Jan 13 -

12:30

I am sitting in the prosthesis office while they adjust my socket. They are moving my socket to knee alignment about 5 mm. That will make it more steady while standing, but also more difficult to initiate the swing forward while walking. So we will increase the hole for the hydraulics during swing forward, and at the same time raise the front of the foot. This should make the toe less likely to catch during the swing forward phase.
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 Whew! What a busy day.
I had very bad phantom pain last night, and was awake til 02:00. I took a lot of drugs last night, and they seemed to have not helped at all.
I was up at 7:30 and put on my leg. I had hoped for a nap during the day.
My friend came over about 08:00 and we chatted a bit.
I did my blood test, and will get the results tomorrow before going to chemo.
I then went to the prosthesis guys, for a 13:00 appointment with the physio.
When I arrived, Bradley came over and said he wanted to see some things first. He had me walk crutch-less, and turn around, and walk around a table. He then called the physio lady and told her not to come. He said I am about equivalent of week 6 or 7 of the training.
He said there is a week 2 patient that still doesn't know how to put on the prosthesis. He has a note book of the procedures to follow.
He said he had another week 3 patient that had not figured out how to force the knee to bend using the stump.
Bradley and I sat in an office, and he asked me if I had any questions or comments. He smiled when I whipped out my list. :-)
1.I told him I never REALLY know where the prosthesis foot is without looking.
2.I told him I had fallen about 10 times, but always caught myself with the crutches.
3.I complained that there is no "stumble recovery” in the Mauch Knee that he sold me.
4.I have small blisters all over the stump.
5. In the morning the stump is too big for the socket, and by evening it is too small.
6.The leg slowly collapses while standing if I don't keep back pressure on the socket.

He then said it was his turn:
1.With much practice you will learn to feel if the prosthetic is extended by the weight on the stump, and the snap of the leg going forward and stopping.
2.With any prosthesis, you will fall. With any set of ice skates, you will fall. Learning a skateboard, you will fall.
3.He agreed. There is no stumble recovery in the Mauch knee, and it is one of the main bad points of the knee. But thousands of people switch to the Mauch knee every year knowing this. There are some very good points about the Mauch knee.
4. Small blisters are not friction or burn blisters, but the squeezing of the stump is forcing liquid out of the stump. If the lymphatic system can't get the water out fast enough, it is forced out through the skin. Ignore them unless they start to hurt.
5. The varying stump size is what we will live with until we get a steady stump size, and can build a permanent socket. Until then we will have these temporary sockets, and varying stump sizes.
6.He will move the line of alignment to make it more steady in stance phase. He said that later when I will be stronger, I will want it moved back to where it is now.

He then took my prosthetic away, and I sat and waited. He then came by and asked if I wanted to watch the programming of a bionic knee. Duh, of course I do.

The guy was a double amputee, both above the knee with short stumps. He was trading in his Medi knees.

http://mediusa.com/portfolio-item/oh5sfkh5/

I got to play with these knees. The are cool, but fail a lot - not very good manufacture or service. They are like a combination of the Mauch knee and the Total knee. Very good idea, just poorly done :-(

He was getting The Rheo 3 knees.

http://www.ossur.co.za/rheoknee

The Rheo are bionic knees, not mechanical. They brag about the computers updating all solutions 200 times a second.
The torque clutches are very similar to autopilot servos. A magnetic gel that changes viscosity with applied electricity.

This guy got up and walked. He liked the fact that the Rheo had a bleed down for sitting. My Mauch knee does that also. It gives about a 75pound (35kg) force to lower you into a chair.
The Rheo knee has an AI (artificial intelligence program that learns each persons way of doing things, and it gets better and better.
He is getting 2 knees, at R930,000 each. My house is worth 1.2 million.

I don't think I'll be getting one of those soon.

Bradly brought back my leg, and he did many adjustments. I walked back and forth. He videoed my walking. He says I need to work on making my prosthesis leg take larger steps.
The moving of the alignment now means I don't need to use muscles to stand, and prevent the leg from collapsing. It feels much better when standing. He made the swing forward time quicker so the end of the swing is more pronounced, and noticable.
He trimmed some off the socket where it was rubbing.

He said he plans on swapping my knees to the total knee 2000, medi knee, and the 3R60. He has all of these in stock.

http://www.ottobock.com.tr/en/prosthetics/lower-limb/solution-overview/knee-joint-3r60-ebs/

He said it will take a few weeks before I will know enough to tell what I like best. He said they can make a plan if I like one of those other 3 knees. They are all more expensive than my Mauch knee.

Before I left I told him about my fear of falling.We discussed it a lot. We talked about wearing skateboarding protection. But the best solution was when he showed me how to kneel.
A "stumble" is when the leg coming forward is delayed or stopped, like hitting a curb or brick. Some prosthesis have stumble recovery. If the leg sees that it is in forward swing phase, and the leg stops before full forward extension, the knee locks up solid. Now, even though it is bent, it can support my full weight. The Mauch knee will stay in swing mode (no hydraulics at all) until the knee is at full extension. No support at all in a stumble.
We practiced a stumble a few times. If I am VERY quick, as soon as I detect a stumble, and totally collapse my good leg, then the prosthetic leg also collapses, but into a kneeling position, not a total collapse. This means that I will now fall from a kneeling position instead of a standing position. Much lower to the ground. Also any forward motion has been addressed. He says it may break the mounting to the socket, but that can be fixed a lot easier than a broken arm. I am not sure I could react quick enough. The times I have tripped, I didn't even know what happened till after the fact.

I have taken lots of pills, and a sleeping pill.
Later
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