Delivery Day (Phase 3 Actual)

Due to a trick of timing, I actually received the new legs about 3 days before I wrote my previous blog post “The Trial (Phase 3 Dawning)”. As I alluded to in that post, life has been exceptionally busy, and I am focusing most of my effort on growing Walking Spirit and better defining and promoting our services. This hasn’t allowed for much writing time, even to document the process of getting a new pair of next-gen legs. As a result, the first time that I had to sit down and write a blogpost about the Trial of the Phase 3 Power Knees which was an experience I felt it important to share, was a few days after my family arrived in South Haven Michigan for a week of vacation.

Sitting on the screened in deck at our almost accessible vacation rental a few blocks away from the beach, I was finally able to put my thoughts together to share that experience. As I wrote about the trail period for me to test the knees, which had taken place a month prior, my new Phase 3 Power Knees were leaning in the corner of our room waiting for me to don them for dinner. Of course, as I wrote the blog post my wife was waiting for me to put on a swimsuit and head to the almost accessible beach, so that would need to come first.

Less than a week before we left to go to South Haven, I was sitting at home anticipating the day’s appointment to get my new sockets made. This is part of the process of getting new legs. If you’re lucky you only have to get new sockets every 5-8 years, on the same cycle as your prosthetics, but that requires maintaining your weight within a 10lb range, so the fit doesn’t change drastically, which can lead to pain and difficulty walking. The process of making new sockets can take weeks. If done right, the fastest it’s taken in the last 17 years has been a two-week process of casting, fitting temporary “check sockets”, and making the final carbon fiber sockets. Also, the sockets come very high up on the outside of the hip, flare out around the top, and traditional mode of thought has been that for proper suspension they have to provide “ischial containment”, which means that they come all the way up to the butt-bone. They are uncomfortable and restrict motion. Recent changes in socket technology have led Ossur, the manufacturer of my Power Knees, to develop a proprietary sub-ischial socket called a “Direct Socket”.

Instead of using carbon-fiber, the direct socket combines fiberglass and epoxy. The socket does not come as high up the hip and has a flexible rubber brim at the top instead of flared plastic. Arguably the best part, it’s molded directly onto your residual limb in the office and is ready that day! I had heard about these sockets and was interested in trying them out It was my hope that the new design would provide enhanced comfort and mobility over the traditional sockets. Knowing that my Prosthetist is very traditional, I risked asking for the opportunity to try the sub-ischial direct sockets and was surprised when he agreed.

Though we had been given approval for the new legs from my insurance company, I knew there were some supply chain issues holding things up…specifically the feet they wanted me to use. After a few weeks had passed from the Phase 3 trial, my Prosthetist reached out to schedule the Socket fitting. I was really looking forward to this aspect, and he had decided to move forward, whether or not we had the new legs yet. On the morning of the appointment, he called to let me know that “only one of the kits” had arrived to make the new sockets. Did I still want to come in to make one socket or wait until he could make both of them? Oh, and the new legs were in so, did I want to go ahead and get them and put them on the old sockets? (He didn’t want me walking on two different styles of sockets). I told him he’d buried the lead, and yes, I was still coming in! I was getting my new legs that day!!!

By the time I arrived, he’d “found enough parts” to make the second socket, so today was going to be the full delivery day! We had thought this was just a socket fitting, which was exciting in and of itself because of the new style, but coming home with the legs was going to be quite the surprise for the family. Irena was going to be disappointed that she wasn’t there for the appointment, as she is great for documenting these events! I was already planning to not have my legs on and send her out by the fire in back when she got home, then put them on and walk out to join her.

First, of course, came the process of making the new sockets. Where usually there are a whole bunch of measurements taken and then casting and possibly 3d images to make the mold that the socket will be made on, this was completely different. First a liner similar to the one I wear under the sockets was put on my leg, then thin membrane like liner was put over that, followed by a connection plate at the end for my legs and 6 layers of fiberglass, the one-way valve for the suction socket was put in place, then another thin membrane liner on top of everything. These layers were smoothed over my muscles and then strapped over my opposite shoulder to keep the materials as tight as possible. Then a tube of epoxy was connected and injected into the material between the two thin membranes. As the epoxy was injected, my prosthetist spread it out evenly around my residual leg. The epoxy was warm and hardened within about ten minutes. After the socket was hardened, they removed it from my leg and took it in back to clean, smooth, and polish. For two sockets it was about a four-and-a-half-hour process!

