p Op Eigen Houtje......

Co LeDahu's continued adventures in 2004.

Januari: Rehabilitation and finishing of the transfered flap.

During the month of Januari I trained a lot to get control of my strong leg again. By working hard all went well and by the end of the month my mobility on one leg was much like before the transplantation surgery again.
The skin flap appeared wel blooded from the new spot on my stump. A remnant of the former connection skein with my right leg had to be cut away, the skin tightened and neatly stitched.

I got this minor surgery on Januari 21st. Unfortunately a week later I got a streptococci infection at the surgery wounds rusulting in fever, pain and a swollen stump. And it all looked so well at first sight just after the operation.
But OK, nothing to do about it other than swallow anti-bioticum medication and to wait getting better. The infection fluids had caused an internal cavity in the stump which I had to rinse and drain by myself with a syringe and catheter twice each day. Just stick a hose in the wound and pump untill clean liquid comes out. I went back to the hospital every week for the docters to check the healing.

Co LeDahu's leg, 
partially without skin (photo Gerard Schoutsen)
The right leg looks pretty (oomph) damaged after the flap of skin is taken off.
Co LeDahu's stump with new skin (photo Gerard Schoutsen)
The removed flap of skin is attached and stiched to the front side of the stump.
(photos Gerard Schoutsen)

February and March: swallow lots of penicillin and wait... and wait.

The nature of the beast in the stump was unvealed after extensive laboratory examination. A special penicilline was described and I had to swallow both sorts to fight the bactery. My visits to the surgian to check the infected stump were still on a weekly basis.
As a result of all those pills I suffered from tiredness and sleeplesness in this period.
Halfway the month the infection swellings on the stump decreased and also the fever vanished slowly. By the end of February the infections appeared to have gone and so I just had to wait for the open wounds to heal before starting rehabilitation again.
To be too active the last weeks has burdened my good rightside knee too much. Due to standing up and sitting down on one leg, in an incorrect movement according to the fysiotherapist.
He's working on the knee with massages and I have to move in the wheelchair. Stay seated instead of standing up too much.
The wounds are getting well fast now. But because they were rather deep, complete healing will last for about another 6 weeks till the end of april.

New model, lightweight prosthesis.

the new Össur Seal-In 
liner (Bron: Össur)
Össur Seal-In liner
(Source: Össur)
Össur Flex Foot Modular 3 (Bron: Össur)
Össur FlexFoot Modular III
(Source: Össur)
The preparations for my new prosthesis are well on their way. My rehabilitation doctor Klaas, my prosthesist Martin and myself all agreed about the components.

It surely had to be an as lightweight as possible prosthesis, because I got cramps with earlier models after a short distance walking allready. With a lightweight model my walking distances would possibly increase.

The prosthesis consists of a new model silicon vacuum liner with a special ring to cause suction in the socket; and a carbon fibre foot type FlexFoot Modular III; both made by Össur.

The webpage Prostheses will show an extended description as soon as it's ready.
March 26th a plaster cast model of my stump will be formed and after that it'll take another 2 weeks before my new artificial leg will be ready. It will be time after waiting in misery for more than a year now.

The last months as usual I got my mobility mainly from walking with my crutches.But to avoid defects on my wrists and shoulders, right foot and -knee by overburdening I used my wheelchair a lot to move along.

Since a few months I have the luck of having a sports-wheelchair. This fast-moving wheelchair makes it easier for me to accept beeing a handicapped.

Rolling along, my Harley-Davidson wheelchair is easy manouverable and fast moving.And it's impressive an impressive sight to balance on only the two rearwheels, just to show off!

H-D sportswheelchair
H-D sportswheelchair

April : What an experience, on 2 legs again.

H-D prosthesis I started the month of April with the great moment of fitting my new prosthesis.
My prosthesist Martin had taken care of a special model socket again: a H-D design, in black this time.
Because my new, superlight Modular III sportsfoot isn't an easy one to adjust, we decided to attach my "old" and trusted Ceterus to the socket.
However much heavier, it's easier to adjust and when adjusted properly, the measures could easier been copied on the Modular III foot. And I first had to get used to the new liner and socket anyway.

It was a very exciting moment when I lowered my stump into the socket to get the air out through the small expulsion valve.
Slowly I got up from the chair to give my left knee time to get used to the burden of my bodyweight again after 5 months of inactivity. I was shocked by the jolts of pain!

