Climbing

I was feeling a little despondent over my setback, it seems a little silly that such a small injury could cause such a large problem. It's something like having a tiny splinter in your finger, an insignificant thing causing a great discomfort. I've run with plenty of blisters making every footstrike a tiny red revolution, but I crushed the revolt with suffering. The tables are turned now, and I have to wait for my conservative healing corps to fix what is broken.

It feels very odd not to have my prosthetic foot on. I am back on the crutches and I have the very real sensation that I should be able to put my right foot down, so real that I could see myself trying to do just that if I was a little distracted in my space cadet world.

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Today - Thursday - I wore my prosthetic leg for the first time since last week. My friend Diane Williamson told me about tea tree oil, which I used over the past few days. It seems to have helped speed healing and I intend to try it as needed in the future.

I think I am going to need a slight adjustment with my prosthesis, I have a pressure spot on the inside the distal end. At first I though it might just be a sensation from not wearing the leg for a few days, but when I saw Larry last time he added a new valve and the fit seems a little different. I hate being a PITA but fit is all-important to help prevent skin breakdown issues.

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TGIF! I fought rainy day traffic and saw Larry today for an adjustment to the leg. This made a big difference in comfort so I will start back walking tomorrow, and if the weather cooperates I will go for a short bike ride too.

I am thinking I might do a 2 mile walk at a local walk/race that Jennifer is considering in September. I have never participated as walker so this would be a first for moi. Since my last 2 mile jaunt landed me on the bench, I have to be careful not to overdo it again. But I'd really REALLY like to get back out there although as I think about it I'm not sure how I'll feel seeing all the runners milling about. I know how I'll feel, that I am now different even when I return to running.

And it is good.

*******

We had a busy Saturday, and I was a little worried that I might have overdone it. Nope! This morning we took Baxter to the dog park and then over to PetSmart to get provisions for the herd. Back home for lunch, then off to Lowes to get some sod for the backyard to touch up where we had a patio installed. Jennifer and I installed the sod, then I seeded the weak spots. We finished off adding topsoil to the sod seams and a few bare spots. Watered everything and then time to check out the stump.

I dumped a quarter cup of sweat out of the liner, then washed and set it up to dry. Checked out the incision...it looked really good, no red spots indicating an owie.

Having only one liner right now means I can't wear my prosthesis while it is drying. Normally I do this at night and it isn't a problem, but sometimes it is a little inconvenient. I'm sure I'll have several liners as I move down the road to my definitive prosthesis.

*******

It's Sunday and I've worked in the yard a bit. Cleaned the liner and then washed the sleeve, socks, and my shoes that were soiled from the manual labor. I'll probably walk a little on the treadmill later once everything has dried, or maybe go to the grocery store with Jennifer. We're having dinner with some friends this evening then it is Monday overnight.

On Tuesday, 9/1, I see Dr. Ohlson for a follow-up. Hoping to see some bones growing together at my bridge this time. I am looking forward to walking into the doctor's office with very little limp after my amputation 20 weeks ago.

*****

Next week I will try to ramp up my walking and will be very attentive to any signs of irritation to the incision line. My plan is to try to jog a little after I walk 3 miles and have a healthy limb. It will be just a few strides at a time, as the added pressure will need to be absorbed and compensated for by the residual limb. I still have a long way to go but the worst is definitely behind me.

Climbing, climbing.

Running to Life

Everything, of course, depends on your attitude to life. You have a choice: take what has happened to you as a slight from destiny and the theft of your natural right to have two legs, or simply embrace life and relish the new opportunities and knowledge that will come with the change.

- Oscar Pistorius, from "Blade Runner"

*******

After a promising start, this last week was a bust. I tried to call my CP on Friday but we were unable to get together. I am not going to put the prosthesis back on until these small scabs are gone and the skin is clear. Once I can wear it again it will be sparingly with extended times off if I notice any drainage.

I did a full PT session on Sunday; still have my strength despite doing less weight lifting as I took more time to walk. It's all I can do now...if I had a boatload of money I'd buy a hand cycle but that will have to wait for the proverbial someday.

*****

It's back to waiting now. A coworker asked me recently if I had any regrets, if I would do this all over again. It's not a fair question, because there is no going back. I could have had an arthritic ankle that would deform and hurt more and more for the rest of my life; stronger drugs would be required to tolerate the pain and cloud the senses. Today I have phantom pain but I'm not on any drugs to control the discomfort, as it is not nearly as bad as the bone-on-bone grinding that caused me to limp.

I would have never run again with my old foot, and I will run again with a prosthetic one.

So no, I wouldn't want my old foot back, but there are days I wish it was not a choice to have been made. I am frustrated with my lack of progress and with the knowledge running, when I get it back, will not be the same. It will require more patience and dedicated, intelligent work. Bad decisions will result in no running for days or weeks, leaving a training plan in shreds and a race in shambles.

