Amputee Prosthetist

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> 

 

Having an Amputee Parent

Having an Amputee Parent

 

 All my kids have ever known was that Dad could take his leg off. I’ve always wondered what it’s like for my two boys to have an amputee parent. What effect does it have on the way they see the world, if any? I never really knew any amputees until I lost my own leg at twenty. I know that my father encouraged me to “get good with the crutches” since that was his perspective of how my future would be.

 I am a prosthetist, so my boys have been exposed to a lot of amputees over their childhood. When they were toddlers, our home was directly behind the prosthetic facility. Many of my clients were from all over the country so I often had amputees staying at our house. There are a couple of stories I want to tell you about when they were young:

 

 We had a fireplace in the kitchen. I always got up first and on cold mornings would build a nice fire in the fireplace. My oldest son was about two years old and he often got up with me and would hang out and observe. The fireplace was tricky and you had to build it just right to get the flu to work so I really had to pay attention to what I was doing. I would carefully lay on paper then stack the kindling just right so the flame would dance up the chimney, otherwise I’d fill the kitchen with smoke. I always broke the kindling across the shin of my prosthesis. A habit I picked up camping, just to impress people. I had just lit the paper and was watching to see if the flame was going to behave when out of the corner of my eye I see my son slam a piece of kindling across his tiny shin. The look of bewilderment was quickly replaced by a cry of pain as the stick just bounced off his shin. I guess he thought if Dad could do it, so could he.

 

 One of the coolest things about living and working in the same building was that I provided day-care for my two boys as well as for the son of one of my employees. This meant that I’d get to see them at lunch or on breaks. The other boy was the same age as my oldest son and his Dad was also an amputee. Our nanny would bring the boys to the shop and meet the clients and occasionally they would get to know the people that were getting legs made. One of my clients was a three year old girl who was a congenital above knee amputee. We had to work on her leg for a couple of hours so we sent her up to play with the boys. That evening my oldest son seemed upset. Finally, after questioning him about his problem he asked how the little girl got a leg. I patiently explained to him that she was born without a leg and we were making her a new one. He was puzzled by this and after some questioning, I finally understood his dilemma. He and the other boys had grown up around people who could take their legs off. The boys were upset because they couldn’t understand how the little girl already could take her leg off. They believed that it was just a natural course of events that when you grew up, you would be able to take your leg off. I had to explain to him that his leg probably wouldn’t have to be cut off and that it was not the case in most people.

 

 

 My boys have experienced an amputee parent for all their lives. It is all they know. Most of the men and women they met as children were amputees but because of good prosthetics the amputees led very normal lives. They always heard amputees talking about going skiing, hiking, camping, and playing all kinds of sports. The fact that someone wore a prosthesis was never a factor in their lives, there weren’t any limitations because of Dad’s leg.

 

 I don’t know what other amputees or children of amputees have experienced. I’d like to hear of anyone’s stories about their situation. Send it to this blog and I’ll post them.

 

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

Email rickjillriley@hotmail.com

Visit my website at <prostheticconsulting.com> 

 

Coming Apart on the Hill

Coming Apart on the Hill

Back at Miami University in the winter of 1975; I was having the time of my life. Classes were easy, good friends

surrounded me, and the girls were friendly.

Southern Ohio rarely got much snow but that year we got a good six inches on the ground.    One evening, a good buddy and I decided to go sled riding at a small hill on campus. Of course, we had no sleds so we went to the dining hall and stole a couple of the large trays to use them as sleds. We arrived at the hill where there was already a large crowd of underclassmen having a blast, “traying” down the hill.

  After a couple of runs down the hill, the group formed a train by sitting one behind the other and locking their legs around the person in front. I immediately sought out the best looking girl and elbowed my way behind her, hoping to make her acquaintance. We all locked our legs around the person in front of us and took off down the hill in a big train. Towards the bottom of the hill the train started to break up at the back and to my dismay my buddy fell off dragging me with him.