The first steps I took were uneasy, painfull and instable. But after half an hour of adjusting the prosthesis it appeared that I hadn't lost my ability to move properly after those long 5 months.
I was able to walk without cane or crutches on my new leg rightaway! However, every ten-or-so meters I had to stop and rest to get rid of the cramps.
Ofcourse I wore my leg longer than was wise in the beginning. But it felt so good to walk the globe again instead of crutching or wheelchairing along! After taking of the leg the stump wasn't damaged or sore from the unusual pressure. And the wounds were not increased or gotten worst.

H-DNow every day some hours of carefull excercise to get used to the prosthesis and walking. The new "seal-in" vacuum linersystem seems to work well in my case for now. Fits stabile and without play on my stump and I don't miss the pressure and tightness of the kneesleeve at all!
No, for now everything looks good and I carefully get confidence to walk in the near future with this prosthesis again.

After wintersleep I checked my Harley's condition before taking her for a ride. She needed cleaning and new oil urgently so I took good care of her and genly shook her to life.
I also attached some new parts and an engine bar to get from under the motorcycle quickly if I should made a unfortunate fall with the bike on my good leg.
The altered gearshift was welded by my old colleage gunsmith and only has to get a chrome-job now.
But how I enjoined myself while taking my bike on our first ride again on a sunny afternoon along the typical meandering Dutch riverdike-roads!

H-D prothese
My new H-D prosthesis
Great day today, April 20th! Martin has attached the ultra light Modular III FlexFoot under the special Harley-Davidson socket.
My prosthesis has gotten its final configuration now, for closer details: click on the picture.

The Modular III is a very flexible bended carbon-fibre L-shaped lath and much lighter than my "old" Ceterus Flexfoot with all extra dampenings features.
However, missing these rotation and gait-dampening devices makes walking a little less comfortable, I expect.

But that's what I'm going to try-out in the next weeks and ofcourse in the meantime I'll keep my Ceterus foot safely in the closet untill I have reached enough vascular progression to walk with it again.

H-D prosthesis
Special H-D design socket

Luxe way of camping As was clear after camping in our tent last year, we had to have our holydays in an other way.
Crawling in tents with an artificial leg, or falling with the comlete tent-frame is defenitely not a succes for a relaxed holyday with the family.
So we decided to look out for a second-hand camper. Not a very big one because the children are of an age now, that they rather go on holydays with their own friends.
We don't need a big mobile home just for the two of us anymore.

We found a nice little camper, complete with an attachable front tent.
I tried moving inside and outside, with and without prosthesis and found no problems doing so. Untill July we stay on a camping-site in a very beautyful surrounding close to the German border, just to try things out.
After that we stay at the coast for North Sea Jazz festival and then we go camping in France. An excellent starting point as well for day-trips on the motorbike into Germany.

May: growing more and more happy with the new leg.

Walking with the new prosthesis is going well after 3 weeks now. Sometimes I have to force myself to don the thing earlier as I wish.
Apart from some minor skin abrations the stump is reacting positively at the continuous pressure.
But the cramps in my calf are still there as much like before after walking for 50 meters or-so. Then I've to take a rest to let the pain vanish.
I don't know if this will improve in the future. I'll work on it as hard as possible and we'll see about it....

The Seal-In silicone liner.

H-D prothese
I have to explain some more about this new model liner, made by Össur. A short, but rather technical story, specially for other amputees who like to know my experiences.
Wearing this new Iceross Seal-In liner is very satisfatory untill now.
For those who are not familiar with Össur liners: my Seal-In Dermo liner is a 3mm thick silicon stumpsock, which has to be put on the stump tightly without air remaining inside. After donning to the stump, the prosthesis socket can be put on.
Special about the Seal-In model is a sealed rubber ring around the liner, designed to trap the air in the socket while donned tightly and press the remaining air away through the expulsion valve.
The air is pushed out and can't get back in through this special one-way valve, so a suction force is created which holds the socket attached to the stump.

H-D prothese Donning the Iceross "Seal-In" suction siliconliner
As said before, the skin of my stump reacts positively to the soft liner material and I have little or no sweating, even after some hours of wearing.
More advantages are: because no kneesleeve is nescessary for suction suspension, I have a lot more freedom of movement around the knee-joint while bending.
Those kneesleeves had a short lifetime of wearing anyway, I ruptured them oftenly and suffered from a loose fitting of the prosthesis after this happened.
How I hated those bloody sleeves!
The fitting of the prosthesis is tighter with the Seal-In, which results in a much more direct contact of the stump with the walking surface. Gives me a better control and "feeling" while walking.

