Thursday, March 16, 2006

measure twice, cut once

Ya' know, I am forever reminding MyFK of the concept that just because someone does something stupid, it doesn't mean that they are stupid. I also frequently remind him that just because maybe someone does something that I don't like, that this does not mean that I completely don't like them.

We all make mistakes.
We should all be okay with none of us on this planet being perfect.
And we should all be okay with not needing to like every single thing about another person in order to like them as a person.

I tell you this because I'm about to tell y'all a little story about my trip to the prosthetist yesterday.
And I want you to apply the above lessons, so as not to have a bad impression of him.

He did something stupid.
And he did something I didn't like.
But it doesn't mean he's stupid.
And it doesn't mean I don't like him.

I don't think he's incompetent, and he's the only prosthetist thus far who has been able to resolve my unique fit issues. As far as I'm concerned, he's a genius (or at the very least, a creative thinker/problem solver).

But yesterday he.....
(well, let's call a spade a spade)...
fucked up.

I dropped by his office to merely pick up a new waist belt (I use one that wraps around the thigh of my prosthesis and then straps around my waist, and it really helps me feel like the leg is more "attached" to me).

My plan was to also mention a couple of other things I've noticed with this test socket, so that those adjustments can be taken into consideration when the definitive socket is being made soon.

I also wanted to have him make the lenght of my prosthesis a tiny-tiny-TINY bit shorter.

As an aside, this might seem hard to understand if you have both your legs, but for me, I have been operating without two legs or a prosthesis for sooooo long now, and I spend sooooo much time standing on only one leg, that when I put on my prosthesis, it's often quite difficult for me to answer things like, "Do you have your weight evenly distributed between both legs?" Beats the hell outa me. And things like, "Does one leg feel longer than the other?" Well, sometimes I just cannot accurately assess that.

I've had the physical therapist watch me both standing and walking, and she thinks the prosthetic leg seems to be the correct length. But the more I walk with it, and the better I get at walking with it (the less I am waddling like a duck with my legs farther apart, and the more I am walking with my legs directly underneath me), the more it feels like the prosthesis is just a tad bit too long. This past weekend, when strolling with TheMIG we noticed that I really lurch up and down when I take a step onto the fake leg, so I'm kinda thinking it's worth checking out.

I've had the leg's alignment tinkered with before. They have to do it every time they make me a new socket. They don't just tinker wiht the height...actually there are all kinds of angles and rotations that can be tweaked. And let me tell you, sometimes just a 1/8" adjustment can change your whole world. It's a very strange thing.

So yesterday, at the prosthetist, we agreed to try shortening my prosthesis by a 1/4". That plan is that we'd let me walk on it for a day or two, let the PT see me walk on it, and then reassess.

I'm not a prosthetist.
I do not know all there is to know about the methods by which a prosthesis can be shortened 1/4".
I'm not a seamstress or a carpenter, either.
But I have heard, "measure twice, cut once" a few times in my life...
and as a knitter, I certainly understand the logic of knitting a gauge swatch before embarking on a sweater....
and as a chef, I certainly understand the logic that you can't take salt out of a dish once you've added it.

Anyhow, I think I know enough about prothetics by now to be able to say for sure, that there are at least two (and probably more) places on the prosthesis where you can make the adjsutment to change the length of the leg. And I think I also think there are ways to make that change in length by only adjusting something or interchanging parts.
Not by cutting them or permanently altering them.
(y'all see where this is going, dont you??)

I think that one place you could make a change is with the little connector pieces that bolt the top part (the socket) onto the mechanical lower limb (the C-Leg). I think those connecting widgets come in different sizes, the same way you can go to hardware store and find both 1/8" and 3/8" screws.

Another place you can make that change is on the mechanical limb itself (ie: the $30K part of my prosthesis), down near the ankle. See, the "ankle" is really just a pipe, and that smaller pipe slides into the slightly larger pipe of the "calf". Kind of like a collapsing telescope. So to shorten the leg, you could just push it together another 1/4". Right?

Well, apparently, my pipe could be pushed in no deeper (that sounds dirty), and rather than go back up to the widgets up near the socket and fiddle with those, the prosthetist took it upon himself to take apart my "ankle pipes".

And trim off 1/4".

