Ghosts and Empty Sockets

And my traveling companions
Are ghosts and empty sockets
I'm looking at ghosts and empties
But I've reason to believe
We all will be received
In Graceland

- Paul Simon "Graceland"

*******

I have been fighting socket issues for a long time. As any amputee, especially amputee runners, and any solid CP will tell you, socket fit is essential for success. I've been told you can wear a 2 x 4 for a prosthetic foot if you have comfortable and well-fitting socket. I was also told before my amputation that if my CP couldn't do this job to find another.

The problem is, how do you know what is your responsibility as an amputee to make sure your CP is successful? Bad feedback from the patient can make things worse, and no one I know is a mind reader. On the other hand, at what point do you say as a patient I've had enough to move on to another CP?

Selecting a CP should be something an amputee should not take lightly. In larger cities there are often a  number of competent practitioners, but in other areas there may be little or no nearby choice. For the amputee athlete, choices are further limited as you will place greater demands on your prosthesis and hence your CP.

Early in an amputee's fitting process, many adjustments are needed, so if decide to go to NY or OK for a larger or specialized practitioner you may have expensive travel to consider. An amputee's residual limb, like the rest of their body, is going to change for the rest their lives. Every individual is different and some will need more attention and others less. Active athletes will need a CP who is understanding and willing to go the extra mile...and then one more.

My CP, Larry Wiley at Floyd Brace, is committed to me as a patient. Even though I am having issues - I just had an adjustment this morning - he has made it clear that I need not worry about how often I contact him; we will work this fit problem out. Most of the largest changes have probably occurred in my residual limb, but even a small area that gains or loses volume can affect surrounding fit.

Towards the end of last week I had a small spot below and inside my knee become sore and swell, not unlike what happened to my fib head here. In the photo below you really can't see the swelling, which is about the size of a butter bean under my skin. This caused me to abort my Sunday long run at 4 miles and my frustration level began to accelerate as I thought about the ground I have been losing with my mileage since receiving Jato.

Yeah, it doesn't look like much but it has a big bite like Baxter

Should I look for another CP? Here is where the patient has to take a close look at all aspects of their options and be honest with themselves. Even if the answer leans toward "yes," if you have established a good rapport with your CP it is worth having an honest conversation with them. "This isn't working, what else can be done?" If they look lost or do not have a reasonable answer, then I would say "thanks" and move on to someone else. But if they say "we can do this...and this...positives are...drawbacks are..." then you have someone who wants to help you and has a vested interest in your success.

I know there are many talented and good-hearted prosthestists out there, probably many more than at in other time in history. Finding one that is a perfect fit is, like any other endeavor, difficult to impossible. When you find one in the "close enough" category, I think it is worth everyone's time to make the relationship work. Both patient and CP will learn from the process, and this will enable others to benefit as time goes by.

*******

My mileage has only averaged in the mid 20s for the past 3 weeks, so I am hoping with this latest socket adjustment that I can work on pushing my mileage back up into the 40s for the rest of the summer, with a long run peaking around 15 - 16 miles before going into dedicated marathon training. I believe at 57 years old, this amputee runner can complete 26.2 in a respectable time.

On January 15, 2011, we will see.

The Answer

 

 KingPop and Jack out for a run

I have been asked a few times if my amputation was worth what I have been through. I could have comfortably retired to the couch intact, or seen in the picture above with Jack.

Yes. A thousand times yes.

The Coming Marathon

 
I don't think many days go by that I don't imagine standing on the Charleston Marathon starting line, thinking about all of this, what I've done to get there, and of my family and friends both present and in my heart. Some on the sidelines, some alongside, and some out of the reach of our hands.

I can see the crowd but not hear them, a low electrical humming. My fellow runners making conversation but minds scattered as we can't absorb the overload of anticipation, thought, and emotion of the day. Static dances along our limbs and crackles in our voices.

I see my left leg, the dominant one, rarely injured through exercise or accident. I look at the right, often injured and scarred and missing below the knee. The left wears a high tech running shoe; the right a higher tech carbon fiber running prosthesis we call a blade and I know as Jato.

