjusting the foot, pylon, etc. No socket changes, just the mechanical components.

Because I was already wearing a prosthesis that was poorly fitted, it was extremely hard for me to truely identify whether the modified 2nd test socket was actually operable. You have to understand that the prosthesis that I had been wearing did not sit underneath me...the artificial leg stuck out...resembling that of the 'Leaning Tower of Pisa'...honestly!!! But this is just another example of what we (amputees) CHOOSE to conform to with our current prosthetist(s).

So, we (Rick & I) went out into the driveway and I walked around a bit with the new socket/prosthesis. There was something different, the leg was correctly adjusted underneath me, the walk was obviously different (better). Because of my previous prosthesis and its fit & design I was feeling some pain.

By now it is 7:30PM and I (we) decided to call it a day. Furthermore, I could not add any detail because my limb needed to get back to its original shape by going to the motel room taking off the new prosthesis and start 'fresh' on Day-4 (Tuesday). It has always been difficult for me to go from a prosthesis (that truely does not fit correctly) to someother prosthesis. More importantly, even though I have so much 'faith' in Rick's talent, we still need to stay 'focused' on the current fitting process. So I got to the motel room and took off the new prosthesis, it was bothering me to where I had to immediately take it off.

To myself, I was saying, "We'll have to wait until tomorrow (Tuesday, Day-4) to see/identify whether it was the changing of prosthesis, the new prosthesis, or both. Regardless, I know we can resolve whatever issue the situation presents itself as on Day-4.

Amputee Experience- Dan's new leg Day 2

Day-2 (Sunday)

Another beautiful morning...the adjustments made/recommended by Rick on the existing prosthesis (not the prosthesis that is currently being made) have had no adverse/negative reactions to my limb:
1)Added a piece of material in the areas that were afflicted.
2)Stopped using an ointment/cream (AD&D) that was being used daily for the past 5-6 years.
3)Added an additonal small & thin gel-liner sock on the end of the residual limb to stop the 'pistoning' ...this is an attribute to break-downs and discomfort. This thin/small Gel liner goes over my kneecap. Then I would place the full length Gel Liner over the smaller liner and proceed to insert the limb into the socket. This small gel liner is made by Silipos...Molding Distal Roll-On by Silipos....Mineral oil Roll-on.

As a matter of fact, it currently seems that the pistoning that was occuring has stopped. The term 'pistoning' is being used here to describe the slight movement of my limb within the socket. This causes additional friction; of which, in turn, is the culprit of breakdowns but a well designed socket should never cause breakdowns to begin with. Pistoning can also cause pain/discomfort from the movement within the socket of the prosthesis. This is where I experience pain after a couple of hours of wearing the prosthetic limb. Let me clarify that if I were to walk a distance (1/2 mile or more)...obviously, this would bring the pain on much quicker.

Previously, I would use 1-ply socks and as the day would move forward I could add up to 2 or 3 1-ply socks. This strategy is never perfect...the socket fit is either too tight or slightly loose (which is where I prefer to be)...again, some pistoning would occur but the pain threshold seems to be more appeasing than the 'too tight' methodology. After a couple of hours of being too tight the pain just overtakes my mindset or comfort zone and becomes mentally distracting.

These variables that have been implemented seem to keep the current socket fit snug...I should clarify term 'snug' as being 'comfortably' fitting. In addition to the smaller Gel Liner and the new Gel Liner, the material that was added at the bottom of the socket filled in a 'gap' where my limb would never become in full contact with. This caused skin growth named "verrucous hyperplasia"...here is the definition:

This is an itchy, red, raised, circular area on the distal end of a residual limb, caused by suction being applied to the end of the limb. This condition frequently occurs when the socket is too tight and the limb does not make total contact with the bottom of the socket.
To prevent verrucous hyperplasia:
-1. Maintain a good “total contact” socket fit.
To treat verrucous hyperplasia:
-1. Remove the cause.

