9 Miles

Sorry about the lack of updates in.... forever. I still have not posted pictures or video of my Catapult foot, which is an outstanding running blade. Last weekend, I completed a 9 mile run without having done more than 2 or 3 miles in the weeks leading up to that. I had to stop a few times along the way to drain sweat from my liner, but that's just the way it is with me. I can sweat like a pig just sitting in a 75 degree room. I've been biking to work almost every day for the last couple of weeks. It was a little uncomfortable at the beginning (it felt like my knee sleeve was getting really bunched up behind my knee) but somehow that all resolved itself. I don't know Whether the liner stretched, or my leg simply got used to it. In any case, biking is fine (on my mountain bike... I haven't dusted off my road bike yet. There's still too much winter silt and gravel on the shoulders here.)

Hickories Park 5K

Some video from my first 5K. Not surprisingly, I was the only amputee runner. Oscar Pistorius would have been disappointed with my results, but I kept a steady pace, and finished pretty much where I started.

Thank You

Valerie Gundrum, who subscribed to this blog, passed away last night after battling kidney cancer. She was an uncommonly good person, and will be missed. It's still hard to believe, especially as I glance over and see her picture in my small list of subscribers. Thanks, Val, for your support.

To help support kidney cancer research, there is a Spin-a-Thon being held Oct 27 at Val's fitness studio in Owego: Spin at the “Kidney Cancer Sucks” Spin-A-Thon. There are two teams from Lockheed, and I will be there some time in the early afternoon for an hour.

One Year Anniversary

I've really neglected this blog, and I apologize. Earlier in the summer, I was having problems with an ill-fitting socket, I was becoming discouraged, and I finally decided to change prosthetists. I'm now with Hanger (Ryan Stark) in Johnson City, NY, and it's been a terrific experience. The test socket fit perfectly (literally no changes were needed) and the new carbon socket is a work of art. Ryan pieced together some components so I could swap between the Fusion everyday foot and the Nitro running foot.

It's now been exactly one year since my surgery. Here are the results:

(not sure why YouTube messed up the colors... I'll try to fix it)

5-Month Update

The 5-month mark (since surgery) is approaching, and I'm very pleased with my progress. I walked 4 miles continuously today (4 miles according to GPS, but 3 miles according to my pedometer) and my only real discomfort was due to the 40 mph wind gusts.

My last post mentioned some pain coming from the distal anterior tibia. I finally solved that. It wasn't actually the bone striking the prosthesis -- it was the gel liner pulling the skin taut over the bone. My solution was to roll on a nylon sheath first, and then roll on the gel liner. I know this completely defeats the purpose of the gel liner, which is to prevent skin shearing forces by adhering to the skin. Now, the gel liner can slide over the bony prominences, but it still does its job of preventing shearing. The bottom line is that my discomfort went away pretty much immediately, and hasn't come back. Now that I have a new socket, things have probably changed enough that I no longer need to do this. (EDIT: it's true! I'm now doing just fine without the nylon under the gel.) I'm reluctant to try. If I can walk 4 miles with no problem, I'm doing something right.

I'm on my second temporary socket (still using the Ohio Willow Wood Fusion carbon fiber foot) which fits much better than the original. There is some excessive upward pressure on my patellar tendon, which I'll have addressed at my next checkup on Wednesday. I still don't understand why the trim lines on below-knee sockets have to come up so high (i.e,. to the top of the knee cap.) It's annoying. My old legs never had it, and I did just fine. My last leg (before the Ertl) started out that way, and I told my prosthetist to saw it off after about a day.

Anyway, some pictures of the new temp prosthesis, the Alpha gel liner, and my leg.

5 Weeks

Today marks five weeks since I picked up the temporary leg. Of course there was an adjustment period, but it seemed like I was making progress every day. Within the last few days, however, I've started getting some soreness from the tibial crest. It's pretty astonishing how quickly the volume of my leg has changed over the last few weeks. The downside is that the relatively sharp edges of the tibial crest are visible, which is an indication of how little soft tissue there is between the bone and the skin.