Furthermore the complete system is lighter and forms less sweat because there is less covered skinsurface of the upper leg.
Ofcourse there are some disadvantages as well.
The in my socket used Össur expulsion valve has been attached wrong once.
It fell apart completely while riding on my Harley-Davidson motorcycle... without doubt a dangerous situation!
So after this experience I always have a back-up valve with me.

In my opinion a (future) user of the Seal-In liner system should consider some important points.
If the suction suspension vanishes due to for instance a defective valve, there is no force left other than friction to hold the prosthesis to the stump. Specially when the stump has a conical shape.
This may result in a dangerous situation; for instance during work, practicing sports or like me; riding a motorbike.
There is also the problem when when you wear the prosthesis during a longer period that the stump shrinks a bit.
The usual way to tighten a loose fit is to don some extra stumpsocks. In case of the Seal-In liner this may result in losing the suction forces.
A solution can be to experiment with cut-off cotton stumpsocks under the sealing membrane to tighten the fitting of the socket.

A beautyful motorcycle tour in Germany, Belgium and Luxemburg; for amputees.

From May 14-16 the yearly motorcycle tour for leg- or armamputees and people with other physical limitation was organized again fot the seventh time now.
Most of the participants have (re)gained their motorcycle license after an amputation and are riding a motorbike with a prosthesis.
The ride takes the approx. 30 cyclists through the pitoresque countryside of Ardennes and Eifel. Which is at its most beautiful during the spring.
Weather was dry and sunny and we hade a very nice time those three days.
A great experience to have this close contact with partners-in-misfortune who share their common handicap and hobby together.
At the end of the tour both men, women and machines were bound home safely after 750 kilometers of riding wunderful roads which took them along meadows, rivers, woods and mountains.

Marco Engels with orthesis
Marco Engels demonstrates how an armprosthesis or orthesis can be attached to the handlebars of a motorcycle.
Ready fot departure
Departure in the morning at one of the hotels in the German Eifel.

June and July: On both legs into the summer?

stompkous oner de liner My walking approved gradually. I could wear my prosthesis for a longer period each day without damaging the surface of the skin on the stump.
Still I had to be carefull, which is quite difficult because I had gained so many possibilities by walking again without crutches.

Because of the excercise of walking the musclevolume around my knee has increased, while the stumpvolume decreases due to a better tranport of bodyliquids in the stump.
However, the socket is made on the stompsize after an inactive period of more than half a year so around the knee fitting is too tight whereas in the stumpend there is too much play.

By trying to reform the socket a little at the rim the tightness around the knee can be approved. Too much space in the distal end of the socket can been filled with cotton stumpsocks.

For those, who use an Össur "Seal In" liner and suffer from this "too much space"-problem, click on the picture to read how I use stump-socks to fill this excessive space.

Bikers' Lodge "Baton Rouge".

Halfway June I got the creeps again and had to go out a few days ridin' my bike in the beautyful Ardennes.
Weather was cold and wet, but I didn't mind at all. Riding piss-wet on my bike through the rain I just had to remember, half a year ago, laying in a hospital bed, both legs sewed together for a month... then the weather didn't bother me anymore and I had the time of my life on my Sportster...

Staying overnight in the Belgium Ardennes doesn't have to be a problem. If you are looking for a nice place to stay, a basecamp to make roundtrips through beautyful landscapes and explore the Ardennes: check in at Biker's Lodge "Baton Rouge" in Vielsalm, Belgium (see also the Links page).
Last year Ben en Hetty van Reek started their hotel in an old beer-brewery (any doubts now about the atmosphere?) for bikers only. Hetty is a very gastronomic gourmet and together with husband Ben and their tough-looking dog Jessy they created a very hospitable, but low-budget place to stay.
The Lodge is still partly under reconstruction but they're working hard to get things ready. As lone rider or in groups, it's a nice place to eat and sleep and explore the beautyful Belgium and Luxembourg Ardennes and the German Eifel. Keep "Baton Rouge" in mind!

Motorherberg Baton Rouge

The garage of bikers lodge "Baton Rouge" along the road Vielsalm-Trois Ponts: a safe place to park your bike.
Motorherberg Baton Rouge

Doesn't matter at all: at dinner, a beer at night or at breakfast: the "sittingroom" is always very cosy.

A piece of thread and a troublesome vacation.

Kastelen bekijken op krukken The last weeks of June I suffered from a minor but annoying complication.
A strange infection occured on the scar-tissue of the sewed together new transposition skin and the original skin on my stump. Just on the tibia area.
A vulnarable area anyway, always a pressure spot from the prosthesis.
Source of the infection was a remained piece of stitch-thread after the surgery a few months ago. Shouldn't be a problem after a few weeks of healing. So untill then: no prosthesis and walking between the crutches again.
But every time after healing I could just wear my prostesis half a day... and the wound was open again!

