My Three Feet

My Rights - walking, running, convenience

On my prosthetic planet I typically have 3 different legs I wear in a 24 hour period. One is for walking, one is for running - you might note I run a little, and one is for backup/convenience. I am going to write about each one, with the new walking leg finally getting some press since I haven't talked about it much.

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The Prosthesis for Convenience aka "Old Paint"

My plastic slipper

This leg is from my previous prosthetist. I walked in it for perhaps a year or more as my everyday leg. With my longer residual limb, I do not have a suspension system employed in this leg, that is, nothing holds it on except the friction between the residual and the socket; there is no suction or even a sleeve required, just prosthetic socks to insure a snug fit.

The design is simple: thermoplastic socket and frame, an Ossur silicone liner, varying number of prosthetic socks, and the foot is a very good Freedom Innovations Renegade LP (low profile). It didn't need to be low profile, which has less energy return than full size, but that is another story. I ran some of my first races on this foot.

I can don (put it on) in less than a minute. If the house was on fire I could don it and escape. It's great for midnight kitchen raids or pit stops, and for walking around first thing in the morning before showering and dressing for the day. Also for travel it's great because in a tight airline seat my knees are jammed against the chair in front of me, and with this leg I can simply pull my residual out of it to have a little more room.

The downside is if I wear it for more than 30 minutes, sometimes less, I have to start adding prosthetic socks as my residual is squeezed like a tube of toothpaste; the fluid goes out of the anatomical leg and the volume decreases. The thing could fall off if I had to run or jump since it is only held on by friction. Lastly, the overall fit is not quite right. This is the same socket I ran some races in, and it irritates the fibula head if I wear it for several hours.

This is also why it and suspensions other than vacuum is less healthy for the limb; it is far less of a natural environment for the residual. Only vacuum systems like the Ohio WillowWood LimbLogic VS that I wear or the Otto Bock Harmony provide this outstanding feature.

Elevated vacuum does not work for all amputees, but for most transtibial (below the knee, aka BK or BTK) gimps like me it should be the suspension of choice in my opinion. It does take a dedicated CP to properly fit it, as considerations like keeping the system airtight is imperative in the prosthesis. The amputee must be educated to the advantages of elevated vacuum to offset what might be seen as inconveniences, particularly the longer donning/doffing processes.

These issues are largely solved by having a "convenience" prosthesis like Old Paint for times when donning/doffing the elevated vac is unreasonable, i.e. the aforementioned fire or the "I gotta go NOW!" 3 a.m. moment. Also if I am having my everyday leg worked on, I can wear this old thing and not lose my mobility.

I believe many who have other systems and particularly elevated vac need something like this that can be donned quickly. I did not have this prosthesis for a few weeks when I was first trying elevated vac and missed it every day. Now I have the best of both worlds and highly recommend this solution.

Although it sees less wear time than my other two legs, it definitely is a great convenience and I would miss not having it.

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The Prosthesis For Running aka "Jato"

My right wingman

Here is my cool friend Jato. In the current iteration, Jato consists of these major components:

• Freedom Innovations Nitro foot. 
• Ohio WillowWood LimbLogic elevated vac
• ProCare high tech proprietary socket and frame
• Otto Bock custom polyurethane liner
• Otto Bock Derma ProFlex sleeve

This incredible prosthesis was designed, fabricated, and fitted by the forward and innovative team at ProCare Prosthetics and Orthotics. With athletes and patients like Scott Rigsby, Jason Gunter, Cadie Jessup, Shea Taylor, Rajesh Durbal, Jarryd Wallace and many others, ProCare has the resources to help amputees achieve their dreams and open new horizons to others.

When I see other high level amputees using yesterday's technology because of other commitments like employment or because an organization requires them to use a particular prosthetist, well, that seems tragic to me. To settle for less than the best should not be the choice to make.

Is Jato perfect? No. No prosthesis is, but then again, neither is the anatomical body. The body remains the most incredible machine I know of, capable of healing itself from many injuries. Yet even the healing process may weaken it over time, or cause things like the very arthritis that rendered my old right foot deformed and painful.

I do know Stephen Schulte and his staff at ProCare never sit still, looking for ways to improve their products to help the disabled excel in life. And I am here to tell you now, my life has been richer since my amputation.

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The Prosthesis for Everyday

Freedom!

This is my current everyday prosthesis. Aside from the OWW LimbLogic VS pump, the brand new Freedom Innovations Renegade A•T All•Terrain prosthetic foot is the real star here.

Originally we tried an Otto Bock Harmony pump, but the length of my residual limb meant the prosthetic foot had to be very low profile. That foot that felt awkward, did not have the rollover characteristics of my old foot, and was uncomfortable. With the more compact LimbLogic electric pump, I was able to use the newly designed Renegade A•T and wear a full height foot on my everyday prosthesis.