My leg came off under the arm of the pretty blond in front of me. She made it intact to the bottom of the hill about 15 feet in front of me.

Being a smart ass; I yelled down to her, “Hey you pulled my leg right off!”  Laughingly she turned around to look at me, expecting me to be right behind her since my foot was still under her arm. The look of incongruity on her face was priceless as she tried to figure out how I could be 15 feet away and yet she still had my foot. Suddenly she realized what had happened. She screamed and dropped my prosthesis in the snow as all of the other people on the hill froze in their tracks.

My buddy and I almost split our guts laughing. I scooted down the hill to retrieve my leg from the shocked blond. Later I apologized for any embarrassment that I caused her and she forgave me for coming apart in her hands. She forgave me so much that she accompanied me back to my apartment for the evening. This was not necessarily the traditional way to meet girls but I figured that I needed to take advantage of any opportunity that presented itself.

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

Email rickjillriley@hotmail.com
Visit my website prostheticconsulting.com

Saved by the Leg

Saved by the Leg

In the summer of 1979 I decided to take a bicycle trip with an old college buddy. We flew to Portland, Oregon where we embarked on a two month excursion; bicycling through the stark beauty of the Pacifici Northwest.

We arrived in Portland,Oregon at the beginning of June, during the height of the oil embargo imposed by OPEC. The great thing about this was that there were very few Recreational Vehicles on the road and even the logging trucks were sparse. We bicycled along the coast of Oregon until we crossed the mountains into Eugene, Oregon.

  At that time it was like walking back in time to the sixties. We had a rather good time, staying with friends of Eddy’s and taking in all of the counterculture fun.

While we were in Eugene we were invited to go to a rodeo in the Oregonian tradition, which included a square dance and beer garden. After watching the rodeo for a while we decided that we needed a beer and so we meandered over to the gymnasium where the square dance was also being held. I got in line for beers and struck up a conversation with a large yet attractive woman ahead of me in line. She invited me to dance with her so I gave my beers to my buddy and proceeded to square dance around the gym floor.  This was a free form kind of square dance and during one of the dotsie-does, I picked up the woman and swung her around. She thought this was cool so on the next dotsie-doe, she picked me up and swung me around. This took me by surprise and as I became airborne I felt my leg start to slip. When she let go of me, the leg came flying off. It skittered across the wooden gym floor and came to rest in front of the band. I went flying; knocking over a table with three people and a pitcher of beer before coming to rest in the middle of the gym floor.

The band stopped, all of the people stopped dancing, and you should have seen the look on the woman’s face.

I looked up at her and said,”Darling, you danced my leg right off.”

Some brave soul walked over with my leg and asked me if it was mine. I didn’t have the heart to be a smart-ass; since he seemed very shook-up, so I just thanked him. The people who I knocked over forgave me and I ended up sitting at their table, drinking my beer with this good-looking woman on my lap.

I was thinking that this might turn out to my advantage after all when a mean looking scrawny guy walks up to us. The woman had neglected to inform me that she was married and her husband was about to kick my “you know what” when someone told him the story of what had just happened with my leg. He took his wife and left.

Saved by the leg, again.

