CT scan results

My last few weeks bounce rate on my blog web site has been 100%. That means that 100% of the people that looked at my blog stayed on it for less than 5 seconds. Either fast readers, or computer bots.
This past week has been a medical week.
On the 19th I did a Parkrun. Lots of stump pain. I walked a very slow 1:26:14. My stump swelled up afterwards, and I couldn't get the socket on for 2 days. The week before, I had done 5 km walks, 3 times. I think my stump needs more than a day or two to heal, and recover.

Wednesday I went to see the Prosthestist. We chatted lots, and decided not to cast a new socket. Because my stump swells so easy, a new socket should be bigger, yet I want one tighter for walking. My current socket is too big, but I can easily shove foam into it to make it smaller. A loose socket is a pain in the ass, but a very tight socket is unusable. I'll keep my "too big" socket.
He gave me some new putty like stuff. It feels like play-dough. I am supposed to put it in the bottom of my socket, and walk. It should squish and flow around the end of the stump, and form a perfect fitting pad between the end of the stump, and the bottom of the socket. It takes about 24 hours to set, and then it should feel like a soft silicone sealer, like you use to seal around your bathtub.

Thursday I went to a Podiatrist. My good foot is having typical problems due to my increased distances I walk each week. When I used to run I had the same problems. Toenails and nerve pains. The second toe on my good foot, has a nail I thought was going to come off. It now grows almost 90 degrees to the left. The nail grows mostly up and gets thicker. I have been using a Dremmel tool to grind it down.
He said that the nail had become detached on the side, so only half is growing, which makes it bend as it grows. He said the solution is to use the Dremmel tool weekly.
I also get a pain in my middle toes that feels like they are broken, but I can twist and massage the toes with out pain. There is a nerve that is in the pad of the foot that causes the pain. He touched it and my toes really hurt. It is fairly common, and called Morton's Neuroma.

He added a pad under my shoe innersole to keep pressure off the nerve, and that helped.

The receptionist came in with a handwritten file, and said that I was an old patient. I had seen this doctor in 2008 for the same problem. Increased running distance, and Morton's Neuroma. They had been in Pretoria then. 

If my brain remembered things better, I could have saved the trip.

Friday was an Oncologist day. First was blood tests. Then I had to drink a liter of liquid.  Then lay in a metal tube, while they injected radioactive Iodine into me. It made me feel hot, and like I had peed my pants. After they were done they asked me to lay still. Then they re-did some of the photos in my pelvic region.

Last CT scan in February 2018 showed swollen lymph nodes in my right groin. They said they must be from an infection. Well, the lymph glands in my right groin are still swollen. The Doctors agreed that this is not a cancer related event, but also agreed that it isn't good. So I am supposed to go see a Lymph Doctor.

On Saturday I did another Parkrun. I had not done any real walking since the previous park run, so I figured I would be out of shape. It turned out to be my fastest ever, 1:10:44, and I finished with no pain or discomfort in the stump. So now I think that if I don't walk during the week, and let the stump rest well, then I can do a faster Parkrun. Maybe some time on my Exercycle to get a cardio workout, and rest the stump.

 I was feeling better than after any other Parkrun, so went over to a friends house. On arrival there she pointed out that I had damaged my good leg in two places, and it was bleeding from both wounds. I had not felt a thing. She also pointed out that my calf was very hard and swollen. I fear there is something wrong with my good leg. It is red and hot, numb, swollen, and the lymph glands are swollen. 

Sigh :-(

June 11-14 2017 - Biopsy results, Park Run venues, Army amputees

June 11
Park Runs are 5 km run/walk/strolls for the family.
For more info, see my May 28 2016 blog about Park Runs.
My favorite nearby one at the Voortrekker monument closed down. It was all on tar roads.
There are usually many baby strollers, and dogs on leads. There are 3 new Park Runs to replace the one that closed down. All three are on rough terrain, and are two lap races. They all say that the terrain is not suitable for strollers, or young children.
Last week I walked one lap of the Bronberrik Park Run venue nearby. It had 3 streams to cross, and a very steep hill. It took me 1 hour 6 minutes to walk the 2.4 km. The up and down slopes slowed me WAY down.

Today I went to another new Park Run venue at Laudium. It is on a large sports ground, and has many 2 meter high berms around the various cricket fields. I zoomed around just one lap.It took me the exact same time, 1 hour 6 minutes and the distance was 2.5 km.
Again, the up and down slopes were the main time killer. Walking up a 2 meter berm, and then back down the other side is so hard for me.

