I am not made for the cold. It is 12C (53F) inside my house.
Three and a half weeks ago my stump hurt itself inside. I have been in a wheel chair since. Some times braving the use of crutches for shopping.
The injury fits all the symptoms of a muscle from the amputation having healed to the femur, that suddenly tore away from the bone. The result is similar to a torn muscle.
Now over 3 weeks later it is healing, and I have less pain, but I still can not get the silicone liner on the stump. And my current prosthetic leg socket requires that I use a silicone liner.
The pain is deep inside the stump. It is made much worse when the skin of the stump is pulled in the direction of my hip or groin. This is the exact action needed to put the silicone liner on, or when pushing the stump into the socket.
My prosthetist (Bradley) has been trying to build/invent a socket that does not require a liner, and does not require pushing, to get the socket on.
This is very time and labor intensive for Bradley, his assistants, and for me. Every new idea has to be implemented on a socket with mold making, silicone shapes, and plastic castings. A few days ago Bradley took another plaster mold of my stump. I had been wearing a compression sock on the stump for days to make the stump as small as possible. Wearing the compression sock is not painful, but getting it on, is a long slow process if I avoid pain.
A small, low volume stump is much better than a stump that has water, muscle, or fat in it.
Check out the size of the thigh socket on this Para-Olympian runner.
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| This lady is Sarah Reinertsen. |
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Proprioception is the unconscious perception of movement and spatial orientation of a limb.
This is important when walking with a prosthesis, because there is no normal nerve feedback regarding the position of the foot or leg. I find it essential to know when the heel is down, and the knee is locked.
When you have been sitting funny for a long time, and try to stand up, finding out that your leg or foot is numb (asleep), you immediately sit back down. You can not walk if you can not tell if your leg can support you, or even where your foot is. I have this "numbness" permanent in my prosthetic leg. What paralyzes you, is normal for people wearing a prosthetic leg.
The closer the prosthetic leg is to the skeleton, the greater the sensitivity, and feedback from the prosthesis to the brain. Many people choose to have the prosthesis attached physically to the end of femur.
This is called Osseointegration.
What are the advantages of Osseointegration?
No socket – therefore, no sweating or skin irritations caused by the socket
No pain, pressure or discomfort caused by the socket,
Easy to don and doff the prosthesis.
Excellent suspension.
No restriction of hip movement.
Comfort in the sitting position.
Osseoperception – a more natural sensation of the prosthetic limb
Increase of bone and muscle mass
What are the disadvantages?
Long rehabilitation process: in total, it may take up to 18 months for the entire process to be complete
Risk of infection
Risk of fractures and loosening of the implant
No high-impact activities permitted, such as running or jumping
Swimming in public facilities is not recommended
Daily care of the abutment skin area is required
It is not for everyone, and hopefully not for me. The reason I have been learning about it, is that often it is used by amputees that are unable to wear a socket.
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OK... back to my 5 hour visit to the prosthetic shop/factory yesterday.
Bradley had a long tube shaped piece of very slick parachute cloth that is put over my bare stump. The end of it goes through the small hole at the bottom of the socket. This hole is for the vacuum valve. I put my stump down inside the slick cloth coated socket, and then Bradley would pull out the cloth through the hole.
This means my stump is "pulled into" the socket, and not pushed into it. It gave me zero pain.
After pulling the cloth out, my stump was way down into the socket, and my dry skin was sort of stuck to the silicone inside of the socket.
The way I currently don the socket is to lubricate the silicone liner with a glycerin mix, and push the stump down inside the socket, called a "wet" doning. Bradley was trying a "dry" doning with no lubricant of any kind.
But my stump wasn't far enough into the socket. I was not able to force the stump in any farther because of the dry skin against the silicon was forming a non slip surface. Getting the socket off was a battle. It was really stuck to the skin. Fortunately pulling my stump is not painful, and with one assistant holding me tight and pulling, and Bradley and another assistant pulling the socket, we were able to get the socket off.
We tried many ways of getting the stump farther into the socket. All failed.
We got desperate, and cut a slot in the outer hard shell of the socket. $$$ This expanded the shell, and I was able to get farther into the socket, but still not enough.
Then we also cut the inner silicone liner of the socket. $$$ This allowed me to get the stump in to the proper depth, but made the socket very weak. But now we know the exact amount necessary to expand the socket to make it work by measuring the gap in the cut. Next week they will build another, slightly larger socket, and we will try the cloth through the hole trick, and dry doning with the larger socket.
Hopefully I'll end up with a tight socket that doesn't cause me any pain to wear, or to put on.
I was supposed to be in George with Maddie last week, and then again this week, and now even next week is not going to happen.
Planing a life is futile, when that life has to include a prosthesis and cancer.
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