April 24 2016 - Trip ( literally ) to the Mall

17:00
I'm just back from a walk to the mall. I am very sweaty and stinky. Be glad this is not a smell blog.

There are many malls within 4 km of my house. I walked to one that is about 2.5km from my house. At a Mall restaurant my GPS said 2.8km (1.74m). Total for the day was...Well here is my phone GPS display:

I never knew that Android phones can do screen shots. Just hold the power button and the volume-down buttons at the same time.

I live in a very nice neighborhood. I took this picture just down the street from where I live. Most of my walk to today's mall was on roads like this. That is one reason I like this particular mall.

When I was putting my leg on, my stump was very large, because I wore no compression on it yesterday. That means it does not fit far enough down into the socket. With just the silicone liner on, the leg was almost 3 inches (7cm) too long. That makes it very hard to walk. It feels more like a limp. Also the chance of catching the toe on the ground during the swing forward phase is much greater.
I put the leg on early, and waited for the stump to shrink. Walking forces the stump down into the socket very hard. In about an hour the leg was the right length, and I started walking to the mall.
About half way to the mall, the stump had shrunk enough, so the stump was bottoming out in the socket. Bottoming used to be very painful till I put some foam pads in the bottom. Now I get a warning that soon, it will be painful.
I stopped under a tree, and removed the leg. I put a special sock over the upper part of the stump. This makes the stump fatter so it doesn't fit so far down in the socket. At the mall, before I started back, I added another sock. I got home with the stump bottoming again. Any more walking now and I would need another sock.

Missing the left leg means that if I am walking where the ground is higher on the left, the foot has a bigger chance of catching on the ground during swing forward. If the ground is lower on my left, the I have extra room during the swing forward, and I feel safer.
In South Africa cars drive on the left, so I should be walking on the right side of the road so I can see on coming cars. But I feel safe walking with the road sloping down to the left to give more toe clearance.

About 500 meters before getting home, I heard a car behind me and looked over my shoulder. The leg didn't swing forward all the way, and I fell.
 Falling face first onto a curb sounds like bad news, so I walk a bit farther toward the center of the road. I'm sure I piss people off. A cripple walking about a meter from the curb in the same direction as the traffic. Many cars come very close to me. They are trying to make a point.
Today when I fell, I remembered to drop the cane so my fingers don't get trapped under it. I fell toward the curb, and ended up next to it. The car that scared me, slowed down and drove around me. So did the next 2 cars. Finally I got a traffic gap and managed to get up. White South Africans don't stop to help a cripple laying in the road. Even, if it is on the way back from Church.
I always wear motorcycle gloves when I walk. I sure needed them today.

Last night, as I was reading, a mouse ran across the kitchen floor. I don't even tolerate ants inside my house, now a mouse!
I like animals, but a mouse, in the house, is not going to be there for long. I searched all over for him, but he was hiding.
About 20 minutes later, I hear plastic rustling in the tool cupboard. I open the door and the mouse runs out of a small plastic bag and disappears into the cupboard junk. Trust me people. A mouse could hide in that cupboard for months with out being found.
 I grab the plastic bag to make sure the mouse doesn't eat any more of what ever was in there. It was Ratex rat poison.
The mouse was killing himself, and I saved him! I had the unique experience of feeling Arrrrggg!, and Duh! at the same time.
I set up motion detection cameras, and a mouse trap. I put in the trap for bait, bread, peanut butter, banana, and cheese. I wanted to see it die. I have a huge internal, emotional, conflict between my Buddhism philosophies, and the killing of things, that really should be dead.
This morning the mouse trap had sprung, and there was the mouse. A cute little thing. I was blessed with a karmic reprieve because the mouse was trapped by only its tail. I bravely put on my motorcycle gloves and got a huge bowl, and put the trap and mouse in the bowl. I then went outside to my fence, un-trapped the mouse, and threw it into my neighbors yard. It scampered away with it's newly bent tail.
I went inside to check the cameras to see just how a mouse gets only it's tail caught in a mouse trap. The mouse must have been to small too trigger the motion detection. No videos. :-(
--

Mar 27 2016 - Walk in the Botanical Garden

17:30
Finally something to write about. Nothing exciting, but not "nothing" either.

This morning Vicky (Maddie's granddaughter) left to go back to Stellenboch University. I sure hope she can stick to her studies of Math and Physics, and not change her major to boys.

Maddie and I decided to go to the Botanical gardens for some exercise. Last weekend Maddie did the 5km (3.10 mile) George park run through the Gardens. Here is proof....

Notice the thousand yard stare of an exhausted athlete.