A big reason NOT to run these Park Runs is the fact they are 2 lap races. Most people finish in about 45 minutes, and they usually stop timing after an hour. That means that every single person running the Park Run will lap me. There is no room to pass people in many sections, so I would end up delaying many, many people if I competed in these races.

So I am thinking about doing my own Park Run at these venues, on a Tuesday or Thursday. I need the exercise. I will miss the atmosphere of the real Park Runs though. :-(

---------------

June 12
Today I went to the surgeon to have my stitches removed.
She said all looked great, and the biopsies were good news. Both tumors were benign Basil Cell Carcinoma.

I also chased up why the PET scan is taking so long. The Medical Aid has not given approval yet. Last time it took days. Now so far it has been 2 weeks.

------------

June 13
I just got news from my Medical Aid. The PET scan is approved.
About 10 minutes later I got a call from, and had a good chat with, the PET scan Ladies. It looks like the morning of June 22 for my PET scan.
---
I got a bit of a shock today, while reading an article in a US Army magazine.
They took active duty Soldiers that had lost either :
1 leg below the knee. (BK).
1 leg above the knee (AK).
2 legs below the knee (BBK)
or
2 legs above the knee (BAK)
They also took about 100 un-amputated soldiers.
All of these people were required to walk (no running or jogging) fast in a straight line for 6 minutes.
The military calls this a 6MWT (Six Minute Walking Test).
The total distances walked were measured.
The distance each group averaged for 6 minutes was:

Able body: 761 m
BK:           661 m
BBK:         576 m
AK:           542 m
BAK:         482 m

 I am an AK, and last week I was just able to walk 2400 m in 66 minutes. That means a double above the knee amputee can walk over twice as fast as I can. ??? What is my problem?
Of course these are young, fit, soldiers, that have received the very best treatment, training, and rehabilitation possible, and they have the best prosthetics money can buy.
The US Military plans on spending $1.76 million for each above knee amputee.
The best prosthetic knee I own, was bought on eBay.

The Army has done some major work on lower leg prosthetics for soldiers returning to active duty.
These papers are all available for download. It is like sipping water from a fire hose.

AK combat soldiers prefer pure mechanical knees while on combat patrols, but use microprocessor controlled knees once back inside the camps.
In the 6MWT the type of prosthetic knee was statistically irrelevant. Not so with the prosthetic feet used. Most military AK personnel are issued feet like these:
"carbon fiber J-shaped energy storage and return feet with shock absorbers and torque rotators"
Us civilians have to pay house like prices for these things.

Interestingly it seems as if personal preference is the single largest determining factor in the usefulness of a prosthetic foot. Users perceive differences between different foot designs with no evidence to support the differences. One foot just "feels" better than another.

----------
June 14
I decided to see just how far I could walk in 6 minutes.
This required changing the setup and adjustments for the prosthetic leg.

The knee locks stiff with weight on the heel, and breaks loose as weight shifts to the toe. There are three things that control when the knee breaks loose on a Total Knee 2000 or 2100..
The over center geometry of the leg.
Geometric lock settings.
The angle of the foot in relation to the leg.
The easier the knee breaks, the less energy it takes to walk, but it is far less stable when washing dishes or walking around in the house. Falls are much more likely.

For my walks around the Park Run courses, I had lowered the toe on the foot. This makes it easier to go downhills, but harder to walk up slopes. This lowered toe resulted in less stability.
The area for my 6 minute walk is flat and tared. So I wanted the foot back to level, but also wanted an easier breaking knee. So I adjusted the foot angle and the over center angle on the Total Knee 2000.

Once I was happy that I could go fast, AND not fall, I went to the section of road by my house and walked fast for 6 minutes. Using 2 different GPSs, I went 401 and 403 meters. Far short of even the double amputees tested. :-(
I went home, had lunch, and increased the knee flexion resistance, and decreased the extension resistance. This should make the leg swing forward quicker, and therefore allow more steps in the same amount of time.
Back on the road, and away I zoomed for 6 minutes. 400 meters, and 401 meters on the GPS. The same speed, no change.
I went home and installed the Total Knee 2100 from eBay. It is a much better knee, but also not a 100% knee. It leaks oil, and makes squishy noises. I got it all adjusted as best as I could, and then back to the road.
This time I did 420 and 422 meters in 6 minutes. That is a 5% increase. I didn't feel faster or better, but obviously it was.