I remember the accident. My deformed and aching right foot. Receding into memory. Part of me gone into forever.

I will want to shout, for us all to shout: IT IS A GOOD DAY TO RUN but speak the words softly to myself. Nothing is impossible. I will never quit. I will finish, whatever it takes, I will finish.

I will honor this day, this gift.

And I will run.


To life.

When the Victim is Victimized

In my short life as an amputee, now just over one year, I have had the opportunity to meet and talk to a number of my truncated peers, each with a unique story and set of circumstances. One thing I have been hearing from them or from others who know them has to do victimization.

My accident in 1963 did not result in any lawsuit; our insurance covered the costs and I don't believe lawyers were involved at all. I did not receive one thin dime for my pain and suffering. Some of the amputees I have talked to were involved in accidents where negligence was clearly at play and they did deserve compensation for their limb loss, but I detect in some a thing more sinister going on in their lives now.

A lawyer wants to represent the client as best they can. The injured person is not encouraged to become "well" or have a positive outlook as that could lower any settlement. The person is a victim and must play that part for a long time. The problem is the amputee becomes a victim to the system, and this may affect their mental outlook for the rest of their lives. They are owned by the idea that their disability rules their lives and have no reason to overcome this crutch for their future. They are now permanent victims, and trying to resist this gravity is often impossible. The ready excuse is real and no one can deny it...except for themselves.

Depression's dark cloud may set in, causing personal and/or family strife, getting a job may not even be an option, and becoming an active, happy member of society doesn't even rate as a fantasy. 'I have been hurt, I have compensation, and my life has been changed forever for the worse.'

Yes, some accidents happen that do cause a lifetime of pain, suffering, and loss of the ability to work and I am not talking about this type of tragedy. However, victimizing an individual for monetary gain should also be a crime, although I am sure next to impossible to prove.

I believe the answer, almost like the choice for elective amputation, is not an easy one but there is better way. Do not choose ANY amount of money over living your life. If it comes to walking into the court room on prosthetic legs, be a beacon of hope over pity and the pit of soft green money. Do not allow yourself to be talked into feeling horrible about your condition and appearance, or depressed because you no longer have 5 or 10 little piggies. Your life is far more valuable than a Porsche, a house on the beach, or a large shiny diamond stone in your ear.

Be an inspiration, not a victim, especially one with self-inflicted mental wounds that will ruin your life.

You must choose life, rise to and embrace the challenge.

Live.

The 7 Minute Mile

Tuesday evening I broke 8 minutes for the first time in my ampdom. This was my track workout for 7 miles total:

1.5 mi at home on tmill warm-up
0.5 mi at track, then light stretches 
4x1 mi w/ 0.25 mi rest laps

After my track warm-up, a man came up and introduced himself and we talked about amputee running some. He had seen me running in the area in the past (I stick out like the proverbial green sore thumb) and then had not noticed me in a while. Among many things we chatted about Oscar Pistorius' "advantage," how the bilateral amputee having no lower legs at all sets world records no able-bodied trackster can touch. No wait, he doesn't. This never ceases to amaze me, the power of negative/juvenile reporting always seems to triumph the good and the truth and sticks in minds like flypaper.

I am wearing my new carbon fiber socket that has already had one adjustment as it gave me 3 cuts and a blister. For this run I applied a layer of Aquaphor to see if it would make a difference. I have used this product for many years for other friction related problems, like where the hydration pack rubs my back and various body parts at times. I also have a new air value in this socket that so far works far better than any of the other ones my CP has tried. I believe it is made by Alps although I would need to confirm it. This valve really sucks the air out of my socket and the sleeve stays nice and taut on my leg, not giving sweat a chance to creep in from a pucker.

At the end of the first lap of my initial mile I see 1:53 on my watch...dang, it was not so long ago that I was running 400 intervals at this pace. A little fast, but the next 3 laps average at 2:00 so I run this mile in 7:53, the first time I have gone under 8 minutes since becoming an amputee.

My next 2 miles are a tad over 8 minutes and my last is much easier around 9 minute pace.

