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.
Appreciation is a wonderful thing: It makes what is excellent in others belong to us as well. Do you agree?
Posted by: Air Jordan 7 | January 27, 2011 at 07:58 PM