At last it turned out to be a serious problem and after two months the only solution was a small operation to remove the hardened wound-tissue and re-stitch the skin.
So for me the months July and August were a very frustrating time.

I couldn't walk during our vacation in France and Luxembourg and riding my Sportster was out-of-the-question.
But with much help of my wife Mieke we managed to see a lot of beautyful sites, walking between my crutches.
We saw castles and vineyards where the famous and delicious Elzas white wines come from. Visited the trenches and cemetaries of the first world war and the beautiful Elzas and Vosges mountains.

A wonderful area for motorcycling as well, with lots of steep and meandering little country roads to climb and descent the mountains. Hairpins going up and down over the top, with wide views on either side.
I definitely go back to this countryside with my Sportster when chanches are better!

bikers roads in the Elzas
curving roads in the Elzas mountains
Achter de wijnkar
Co behind the wine-cart.

In Memoriam: Marianne Timmer.

Friday Juli 2, 2004 Marianne Timmer died from cancer she initially got from a wrong radiation therapy of her femur in 1974.
In 1995 Marianne got her first amputation, a transfemural but that was not sufficient to stop the cancer.
She got the most serious lower-limb amputatio possible in 2000: a hemipelvectomia, a complete removal of the limb including a part of the pelvis.

Marianne fought hard and after rehabilitation she managed to walk again with a prosthesis from the hip downward. She even rode a bicycle; in spite of falling hard several times.
This characterized her fighting spirit and perceverance. After falling she was even more motivated to step up again and continue!

Marianne was a journalist of her profession and she wrote many articles about how te manage with an amputation and aprosthesis.
During 2003 her cancer became more agressive and the possibility that she could not defeat her illness became more realistic every month.
But she did not surrender, on the internet she found curing methods for treatment of het specific kind of cancer.
Unfortunately all in vaine, beginning of July she lost her uneven battle and died in the much too young age of 46.

More about Marianne on her site: www.beenamputatie.nl
e-mail groep Lunch of Marianne's amputation e-mail group, on the left Marianne Timmer

Wound open, wound closed, etc....

Since half June the wound on my stump is constantly open.
Mostly just a wounded spot but sometimes an infection as well. The surgeon decided to do a minor surgery to clean the wound from damaged tissue and stitch it together again.
Hopefully after this operation the wound will stay closed and I can carefully start to walk again with my prosthesis.
Beginning of September the stitches will be removed and hopefully the wound will stay closed. But before putting on the prostheses it has to be altered to take away pressure points which could cause stump trouble again.
Then, at last I can carefully think about walking, riding my motorbike again, swimming and...... oh, how I missed that all!!!!!

Autumn: Slippery showertiles.

Some wet adventures.

The one moment I'm still standing straight and proud... the next I lay on the slippery tiles of the showerfloor.
Looking upward to tufts of pubic hair, wrinkled scrotems and hanging breasts; from an extreme frog-perspective.
Every time again it's an unreal occurrance how the view on the world can change in a split-second.... faster than the wink of an eye.

There I found myself... laying in the sauna, just slipped with my crutches and standing on only one leg; down on the floor of the shower, smooth like ice from soap and shampoo!
How I do it I don't know, but somehow I manage to fall very gracious and roll over without hurting myself. It's more a reflex then a technique I think.
Today on the first day of the autumn, Mieke and I went for a relaxing day to the sauna again, since ages.

From my accident on I wasn't able to visit the Sauna because of operation wounds, infections, sore spots or other medical reasons on my stump.
But how terrific it felt to sweat, bath, bubble, to plunge in cold and hot water again, and rest afterwards with a glass of beer or two.
In the end of the day I went for a last bath and fell again, this time not so gracious as before and wounded my stump. My sweat-exercition was over for that day and I had to let the wound heal again.

Wanneer hoor ik nou 's wat?
Hallo... When will I hear some good news at last?

Patience enough after more than 3 ½ years now! Since the last operation 6 weeks ago I haven't made any progression.
After the operation wounds were healed my prosthetist modified the socket to take away the pressure on the sensitive spot on my tibia. Right on this spot is a swelling on the tibia-bone which damages the weak skin when pressure of the prosthesis is applied.
He made more room in the socket and I tried by walking 10 minutes: the skin appeared OK. After another 10 minutes I took of the prosthesis and we were very disappointed to see a sore spot again.
At that moment it was over for me... I reached the very limit: after just 20 minutes of careful walking again a damaged stump!
I put the darn prosthesis aside and went on like the months before: on crutches and in the wheelchair.
I know my possibilities and limits, so I know what I can do with those mobility supplies and I won't think of any prosthesis for a time.
If only I could ride my motorbike again. Man, how I miss riding on my Sportster, knees-in-the-breeze!