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

Email rickjillriley@hotmail.com

Visit my website at prostheticconsulting.com

Inadvertently Playing Footsie

Inadvertently Playing Footsie

Armed with my new leg I embarked on my first overseas adventure.  I left Oxford, Ohio to perform my student teaching in the American school in Monterrey, Mexico.  Monterrey is a large industrial city about 100 miles south of Brownsville, Texas.  I was with a group of student teachers from Miami University that included two other men (this represented half of all the men majoring in Elementary Education) and eight women.  This was my kind of odds plus one of the men was a good buddy of mine and we decided to drive down to Monterrey together.  I traveled to Atlanta to see my family and my Dad gave me the old family station wagon which today would be classfied as a sailing vessel.  Dave was a former Miami football player and a really great guy to travel with.  First I drove up to Akron, Ohio to pick him up where I also decided to visit my former girlfriend who resided close by.   
I had this need to show her that I wasn’t the crippled man that she had seen when I first lost my leg. In retrospect this has been one of the powerful forces in my mania to excel in sports and activities, I had to show people that I was just as good as anyone else. As a matter of fact, I unconsciously developed a philosophy of having to be better at something than anyone else just to be equal. I reasoned that having only one leg put me at a disadvantage in competition for everything, girls, jobs, sports, and girls. Needless to say girls were very important and I was still struggling to come to grips with how I appeared to women. I strove to walk with no limp and rarely showed my pain in public, reserving it for when I was in the relative safety of home.

Dave and I drove south in the mammoth Fury III station wagon, pausing for a stop in

New   Orleans

where we learned to barf hurricanes in the gutter. Dave had a friend in

Houston

so after driving all night we stopped in to visit with him for a day. Dave’s buddy had a waiter’s job and departed for the evening leaving us to ourselves.

We were surprised to hear a knock at the door and when I opened it there was the downstairs neighbor introducing himself. He was quite friendly and invited Dave and I out for Mexican food. Since we had no other plans, we accompanied him to a local restaurant where we had a nice dinner.

I started to get a bit suspicious of his motives as the conversation progressed. Each time I asked where you could meet girls in

Houston

he changed the subject and I began to get the feeling that he was trying to pick up on Dave and I. I did not have extensive experience with homosexuals but I had been approached before and knew where my sexuality lay so I was polite but cautious.

As dinner progressed he began to get very friendly with me, touching my shoulder and leaning towards me as he sat on my right side. I wondered what I was doing to make him think that I was interested. I was not the most effeminate looking guy, having gotten my face stepped on by a 220 pound rugby player only a year and a half prior. As I sat back from the table I glanced down at my prosthesis and noticed that the guy had his leg up against my prosthesis and was rubbing back and forth. He was playing footsie with me and since I had not pulled away from him he assumed that I was interested in something. He must have been impressed by my firm calf muscles when he reached down and gave the hard laminated plastic a squeeze.

What was I to do? The guy had been very nice to us but I was not interested in him so; I feigned sickness. We went back to the apartment and begged off to bed. He invited my buddy Dave down to his apartment. Dave, being totally naïve went with him and after about 30 minutes, burst back into the room. He scowled at me and threw a stack of dirty magazines in my lap on his way to lock himself in the bathroom. The gay man sauntered into the room and took his magazines back. Before he left, he called through the locked bathroom door that if we were ever in Houston again to look him up. Dave was kind of pissed at me for not clueing him in on the situation but he did learn how to handle himself.

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

Email rickjillriley@hotmail.com

Visit my website at prostheticconsulting.com 

The Amputee Survival Kit

The Amputee Survival Kit

  All amputees have a basic dilemma. No matter how well fitting there prosthesis may be, their residual limb doesn't stay the same. It swells, it shrinks, and it gets pimples, muscle cramps, calluses, blisters, and any other maladies that afflict normal human skin. To compound matters, often time’s amputees do not even have normal skin; scar tissue, skin grafts, and skin folds can complicate matters. To add insult to injury, this skin is placed in a warm, moist, and dark environment and placed under pressures that it was never designed to withstand. This is the situation for the residual limb.

How do amputees cope with this dilemma? Most of us utilize some type of survival kit. This article will describe some of the items that amputees have found useful when their residual limb has problems. This information is based on my personal experience as an amputee (since 1974) and having been a Certified Prosthetist for fifteen years.