I told about Maddie showing me the hard part of the run through the woods. Today we stayed on the easy part of the run.
The weather was cool, windy, and beautiful skies.  We appealed to the gate guard to let the poor, helpless, cripple, park his car inside the Botanical Garden. Inside the Garden are two large grassy plains, and a hill that is called the labyrinth. We parked in the one big grassy field.
The labyrinth is a 10 meter high hill with a spiral path leading up to the top, and another spiral path leading down. The paths never cross, so you never meet anyone on the path.

Here is a Google map of the Labyrinth Spiral and the one big field.

Maddie zoomed off to get her exercise, and I started walking with my cane, crutches, and Maddie's walking sticks. I needed to learn slope walking, and uneven ground walking.
First I walked the length of the grassy field a few times with the walking sticks. They are better than the cane for walking fast on uneven ground.
 My prosthesis is designed to lock the knee when weight is on the heel, and to unlock the knee when weight is put on the toe.
When walking on uneven ground, one step may have a clump of earth under the heel, so the knee will never get weight on the toe to unlock the knee. So just when you need to swing the leg forward, it won't swing forward because the leg is stiff, and doesn't leave the ground. The opposite is true if there is a clump of dirt under the toe. As soon as you put any weight on the foot, the knee unlocks, and the leg collapses. After quite a bit of walking I figured out that taking LARGE steps greatly increases the angle of the prosthesis foot on the ground, which greatly increases the knee breaking loose if something is under the heel, and helping hold the leg stiff if something is under the toe.

I then went to the Labyrinth, and practiced walking up slopes, and down slopes. I used a walking stick in my right hand, and the cane in my left hand. Once again I found large steps to be a big help for up slopes.
If the down slope is steep, I found that a method similar to going down stairs works best. First put the prosthetic foot down in front, then because the weight is on the heel, I must use LOTS of force to move my stump forward to break the knee loose so it collapses. (OH NO...I'm going to die.) then quickly move my good leg to prevent me falling on my face. It feels very much like I save my life every step.
 Then I got a bright idea. What if the leg never locked? So I changed the settings so the leg was floppy. It just would swing free. The only thing to keep it straight was to snap it forward, then hold it against the ground with strong back pressure. If the back pressure was released, the knee collapsed.
Now I had no problem getting the knee to break and bend. This allowed controlled collapsing.
 I did 2 more up and down the Labyrinth.

 The view from the top was fantastic.

A couple at the top took a picture of Maddie and I.

Here is a panorama of the view from the top.

I walked fast with the knee loose back and forth the length of the big field, then with Maddie close by, I "fell" and got up by myself twice.

Then home for a welcome shower, and a movie. "Now you see me".
--

Mar 19 - Market and Walk in the woods

19:30
Today was a busy day.
There are 4 people staying in the other part of this house, so it is a busy place.
Maddie and I went to a Farm Market this morning. We walked lots on very uneven ground. There were hundreds of people there and 99% of them would not look at me, or else they would smile in a sheepish manner.
A boy walked up to me and asked what happened to my leg. I started explaining about it, and he invited me over to his parents stall. They were selling hippy jewelry. His parents quickly said he had a super curiosity about everything.
I explained about the leg, and he asked if I could take it off. He brought a stool over and I took off the leg. Now there were maybe 10 people watching. I showed them all how it worked, and they played with it. The kid wanted his picture taken holding a leg. I then put it back on. Everybody asked about the cancer, and we had a good talk.

Maddie bought us some Jalepeno poppers for way too much money, then we had some coffee.

Maddie's one grand daughter was supposed to arrive today, but will only be here tomorrow. So Maddie and I quickly went to the forest section of the parkrun course to see if I would be able to do that section.
It was very steep, muddy, slippery, and had lots of large roots crossing the pathway. VERY difficult for me. As expected, the down slope was much worse than the up slope.
If I try that section again, I will take my crutches along. We both were sweaty and muddy by the time we got back to the car.

On the way home we decided to get take away food, so Maddie didn't have to cook. Almost everything was closed, so we went to a Dros (fancy restaurant) to see if they did take aways. They didn't so we had to go in to eat. They stuck us off in a secluded corner. Probably because we stank, or maybe because we were muddy, or maybe because my leg would scare customers or maybe they thought we were homeless. We had very expensive hamburgers. (The cheapest thing on the menu.)
We also had a large draft beer each, which left us in a giggly mood, which only re-enforced the managements thoughtful precaution of secluding us.
--

We watched Kill Bill Vol 1. before bed. I like women with guns (or swords).
--

Jan 10 - Triping on a trip

9:00
There is so much to write about, that this is becoming a daily blog again. I'm sure that won't last for long.

I woke up at 8 after a good night sleep. (drug assisted).

I decided to make the day a leg only day. No Wheelchair.
The leg went on in record time. It is getting easier every time. There is still the problem of it not going in far enough, but it will settle as the day goes on, and the leg will get shorter.