The above was taken from the following link...pay attention to the web address...
http://www.amputee-coalition.org/first_step/firststepv2_s3a02.html

http://www.amputee-coalition.org should be a reputable site for the readers to believe
my personal experience(s).

In laymen's terms, the growth of skin that occurs looks cauliflower/brocolli-like.

Well, this is some food for thought...the previous prosthetist (at least 2 of them) knew this. I knew this via the internet...my personal attempt at resolving the issue was by adding these Gel disks at the bottom of the socket...this would not work. I have been caught in between the vendors and the product that they sell. My socket is a very 'general' design; that is, the socket does not resemble the shape of my residual limb at all. The socket resembles my residual limb within a gel liner. This design was conceptually delivered on the premise that we do not want to rip the liner...the vendor would not reimburse the cost of the liner if it tears because of a poorly designed socket. This happened to me...the liner ripped after 1-2 months, so we added leather to the bottom of the liner...this is where it ripped and the liner issue was resolved.

BUT the "verrucous hyperplasia" continued to live on. This did not concern the vendor, prosthetist, and all others (aside of myself)...the expensive liner(s) do not rip ANYMORE!

Please be aware of your surroundings...I lead a very busy life and when I go to see a professional, there a lot of other variables to take into consideration...especially within the medical field. In the northeast there is money to be made...I know 1st hand. I see the scheduling of a few orthotic/prosthetic practioners...its insane...how can they even find the time to absorb such issues as myself for this example. Then move on to the next patient immediately...there is no time to test & observe the product...the actual fit for the amputee and the socket.

Okay, so I seem to be on my way to recovery with the current prosthesis...for the time being...even though I know of RIck's potential...I have had so many BAD experiences with fittings...I look at him and say...can he do this again....95% of me internally still believes this will be done...but we all know that the possibility of error always exists. Heck, Rick and I both had this conversation on Day-2...gave me that 'kinda' were both on the same page...not a good feeling BUT a realistic one...keep in mind, where both people that are attempting to accomplish something that has been in a negative zone for sooo many years. But I have to go on evidence, and that is, out of all the prosthetists and their attempts...Rick got me more than 'up & moving about'. I was enabled as a whole person that can do as much as the next man standing beside me...that is a lot to say.

So, Rick finally gets the 1st test socket completed. Assembles the socket onto a pylon with a Safe2 foot...very basic technolgy. My current prosthesis has a shaft with a pump built into it...when I bear weight onto the amputated limb the shaft 'abosrbs' the initial pressure received, thus, eliminating any substantial friction on the residual limb...boy, that sounds really good doesn't it. The foot on my current prosthesis is a Freedom foot; of which, is built for high endurance. So, I see Rick placing the 1st test socket on a basic aluminum shaft with a Safe2 foot and I'm like back into the 1980's...guess what, I'm not shaking here...this worked for me back then...as a matter of fact...this woked GREAT for me. We will see as the days unfold.

We then proceeded into the 'GAIT' room I always referred to them...you know, the steel/metal rails that stand between.

Here I placed my limb (no sock) with vaseline on it into the test socket and stood up. I could barely place any pressure on this BUT we need to align the foot/shaft/socket correctly so that the prosthesis sat correctly underneath me. We needed to address a few areas of concern in regards to pressure, and more importantly, categorize these areas relative to the amount of pain I was feeling. Rick marked these areas with a marker (bring some lipstick, this is what he likes to use...just an insider's joke). Then proceeded to cast the socket again. This will be the 2nd test socket; of which, we will work with later on.

All of this took a few hours...we had the entire day if needed, but was not. We had some hamburgers on the grill out back and consumed the beauty of Nevada...it is truely something to experience. I will go into detail of the different areas to see at some other point in the blogs.

One additonal note...I started using another recommendation from RIck...use the waterless Hand sanitizer for your residual limb when you take it off at night. Do not use the soap that we are accustomed to when taking showers or baths. Also, use this sanitizer on the Gel Liner to clean it. One last note, if your limb is sweating within the liner throughout the day, take the liner off and wash the limb with this sanitizer...this is remarkable...I am using the Purell brand right now...but Rick is loaded with these simple little remedies for amputees. This in itself opens so many doors.