I have not done any mile time trials or any other all-out running for a couple of reasons. First, being a long time runner I know my approximate ability and am confident I do not need a time trial to confirm it. Secondly, I do not want to do a time trial that puts the thought in my head "this is a limit." As I get more fit my times will naturally drop and I will know what an honest pace is; I won't worry that I am slow or that I need to work even harder. In runner's jargon, I am listening to my body as best I can.

This run gave me a peek at my running future and I was happy for a couple of other reasons. I can finally see a runner in the distance that I am gaining on...the old able-bodied runner known as me. Also, during my third mile interval, I was expecting to struggle more, but I felt my body move to a new fitness level and the effort felt...easier. It was a minor shift but anytime you are running hard and it gets easier you notice it. I am sure I smiled too.

Thinking to myself...if I could cut 4 more minutes off my mile time now that would be something. No, that is just a fantasy, but it did make me wonder if an amputee will have a shot at this old barrier some time soon? Now that would be a cool thing to see and an amazing accomplishment. Hopefully the press won't drag up the myth of Oscar's advantage when it does.

Elective Amputation Part II

(This is a follow-up to my post "Elective Amputation" found here. I also have another post "Elective Amputation Part III - The Physician and Saving Lives" found here.)

I received an email from a person asking a couple of good questions which go something like this:


"How does insurance pay for elective amputation?"


"If I don't have a local surgeon, who would I recommend?"


I am not an expert on insurance, and go only go by my and others experience(s). My doctor submitted my case to the insurance company and they approved it as at least two others I am aware of since my operation. My blog outlines what I went through before my amputation. I could have undergone many more surgeries at great cost to the insurance company without any relief whatsoever; as I've noted, I didn't really hold out great hope my first surgery would work to allow me to run again or even have a tolerable pain threshold.

Also as I've mentioned, others have gone through many surgeries without success, success meaning having a healthy foot, one that would allow activity without pain. So it would make some sense for the insurance company to pay for the single amputation rather than a multitude of other surgeries. They would save money and the person would return to a more normal lifestyle. I know of two amputees who went through 16 and 26 surgeries each, how is this "better" when the surgeries do nothing to improve or restore the quality of life, only serves to keep a non-functioning and painful limb intact?

One issue that must be considered is the cost of prosthetic feet, which can be costly. Still, an insurance company that is saving a huge sum from stopping the unnecessary surgeries could provide a better benefit for prosthetics. The rub here is some insurance companies provide minimal amounts for prosthetics while others provide for a fair amount.

I think for many people sight is lost about what insurance companies do provide, they think "I pay X dollars a year in premiums but I demand X * 2 dollars in benefits." Different companies - if allowed to compete fairly - will try to offer a wide range of benefits and price points. But without a doubt parity should be given to amputees, same as say, heart patients. Here is what my current insurance company provides for the prosthetic device benefit: "$2,500 per year and are limited to a single purchase of each type of prosthetic device every three years."

No definition is given they mean by "each type of prosthetic device" although it seems I quality for one $2500 foot every three years. This would give me something like this and I am NOT being entirely facetious:

Wooden leg of Gen. Józef Sowiński (Image by Halibutt 8/3/2006)

Our previous carrier had what I thought was a fair prosthetic amount of $8000/year. However, given the rising costs and the fact real competition is denied in the United States - oh the irony - my company had to change providers. This is certainly a subject all its own and one the American people spoke on, but were given a boot to their collective throats.

I would like to add I was prepared to have to buy my running foot out of pocket, not because my pockets are full, but because running is my sport and passion. Some guys like to fish and spend tidy sums on boats and associated equipment like beer coolers. My sport is running and a running prosthesis is my required equipment. Hello Jato.

*******

Had insurance not paid for my operation I might have had to look at doing it out of pocket. I already considered that I might have had to pay an exorbitant amount for prosthetics, but I did not fully investigate what it might cost me if I paid for the operation myself. One surgeon who was not on my insurance network said they would work with me on a payment schedule for any difference in cost, but once I found my local surgeon I did not need to consider this further. It is possible, given all these costs, that unless I received some significant help outside my realm that I would not be writing this now...I'd be loopy on pain meds while my life disappeared over the smoky horizon.