Last night my Texas buddy and I were chatting about how the brain never really knows where the prosthetic leg is. Like when you get out of a chair and find your leg is numb and asleep. There is no feeling, and no feedback of what it is doing. So you sit down and massage it till the feeling comes back. I live with that "no feeling" every day.
All the modern prosthesis, whether mechanical like mine, or computerized bionic ones, all leave the human brain out of the loop. I never KNOW positively what is happening. I simply eventually build up trust that the leg will be, where it should be. The position of the leg is always a probability. We strive for 100%, but it never will be.
I used to walk about 10,000 steps a day. If the leg is 99.99% always in the correct position, that still means I will fall once every day. That falling will probably be at the worst time, when something important distracts me. (Like a coming train, or an attacking dog)
A fall a day means, an  injury a day.

I found online about some guys that are working on this exact problem. They are trying to incorporate some means of telling the brain what is happening.

http://www.amazon.com/Neuro-Robotics-Interfaces-Rehabilitation-Augmentation-Performance-ebook/dp/B00S16PTL0

They are wanting the prosthesis to be a robot controlled by the human brain.
One thing I found interesting in the excerpt from this book, was that they used many force sensors to measure everything on a prosthetic leg. One thing they measured was the force applied by the human muscle to push the stump downward when rising from sitting.
They found that more force was applied when using a power servo assisted knee than with a non assisted knee. The more assistance in getting up, the more force from the human. Exactly backwards from the way you would think.
--
11:30
Whew. I just walked to the big gate down the street like I did when learning the crutches. Only a few hundred meters, but it is a start. I can walk much faster than I can crutch. When going fast, I can feel the leg snap straight better. I was keeping the good leg, and prosthesis leg length of stride the same. This knee does that kind of walking well.
As usual I used the two crutches, but the left one never touches the ground. It is for fall stopping only.
The knee doesn't do busy standing well. While cooking my breakfast it collapsed twice, but I stand with the leg almost against the cabinet, so the knee hits the cabinet, and stops, and that also warns me.

I need a warning buzzer when the leg is not locked, and weight is on the heel. The only time this condition exists, is when sitting down, or falling down.
--
13:00
 I decided to play with the adjustment on the leg. I want to make it have more resistance when collapsing to give me more time to catch myself. I call it stumble recovery. The official manual calls it "Stance phase resistance to knee flexion when the prosthesis is loaded." I guess that would be "sprtkfwtpil" for short.
The sprtkfwtpil adjustment is a tiny Allen screw that is hidden, and hard to reach. Not like the swing phase adjustment that are big easy knobs.
I get a mirror, and have to bend way over to reach, and see the back of the knee. I struggle to get the Allen head wrench in the sprtkfwtpil hole while upside down using a mirror. The mirror makes the upside down, upside up but backwards, so everything is upside up, except my head. Now...I have to turn the screw which way?
I take my leg off, and put it on my lap.
I find that the screw is all the way at maximum resistance already. I wish it could go much farther.
Oh well...That was a total waste of a half an hour.

I put the leg back on, but it is a bit skew, so when I stand I look like a duck (well half a duck).
I take it off and try again. Now I am pigeon toed.
I try again, and third time I am lucky.

I wasn't quite as skewed as this guy.

--
17:00
I have walked to the gate twice more. That's 600 meters for the day. On the second trip I tripped. :-)  But that crutch held just off the ground at the 10 O'clock position saved me. It hit the ground hard at exactly the right angle. My legs were way back behind me. I don't know what happened. I think I didn't push on the toe with enough force, and it thought I was still in stance mode, and starting to sit, so the hydraulics were tight to lower me into a chair slowly, and what I wanted was zero hydraulics to swing the leg forward.
 A simple thing like that means a bad fall. Without that crutch, I probably would have been hurt bad. There is nothing to break your fall except the one hand. That is why there are so many broken wrists from leg prosthesis.
Usually when a two legged person trips, a knee is first to hit the ground. But with a prosthetic, the good leg is behind you with the bad leg. Both feet are together behind you as you fall. Similar to being tackled in football or rugby.

 That old man at the pharmacy had it right. If I make a 3 page list of the important things to do when walking on a prosthesis. Top of the list is "DON'T FALL". Now got to page three and you will see the things that Bradley talks about.
 "Keep the strides the same between prosthetic and the good leg" That is on page 3.
"Keep your hips forward so the hip flexors can be used to put pressure on the toe." That is on page 3.
Everything listed on page one and page two is "DON'T FALL!"

That old man, when he got to work, he locked the knee straight. On a R230,000 bionic knee, and his first and only thought was "DON'T FALL!".
Maybe a young athletic person can handle a fall, and the injury that goes with it. But for an old man with cancer, an injury can last for the rest of their life.
--

Day 87 - Pain 101

I slept OK, not well. I still have bad phantom pain. The pain is till my broken toes on the missing leg.

