Tuesday, June 29, 2010

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


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.

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