First we must keep the skin clean. Soap and water work great on a daily basis for most of the body. However, you've got a part of your body in what is essentially a Petri dish, growing bacteria. Even if you utilize an antibacterial soap, within a short time most of the bacteria has regrown. Products that kill lots of bacteria are rubbing alcohol, Phisoderm, Hibiclens, and Betadine. These are all over-the-counter cleansers. Alcohol will dry your skin out, so be cautious using it. The other antibacterial soaps kill most of the bacteria yet provide little long lasting antibacterial protection. A former disabled ski team member, named George Lombard, introduced me to Phisohex. It is a prescription item and must be prescribed by your physician. The difference with Phisohex is that it contains hexachlorophene, which inhibits the growth of bacteria over a long period of time. This means hours after you have washed you still have a low bacteria count, greatly reducing the possibility of irritation or infection. Any skin rash or itch should be a signal to discontinue use of whatever you utilize to clean your skin. Take particular care to dry out any skin folds, dimples, or any place that can trap moisture.

Skin protection materials are a topic I've lectured on for years. When I lost my leg twenty-two years ago, the only product available was Ampubalm, a salve with lots of lanolin and mutton tallow (Yuk) the stuff smelled awful but did provide some friction relief. Then came Ampaid; which smelled better and had a similar effect as Ampubalm. Bagbalm is a lubricant utilized in the dairy industry (use your imagination) and also provides a friction reduction element that can soothe the skin. One of the most common errors that amputees make on skin care is the use of band-aids or gauze bandages on abrasions. Often time’s abrasions are created by excessive pressure on a limited skin surface area. Bandages only increase the pressure and can actually do more damage than good. Also the adhesive on bandages can damage delicate or healing skin when removed.

Over thirteen years ago, I became acquainted with Second Skin, a Spenco product. Second Skin is a thin (1/16 inch) piece of perforated silicone gel. It applies directly to the skin and adheres by its own viscosity. It totally eliminates skin friction, allows the skin to breathe, and can actually promote healing. It can be utilized for prevention or if an abrasion or blister appears. It is expensive and can only be used once, but for anyone who has had to endure days of pain because of a simple abrasion, it is worth it.

Second Skin does not work well on above knee suction sockets unless held in place with their adhesive strips. There are some products that will work; Bioclusive, Tegaderm, Op-Site, and Acuderm are the ones I am familiar with. These products provide a thin, adherent membrane that prevents friction and allows the skin to breathe. The product can be left on for several days and it is best removed under water. Be careful not to leave it on for too long as it prevents the skin from sloughing off and should be replaced every 2-3 days.

For all amputees who wear some type of sock there is a simple way to make temporary socket adjustments. A small hole cut into the sock will provide temporary relief to skin that has been damaged by either an abrasion or a pimple, especially when there is associated tissue swelling. This works best with a five ply sock, (the thinner the sock, the less relief), and the trick is to cut as small a hole as possible. Use an older sock if you have one, and pull onto your residual limb, take a pencil and draw a circle around the affected area. Remove the sock and cut a hole about half the size of what you drew. When the sock is put back on, the hole generally stretches giving plenty of relief. If not, then carefully open up the hole a little more. Too big of a hole does not provide good relief.

What constitutes a good amputee survival kit? I am a below knee amputee and my kit consists of: Second Skin, a tiny pair of scissors (for cutting holes in socks), Hydrocortisone (will lubricate and kill an itch), duct tape (I have hiked many miles on feet taped together), a foot bolt wrench and any other Allen wrenches that my let utilizes. I also carry a washcloth or bandana to wipe perspiration off my residual limb and my sleeves. When I am engaged in heavy activities where I perspire a lot, I sometimes have to wipe my suspension sleeve about every half hour. I carry my kit in a fanny pack with a water bottle.

Above knee amputees will use slightly different materials in their kits, depending on whether they utilize suction or a sock. Tegaderm or one of the other adherent membranes may be substituted for Second Skin. An excellent lubricant for when your skin rubs against any surface is Vaseline. Since it does not absorb into the skin, it provides friction relief for hours. Make sure you use it sparingly. For suction socket wearers who will be engaging in activities that could cause a lot of perspiration, I recommend some auxiliary means of suspension. A removable Silesian belt is an excellent addition to any above knee suction socket but it needs to be built into the prosthesis. There are neoprene suspension belts that give great freedom of motion that can be obtained through your prosthetist.