Here's a picture, showing how the leg looks today, versus post-operatively:




My prosthetist has been trying to adjust the socket by heating it and having me step into it -- this allows the plastic to conform to any bony prominences. Unfortunately, whatever is causing this soreness is probably not from the pressure against the socket. Even with the adjustments, I'm still getting those "whoa" moments. Best guess is that I was over-socking, causing me to "hammock." This probably put a lot of shearing forces on the skin over that sharp bone. Luckily, I still have plenty of percocet left for this sort of thing.

I'm going to be re-casted Feb 8th for the next socket, so I'm optimistic that a new socket will really solve this. I think the basic problem is that I've lost nearly 1.5 inches in circumference in my leg since I started wearing this socket. Too much walking with an ill-fitting prosthesis is always a bad idea, so I imagine most of my pain right now is residual.

Things will get better.

One Mile

Everything's coming up Milhouse today. I was able to walk a mile at the Vestal rail trail without a cane or crutches!

Three more weeks until I can have a new socket made. My prosthetist wants to wait until my daily swelling is less volatile. I'm currently starting the day at around 8 ply, and ending around 13.

It would be awesome if I could wear shorts to work -- it would make sock maintenance a lot easier.

Professional Cycling Career in Jeopardy

Since it's -34 degrees out, and since I really could use some exercise, I put my road bike on the stationary trainer. No dice... I don't have the range of motion in my knee to make it past top-dead-center in my pedal stroke, even with the neoprene suspension sleeve rolled down. It's a combination of the back wall of the prosthesis coming up too high, the fact that my roll-on silicone liner rolls up over my knee, and the fact that I have about an inch-thick layer of socks over my silicone liner. I know that BK amputees can ride bikes just fine, so I'm not going to panic just yet. It's just frustrating, because the only exercise alternative is the elliptical machine, which isn't quite as low-impact as a bike. The goal is to get blood pumping without stressing my leg.

On the bright side, I was able to go grocery shopping without a crutch (although I did use the shopping cart as a walker, I suppose.) Still, I'm slowing increasing the distances I can walk unassisted.

The issue now (which will be addressed on Wednesday, when I have my next appointment with my prosthetist) is that I'm starting the day with about 8 ply of socks, and ending up at about 13. By the time I reach 13, I'm way too tight in some places, and still not tight enough in others.

Waiting Game

I've had a temporary socket for two weeks, and I've got an appointment on Monday to decide whether to proceed with the permanent carbon fiber socket, or make another temporary.

My leg is far less swollen now than when this socket was made, so I'm leaning toward another temporary socket. I can walk a few miles with one crutch or a cane, but this socket is not where it needs to be. The problem is that I can't tell if my leg simply hasn't healed enough, or whether the socket fit isn't quite right.

That last x-ray is burned into my mind, and I worry about that bone bridge becoming dislodged. It just looks so tenuous in the image. From what I've read, it takes about 6 months for the bone bridge to consolidate. During that time, high-impact activities should be avoided. Hopefully, as long as I abide by those instructions, I should be OK.

I can't really tell much about the Fusion foot. I guess it feels slightly springier than my last foot (which was an Otto Bock Lo-Rider, and really had no shock absorption) but I haven't exactly gone for a spirited walk yet.

Two annoying things:
(1) I didn't anticipate the onslaught of "So, are you in the military?" I get that ALL the time now, if I'm wearing shorts. I never got that before, I guess because my prosthesis was far more cosmetic. I wasn't planning to make this one cosmetic**, but it looks like I might have to, just so I'm stealth once again.

(2) Having to adjust socks all day long, and having a neoprene sleeve that comes halfway up my thigh. Thus, I much prefer to wear shorts (even if it's cold.) It's super annoying at work, because I can't roll my pant leg up high enough to be able to add or remove socks at my desk. So, I have to jam a few different socks into my pockets, and hobble to the restroom. (No, that's not a First World Problem. This is a First World Problem.)


**Some uppity, so-called journalist posted something a while back complaining about amputees sporting carbon-fiber-and-titanium prosthetics. He said it's disgusting, and that an amputee should go out of his way to conceal his prosthesis. Well, dude, the reason is that it adds unnecessary weight and doesn't benefit the amputee at all.