*******

Anyone looking at elective foot amputation - especially to return to an active lifestyle - must have the Ertl procedure done in my opinion.

Ron King currently is the webmaster at this excellent site for information about this procedure here. If you go to the "Ertl Pages" on the left column and then click on "Ertl Surgeons" the top of the next page you can find a list of physicians who perform the operation here in the US. This is not a comprehensive list of all surgeons who do the procedure, but certainly one to help get you started if you have no local doctor available.

I certainly recommend my surgeon, Dr. Blake Ohlson. A surgeon I talked to while researching the Ertl procedure in Virginia was Dr. Joel D. Stewart; my CP has seen him do the operation and was very impressed with his skill. Dr. Ohlson's mentor was Lew Schon, MD who can be found on the aforementioned Ertl pages. I've also heard good things about Dr. William Ertl through Ron King. I recently read an article about Dr. Douglas G. Smith found here.

Whoever you choose, you I think you need to feel a good chemistry with your surgeon. You should never be made to feel you are dumb for asking a question. Having confidence and a positive attitude is going to carry you a long way to success. This is your life and your call. Do not depend on others to make it for you.

Bolder Boulder 2010 - Memorial Day

Skydiver and Old Glory

Last week Jennifer, my mom, and I flew out to Colorado to visit with family, see a few sights, and run with fifty thousand of our peers in the Bolder Boulder 10k on Memorial Day. We stayed with Jen's brother Gary and his soon-to-have-a-spinal-fusion wife Nancy and their best friend Wrigley the pooch.

 Gary, Jennifer, Moi, Mom, and Nancy

 

Our house sits at exactly 14' above sea level and we arrived at over 1 mile in altitude. I was concerned that the thin air might cause my mom some breathing problems, but she didn't seem to be affected as much as us runners. I knew it would slow our running and scaled back any idea whatsoever of PRing, but thought if conditions were right I could do around 58:00 and certainly break 1 hour as a minimal goal.

I did not run all week before our trip because of the fibula swelling I talked about in this post. I missed my race tune-up/confidence building track session, which I find important from the mental aspect of racing. Knowing you have prepared and left little to chance means on race day you are ready to go, circumstance takes care of the rest.

The day after our arrival, Jen, Gary, and I went out for a short run for us to acclimate to the altitude. We went at a very easy pace, but with higher than normal temps it was more like our home than the coolness we were expecting. After my shower I found my right leg around the fibula head was very sore; upon closer inspection I saw swelling and at what is almost certainly a bursa about the size of my thumb. I found my walking prosthesis actually caused more pain so I hobbled around in my running prosthesis as its socket was more comfortable.

We did some sightseeing - Red Rocks and Estes Park - on Saturday. I had to wear my walking prosthesis but tried to minimize time on my feet and range of motion to avoid further irritation. More icing in the evening and a little cortisone cream that I thought might also help calm the owie. I was very concerned that I might not even make the starting line of the race. I texted my CP and we set up an appointment for me so see him the day we returned home.

On Sunday, my leg felt much better and the bursa was noticeably smaller. We did another short run and everything felt surprising good. I ran 2 miles at what I thought would be near race pace and found my time to be at least 30s slower than sea level. My new goal was to just be able to run the 10k without having to stop, or worse, have the bursa return and cause me to call for assistance to the finish line.

I had one other concern: the rolling course. Although I had run this race as an able-bodied athlete for fun with Jennifer some years before, I have not run at faster pace on hills as an amputee with Jato. I have found going uphill is relatively easy, but going downhill fast can be treacherous. We watched the race video of the course that Frank Shorter narrated, but film does not visually translate grade changes very well. Mentally I decided I would go as slow as needed to avoid another fall especially going downhill, and hoped nothing was too steep to slow me to a walk.

Race morning my leg looked and felt good. After some anxious moments as to whether or not I'd be on time for my wave start, we arrived with minutes to spare. I weaseled my way through the various waves before locating mine: ED. After a quick sock check and adding a one-ply, my wave approached the start. A fellow runner struck up a conversation with me by looking at my prosthesis and saying "I could sure use one of those springs." to which I replied: "Trade ya!" We chatted a bit and then were set for our start.