Maddie wanted to go to Church this morning, so she was busy with the typical woman fluffing hair routine. She did look nice though.
While she was busy getting ready, I made myself a cup of coffee for the first time in weeks. The biggest problem was moving the full cup to the computer. During this comedy skit, I dropped a crutch. What a mission. I finally ended up smacking the fallen crutch with the other crutch till it got jammed on a cupboard, and I was able to get it up to my hip and grab it.
I was unable to move the coffee cup without spilling, so I found a travel mug that has a lid. I decanted the coffee into it, then sort of held the cup and crutched at the same time. It felt more like crutching the coffee, and the body coming along, was a secondary thing.

While I was in the hospital, there was a fat, spoiled teenager in the next bed. He had broken his ankle. After surgery he was moaning lots.
When the nurse comes by every hour, to take blood pressure and temperature, she always asks if I have nausea, and what is the current level of pain I am feeling. They explained the pain scale to everyone in the ward. She came by and asked my pain level. I told her about a 3, so hold my pills. I may want them later.
The nurse asked the kid his pain level, and he whines it is a TEN. I told him don't say it is a ten, but tell the actual truth. He then whined louder "It is a TEN a TEN."
 I told him they just cut my leg off, and the pain never got above a 7.
But he insisted the pain level was a ten, so the nurse presses the button and Doctors zoom in and drug him unconscious.

Pain is a subjective thing. Some people suffer some pains better than others. A person may be able to handle steady, constant pain, but sharp, stabbing pain bothers them much more, or visa versa.

Unfortunately I am a bit of a pain expert. I wish I was ignorant of pain like that teenager was. I suffered migraines for many years, I suffered lower back pain for many years, and now I have cancer and they chopped off my leg.

There is a pain scale, that attempts to quantify pain into usable values. Different Doctors have different pain scales, and different types of pain, affect different people, differently.

Basically a 0 pain level is no pain or discomfort.
1-2-3 - are more of discomforts, than actual pains.
4-5-6 - are real pains, that significantly affect your daily activities, and your quality of life.
7-8-9-10 - these are severe and disabling. No daily routines or actions are possible.

I have arthritis in my one hand. It is a constant discomfort. I can still do anything with that hand, but I am conscious that it is unpleasant to do that action. I call that pain a 2, and sometimes a 3.

When I stub a toe, it is like a 5 for a few seconds, then quickly drops to a 2 or 3.

A bee sting is a like a 4 that soon drops to a 2 or 3.

The sciatica from my back was often a 5 or 6. It would make me think of little else than the pain. No coffee, no lunch, and normal daily tasks are impossible.

After the leg amputation, the pain was a 7, but drugs took it down to a 3. I never suffered much from pain after the amputation. The Doctor that did the surgery said he believes that pain is a strong negative to quick recovery. He never wanted me to feel more than a 3. This phantom pain becomes a 4 or 5, and when Maddie talks to me my mind quickly drifts to the pain.

The worse were the migraines. When ever a migraine snuck up, and got out of control, it was a real 7 or 8. There was no other thought on earth but the stupor of pain. It was my entire world.

I had one migraine that was a 9 or 10. It was life threatening. Suicide was a pleasant relief that I was unable to perform due to the pain.

Some pills like Celebrex are wonderful additions to my life. I take 2 a day, and they seem to lower my whole pain down 1 or maybe 2 points, but only if the original pain is below a 4.

I have been taking way to much Tramacet lately. Tramacet lowers steady pains down a few points as long as the pain is steady, and below a 6 to start with.
When I get a sharp phantom pain, the Tramacet seems to do little. But it is very hard to tell what it would have been with a different dosage.

Ok, now back to the real world.
Maddie is back from Church with food shopping. She showed what she bought, and all of a sudden I am hungry.

I put the carpet sliders on our 2 living room chairs, so they slide easier on the tiles.
 --
Evening -
Maddie is busy making supper. She just swept the driveway. I am a real slave driver.
We just went for a walk. About 50 meters to the gate and back, twice.

I lengthened the crutches, and they are more comfortable, but now they sometimes catch on the ground when bringing them forward. Whether I leave them this long will depend on whether I trip tomorrow or not. :-)

Tomorrow morning at 11:00 is an appointment with the Wound Care Lady   so she can inspect and re-wrap the stump. I am going to nag her about a prosthesis. But I am sure they will want another 2 weeks for the wound to heal.

I am still having bad phantom pain. It is a steady pain level 3 with a jump up to 5 every minute or so. It is very distracting to have a strong pain every few minutes. I spend much time anticipating the pain.
My pain killing tablets seem to reduce the steady pain to about a 1, but they have little affect on the strong sharp pains. My sleep comes in many short naps.
I did a total of 30 minutes of "mirroring" today. If it helps, it will be a slow solution.

Maddie just served supper. I challenge anyone to find a healthier supper :-)
Yummy.

--