Upper extremity amputees rarely experience the friction and pressures of ones body weight on a prosthesis. However, under heavy loading, or over delicate skin, pressure and friction can occur. A kit including scissors, Second Skin, and Vaseline can also come in handy.

Each amputee will find the specific combination of skin protection materials to create their amputee survival kit tailored for them personally. Residual limbs change under pressure, over time, especially under increased activity. If you are an amputee and you don't have some type of survival kit then it's like driving around without a spare tire for your car.

  The Survival kits you should have, one for home and one for travel. These kits contain the same proven ideas that we have found that work, you will find that you will tailor the kit to fit your needs as time goes on.

• 1 small pair of scissors

• Bioclusive, Tegaderm, Op-Site, or Acuderm (for abrasions or blisters, 3-5 units depending on time away)

• Hydrocortisone for itch and lubrication

• Talc, Zeasorb, Baby powder or another sweat absorbent (for help f or putting your  Prosthesis on)

• A small towel, to dry your stump for sweat

• If you're on a trip then I would take Phisohex, Hibiclens, or one of the other strong Antibacterial soaps to keep your stump clean

• Waterless hand cleanser, handy wipes, alcohol preps or something similar (to keep the stump and socket clean)

• Extra stump socks and sheaths

• A stocking net and valve tool (to help you get your suction socket on after you've repaired your body parts or prosthesis)

• A Foot Bolt and wrench plus all of the Allen wrenches (for your prosthesis for adjustments and repair)

• Duct tape (for temp repairs, like if your frame, foot, or socket needs temp help - smallest roll you can find)

• Thin cell foam (to help alleviate pressure points on your weights bearing areas)

• Lubriderm or some other Medicated cream (for dryness)

• Stump shrinkers (if you have to take it off to repair then you want to be able to get it back on)

• Topical antibiotic (for minor sores or popped pimples then cover them with Tegaderm)

• 5-10 Pain killers (depending how long you will be away from home)

 

This is just a basic travel kit you can be as elaborate or delete things that don't apply to your situation. You should try to get all of your creams, powders, Duct tape, and cleansing agents in the smallest possible sizes so that you can have them with you at all times. It goes without saying that you should carry all of your necessary medications with you when you will be away from home for any period of time.

 

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

Email rickjillriley@hotmail.com

Visit my website at prostheticconsulting.com                 

Case Management of the Amputee

Case Management of the Amputee

Limb Loss, the Statistics

 There are three causes of amputation in today’s world; disease, trauma, and congenital defects. Statistically these break down to; 70% due to peripheral vascular disease, 22% to trauma, 4% to malignancies, and 4% due to congenital birth defects.

Statistics are not current but the best information that I have found is that there are over 130,000 amputations performed in the US every year and that number is on the increase. It is estimated that there are well over 300,000 lower limb amputees in the

United States

, alone and over 200,000 prosthetic limbs made on an annual basis.

Another interesting statistic that you possibly were unaware of is that there is no state regulation on Prosthetics or Orthotics in

Nevada

. There are only nine states that have some type of licensing for our profession and it is not likely that

Nevada

will invest in the infrastructure to regulate such a small industry. What this means is that whoever cuts your hair needs a license but whoever makes your prosthesis does not. This creates a wide variety of quality of care and service from practitioner to practitioner.   

Functional Capabilities of Amputees

 Prosthetic devices and the materials available to the prosthetist have improved dramatically over the thirty-two years that I have been an amputee. The result is that most trans-tibial (below the knee) amputees can often return to a style of life approximating the life they experienced prior to amputation.

In my experience, the critical factor for success is motivation. No matter what amount of resources that are provided for an unmotivated amputee, their likelihood of success is minimal. On the other hand, a highly motivate individual can even overcome multiple amputations to go on to experience a rich and rewarding life.