Incidentally, there are those who say that a bel0w-knee prosthesis is a lot heavier than a Symes prosthesis. I guess that might be true if it's made out of cast iron, but I weighed my old and new legs last night: 3.6 versus 4.2 lbs, respectively. And that's the big, clunky temporary plastic socket. When I finally get a slimmed-down carbon fiber socket, this might actually weigh less than my old leg.

New Xrays

Not much has changed over the last month. The bone bridge will probably consolidate by my next visit, which isn't for 6 months.

Test Socket

I've been laid up for the past few days with a pretty awesome bout of viral gastroenteritis, and I don't really feel like typing much at the moment. Nevertheless, I had my test socket fitting today, and I'm pretty excited about the prospect of ditching the crutches. It will definitely take some getting used to, and my leg will continue to get stronger as the bone bridge solidifies. For now, I've decided on the Fusion foot, from Ohio Willow Wood.

Cleared!

Surprising turn of events... I had my checkup on Wednesday, and I was actually cleared for prosthetics! The doctor applied a decent amount of force with the palm of his hand to the end of my leg, and I tolerated it just fine. It wasn't uncomfortable or painful, and nothing snapped... so I guess that's a good sign.

I won't delete my earlier post. I think Ertl patients need to realize that you will get frustrated, you will hit a low, and you will rethink the decision. I have yet to see whether my outcome will leave me better off, but things are certainly starting to look better.

More x-rays coming soon.

9 Weeks

Tomorrow is the 9 week mark. Another check-up in Cleveland next week. Not expecting anything except, "Come back in 3 or 4 weeks." Probably shouldn't even waste my time going there, but I'm a sucker.

X-Ray Time

Here they are:

Ertl = waste of time

To anyone seriously considering this surgery: don't do it. If you're doing all right, you're doing much better than you think. Don't do what I did, and believe the surgeon who told you his technique heals faster and stronger than the "true" Ertl procedure. I still had stitches at 5 weeks; a true Ertl has stitches for 10 days. A true Ertl is walking within 4 weeks.

I'm now 8 weeks post-op, and I still don't have "significant bony healing" (their words.) So, it'll be another 4 weeks before I can think about a prosthesis. But don't worry, when those 4 weeks are up, and I've slipped and fallen on the ice too many times to count, then it'll just be another 6 weeks. In other words, I'll most likely never walk again. All because I was greedy, and wanted to be able to run. This should be an awesome Christmas.

If, by some miracle, I ever do walk again, I'll be too fat to walk more than 10 feet without having a heart attack. For those who don't know, spending every waking second on crutches is probably the worst possible way to go through life. Drop something? That's a 30-second penalty, and hopefully you don't lose your balance. Need to carry coffee across the room? Better take your time, and don't spill a drop. Oops, you did spill a drop, now that's a 2-minute penalty as you try to wipe it up without falling over. Need to carry anything at all up or down the stairs? Good luck.

When I'm not sitting at my desk all day, I'm sitting at home. Because I no longer have any desire to walk around. Thus, I'm probably gaining about a pound a day. That's pretty easy to do when all you do is sit and eat all day.

What if I just never go back for any more follow-ups?

Week 7

Thanksgiving will be the 7 week mark. Nothing really significant has happened lately, although the trip to Cleveland was a little disappointing. Dr Clair would like me to return in mid-December for another check-up, and only then can I start thinking about prosthetics. The problem is that I know that no one will be available during the Christmas holidays, which means I realistically won't have a leg until some time in January. I really didn't want to be contending with snow while on crutches, but it looks like that's where I'm headed.

I did have some x-rays taken in Cleveland, and I'll post them if I can obtain copies. If the bone bridge shows a callus formation, that should be the trigger for prosthetic fitting. Of course the bone bridge won't reach full strength for probably a year, but as long as the initial fusion has occurred, that's all that's important.

This goes against doctor's orders, but I made an appointment with my prosthetist for next Tuesday, 11/29, to have a plaster impression made. By the time the test socket is ready, hopefully I will have had my next check-up in Cleveland. And then, hopefully the real prosthesis could be ready before Christmas. That would be just over 11 weeks, which certainly should be adequate time for healing. Throwing away these crutches would be an excellent Christmas present.