I am thinking over my situation, and what I may need to do to insure success. Change for the sake of change is idiocy, but change for a positive outcome is smart. Loyalty has its place, but it is a joint venture, an equal partnership.

And I intend to do my bit.

Friday Blues

Yuck!

I took today off and did little to nothing; I did do a simple upper body PT session but nothing more. I canceled my lunch plans since I would have had to travel without my prosthetic.

All I can do is wait for this to heal again. I emailed Larry (CP) but we didn't get a chance to talk today. I see Dr. Ohlson on 9/1 and I'll try to find out why this one area took so long to heal and why it continues to be a problem. The rest of the incision line looks quite good.

Since liners DO NOT BREATHE the skin cannot heal underneath it properly. I also had a problem where the sleeve fits on my thigh with rubbing my 2 mile walk last Tuesday. From last weekend and making real progress to this weekend and taking a big step backward is a little disheartening. The thing is I am still learning and this is part of the process. When I can wear my prosthesis again I will be more careful, wearing it less at work and taking days off from walking until I can discern if I have overdone anything. I am use to pushing through the pain and discomfort of running; I couldn't even feel this current problem arising.

I am hoping I can start walking again later next week. I imagine I will see Larry at some point to check out my fit. This is my second prosthesis and is still a temporary, being a heavy plastic socket with a steel post. Eventually I will have a carbon fiber socket and will want a titanium post. The lighter leg should help prevent problems too, since there will be less weight to aggravate any less than optimal fit.

Nothing to do but be patient now, and hopefully a little smarter in the future. Both are lifetime endeavors of mine.

Off Club Med

I haven't taken any Lyrica since last Thursday. I have been sleeping okay, usually waking at least once in the wee hours but usually able to return to unconsciousness in short order.

So right now I am on zero meds, except for allergy stuff as needed. I probably need something for cholesterol, but I am going to try to be better about what I eat and with exercise keep it controlled.

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Tuesday: I just finished walking two miles on the treadmill. I'm probably going to do a good bit of preparation on the tmill since it is cooler inside and it's easy for me to doff the leg and dry the liner out. I had a little irritation at the top of the liner where the sleeve comes over it, I think I need to pull the sleeve up a little higher or maybe need a little longer one. I'll ask Larry when I see him next. Right now I don't have an appointment with him.

I do have an appointment with Dr. Ohlson in two weeks, which will be week 20 as it is 18 weeks post-op today. It's going to be great to walk in with the only limp the additional compression of my prosthetic foot, not because of any arthritic pain.

It is my plan to walk three miles this weekend, likely on Sunday. My right leg has atrophied and looks rather puny next to my left leg, which has been getting more work.

*******

Wednesday: This morning I had a raw spot on my incision line, so I overdid it a little last night with the two miles. Oh well, a man's gotta find his limitations before he can know them. I am going to take some time off and let it heal again.

On Friday I'm going to have lunch with my physical rehab roommate, Joe Bresnahan. Joe is taking PT and I'm going to pick up my mom Betsy and meet Joe and his wife Rosa at the hospital cafeteria. I feel a connection with Joe, the same generation as my dad, a feeling of looking into a world almost gone.

The greatest generation indeed.

Getting a Leg Up

It's been a good week. My progress continues in vertical direction with The Prize (running) - if I squint - on the horizon.

On Monday I took the one mile walk by myself. My leg was sloshing around in the liner halfway through it, which continues to remind me to buy a chamois to dry it out in the future. Man I wish perspiration could be controlled! I also called the Trek Store of Mount Pleasant to see when the best time might be to go in and try some shoes and pedals; Ben there said just come in as there's no predicting when they might be busy.

I decide to try around 11:30 am on Tuesday, the store wasn't too busy but soon it looked like they were having a fire sale. We tried the Speedplay Zero pedals but I had a great deal of difficulty clipping in and out of them. I think something had to be wrong with the setup as I couldn't clip in with either foot easily and it was nearly impossible to clip out of my right pedal with the prosthesis. We changed to a Shimano mountain pedal (M520) and it was the polar opposite, I could clip in and out easily and gave me great confidence I wouldn't have any trouble doing this on the road.

Unfortunately I wouldn't get a chance to try the new shoes - Bontrager RL mountain - and the pedals for a few days due to work and weather. I should mention I didn't want to spend much for my first shoes and pedals, as I don't have the experience to appreciate the difference with a higher end product. And I definitely didn't want to spend a lot of money only to find the shoes and pedals didn't really fit my style of riding either. I'll buy better when it makes a difference.