How do you change a person’s motivation? First you have to determine the attitude of the individual regarding their future expectations. A small percentage of people will not need any stimulation toward rehabilitation and conversely a small percentage will not respond to any stimulation. Often times, people are subject to their initial experience with the prosthetic and rehabilitation process. If they have a negative experience with their prosthetist or therapist, it can affect their future effort towards rehabilitation. If on the other hand; the experience is positive, than it can maximize their effort and success in dealing with their amputation.

Functional capability is also a factor of the level of amputation. The higher the level of amputation; the more energy that will be required to operate the device. Upper extremity amputees have a low incidence of prosthetic usage, especially if they are not fit with a prosthesis within the first ninety days. Bilateral or multiple levels of amputation also have an increased energy requirement to compensate for lack of musculature. Experience has shown me that with the proper team approach and good prosthetic care will allow an amputee to reach their full potential. Many manual labor jobs can still be accomplished but often times the amputee will require retraining in a field that is more suited to their prosthetic adaptations.

 

State of the Art of Prosthetics

Prosthetics has come a long way since I lost my leg in 1974. Back then there were only two different feet available to amputees, today there are over fifty different feet. One of the biggest revolutions in the comfort of the amputee is the introduction of gel and silicones into socket interfaces. When I first became an amputee the most common problem was skin breakdown and abrasions. Today we see very little skin breakdown due to the friction absorption of the gels or silicones that now interface with the skin.

Does this mean that amputees no longer have socket problems? Not at all. There is still the basic dilemma; that we have to take a living, changing piece of human tissue and place it into a dead, unchanging prosthetic socket. The result is that pressures and forces can alter as the residual limb shrinks and swells. There is no substitute for a well fitted socket designed to accommodate the anticipated changes in the residual limb. Test sockets allow the prosthetist to analyze the socket fit prior to the actual fitting of the prosthesis and are one of our best tools to maximizing the amputee’s comfort.

Most of you have seen television programs or news articles about the newest microprocessor knees. I recently attended the C-leg course put on by Otto Bock, one of the manufacturers of microprocessor knees. The major advantage of these devices is that they provide a lifelike stumble control for the trans-femoral amputee (above knee) during that all important swing phase. If an amputee’s knee is not in full extension at heel strike, then the microprocessor monitors their gait and provides knee resistance even when the knee is flexed. This allows the trained AK to walk step over step down steps, ramps, and to slowly sit into a chair. This can be a huge advantage for the above knee amputee’s confidence in the prosthesis.

Upper extremity amputees also have an electric powered prosthetic option. Myoelectric prostheses have been around for twenty-five years and several companies have produced very viable systems that can return function to the amputee.

My observation over the years is that the most perfect prosthesis is still one that you put on in the morning and don’t have to think about until you take it off that night. Many high tech components are also high maintenance and therefore invasive to the user. Old time amputees invariably gravitate towards equipment that is low maintenance and simple. If you have a life then you don’t want to be spending your time going to the prosthetist for repairs and adjustments.

 

Realities of Our Industry

The prosthetic industry, as has the rest of the medical profession, seen many changes in the past thirty years. Managed care has eroded the team approach to rehabilitation and taken the decision of prescription from the doctor and given it to the bureaucracy of the managed care company.

Medicare sets the fees as the standard for our industry and due to the fact that our profession is very fractured they have continued to cut fees for services even though costs have increased. What does that mean for the amputee? Many companies focus more on what can be justified for their patient then what is necessarily the most appropriate prescription for the amputee. If insurance will pay for an energy storing foot, then the amputee will get one even if a simple SACH foot is more appropriate. Is this unethical? Hey, these guys are just trying to make a living in an industry that continually reduces fees for services and rewards discounts, regardless of quality.