I think I agree with the Army's result. Basically....
A good knee is essential for stability and mobility, but the type and cost of the knee is not a significant factor in speed.
A variable angle foot, a shock absorber, and an energy recovery system is more important in gaining speed.
If my goal is a one hour Park Run, then I think a variable angle foot to handle slopes better would benefit me far more than a fancy bionic knee.

Also losing some weight, and getting in better shape wouldn't hurt either. :-)

-----------------------

Oct 30 2016 - Yellow toenails and failed ParkRun.

Oct 30 2016
On Friday I spent 5 hours at the prosthesist trying to get my new socket to fit. We totally failed, and I ended up walking out with the old socket that I had put the two bladders in. I really wanted to use the new socket to do another 5km Park Run. That was not to be.

I had planned to do the Park Run with some friends. But with this older socket, I seriously doubted if I could do 5 km. I sort of wanted to cancel, but my friends wanted to go anyway, so we went, and pitched up in plenty of time for the start.

My friends started walking with me, and we watched everybody else zoom off into the distance. At about half way, I stumbled a few times.  I was gasping and wheezing, and having problems with my cane arm. I was not able to get the cane forward enough to help with balance. Maybe from my sore wrist. So with a heavy heart I quit.
We slowly walked back to the car. I was sad. Total distance walked was 3.1 km.

At home I showered and went straight to sleep for 3 hours. I have numerous blisters and am sore everywhere. My right shoulder and wrist are the worst.

My good foot is always swollen. Everybody asks if I have diabetes. I massage it every day, and keep it elevated. There is a problem with the circulation, and the foot is always cold.
I have also been worried about my toenails. They are turning yellow and flaking off. 

At first I thought they had a fungus, but now I am sure that it is "Yellow nail syndrome". Our "google friend" says:
Many of the symptoms of yellow nail syndrome are commonly associated with malfunction of the lymphatic system including yellow nails, lymphedema, and breathing (respiratory abnormalities). The lymphatic system is a circulatory network of vessels, ducts, and nodes that filter and distribute certain protein-rich fluid (lymph) and blood cells throughout the body. Researchers believe that in yellow nail syndrome, lymphatic fluid collects in the soft tissues in and under the skin (subcutaneous) due to obstruction, malformation, or underdevelopment (hypoplasia) of various lymphatic vessels. Researchers have also speculated that abnormal of leakage of fluid through very tiny vessels (microvascular permeability) may also contribute to the development of lymphedema in yellow nail syndrome.

I see the Oncologist next week. I'll ask her about the foot and the toenails.
--

I have been thinking a lot about double above the knee amputations. I believe in the near future, it will be the norm to take off both legs, not just one. Until then, I will gladly keep my one good leg. :-)

With a little bit of electronic aid, there could be certain advantages to being a double amputee.

---Imagine a car mechanic with knees that bent the wrong way. He could easily spend all day bent over the hood of a car.
---Or if the knees would bend all the way backwards, and had motors to control how far they bent, then with feet flat on the floor, as the knees bent, the body would lower, So a painter could lower himself to the floor to paint there, then raise himself up to paint the ceiling.
---Put on real long legs, and you could take huge steps while walking. Or work on house gutters all day without ladders.
---With extensions to the sockets in the rear by the ass bone, and a longer shin, shorter thigh,  and an ankle that bends about 120 degrees, it would be possible to fold them all so it would form a seat like structure, made up of your legs. That would be great for people that get up and down from sitting all day.
---How about a fish tail suit to make you look like a mermaid, or merman. Some ex Navy seal just swam 300 meters underwater on one breath, with a fish tail.
---How about combat aircraft pilots. Less place for blood to flow during high g maneuvers. Or astronauts needing less nourishment, and room during space travel.
---Maybe build legs that could split from the knee to form 4 legs with feet. This would be very steady for sailors working during rough seas.
--- And my favorite. What about two sockets bolted onto a Segway. A wheel chair that keeps you eye to eye with others, and can't fall over.

My Birthday is coming up soon. :-)
--

May 28 2016 - My first Park Run on Prosthesis

This morning I awoke to the desire for a long walk.
Then I remembered it was Saturday, and every Saturday there are Park Runs through out Pretoria. (and throughout the world)

I chose the Voortrekker Monument Park Run, as I have done this run a few times (when I had two legs). My best time (when I had two legs) was 35 minutes for the 5 km (3.1 miles) run.