Am I satisfied so far...I have to say, for the time being...definitely. I have been given a temporary remedy to the current prosthesis I am using. Also, the recommendations given by Rick and put into place seem to be improving the quality of my skin (verrucous hyperplasia). The current socket is fitting just right, not too tight, even after 8-10-12 hours...it is not loose.

We get to see how Day-3 unfolds in this continuance of blogs over a 5-6 day period.

Amputee Experience- Dan's new leg

This is the first of a series of blogs by Dan Nault, a client of mine who is here getting a new leg made. I last made him a prosthesis over twenty years ago and what follows is a day by day account of his experience here. It is raw and unedited, if I screw up, you'll here about it. Enjoy his experience.
Rick Riley

Below is the Day-1 blog that I spent most of the morning
composing...let me know if we need to change anything...I am trying to
assist in selling your sevices to those who are unaware...

Day-1 (Saturday)

Well I landed in Reno from Boston and immediately was greeted by all
types of slot machines within the airport. Obviously I was not here
to gamble...a sure bet was my intention!

I had not seen Rick Riley in over 20 years...and this has been long
over due. Rick's office could not be any easier to find on US-395S;
look for a 4x5 foot sign on the right (approx. 15 miles from Reno).
The sign states "Rick Riley's Prosthetic Consulting Technologies."
Of course, I found his office with guidance from Rick..he will make
sure you do not get lost.

As I pulled into the parking lot I happened to notice someone peering
through the front office window. Of course, Rick was awaiting my
arrival, he came out, and we cordially greeted one another. It was
like we never missed a beat from 20 years ago. Very approachable,
inviting and a sense of 'Hey, lets talk about the trip, and the
schedule' for the week." Obviousy, by now, we both have family, aged,
gained weight, and are truely, real people in today's society.

I have been married for 23 years and now have 5 kids (23, 21, 18, 16,
and 4). I have always worked...I was in a train accident when I was
15, it took me about a year to get back on my feet again. I have an
amputated below right knee limb.
There have been times where I would work 2 or 3 jobs in my life. I
own a home, 3 stall garage, inground pool (love to swim) ...I am
providing this information so that you can see that I am not someone
who wakes up and sits at home...I want to be as productive in society
as can be. I live, eat, and breath LIFE...we are only here once, so
we all must do the best that we are capable of doing...there are very
few Sundays in my week-to-week schedule...I like it this way...YOU
really have to see the scenery in the Reno/Washoe Valley/Carson City,
Nevada area...UNBELIEVABLE!!!...especially if you are from New
England...mulitply the white mountains x 10 ...I know, my family has a
place right on the White Lakes of NH...this area (Nevada) is on a much
larger scale.

You see, I was fortunate to 1st meet Rick in my hometown
(Massachusetts) when he was employed by a local orthotic & prothetic
business. This experience did not cost me a round trip flight, 6
night hotel stay, car rental, etc...plus the cost of the prosthesis.
His services enabled me to do almost anything I coud not even dream of
with all of my previous prosthesis (approx. 3 or 4 legs). Rick
enabled me to realize that a prosthetic life does not need to be one
that is ful of pain!!!!

This is the CRUX of my 1st day 'blog'...trying to convince all you
readers out there that this is not a hoax. I have been through 3 or 4
prosthetists since seeing Rick in the late 80s and guess what, the
prosthetist end up trying to duplicate 'Rick's socket' from the 80s...
HONEST! I was extremely fortunate to meet this dude... hence, my
message to you is...this not a hoax or commercial add, it is not an
insurance scam, it is not 'some internet guru' 'phishing' for credit
cards or cold cash to take from those who are desperate to improve the
quality of their lives. This is the fact...I was so fortunate to have
Rick as a prosthetist and hence...every penny I spend/spent to come
here is worth IT!!! Understand...I am trying to 'sell' you a product
(an individual's services) that is genuine!!! I am the end user...I
do not benefit with any proceeds from this.