Holy cow was I impressed!  For the first time I became UNAWARE of my prosthetic foot, the Renegade A•T is so natural and comfortable and a joy to wear. Rollover is entirely transparent to me; I remember thinking "if only my anatomical foot felt this good!" I believe this foot would be an excellent choice for running trails or other uneven surface where Jato is not as well suited to the terrain. I haven't tried this because the socket is not really designed for running.

As I've already mentioned, the elevated vacuum suspension system utilized in this prosthesis is key. Why is this so much better than any other suspension system? Because the residual limb is not squeezed, rather, uniformly pulled toward the socket, and as best I can tell, in similar position as a normal limb. An article appears here that discusses this giant step for amputees. 

My limb is in a healthy environment and I rarely (meaning nearly never) have to adjust my prosthetic socks.  Another huge plus is when set up properly, sweat can be removed from the prosthesis. In my old suction prosthesis this had been a huge issue for me. Now no more horrid Drysol or other anti-antiperspirants that made my skin far less healthy than normal. I have less issues like ingrown hair because the residual is not being compressed.

Socket comfort is usually outstanding, but after my recent meniscus surgery and subsequent return to running, I have felt some discomfort at the distal end of my fibula where the Ertl bone bridge is formed. This is in both my everyday and running prostheses. I believe the shape of my residual has changed some causing this, along with the fact there seems to be no specific loading on the end of my residual. Most "guillotine" amputees cannot tolerate load bearing in the end of their residuals;  Ertl amputees can because of the nature of the procedure. That said, I have contacted my CP and we'll see if an adjustment is in order.

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So there is my current lineup of right feet. These give me a life where I don't cringe at the thought of walking good dog Baxter to the field to play, or even to my vehicle to go to work. Prosthetics continue to evolve to improve the lives of people with limb loss. For me, running is a large part of my life, and that loss would be been the true tragic amputation.

I'm Baxman!

Day. dream.

What a beautiful day.

What a wonder to be alive.

From wonder folding into wonder

love this moment

together

Go the Distance

I began watching "Field of Dreams" last night while on the treadmill, and many memories and thoughts floated up through the images. I have some personal history with the book, but tonight a couple of the movie scenes became more poignant. One was the excerpt below and the other was seeing the Citgo sign over Fenway Park, a sign to a runner of a Great Thing.

via Google images

In the movie Shoeless Joe Jackson is talking about being banned from professional baseball for life. And the pain he had was...

"Like having a part of me amputated, slick and smooth and painless." Joe looks up at me and his dark eyes seem about to burst with the pain of it. "A friend of mine use to tell about the war, how him and a buddy was running across a field when a piece of shrapnel took his friend's head off, and how the friend ran, headless, for several strides before he fell. I'm told that old men wake in the night and scratch itchy legs that have been dust for years. That was me. Years and years later, I'd wake in the night with the smell of the ballpark in my nose and the cool of the grass on my feet. The thrill of the grass..."

-  Shoeless Joe from "Shoeless Joe" (W.P. Kinsella)

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That is me. I don't think so much of the cool of the grass, but I do think of a cold North Carolina mountain stream, and my two doggies dangling blue in it.

Blue as the deep endless sky.

All around.

Back in the Saddle

My physical therapy with Dr. Will Avery of Private Therapy Services will soon be coming to an end unless I choose to extend it a couple of sessions. I must continue many of the routines to keep my left leg strong and the knee free from undue stress. This may be my new lunch hour activity.

I am not back to my running groove yet, the longest run to date was 4.25 very slow miles last Sunday. My knee did not bother me in the least, but my residual has taken up the whining slack. I can feel at the distal end of the fibula where it seems the bone is rubbing over a ridge; it may be the skin is being pulled across the bone and the socket needs to be a wider there.

At my last therapy session I asked Will if he could hear the actual sound this makes, as I wasn't sure if what I thought I was hearing was correct. Yes, he could hear a muted 'thump' as I moved the socket back and forth. After this session I called ProCare for a followup to see if we can get this attended to before I start piling on the miles in preparation for the late summer marathon. It is somewhat painful and the discomfort is very distracting to the runner.

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I am not sure when my next race will be, likely May or maybe June. We will be doing the beloved and horrendous Hannibal Cannibal in July, where I crashed and burned last year running the 10k. Since it has a been a year I may utilize my Stupid Card and try it again. Or perhaps the 5k and leave the card at home.

As my next goal race is a marathon in August, I will not be competing much over the hot summer months.  I will train to requalify for Boston and not take chances on hurting myself and particularly my knee. My training will be geared toward that goal only, and then next year I will be putting more effort into the dream that is running Boston.

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My plan is to try to run 6 miles this Sunday if the residual does not bother me too much. I'll ease back into the routine through April, taking extra days off to make sure the last of the recovery is not compromised. Beginning in May it will be back to the future...taking a detour through Sonoma and Napa could be far worse than...well...hmmm....

Taking A Knee

Testing compression wear on 0.5 mi run

 "Men, today we die a little."

 - Emil Zatopek at the start of the 1956 Olympic Marathon.