 

 A wave takes off

The very slight downhill at the beginning is not noticeable to me, but for the next 2 miles I can feel the tug of gravity as well as the altitude. Per Frank Shorter's advice, I back off my pace to something more comfortable. Redlining at altitude is not something you recovery from without grabbing the knees for a few minutes. This is unacceptable behavior to me. I get my breathing under control but see I am running slower as the nearly constant climbing drags an anchor behind me.

Somewhere in a residential section I smell BACON. What the...? I miss the source of the piggy perfume, but later heard someone was indeed cooking and handing out bacon strips to the passing runners. I am aware of the crowds and other runners, but have to concentrate on the road and my form, The Fall still being fresh in my memory and on my skin. I have a couple of runners give me some words of encouragement and thumb's up, and I gratefully acknowledge their support. 

Just after mile 4 there is a mile long downhill. I find a good rhythm but do not trust myself to open my stride. Even with gravity's reluctant help, I do not run under 9 minutes for this mile; a couple of times I have to slow myself as I feel out of control. I do feel some stress in the right hip adductor area that will be sore afterward.

As we head uphill toward the finish we approach a steeper grade and I hear a woman's voice: "If you can hear me you are on pace to run under an hour! Keep going!" I think it is the same person who sidles alongside of me, gives me a high five and more supporting comments. I stab my blade into the grade and up we go, then I hear something that brings goose bumps to my residual: a bagpipe brigade playing "Scotland the Brave." Oh my.

Coming into CU stadium, I have to slow to descend the steep grade...then onto the aluminum decking which I have to run a few slower steps on to see how Jato responded to it. No slipping, time to pick it up for the sprint to the finish. Opening the stride, dig, dig, dig, and I'm done, noticing I have run under the hour mark. My race splits are here.

I find my way to our appointed Section 105 meeting area where mom and Nancy have staked out a row of seats. Soon Gary finishes and has run much better than he expected, having a nagging injury that has put a hitch in his giddy-up. We trade our race stories and Jennifer is unhappy with some bozo who hit her in the back with a football. 

The elite runners start last in this race, so we get to seem them finish in the stadium. In an amazing show of strength, speed, and friendship, the Ethiopian men's team finish together with hands joined over their heads. The crowd erupted in a spontaneously roar of appreciation. The women's elite race was dominated by the Ethiopian runners, finishing one-two.

We then enjoy the Memorial Day tribute to our service people, with skydivers landing in the infield from each branch of service and an American flag capping the jumps.

 

Two WWII veterans are honored, members of a generation that saved the world from dictators and tyranny, a diminishing breed that many in the current generations cannot, I fear, truly understand. Even my generation, barely removed from this historical madness, can barely comprehend it without experiencing the thing that is unimaginable. 

Runners are given additional tags to pin to their shirts to run in honor of the military on this day; Jennifer and Gary ran for their dad Bill Starrett, and I ran for my dad and his last living shipmate, Jim Westcott, on the LSM 447, which participated in the landing on Okinawa. My dad went by the name "Tal" but during WW II apparently he had to go by the nickname "Bill" and his shipmates knew him by this name.

Honoring the Greatest

The following day my residual felt fine, and I delayed my trip to Floyd Brace until they finished the carbon fiber socket for Jato. More on this later, but finally Jato is in his proper garb that has been a long, long time in coming to me.

*******

Gary's wife Nancy, our SIL, will be having significant spinal surgery soon to help stabilize her scoliosis. This is much more complicated and longer than my amputation and takes two days to complete with a short period in between the procedures. Nancy is currently in a great deal of discomfort, but I don't think I ever heard her complain. We talked at some length about the similar aspect of our journeys, which it getting the quality of one's life back. 

Nancy has the attitude she needs to make this operation a success on her part, her surgeon has the other key. She is already planning her next marathon, which tells you she does not accept limits either. She has a long recovery and much therapy ahead of her; I know she will do everything expected by her, including crossing the finish line after 26.2 miles carrying titanium rods and screws along in her spine.

That, my friends, is the way to celebrate life.