Somehow I just took a right on this blog...sorry about that, lets get
back to DAY-1...

If you know Rick...and TRUST ME, you will per all of the phone and
email transactions that occur in the scheduling of the visit...you
will definitively have a sense of comfortability in conversation.
This includes how the actual process/fitting will occur and the
'locale' on the 'what-to-do' list. For myself, being around someone
who has this technical approach (and character) is a life-lesson in
itself. You have to give this a try JUST for the experience alone.

Logically, one would think...there has to be a prosthetist in my area;
give or take 100 miles that can do this...I am from, as they say. 'The
Beast from the East' and I could not find one as competent as Rick.

So, after about 15-20 minutes of introductory conversation (how's the
kids, this-that, etc) we immediately got to work...yes, DAY-1 was a
Saturday...Memorial weekend on top of that. My previous 3
prosthetists used a scanner to get the image of my residual limb.
Rick takes this approach as an art, he uses the 'old fashion' casting
procedure...then highlights (using a marker) the areas of the limb
that are sensitive. He also highlights areas that can take more
pressure than the sensitive area(s).

During this phase, we also conversed about all of the 'trials &
tribulations' that I have experienced with breakdowns, discomforts,
additonal surgery from inappropriately fitted sockets, etc. Including
a current condition (veruca hyperplacia) that I have had for at least
4 years now caused by the lack of contact on my limb...and we
(Prosthetists in my locale area) have attempted to resolve in this
time with no success. Not to mention, I have had a intrusion/cut/gap
opened on my limb for at least 2 years...it is a pressure point that
is obviously taking on too much.

So you see, I did not just walk into Rick's office as a candidate for
a new limb...I am a disaster zone...I am the situation that occurs
JUST before the day ends at work and now we have to stay until it is
completed...I currently work within an environment like this ...this
is not something that you wish on your worst enemy...BUT guess what,
Rick invites these challenges and after the casting, we conversed
about my current prosthesis and made some aterations...
1)Added a piece of material in the areas that were afflicted.
2)Stopped using an ointment/cream that was being used daily for the
past 5-6 years.
3)Added a small gel-liner sock on the end of the residual limb to stop
the 'pistoning' ...this is an attribute to break-downs.

Of course, Rick always supplies his recommendations with a variety of
premises to support such actions. Keep in mind, he will always ask
you a variety of questions in regards to the current prosthesis and
how it fits. This is what the fitting process is all about. How does
the prosthetist interpret the amputees' expression of the overall fit?
He is an amputee..an active one at that to say the least...he KNOWS
what you are relaying to him in regards to how the prosthesis fits.
More importantly, what is the comfortability level...So my current
prosthesis feels better...the socket really needs to be redone...BUT
hey, that is why I came here, to finally get a socket made that will
enable to do more than I have been able to in the last 10 years.

So, once the casting, measurements, alterations w/ the existing
prosthesis were completed...we went to Rick's house for a tour...met
his wife and kids...I told you that 'we are real people'...we work,
play, like most american families (I hope)...we had a beer, some
shrimp w/ Rick's cocktail sauce ...I have not been approved of
revealing the recipe...but it was really good. Great people is what
makes the world go round...I am truley please with DAY-1 ...stay Tuned
because we still have the week's day-by-day blog.

