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. :-(

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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.

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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.
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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.

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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. :-)

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June 8 2016 - A disappointing day

My prosthetic leg has been in the prosthetic hospital for a few days. I went to get it this afternoon.
I arrived at the prosthetic shop to see Bradley busy opening a box with a Total Knee 2100 in it. The knee arrived from the  factory in Iceland this morning. I was looking forward to using the knee for a few weeks. The 2100 is the main athletic Knee used in the special Olympics.

Yesterday they moved the attachment point on the bottom of my socket. This means that all previous adjustments are lost. They had to re carbon fiber the attachment point.

Today for the first time Bradley got to try out his new computerized painting machine. The machine painted the Texas flag on my prosthesis. It was bright and clear.
Then they applied the last coat of clear plastic sealant, and the colors all faded and blurred. :-(

Then they had to cut the holes in the  socket to allow the inside liner to stretch in the spots that give me the most trouble. Cutting the holes made the flag not look a flag anymore :-(

At least it has a Texas motif.

I put the leg on, and tried to walk. After a few steps, one of the fittings came loose. I was between the parallel bars, so I didn't fall. They replaced the faulty part, and I walked again. Soon the same fitting came loose again.
I now have a new fear, of something coming loose on the leg while I am using it. It made the leg instantly, totally, unstable, and almost guarantees a fall. If I was walking fast, I could get hurt bad.
The part that the suspect part connected to was the actual faulty part. They finally got the parts working, but the leg just wouldn't adjust properly. It felt all wrong.
Next we tried to get the 2100 knee adjusted, but it was not possible. After way too long messing with it we found out that it had no hydraulic fluid in it. From the factory, with no fluid in it! GRRRR!!!!

So we had to put the 2000 Knee that I have been using back on. It was loaned for 2 weeks, which was up today. My Mauch Knee is still in Iceland for repairs.
Fortunately, Bradley was able to keep the 2000 knee as a loaner for another week. After that I don't know what I'll do.

We worked adjusting the 2000 until way after closing time, but never got it right.
We both feel that the new position where the knee attaches to the socket is at the wrong angle. This whole adjustment thing sounds like a screwed up way of doing things. The angle has to be +1 to -2 degrees. That is a very fine adjustment. It seems silly to get this adjusted to within a degree, the go walk on a sloped road, or on uneven grass.
Bradley says we need to try a fitting that allows the real time re positioning of the place the knee attaches to the socket. He will try to get the fitting from a friend on Friday.

In between the different tests and adjustments, I got to talk to the accountant lady. She says that Medical Aid will pay a certain amount for maintenance and replacement of prosthetics. She said that maybe after 4 years I could get an up grade from the Mauch Knee. Probably to a Total Knee 2000. I reminded her that I have Angiosarcoma hanging over me, and that waiting 4 years between upgrades is probably not going to happen.

This just re-enforces my need to get to America, and sell my assets there, so I can afford to buy a better knee.
The Accountant lady also mentioned that the factory in Iceland promised again, that I can have a Rheo 3 Knee to try out for 2 weeks from the 22nd of July until the 8th of August.
I hope the factory doesn't screw that up like they did the 2100 knee.

https://www.ossur.com/prosthetic-solutions/products/dynamic-solutions/rheo-knee-3

While heading back home, I found that the new foot angle made my prosthetic foot stay under the brake pedal on the car. So pushing on the brake, doesn't move the pedal, because the foot blocks it. Normally I can push it aside, but not now. So I had to take my leg off before I could drive home.

Oh well, At least I am alive and safe for the present.
I can walk on my leg the way it is, but it sure feels unsteady.
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May 26 2016 - New prosthetic socket.

The last four days have been busy. Three of those four days were spent trying to get my new socket aligned properly.

My old socket was loose on my stump, and I was wearing many stump socks to try and expand the stump to fit the socket tightly.
Bradley made a new socket for me. It was very tight, and it took an hour to get the stump seated all the way in. He worked for hours to try to get it aligned. It would feel OK, then a few minutes later is was not OK. He told me to come back the next day.
The next day we spent a farther 3 hours trying to sort out the socket.  It was as if when weight was on the leg, it would change the alignment. He stacked the adjustment adapter, so there was twice the adjustment. I went home, but soon found that walking around the house was just not right. Whenever the leg would swing forward, it would swing to the right, which put lots of strain on my stump.
Also when I took a long step, and just the heel was in contact with the floor, as the weight increased the leg would rotate on the stump. The alignment changed as I walked.
If I took small steps so more of the shoe sole was in contact with the ground, the leg couldn't rotate, so the stump rotated inside the socket as the weight increased. This put torque on my hip and felt like someone was nudging me sideway.

Today I was again with Bradley for over 4 hours. He got out a laser device and checked the original alignment. the fore and aft alignment looked good, but as the weight changes, the side to side alignment would change. (Abduction) He took the prosthesis away, and cut off the end of the stump, replaced the attachment point in a different place, where the laser had said it should be. We then spent a long time aligning the leg from scratch. It got much better.


The fourth day was spent at a Computer Cloud conference. As with most conferences, about 95% was boring, and about 5% was well worth the effort. Also as with many conferences, the main benefit wasn't from the formal lectures, but what was learned over coffee with someone not connected to the conference.
At the risk of sounding brainwashed, "The cloud is the future of IT."
Huge data centers have sprung up throughout the world. Data Centers (DC) house many thousands of computers. You can rent these computers on an "as need" basis. If you want to do a spread sheet, just rent a spreadsheet computer for an hour or so. You get a very powerful computer, with someone else worried about doing backups, maintenance, upgrades, and hard drive crashes.
Companies like Google offer free word processing, spreadsheets, disc drives, and email. Other DC's offer these services for a fee.
All you need are a keyboard, mouse, and screen. Google or the DC,does the rest. This means you no longer need to buy a fancy high specification computer for your house. Your cell phone hooked to a DC has more power than you could probably ever afford for your house.
DCs usually also have very high speed internet connections. So if you have a huge file you want to send to a friend, you send it from your cloud hard drive to your buddies cloud hard drive at unimaginable speeds. On of the DCs at the conference bragged about a 24 GB/s data rate.  In South Africa the average DSL line has a 375 KB/s data rate. For the math challenged, that is 64,000 times faster.
Most DCs offer the service of hooking up two separate networks ( your Hong Kong office and your New York office) together into one network. Now intra company communication is lightning quick.

I would like to do a long walk tomorrow, but I have a few tender spots on the stump end. I think a few days rest would help more than a long walk.
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