This Park Run is around the Voortrekker Monument. It is also in a game reserve, so I should see different types of antelopes.
The Voortrekker Monument is an Afrikaans monument to the early Dutch settlers. It is sometimes controversial because it is a monument to the same people that gave us Apartheid.
 I see many similarities, between the people that this monument is in honor of, and the people the Alamo is in honor of.

The Monument from the start line.

http://www.vtm.org.za/

I arrived at the Voortrekker Monument early, and talked with the officials. I explained that I know they only keep times up to one hour, but I would probably take 2 hours. Is there any plan we could make so I could get credit for doing the run.
Everyone was so nice. They scanned my bar-code which is normally done at the finish line, and said that I could call the head lady with my time when I finished. So refreshing to find people that just solve a problem. No Paperwork, No Committees, and No Bureaucracies.

The start was about 300 yards/meters from the finish line where I had talked with the officials. I had to rush to get all my body armor on, and get up the steep hill to the start.
I got to the start line and sat gasping. I was dripping with sweat. A lady came by and said "You do know that this is only the start, NOT the finish?"  I assured her that I was aware of that.

There were about 800 runners at the start line. The full spectrum of people was there. Some were hard core athletes, some were trying to get fit, some were trying to loose weight, and some were just on an outing with their children. There were maybe 20 people pushing prams.
Usually there are many dogs on a Park Run, but since this one was in a game reserve, no dogs were allowed.

As everyone got ready, the group of runners sorts itself out. The fastest to the front, and the children and baby strollers more toward the rear, and cripples at the far back.
I positioned myself way at the back, behind some parents with a 1 year old toddler in diapers. I asked if the child would be carried later. The man said probably, but this was the kids 3rd Park run.
I would initially just walk behind the toddler, and not try to pass him to early in the race.

The organizers gave the word, and off the herd went.

And the toddler took off like a rocket. I felt like I was in "Park". Maybe because of me, is why they call it the "Park" Run?
By the time I got to the "start" line the nearest person was about 20 meters ahead of me, and I couldn't even see the toddler. Fortunately the route is well marked because a few minutes later, I was all alone.

At about the halfway mark, I passed the finish line. (going in the opposite direction to everyone else). There was already a huge automobile traffic jam of the runners going home after finishing, cooling off, and chatting to all their buddies. Most of the people had finished. I was only about half way.

Green teardrop is the start, and Red teardrop is finish.

The first half was on fairly level ground, but the second half was up a 100 meter hill and back down from it.
I found the walking uphill to be much easier than I had expected. That meant to angle of my prosthetic foot was a bit off, and the downhill part would be much harder.

At the top of the hill, waiting, was one of the officials. He said he just wanted to make sure I was OK. I checked my GPS and saw that my time was 1:17, and my average speed so far was a blistering 3.2 km/hr.

What a unique view of Pretoria.

At the top of the hill is Fort Schanskop.

There is a very steep ramp around it that spirals down. This ramp was long and very difficult for me. For that 100 meters, my leg never unlocked. Very slow and awkward. This was followed by 200 meters of steep downhill of cobble stones. Again the leg would not unlock, and my biggest steps were the width of a cobblestone. During this section I felt blisters coming at the top of the socket. I stopped and lubed everything with some glycerin I had thankfully brought with me. Before the bottom of the cobblestone I stopped again to lube the stump. I could now feel definite blisters forming at the top of the socket.

The last 400 meters was moderate downhill. Not a problem, except the blisters were now getting worse.
At the finish line were 4 of the officials. They read out my time... 1 hr, 47 min, 30 sec.
I told them they should all be at home now, not waiting for me. They said that they normally stop the race and all timing at 1 hour. But because they waited for me, they also recorded an extra 20 people that normally would not have gotten timed. The one lady said they have to rethink the 1 hour limit. She said maybe at 1 hour they could start packing up, but leave one person at the finish line for slow people.
This would be a good thing, as anyone that finishes after an hour must really be the sort of person whom the whole Park Run philosophy is aimed at.

My average speed was 2.7 km/hr. That steep downhill really slowed me down.
The slowest part was at the top of Fort Schanskop. But I did notice that there were stairs also in addition to the ramp. I asked if I could have used the stairs instead of the ramp. The officials said yes, as it would actually have been farther, not shorter. For me the stairs with banisters followed by a flat grassy area would definitely be faster.

I finished 806th.
http://www.parkrun.co.za/voortrekkermonument/results/athletehistory/?athleteNumber=836071
 I can only get better.

But for now I am experiencing PLP and twitching. There is a burning spot above my left outside ankle. (That is the leg that is not there.)
--