I did have a minor moment Thursday: while leaving the office my leg felt really good in the socket and I had the spontaneous urge to run. I did jog maybe five steps and stopped. No pain in the leg but the socket is heavy and it felt very different. Yes, it did make me smile but it is not close to running. I have a lot of work to do and I will not claim the victory yet. I did an upper body workout that night..I had a little tendinitis in my left arm that seems to be gone now.

I had looked forward since last week to going to see Larry at Floyd Brace on Friday to get my new socket and suspension. We tried it on, made several adjustments, and by the time I left it felt for the first time like a real leg. This is a suction only system; I pull on a liner, stick my stump in the socket, then pull a sleeve over the socket and my upper thigh. I don't have to monkey around adjusting the strap as there is none. Larry also showed me how to adjust the rotation of my prosthetic foot should I want to toe it in some for riding the bike.

This felt so good when I got home I just had to go for a bike ride. The more I thought about it the more excited I got, thinking that this would be the first time I could ride my bike since April 12 of this year when I rode 26.2 miles before my amputation. That post is here.

I threw on my bike togs, changed into the bike shoes, found my helmet and gloves, grabbed a water bottle out of habit, and went out into the garage and pumped up the tires. All the while I was getting a little nervous about the prospect of clipping in and out for the first time while riding. This made it all feel like riding a bike for the very first time, a sort of scared anticipation of what I hoped wouldn't be a kiss of the pavement.

Our driveway is on about a 4% grade and maybe 40 feet from garage to the street. I clip in the right foot and shove off, immediately careening to the left, into the grass by the palmetto tree. I steer right, narrowly missing the mailbox and make it to the street. I clip the left foot in, take a few strokes, then clip out on the left and come to a stop. Wow, that was exciting and the exact way NOT to do it.

Okay, I start again, clip in the right, shove off, wobble, clip in the left, and I'm away. I ride around the corner and practice clipping in and out. Nerves settled, off again for le grande tour of the neighborhood. Immediately I notice the liner/sleeve bunches some behind my knee. I decide I better not ride too far in case the pinching irritates my skin, so I go 5 miles and head home with a silly grin for my trophy when I finish.

Life is coming back to me.

*******

Saturday I walked a about 0.75 mi., my leg never felt settled in the socket so I didn't push it. We went to a Riverdogs game Saturday night with our best friend Nancy Cumbee and her son Drew. Last time I was in my wheelchair, this time I walked in with minor assistance from Mr. Kane. The Dogs won, maybe the first time I've seen them do this rare treat. Not a knock on the Dogs, just my luck for their games. Having a Yankees farm team in Charleston is the kind of irony that is perfect. Thanks Mr. Bill!

This morning - Sunday - Jen, Baxter and I walked 1.62 miles. I know this exact distance because I wore my old running watch, a Garmin 305. Giant size, but it has all the features I wanted and needed. GPS watches keep getting smaller but the size really doesn't bother me. I think I could have easily walked 2 miles or more, again I am being carefully not to do too much too soon, and 2 miles would be a 100% increase in distance.

About halfway through the walk I could feel the sweat in the liner, which continued to feel more wet and sloshy. When we got home, I pulled the liner off and there was easily a quarter cup of sweat in the bottom. With the foot off I was in a bit of a pickle, a sticky wicket, a fishy stick it. I glanced at Jen at the other end of the couch; she glanced at me as if I had stepped in something equally offensive with my other foot.

I hop in the trusty wheelchair and dispose of the bodily fluid.

For the rest of the day I've been wearing my leg, thinking about maybe retiring the wheelchair. The main problem is the midnight pit stop; I am thinking all in all actually putting on my leg to make that short trip is only slightly more time consuming but probably a bit safer. It would be cool to have some sort of temporary leg that could just be pulled on without a lot of fuss. Opportunity in adversity!

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It is my present plan to walk 3 miles before attempting to run much. I'll have to do some run/walking initially, and I'll have to use the old runner's adage, "listen to your body" for input on how much I will do. I'll keep a close eye on the skin as running will put more pressure on my leg and I don't want to do something that will reset the comeback clock. I fully expect to have some problems as I learn my limitations or lack of discretion.

Only time will tell.

Hours, minutes, seconds

I had great hopes for my new socket, which I was suppose to get on Friday. Unfortunately it did not fit very well, I had significant discomfort on the tibial crest at the distal end. For you in Rio Linda, that would be the shin bone where it was cut.

Until next Friday, I'm back in my original socket, which has been modified for a better fit but is getting long in the tooth. I have been wearing it nearly all day and walking in it almost every evening, and this Saturday I walked one mile on the treadmill. No muss, no fuss, and NO blisters. This morning Jennifer, Baxter and I walked around White Point Gardens for about a mile. It was a very pleasant morning indeed. Seeing the Little Dancer always makes me smile. The joy of childhood captured where I spend a few hours of mine is a sweet, sweet memory.

