Dec 17 - Visit to coning school.

I slept well last night. About 16 hours. The night before, I sat listening to loud music til 3:30. On the internet some guy said that loud music will stop phantom pain.
I think that any strong sensory input will stop the phantom pain, but any strong sensory input will also make sleep impossible.

I have a coning lesson today. The next step on the jouney.
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I'm just back from Bradley's prosthesis factory. He wasn't there, but I chatted lots to a younger guy.
He looked lots at my stump. He was really rough with it. I was surprised. He said that he does that to check the sensitivity and pain levels. He said that I was in good shape. He was very happy.
He said that some people have strings sticking out of the scars for months.

He showed me how to wrap the stump. Very tight at the end of the stump. Again I was surprised. Loose at the top of the thigh. No wrapping around the waist. He said that the way he showed me is better if re wrapped often. He then unwrapped it, and massaged it. Very roughly. Then wrapped it again, then unwrapped it, massaged it roughly, then had me wrap it. I didn't do so good and redid it.

The whole purpose of coning is not what I thought. The purpose is to force the building of some paths for the return of the blood and lymph out of the stump. Once good drainage is formed, the leg size should stabilize. He said that once the leg drains well, and the leg size stabilized, the socket can be built in one size, that shouldn't change much during the day.
Since I have a large variation in the size of my stump between morning and evening, it shows very poor drainage, and we need to work lots on that.

So the length of time I'll have to do the cone wrapping is dependent on the formation of new blood vessels and lymph vessels. He says to measure the circumference every day at the same time to see when it stabilizes. He has seen some people that never have the drainage form, and they can never wear a prosthesis. But usually it takes about a month.
I will see him again in mid Jan.

He took me to talk with another patient. This was an old black guy from Zimbabwe. He lost his leg 3 years ago above the knee from diabetes. He was wearing a prosthesis for the very first time today. He showed me he could stand very securely, but had to hold on while walking. He was using a Osser Balance Knee. That knee is a very good "value for money". The cheapest 4 bar, polycentric, hydraulic knee.

The young guy had me feel the knee. It was warm from the hydraulics. He said that this knee will get warm if used lots, so is best only for low activity levels. He said if it is used for down hill walking it can get very hot.
We then left the Zim guy.

I chatted more to the young guy. He said that I would probably get a knee a bit better than the Zim guys. He said the knee they want to give me is a Osser model 2000. It has a triple hydraulic system, and is for unlimited walking. He said that if It gets hot with me, there is a 2100
model with much bigger hydraulic reservoir.

 This knee has a function that if any weight is put on the heal, the knee locks tight, so the leg is very secure, and won't collapse. This also good for stumble recovery. When the weight is shifted to the toe, the lock undoes, and the hydraulics control the speed of the leg swinging forward. Also the hydraulics recognize when the leg is bent, but weigh is on the foot. It then limits the bending rate with hydraulics. This is for standing up and sitting. So it looks natural to stand, sit, or kneel, but the rate is a set rate, so to look natural, you must move at the rate the hydraulics is set for. The 2000 allows a knee bend of 160 degrees. Great for kneeling.
The 4 bar system also means the total leg length gets shorter as the leg bends. There is less chance of a toe strike while walking because the leg is shorter when the leg swings forward.
The word polycentric means the bearing surface of the knee shifts as the knee bends. Your real knee does the same thing.
I like the fact that all these features are mechanical and no batteries required. The fancy bionic knees need charging every night.

The young guy explained how we would not be swapping knees for about a year, as I would not have enough experience to notice the subtleties of the different knees.
He also explained that the Zim guy will battle because his hip flexors are very tight. He has not been doing the exercises, and stretching.
We then talked about the stump socket. They have had good success with vacuum systems. The socket is held onto the stump with vacuum. 

Once coning is done, it will be days till a good socket is made, and I'll be walking soon after. I can't wait.

I am having a problem with some basic things around the house. I need a small trailer/garden cart. I could then crutch forward, then pull it with a rope. I am thinking about taking out the garbage, and doing laundry. Both are now almost impossible.

That is enough of my mental ramblings about prosthesis.

PS...(There is still the elephant in the room.)