Buckeye Bound

Off to Cleveland tomorrow morning, and stitches come out on Monday. Corrine almost convinced me to snip a few of the really painful stitches that are cutting deep into the skin, but I decided just to leave them alone. The incision is completely healed now, so the stitches truly are doing more harm than good.

Even though my thigh has atrophied down to nothing, my lower leg actually does feel quite strong. I can push with my palm against the end, and I have absolutely no sensitivity. This probably doesn't sound particularly remarkable, but I could never do that with my old stump. My old stump was basically just a big nerve ending.

I hope they clear me for prosthetics at my appointment on Monday. I don't know how I was able to handle crutches for almost 9 months back in 1995. I am really quite fed up with hobbling around on one foot. I also can't stand parking in handicapped spots. I've had a handicapped placard for a while, but just ask Corrine: I'll park half a mile away, rather than use handicapped parking. I never limped, and my prosthesis basically looked like an ordinary leg, so I assumed that everyone thought I was a fraud when I parked in a handicapped spot. I distinctly remember one time we visited the Kinzua viaduct. I was actually in some pain that day, and the lot was full, so I asked the parking attendant to direct us to the handicapped spots. She glared at us, assuming that a male in his 20s couldn't possibly need handicapped parking. As Corrine and I later walked past her, I heard her say, "Oh, there goes the handicapped couple!" I definitely stopped dead in my tracks, and thought about taking off my leg and waving it in her face. I opted for decorum, and I let it go.

I work with an amazing troop at Lockheed. Engineers have an undeserved reputation for being socially inept, maybe even antisocial. Nothing could be further from the truth. Every single person I work with has been supportive beyond my expectations. I guess that's why I returned to a full-time schedule so quickly.

When I was in high school, after I was fully recovered from my accident, there was a kid from Erie who managed to get his bicycle entangled with a train, and his leg was severed below the knee. (This was back when West 19th street had railroad tracks literally right down the middle. Yes, mile-long freight trains instead of streetcars.) I decided that I really needed to find this kid, and assure him that everything would be fine. I found out where he was taken, and I visited him in the hospital. A few days after that, one of the nuns at my school came to me and suggested that I go visit this kid in the hospital.... and I explained that I had already done so. After I'm fully recovered from this, I hope I can somehow promote the Ertl procedure. There's a lot of information on the internet, if you're willing to look, but it seems as though a lot of the medical establishment isn't convinced that it's worth all the extra hassle.

My Mentor

I wanted to give some recognition to the guy who basically singlehandedly inspired me to go through with this procedure: Earl Barnes. Here's his glamour shot (I hope he doesn't mind!)

Earl basically was in the same situation as myself. He lost his foot in an accident (his was a motorcycle, mine was a train) and lived with an amputation at the ankle for about 15 years. He finally decided that enough was enough, and went through with the Ertl BK. Obviously, he's a tremendous athlete now. But he's also a firefighter and rescue diver, so he routinely carries 80 pounds of equipment (or another human being.) So, this is all further testimony to the credibility of this procedure.

Out, damned stitches

Counting the days. minutes, and seconds until these stitches come out. I'm putting the odds of them actually coming out at 2:1. I surfed the entire Internet, from start to finish, and found no other cases of stitches being in this long. I am making medical history, folks.

I started to think that I would get used to them, but that's preposterous. For the last month, my body has been trying to tell me that I have 25 pieces of nylon sewn deep into the skin. I'm pretty sure that's something your body doesn't ever adjust to.

Pictures

Warning! Skip this post if you do not like seeing stitches. I'm posting this as medical information for anyone who wants to see what an incision looks like after 4 weeks. Other than one stubborn spot, I think mine looks good.

And here is the gallery: http://flickr.com/gp/jtocwru/438xog/

If your reaction is, "Wow, that doesn't look good at all," then (1) I should see if I can find the pictures taken right after the surgery, and (2) my old stump looked pretty bad, yet I was able to do just about anything except run. Before, I basically had skin over bone at the end, whereas now I have a thick cushion of muscle and connective tissue over a bone graft. Tim 2.0 should be bomb proof -- check back in a few months.