Jan 6 - First Prosthesis Day :-)

Jan 5
 08:00
 I slept great from 22:30 til about 01:30. I have been awake since.
Today I go see the prosthesis guys. I am VERY fortunate that the factory for the prosthesis is 1 km from my house. I used to walk past it 5 times a week. There are no signs, and it is a factory, and not a retail store. Everybody is covered in fiberglass dust, and it FEELS like a factory. Full of skilled workers. I feel comfortable there.
I hope they approve of how I have been doing the coning.
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13:00
I went to see Bradley the (prosthesis guy) at 10:00. At first his assistant saw me, then Bradley walked in. He said he was still on holiday, but the family was doing their separate things so he figured to go to work. He likes his job.

The one lady asked if this was my first appointment to have a prosthesis fitted, I said yes. She ran around getting plaster of Paris ready to mix.

Bradley asked me many questions about my chemo, then got a big form and started taking measurements. I had to take off my good shoe, and get my foot measured. The artificial foot needs to be the same size as the good foot so the same pair of shoes will fit both.

He then took the wrapping of my stump. He said I had  wrapped it very well. He was then quite rough with it and treated it mean. Then he asked "Any pain?"
 I said "no", and he was happy.

 He measured the stump, then the good leg to see what the differences were. Then he asked about the times that I wrap it, and how often I washed it.

 He said he had certain things that were prerequisite to prosthesis fitting. Like range of motion of the stump, (I passed with lots of extra motion) and strength of new muscles, He said they were very strong for a first fitting, but would be about 3 time as strong in 6 months.

Then he measured the stump in many ways, and said I needed a #38 silicon stocking, and sent the lady to find one. She came back with a 35,36, 39, and 40....No 38. Bradley got on the phone and arranged one to be delivered by 08:00 tomorrow morning. He told me to be there at 9:00.

Once the silicon stocking is fitted, it is worn 24/7. It is a very special stocking. It has a band around it that is like a one way valve, so when you put the leg socket on, all the air is squeezed out, and it can't get back in. So the prosthetic is stuck on the stump by vacuum. To release the vacuum so you can remove the leg, you open a valve to let air in. Ossur (the Icelandic manufacturer) has a new silicone liner with a movable ring. This allows a greater variance in the suction you require to keep the leg on. Mine will have a movable valve ring, so we will have to adjust it correctly.

This is the Normal Silicon liner with a fixed vacuum ring.

This will be my liner with a movable vacuum ring.

Then the plaster lady will make a mold of my stump. He says to bring a book. They will then remove the mold, and the lady will start making the fiberglass socket. The fiberglass socket will only be done on Friday afternoon.
Also tomorrow Bradley will start assembling the leg. Foot, shank, knee, and the socket attachment.

Initially for stability reasons, I will not have an ankle.
The knee will be a Ossur Mauch. This knee has many settings, and is quite complicated. Kind of like learning to drive a car the first time.

Notice the 2 dials on the hydraulic cylinder, and the U-shaped valve that lock the knee in fail safe mode.

One setting it has is a fail safe mode. I will be in this mode for a few days. I asked Bradley which knee he would want if he needed one. He said the Total 2000 is the best walking knee made, but the Mauch knee does  everything. It can do stairs, and bicycles, and long distance walking. He would choose the Mauch, then buy a Total 2000 for everyday use.

Bradley says he is sure that if all goes well my training on Friday, I will go home with the prosthesis on. If things don't go so well, then I will only wear it home on Saturday.
I will probably use crutches for the first week or two until the stump gets stronger. I will only put between 25% and 30% of my weight on the prosthesis.

I just got an e-mail saying that R77,000 of the prosthesis invoice was rejected by medical aid, and must be paid by the client. (me) They will only pay R41,000 of the R118,000 invoice. Grrrr.

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Jan 6 07:00
I wanted a good night sleep because of the important day today, so I pilled up last night, and slept well.
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11:00
There is so much they told me today.  I fear I'll forget most. I am so excited about the prosthesis, that I sometimes forget about the elephant in the room.

Bradley started out by apologizing for the intimacy of the next hour. He
said they will spend time at the very top of the thigh, in the inside
and outside. He had asked me to wear a swimming suit so it would be easy
to reach the top of the thigh..
He again measured the stump. He said he is sure that in a week or two, the
new socket will not work anymore. He says there will still be major
shrinkage from the silicone compression sock.
He showed me the silicone sock. He says they cost about R20,000. It has
a movable vacuum seal ring. Most socks have fixed rings. These end up
always forming a tight ring in the same place, and the ring sometimes
wears out before the sock. I will only have to replace the ring after 6
months. The sock should last a year. He says some people get 2 years out
of them, and some are totally wore out in 6 months. He says in 5 years time,
all socks sold will have movable rings. It is both cheaper and better.
One slight problem is that if my stump shrinks too much, the liner will
need to be replace with a smaller size.