Busy in Boston (currently Nevada)
Daniel Nault
daniel.nault@gmail.com

Medicare Blues and Hiking with Poles

I've been "off the blog" for a month. I have moved my office from my home, into my office building. It took thirty days to find all my stuff and get organized but I'll be a bit more regular from now on. Plus, I got a Mac. Yes, ditched the old PC and went Mac. The verdict is still out as to how swell it really is but so far it has not pissed me off as much as my old PC.
As I mentioned before, I have hired a billing service and very soon will be accepting Medicare, Anthem/Blue Cross, Workers Comp, and Universal Health Network. This has been a traumatic endeavor, dealing with Medicare is mind boggling. Thank god, I have someone to interface with them because I don't believe my patience would have held.
Big changes at the shop also. I have added a fitting room with parallel bars and a real plastic skeleton. Although most of my clients prefer to sit in the lab and watch everything be made, I now have a quieter, cleaner, space to work in. One of the nicest additions is the lawn furniture beneath the trees and my old BBQ grill for cooking a few burgers or steaks when I'm working. Not a bad way to get a prosthesis made, hanging out at the BBQ instead of sitting in a little room with no windows.
It is finally Spring here in the Sierra Nevadas and the snow has melted. This means hiking and backpacking time for me. There is a trick for amputees to get to enjoy backpacking. Whether you are below or above knee, one of the biggest problems when you are hiking on uneven terrain is tripping over roots or rocks.
Amputees compensate for lack of musculature by generating more forward momentum.This allows us to move forward at a reasonable pace. On uneven terrain, every time we stumble over a root or rock we lose our forward momentum and often times have to recover or even fall. Either of these circumstances makes hiking in the woods a real challenge. It can be enormously tiring to be stumbling every fifth step which causes us to look in only one direction. Down. I can be hiking through the most magnificent forest on the planet but until I stop, I can't see anything but the ground directly in front of me.
The solution: hike with poles. Hiking poles that have straps at the handles can give the amputee hiker tremendous stability and allow them to actually see where they are hiking. What a concept! I started with cross country ski poles but now have a bitchin pair of Leki collapsible hiking poles. The trick is the strap. If you pull with the strap tight against your wrist, you use the largest muscle groups in the upper body. If you grab with your hands, you use the smallest and weakest muscles in the upper body. Walk normally with arms alternating with feet and you are on your way. I not only hike but backpack with a fifty pound pack and I have a pretty short below knee stump and weigh, well it's none of your business how much I weigh but lets just say it's a bunch.
Give it a try. If you have stayed away from hiking in the woods because of fear of falling or tripping, give poles a try. It really makes a difference.

Rick Donates books to OPAF first bid

The American Academy of Orthotists and Prosthetists annual meeting will be in San Francisco from March 21-24. I have donated five of my books, "Living with a Below Knee Amputee, A Unique Perspective from a Prosthetist/Amputee" to the "First Bid"  OPAF (The Orthotic & Prosthetic Assistance Fund) auction.

I will autograph them all and they will make a great buy for a prosthetic facility to give to their amputees.

Living with a Below-Knee Amputation provides an insightful look at the entire spectrum of the below-knee experience from amputation to rehabilitation. As a prosthetist for 22 years, author Richard Riley uses real-life examples to answer many of the questions facing amputees, including, “WHAT NOW?”

 

This quick, easy-access guide not only discusses the psychosocial and physical issues; it also clearly explains the role of the medical professional and the complexities of constructing a prosthetic device during each phase of rehabilitation. A visual index displays all of the available options and components of an artificial leg.

 

Topics inside Living with a Below-Knee Amputation include amputation surgery, pain, postoperative care, therapy, purpose and design, fittings, maintenance and hygiene, integration of the prosthesis, child amputees, and recreation and sports.

 

Amputees aren’t the only ones to benefit from this book. The unique perspective used by the author helps physical therapists, occupational therapists, physicians, orthopedic surgeons, and rehabilitation professionals better identify and relate to their patients. With a better understanding of the amputee’s emotions and expectations, professionals can cohesively work with their patients to help them successfully reintegrate into their lifestyle.

 

Living with a below-knee amputation does not have to mean

loss of living a complete and gratifying life.

 

TO ORDER:

 

www.slackbooks.com  OR  www.Amazon.com

 

  SLACK Incorporated

6900 Grove Road   Thorofare, NJ 08086 USA  856-848-1000

For More Information call Rick Riley at 775-830-1783

Email rickjillriley@hotmail.com

Visit my website at <prostheticconsulting.com>