With a saw.

I dont know enough about the C-Leg to know why that shave job was such an issue (because I guess that's how they do things all the time with a more manual/less computerized prosthesis).....but apparently with the C-Leg it IS an issue. And now my leg doesn't work. That little trim job made the computerized knee no longer able to bend for some reason. Big problem.

The C-Leg is manufactured by OttoBock, a German company, and most mechanical things from that nation require strict conformity to the rules and regulataions.
(Say it with the tone of an Evil German Nanny/Ballet Mistress): "Vee vill not varrantee your produkt if you do not adhere to auer protocols and if you do not use auer replacement pahrts!!! Your varrantee shall be void!!!!!! Mwahahaha."

Well. So. I have no prosthesis for a little while.
Luckily it is no fault of mine, and it's not my problem (or expense) to fix it.

As for the prosthetist? Well...
he feels bad and I feel bad that he feels bad and so we all feel bad...but whatchagonnado.

Hopefully I'll be up and running (okay, well, walking) by Monday.


Anonymous said...

Prosthetics are always a pain. I love where I go, but they are always making silly mistakes like this. I've never had a prosthetic experience that went very smoothly.

Gray said...

You gracefully metered out your frustration, but communicated it very well!

I like how you slowly revealed the layers your story. But mostly, I'm sorry you have to deal with that annoyance.

I hope it is repaired soon and well!


Anonymous said...

Yeah. This happens. Frustrating.

I'll tell you a little secret. It's got nothing to do with how long you've been on one leg. Once that organic leg goes, it is impossible to really remember what it felt like when it felt "right," because any fake support put in there instead just feels so different. It has to. It's constructed completely differently, and the method of support is now external, cupping, not internal, skeletal. More on that further down.

For me, my prosthetist started with too-short a shin pipe, added 1/8" shims, and then let me walk around on the shims for awhile until (a) my skills improved and (b) I could work out the right length. (I'm actually still using shims, over two years later, and even am ready for another one, but I don't have time or money to go in right now -- but I digress.) As I've mentioned to you before, my prosthetist's boss is also in favor of starting people off on non-computerized knees so that (a) they can learn fully how to use a prosthetic without becoming dependent on the electronics, and (b) if mistakes are made, it doesn't cost $30K. Maybe you can share these ideas with your genius-at-fitting prosthetist. I know somebody else gave you the C-leg, but I think people really need to rethink how they're used, and the more who consider this idea for the patient's sake, the better. See, everyone's hot to sell the expensive hardware, and there are a lot of promises that get thrown about with that equipment, but this problem you've described is just one of many that simply don't occur with a good analog knee. The long process of learning how to ambulate efficiently and comfortably is not the time to be worrying about equipment failures.

BTW, to revisit the structural issue, one of the reasons you may lurch up and down is the pistoning of your thigh of woman-flesh inside the rigid plastic socket. On your now absent organic leg, this didn't happen; all your flesh hung on the same contiguous skeletal structure, and it was all hooked up together in one stream of musculature, ligaments, etc. Now you have a sack of meat with a stick inside. It's a short stick, it's only connected on one end, and it doesn't care where your artificial and now completely external replacement structure is. Consequently, you are now supported by liquidy flesh plunging up and down as weight is applied to it inside a giant cup. This tends to add some up-and-down motion.

A good PT can help you with your gait, but you will probably always have a lot more up and down motion than you remember from using the missing natural leg.

Of course, one doesn't choose a prosthetic leg to become more graceful. One chooses a prosthetic to become more free. You will never be as physically free and graceful as you were on two organic legs. But lots and lots of practice will raise your skill level and greatly reduce how clumsy and trapped you might feel right now.

My project for this summer? Curb walking. I'm trying to teach myself how to curb-walk (the five-year-old's version of tightrope) on my fake leg. It's quite challenging. It's something you take for granted with two organic legs, because, again, you control an organic leg from the inside. Controlling a prosthetic with muscles inside a liquidy flesh sack is a whole other ball game. The amount of liquidy flesh (on me, anyway -- I do love my food) pretty much overrides instructions sent from the hip. Maybe I should wear a helmet while I do this. :)

Hang in there, sweetie. This stuff isn't easy and it takes a long time, but I know you can get through it.