But there's good news too: end of September I made a scuba-dive in an introduction event, organized by a diving club in my neighbourhood "Sub'70".
Last year I made some intro-dives (one in open water) and I liked it very much. In the water there's no handicap left, you can't fall and don't need special walking-divices.
Maybe I'm a little slower than other swimmers, but even that's not always the case.
A year of surgery and open wounds prevented me to dive again but now, with my stump healed I could!
The instructors of the club helped me fantastic and they saw no problem for me to start a diving course in order to get my licences.
So I was happy to subscribe as a member of the diving club "Sub'70" now.

3-D Laser socket.

Beginning of October I was invited by Össur Europe, one of the most important manufacturers of prosthesis-parts, to take part in a demonstration for a new method of making a prosthesis socket.
Ofcourse I was more than enthousiastic to take this welcome invitation for a different way of finding a solution to my problem.

First a temporarily socket was made of my stump which was measured with a laser system.
The digitalized data is then put through a computer program which designes a virtual model and projects this as a 3-dimentional image to a monitor. This image can be corrected by the program at pressure points or altered in -for instance- a slightly tapered form, increasing from zero on the distal end to 3% at the rim of the socket.
As soon as the image is modified to satisfaction, the corrected data is fed into a CNC milling machine to make a mould out of a solid block of foam. The mould is used to finally make the socket from.
The whole procedure can be finished in a couple of hours so it's possible to measure, make, fit and wear a prosthesis within one day with this method.

After travelling to Össur Europe several times for fitting corrections, the prosthesis was ready to wear in the end of October.
The first steps were very carefully ofcourse. But checking after 10 minutes showed no defects on the stump. After another ten minutes... still nothing alarming, very encouraging!
Ofcourse the first days I continued to be carefull, but I wore the protheses for about an hour already with check-ups in beteween.
Now, after more than a month I wear it for several hours a day and I gradually get more faith in my prostheses.
But, not too optimistic... things have gone wrong earlier after some time!
speciale (blauwe) vulmanchet om de knie te fixeren
the Össur Seal-in liner with the speciale (blue) innersocket to fixate the knee
click on the picture for more info

I'm happy with the good contacts with Kim, Peter and Stephan from Össur Europe, they are always ready to help me and my prosthetist when problems occur.

I love diving.

What a nice sport is scuba diving... I just started at my club "Sub'70" with the course Open Water Diver and I enjoy it so much already!

Harry legt de laatste hand aan de apparatuur
clubmate Harry adjusts the gear
Buddy-check samen met Marije
Buddy-check with Marije... check my wet-leg!

co te water For the "Sub'70" clubmembers I am a stange bird. I'm always too late because I have do don or dof my prosthesis first... or am I just a little lazier... My left hand is partially paralized so I have problems with making hand-signs and with handling the inflator of my stab-jack.
But nobody gives a shit... they try to find a (safe) solution for each problem. My instructor Peter constantly thinks about alternative ways to solve my typical problems and technical specialist Harry modifies the gear to my needs and possibilities. A wunderful mentality do those "Sub'70" members have, I'm glad I found this club!

Walking with crutches is of no use when taking the heavy diving-gear with me. For moving around save and easy in wet areas as swimming-pools or Sauna's, I constructed a wet-leg myself.
To the socket of a former prosthesis I attached a piece of titanium tube and a simple old rubber Multi-Flex foot.
A bit primitive compared to my Modular III prosthesis, but it works well for short distances! The liner is my old Seal-in.
This is my Wet-Operations leg what I put on before I go into the pool dressed in swimming-suit... and I change back again with my Modular III leg before entering the normal world.
But: I do not plunge into the water with it. Before jumping I step out of the wet-leg, move to the rim of the basin and go into the water.
As soon as I want to move outside the water, I towel-dry stump and liner and get on the wet-leg again.
Under the shower I hold it up-and-out a little so it doesn't run full with water. Also in the Finnish sauna-rooms or Turkish steam-bath it works perfectly. Maybe a kneesleeve isn't a bad idea to try one time.

Everyone is willing to help me with everything... no problem at all. But with my wet-leg I can do things my own way. I've always been one stubborn guy, you know.