Once the sockets were finished, they were attached to the new knees, and I tried them on. They fit like gloves! The big test was going to be whether or not I could walk without the reinforcement to my left hip that the ischial containment sockets had provided. As a result of the burn trauma, abnormal bone had grown inside of my glute-mead, a muscle that I needed to walk. 16 years ago, one orthopedic surgeon would not operate on it, fearing that I would not be able to use a prosthetic…even though the bone was currently blocking my range of motion which was causing issues with my use of a prosthetic. A second orthopedic surgeon asked for x-rays and decided he could perform the surgery. Over a cup of abnormal bone was removed from my left hip. It’s never been an issue, but I was concerned there would be a weakness in my left hip without the rigid sidewall of the former socket. I took my first few steps and those concerns were gone, though the hip will give a little if I’m being lazy, it is plenty strong!

The next hour and a half was spent aligning the legs and the new feet. During the trial I experienced an issue with the right knee moving on its own in standing phase, just slightly, but enough to alter my stance. This made finding a “quiet standing” stance where I can balance without needing the crutches challenging, to say the least. We tracked it down to the position of my “ankle” being different on the feet we used at the trial from the position on my usual feet. The ones that I tested were shorter, with less spring to them. The spring on this new set of feet is taller and moves that ankle from the back part of the heel a little more forward and also higher above the foot, which seems to have alleviated the issue.

The unfortunate thing is that they also make me taller, possibly even taller than my last pair of legs. I haven’t been within 6 inches of my original height for 17 years! The trial feet got me close, but the energy return and stability provided by this set is worth it, I just have to find my balance point again. On delivery day we never quite got the alignment to that perfect “quiet standing” position, but we got it as close as we could. My prosthetist had given me 6 hours of his day and it was time to wrap up. After my third alignment I felt more confident, so we went with that set of adjustments. I took my legs off and my prosthetist and his partner went over every screw, applying locktight and securing them in their positions.

Then, when I went to stand up, I encountered my first issues. Not sure what happened, but when I leaned into the knees to get up, they didn’t respond. There was no lift. This was exceptionally confusing, almost like the sensation of something having been stolen. I tried again and there was a delay but the lift assist kicked in. I was up, and the team was clearly exhausted. They were ready to leave for the day, so I decided to chalk it up to my own dwindling endurance and not moving my body right to trigger the sit to stand mode properly. I took a few steps and realized the right leg was not turned on, which was odd because their power buttons flash bright green and I had looked at them before attempting to stand. In the process I had leaned against the frame of the exam plinth, so must have accidentally shut it off somehow.

We reactivated the leg and I said my goodbyes. I had no issues sitting down into the car. The drive home was comfortable, without an inner plastic socket digging into my belly. Irena called and asked how the fitting went. I told her “longer than expected, but really good!” I couldn’t stop raving about how comfortable the sockets were, but didn’t mention the legs. She was going to dinner with a group of friends, so I still had time to get home and get a fire going for the evening! Then she asked if they had said anything about when I would be getting the new legs. “We’ll talk about that at home” was all I could think of to say. After getting home, before getting out of the car, I took a picture of how much more flexibility the new socket design had restored for me!

When I got home, I was disappointed to discover that I was still having issues with sit-to-stand. For some reason I was having to lift my hips to get the function to trigger properly. Normally, it required a load of the toe while simultaneously moving the knees forward, but no lift…that sort of defeats the purpose of the lift assist. I went inside, took my legs off, and got the fire going for when Irena would get home. When she finally came in, I directed her toward the back yard and told her I would join her outside in a few minutes. She went out and I circled around to our bedroom, which has a door to the back yard. After getting my legs on, I walked out onto the deck off our bedroom and down the ramp toward our firepit area. She heard the tell-tale robotic motors of my knees and turned, stunned as she said, “are you walking?!”

I was a bit timid on that first walk outside, and part of that was the issue with the sit-to-stand affecting my confidence. I reached out to my Prosthetist, and he reached out to the local rep for the manufacturer, who had a tech meet us at the office the next morning. Come to find out, these knees (which were brand new and not the exact pair that I had tested) had not been told that I was a bi-lateral amputee, so each knee was looking for the physical support that it would get from someone with a sound leg on the opposite side. Due to a tech issue, that information had not come across when they downloaded the programming from my trial day a month prior. Once they activated the bi-lateral setting, the trigger point for the sit-to-stand function changed to only require a simple forward motion in each knee and they lift! With my previous set I typically was only able to trigger both knees about 40% of the time. Usually, the right knee would trigger, and the left knee would follow along. It’s an amazing sensation to consistently stand up with the full assistance of each knee!

Since then, my usage of my legs has increased. They truly are game changers! I’ve climbed steps instead of taking ramps…a straight line is once again the fastest way to get someplace…I’ve sat in the row above the accessible seats with my friends and family at the movies (because the accessible seats typically only allow room for two), and I’ve stood on my legs for 45 minutes rearranging collectibles around on the high selves on my office. As I use them in my adaptive karate sessions, my balance and range of motion is steadily improving. I don’t know if these will lead to “unassisted walking” (which just doesn’t seem safe to me) but I’m not closing the door.

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