He then put on the sock. Then took it off and I put it on. It is not
hard to do, but there are some things that make it better and easier.
Already I can feel the upper edge sliding and causing friction. He said
that may happen, especially if it is warm out, and today will be in the
high 30C's. (98F). The solution is to apply a tiny bit of aqueous gel
around the lip. TINY is the word.
It can't get much hotter than an 1/8th inch of silicon rubber all over
the stump. He says when I take it off tonight to shower, I will pour
sweat out. The lady suggested I remove it in the shower, then only wash
the liner after I get out of the shower. The liner needs to be washed
daily with a special solution. He showed the cheap version that is
available at a pharmacy. It is called Sanex Zero. No fragrance, no
colorants, and no ethanols. A very mild body wash. This is used every
night to clean the inside of the liner. I'll do that when I shower. A
shower is pretty much mandatory every day.

He then spent some time explaining what we will do today.
With the silicone liner in place, they will make a plaster cast of the
stump. It will be very important that I do two things.
One: keep my pelvis level.
Two: Relax the muscles in the stump.
Keeping the pelvis level is very hard. Try something...Stand normal and
notice how the pelvis is level. Now pick up one leg keeping the pelvis
level. Almost impossible. So I will have a strong grip on a bar attached
to the floor, and force the pelvis level using force on the bar.
Relaxing all the muscles in the stump is hard. When ever I feel
imbalanced, even by a tiny bit, it is instinctive to correct. This has
been with the hamstring and quadriceps for 64 years. Now to just relax
those muscles. The socket will use these muscles to help stabilize the
socket to the stump.

So as I stood gripping the bar and keeping the pelvis level, and
relaxing all muscles in the stump, they proceeded to slop plaster of
Paris all over. They have to work quick, and therefore it was a bit
sloppy. They moved the stump in a funny position behind the other leg,
and let it all dry. They then removed the mold, and proceeded to draw
lots inside of the mold. These were special places of interest. Once the dry
mold was safe out of the room, we began clean up. What a mess. My brand
new silicon liner was now covered in white plaster of Paris residue
It had been clean and new for about 10 minutes.
My swim suit was also covered with white, as well as my good leg and
shoe. We wiped me down, and cleaned up as best as possible. They took
off the new liner and the lady took it away to clean it. She came back
and I put it back on again.
The silicone liner is very hot, and tight. It does mean I don't have to wrap the leg every 6 hours.

Bradley says he will start on the fiberglass socket after lunch, and it
should be ready 10:00 on Friday. He said that I should plan on a 5 hour fitting and adjustment session on Friday. Then on the following Wednesday a 3 hour session with a physio training me to walk.
I have a blood test on that day because chemo is the next day :-(

He then brought out all the part to make up the leg. We looked at the
knee, foot and all the connecting parts. It was good to see all this
stuff in boxes with my name on it. This is finally happening.
The foot looks so cool, but it is carbon fiber, so is extremely strong, but needs protecting. A rubber sock protects it. The sock looks like a real foot. This isn't for cosmetic reasons as much to protect the foot, and allow a shoe to be worn.

This is my actual foot.

This is the foot protector.

He said he will assemble the leg with me watching because I will enjoy
that. He showed me how the alignment works, and all the adjustment.
Wow.. what a lot of ways to adjust the alignment of the knee, foot, and
pylon.

I then drove to buy the Sanex Zero, and back home.

The liner is hot and tight.
I asked the accountant lady at the factory about the letter from the medical aid saying I have to pay R77,000 to them from my pocket.
She thought a bit then she gave a big smile. She had taken a chance, and submitted the invoice for R118,000 to the medical aid on 30 Dec 2015.
They only paid R41,000 and the client must pay the rest.
But she had planned on submitting the invoice in the New Year when she knew the funds would be available. She took a chance and submitted it during last year. Since they paid R41,000 out of last years account, that means we have R41,000 more available for this years account. :-)

Oh... did I mention that the liner is hot and tight?
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I have started doing mini loads of laundry. 3 t-shirts and 2 underwear. These I can hang up in the shower. I have one of those expanding clothes racks  near the ceiling in my shower. Using the big grab bar across the shower, I feel safe hanging up the laundry.
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