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I had been thinking about swimming soon, no excuse really, just have to do it. I have to admit I'm a little bothered about going for the first time, getting the stares whether real or imagined. There are also the problems of working out how to get in and out of the water while having nightmares of some juvenile running off with my foot. Maybe there are worse things to worry about.

I do want to start biking soon. I've been researching how amps bike and think I will start with regular bike shoes. Some use an uncovered prosthesis with a cleat attached directly to it. Eventually I may use this setup, but for now bike shoes with a standard cleat system will allow me to ride and decide what I want to use in the future. I still haven't decided on a pedal system, other than I will likely want to be able to clip in from either side (top of bottom) of the pedal. Right now I will likely go with a light action Speedplay pedal.

One thing I have to consider is that prosthetic feet are usually setup with the toes pointing slightly outward whereas when biking the feet are typically parallel to the frame, or toe neutral. I ran toe neutral and think I walk more toe neutral, so I need to talk this over with Larry. I will either need a separate biking foot or be able to adjust my foot when I ride the bike...something of an inconvenience.

Oh...on the phantom pain front, I am only taking 150 mg of Lyrica at night to help minimize the discomfort so I can sleep. During the day it is better although by late afternoon I may have some sharp reminders that it is not gone. Phantom pain remains a significant problem for amputees, and the quality of lives would be much improved if it could be cured.

*******

At times I feel to-the-bone fatigue. I think I understand some of the reasons for it. Amputation is a difficult ordeal. There is a loss of a part of your body; a real, physical part of who you are. The realization life is forever changed, that a prosthesis, no matter how good, still affects your life everyday. You don't hop into the shower in the morning or pop into the bathroom at night. You can't drive or even sit the same way. You see everything differently.

*****

I can't wait to run again, that loneness where I am lost inside. Where nothing matters but breathing, effort, and time. Where my competitor is only me and the time we never get back. Precious hours, minutes, seconds.

Run and embrace it all.

Mockingbird Update

If you have been following my mutterings you may remember the mockingbird mentioned in this post. I am happy to report I saw the same bird today. I tossed out another fig newton but by the time I got back to my chair it had flown away.

Today I had two friends contact me and then I see this bird. I can't tell you why but it was good to hear from all of them.

Steps Before Walking

With my first leg strap-in suspension system, here are the basic steps for donning (putting on) the prosthesis. I am getting a new suction only system this Friday which should be easier to don. You will soon see why I am looking forward to it.

This strap-in system is a bit of a pain in the butt in that it takes a long time to don, and even after it is on it takes a good bit of monkeying to get the fit right. I'll explain as we go through the pics. The official name for this particular system is called KISS: Keep It Simple Suspension.


These are the basic pieces. From left, the strap-in liner, a multi-ply sock, and the leg. The leg has multiple parts, the main one for this exercise is the plastic socket. The strap itself has velcro on one side.


Here is the liner and my stump (residual limb). The liner is rolled down to be ready for donning.


This is the tricky past, getting the liner over the end of the stump. There is a plastic cup at this end that needs to be held in a flattened position to get good contact over the distal end of the stump. Harder than it looks!


Once over the end the process of rolling the liner up the leg is done. The distal end of the limb is still a little tender so the first inch or so is, uh, uncomfortable.


Rolling the liner up the leg is sometimes easier than others. The main thing is to keep good contact with the skin and keeping air out. If I don't get it right then it's back off for another try.


Once the liner is on, prosthetic socks are added or removed over it for a snug fit in the socket. This is a 3-ply sock.


Here I'm adding a single-ply sock after testing the fit in the socket. Fit is paramount or it will hurt more to walk!


The leg is ready to be put in the socket.


The strap must be put through a slot in the bottom of the socket.


The strap is pulled through and I push my stump into the socket while tightening the strap.


I usually stand and make sure I have a snug fit, adjusting the strap again.


The velcro strap is pulled through a metal ring at the top of the socket at secured on itself.


Leg on and ready to go? Not exactly. I walk around a bit, sometimes with my crutches or cane as the leg is not a happy camper at first. I often stop to adjust the strap before the stump settles into a comfortable enough position before I can walk without limping.

Time to get in the SUV, loosen the strap (!) so I can move my knee enough to get the leg out of the way of the gas pedal so I can drive with my left foot. When I get to the office or wherever I'm going I have to go through the strap tightening process all over again. For some this system might work well; for me, it doesn't mainly due to it being on my right leg.

So yes, I am looking forward to a new suction suspension this Friday (no strap!) and have a great interest in the new vacuum systems for running a few months hence. The latter is getting a lot of new development in O&P and as units get smaller and more sophisticated perhaps perspiration can be finally addressed too.

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A journey of a thousand miles begins preparing for the first step, not taking it.