Due to the lack of long term follow up, there is little tracking of costs over time. One way to make a profit in this type of system is to replace sockets frequently. A well designed socket that is adaptable to anatomical change gets the same reimbursement as a socket that is quickly made to the volume of the residual limb. Only difference is that the volumetric socket will need to be replaced frequently since it has not been constructed to be adaptable. If you had to make the business decision, what would you choose?

 

Returning to Work/Recreation and Quality of Life

I believe that most amputees want to return to some type of gainful employment. Certainly there is a minority who are looking for some way to milk the system so that they won’t have to work but they are in the minority.

Employment or vocation is one of the main keys to successful rehabilitation. It is one of the deciding factors in positive self-esteem and the fight to overcome depression. Most amputees will require encouragement and training to achieve this. Another very effective tool to help amputees is for them to associate with other amputees who have returned to employment. Amputee support groups or other amputees within your system will provide an alternative role model to a person’s worst fears.

Amputee sports organizations also provide positive role models as well as a fun way to experience the rewards of exercise. Most trans-tibial amputees can return to recreational activities similar to their pre-amputation life. Trans-femoral amputees and upper extremity amputees may need to alter their activities or use adaptive equipment to reengage a recreational component.

Adaptive prostheses can take many forms. One of the most common types of adaptive limbs is the shower/swim prosthesis. This limb is designed to be submerged in water and allows the amputee to stand safely in a shower, go to the beach or pool, and not to damage their regular prosthesis by subjecting it to moisture.

Other sports and recreational prostheses include; skiing limbs, climbing and hiking, running, hunting, golf, bicycling, and a myriad of upper extremity attachments that allow for specific activities. These limbs are often cost effective when compared to the cost of replacing a regular limb more often due to the abuse it takes while engaging in activities for which it wasn’t designed.

 

Legal Issues and Projecting the Costs of the Amputee

One of my specialties in the prosthetics field is providing expert witness testimony for litigation. I have developed a systematic approach to projecting how much it will cost to keep someone in prostheses for the rest of their life.

I break an amputee’s life expectancy into three phases. The initial phase is the first three to five years (unless the amputee is a child, then the initial phase lasts until the end of their growth phase). This is the time when an amputee encounters the most rapid anatomical changes as well as experimenting with different components to find what combination of materials and equipment works best for them.

The next phase is the stable phase where the amputee’s residual limb has stabilized and they have settled into a more predictable lifestyle. This phase results in fewer prosthetic replacements.

The third phase is the geriatric phase and describes the amputees lessening of activities due to age. This phase sees the least amount of prosthetic replacements.

I also generally project a backup and ancillary prosthesis for each individual. The backup prosthesis is usually made from components salvaged from an older limb. The socket is new to maintain an adequate fit. Ancillary prostheses can be for sports or more often for water applications.

 

Replacement and Maintenance of Prostheses

 Prostheses don’t last forever. The average life expectancy of a prosthesis is four to eight years, depending on the activity of the amputee. Quality of components is also an issue as is initial construction and attention to fit.

Nearly all prostheses require consumable products to keep them fitting comfortably. Stump socks, suction liners, suspension sleeves, cosmetic covers, all need periodic replacement. There will be an annual maintenance expense for any prosthesis and amputees should be made aware of this by their prosthetist. A prosthesis should come with all of the components and supplies to last for a prescribed period of time. I provide a years worth of consumable materials with each prosthesis. If an amputee is going through more supplies than usual it could point to a problem with the fit or design.

 

 

Summary

Prosthetics has come a long way in the past decades. Today’s materials and components provide motivated amputees the ability to return to most employment opportunities. Ancillary prostheses allow amputees to experience and enjoy a recreational component to their lives permitting them far greater integration into normal society. Prostheses require maintenance and soft goods on a yearly basis in order to function optimally, with the average prosthesis lasting from 4-8 years. If the team approach is used and amputees are followed with an adequate plan then they can typically return to a style of life similar to their pre-amputation experience.

For More Information call Rick Riley at 775-830-1783
Email rickjillriley@hotmail.com
Visit my website at prostheticconsulting.com