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Here, five weeks before the Boston Marathon, I have had one of my harder running decisions to make. Having only starting back to running after my arthroscopic meniscectomy surgery, I can do one of two things: show up and struggle through the race, or take a knee, start over and plan on 2013. My first post-op run was half a mile on the treadmill on Saturday, causing only a few twinges in the outer incision area. I jogged a mile on Sunday with a couple of breaks.

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All along it was my intention and goal to run Boston to the best of my ability. After the test that was the Charleston Marathon, I know I can finish the race off minimal training and feel I have nothing to prove on that count. Boston, however, is a different beast. It is one of the planet's greatest marathons; I respect its traditions and value the work it takes to toe the starting line.

I had considered earlier that I would go the distance even if I could not perform my best, best being relative to what my body could offer on race day. I have come to realize that would neither honor the race nor my ability. Giving a second best effort is simply not in my constitution, nor is asking for a special exception. 

So I feel I must run Boston by giving it my respect, and that respect requires me to train to run it the best I can on Patriot's Day. There can be no excuses and no quarter asked or given.

Therefore I will train to requalify for the race before the September registration, likely the Santa Rosa Marathon in August. I certainly know through all of this that there are no guarantees I will qualify again or make it to Hopkinton on April 15, 2013. But I do know if I am there I will be ready and can accept whatever the day brings.

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I do regret I won't be able to bring more recognition to the IFOPA at Boston this year. We have raised over $300 more for a total of $2356 with the addition of the Charleston Marathon efforts. Ashley, you inspire so many with your courage, kindness, and joy. Wind beneath wings. Yes.

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We all have different goals in life. This is a good thing; it makes each one unique and keeps us alive. But we have to live with ourselves and the choices we make; as a runner there is no one to come off the bench to give us a breather. If we sit on the bench we do not run. Life is indeed what we make it.

I think of all the days I woke up at 4 am to run before work, the miles and sweat and planning and dreaming of how it would feel to stand on that starting line on Hopkinton. For me none of the journey is wasted, for it is the act of running that I love. Am I disappointed I will not be there with Jennifer and my friends Kelly, Shariff, Scott, and Mike this April? Not to see Ashley at the finish line? Yes. It hurts. It will hurt more on April 14. I will be wishing them the best, knowing they would feel the same in my shoe, and hope perhaps the thought of a friend not there will help them strive to keep.  moving.    forward.

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I know this: on April 15, 2013, the impossible can happen. The Boston Marathon will mean even more to me and I will honor it the best way I know how.

I will fly.   And remember.   It all.

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My face is set to a grim and determined expression. I speak in all modesty as I say this, but I discovered at that moment that I have a fierce will to live. It's not something evident, in my experience. Some of us give up on life with only a resigned sigh. Others fight a little, then lose hope. Still others - and I am one of those - never give up. We fight and we fight and we fight. We fight no matter what the cost of battle, the losses we take, the improbability of success. We fight until the very end. It's not a question of courage. It's something constitutional, an inability to let go.

- Pi, from "The Life of Pi" (Yann Martel)

A man truly himself will not enrich his own interests, and make a virtue of poverty. He goes his own way, without depending on others. Yet is not arrogant that he needs no one. The greatest man is nobody.

- Chuang-Tze

Longing to Fly

A treadmill with a view

 Wednesday night I was briskly walking on the treadmill, again cruising along the Capetown ocean cliffs and occasionally racked with laughter as I watched a small truck cross the English Channel on Top Gear. This served to keep my mind off of The Race. The Marathon. Boston.

Despite all the sensory input, the brain still found a little room to think. A small upper room, away from the static, the distractions, the attempt to not think about The Race. The Marathon. Boston.

I thought about all the people who supported me, unconditionally, friends and family and some strangers who only know me through the transmissions of electrons. In another corner of my mind I had begun quiet preparations for what might have been this year and would have to wait until next.

I walked on.

In a quiet epiphany it occurred to me that I was able to walk without pain, that I could walk and walk and walk. It would be slow but it would be time on my feet. Four miles walking could be three miles of easy running. And as my running came around I would have a base to build on, not ideal but something that could keep The Dream alive.

In my mind I was preparing myself to not be disappointed, because the disappointment would be too great should I not make the starting line. In truth it would be impossible to run well, in reality would it be possible to run at all?

No one except little me doubted this. My inner struggles are hidden; I know I will never give up, never ever quit, that I will run to my potential. But it cannot be this year.

But it can be.

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Doing today's PT session, after some of the first routines, I walked over to get drink of water. As I approached the fountain, Will mentioned that I should bring my running prosthesis to therapy next week. This means he sees enough progress that we can think about running again.

My throat tightened and my eyes grew distant...and I was thankful I could lean over and drink some cool water. Well. Well. The rest of the workout is attacked. When the vines of hurt wrap around me, I look to a distant point, clear my mind, and think...I could make it after all.

To The Race.

The Marathon.

Boston.

And the pain falls away. I find myself.

Longing to fly.