Jump to content
Heather Mills - Amputee Forum
FordGuy48

OttoBock Triton Harmony

Recommended Posts

I've been an amputee for almost 50 years now, RBK, had a ton of prosthetics over the years. First were the PTB legs.  In the past ten years, I've been using the OttoBock Harmony system, first the Harmony HD, and now the Triton Harmony . Lately I've been having some issues on my stump, that seem like old PTB troubles. With the PTB, I'd have an occasional problem with "splitting" around the scar area, if my leg wasn't making good contact on the distal end, now I seem to be having the same problem with my Harmony socket. I know, if there is a gap between the bottom of the socket and stump, it can cause a "hickey" like issue, but this issue appears to be like the old PTB "splitting" issue. I have been to Hanger with this twice in the past week, even walked on crutches for several days. The tech did remove a "tech" spot (little urethane spots that OttoBock provides with a new system) which was put in there when my socket was new, February 2015, and it is feeling better, but I'm still getting a bit of drainage at that spot after a day using the prosthesis again. Just wondering if anyone has had a similar problem with a vacuum system. I've found over the many years of being an amputee, that things correct better by still using the leg, rather than laying low with it off. I am a Veteran, and deal with the VA, I am trying to get into the Amputee Clinic, but sometimes it takes a long time to get in touch. I'd appreciate anything anyone has experienced of similar issues.

Tom

Edited by FordGuy48
Corrections
  • Like 1

Share this post


Link to post
Share on other sites

Not familiar with the problem. Just be very cautious about infection. And since you are dealing with the VA, don't be shy and just be a walk in ASAP.

Thank you for your service and best wishes !

Share this post


Link to post
Share on other sites

I've never worn a PTB suspension--I actually did quite well with a pin-lock system for several years--but I've worn a elevated vacuum-assisted pump suspension for a few years now.  In the beginning, I went through some miserable times with the pump...it literally tore the skin off my distal end in long, wide strips.  Yes...it hurt!

My prosthetist spent a fair amount of time consulting with OttoBock.  Even though my system is not "fully" OttoBock components, they were very helpful.  Their suggestion was that I try a custom-molded liner, even though I was technically sized for a normal "prefab" liner.  I have to admit that I was skeptical, but the custom-made liner completely solved the issue.  Any sort of airspace in the liner can be bad news. 

On my current leg, we tried moving the place where the hose fed into the socket to make the entire assemblage more compact and less likely to get caught on things...and simply the change in position caused skin irritation--almost a blister--on my distal end near the hose.  That one required an adjustment in suction strength...and then everything was lovely again.  

It's a tricky suspension to wear...but it's soooo grand when it's set up "just right."  I'd hate to have to give it up! 

I hope your leg guy can come up with a solution for you...................:smile:

Share this post


Link to post
Share on other sites

I've had this current prosthesis since March 2015, I've had a few issues. I'm finding I may have been trying the wrong approach, I'm feeling like I have just been going in to far, I'm trying today to add another layer of sock, I've put clay in the bottom, and it flattened out pretty good, so that's why I am trying the socks. I never thought about that, my last leg, I didn't have an issue with that, but I'll try anything. My liner is custom fit, and I do know what the airspace can do, when I first got this leg, I had a space, and that created a few blisters. I've been using a prescription antibiotic ointment on the affected area.

Share this post


Link to post
Share on other sites
9 hours ago, cherylm said:

I've never worn a PTB suspension--I actually did quite well with a pin-lock system for several years--but I've worn a elevated vacuum-assisted pump suspension for a few years now.  In the beginning, I went through some miserable times with the pump...it literally tore the skin off my distal end in long, wide strips.  Yes...it hurt!

My prosthetist spent a fair amount of time consulting with OttoBock.  Even though my system is not "fully" OttoBock components, they were very helpful.  Their suggestion was that I try a custom-molded liner, even though I was technically sized for a normal "prefab" liner.  I have to admit that I was skeptical, but the custom-made liner completely solved the issue.  Any sort of airspace in the liner can be bad news. 

On my current leg, we tried moving the place where the hose fed into the socket to make the entire assemblage more compact and less likely to get caught on things...and simply the change in position caused skin irritation--almost a blister--on my distal end near the hose.  That one required an adjustment in suction strength...and then everything was lovely again.  

It's a tricky suspension to wear...but it's soooo grand when it's set up "just right."  I'd hate to have to give it up! 

I hope your leg guy can come up with a solution for you...................:smile:

Oh wait, you had trouble with air space in the liner? I had an issue like that with my last Harmony, the tech gave me a little "cup" that fit over the end of my stump before I put the liner on, and that helped a lot, it came for Ohio Willow Wood. I wish I still had it! Plus, it wasn't porous like the OttoBock liner, easier to clean! What I have is a "crevice" that has been there for a long time, like where my scar is, and the tissue recessed as my stump shrunk over the first several years, thats where I'm having the issue right now.

alpha-gel-cup.jpg

Share this post


Link to post
Share on other sites

The little "cup" thing looks interesting...at various times, due to a long, long history of stump shrinking, I've worn assorted lengths and thicknesses of socks...and leather pads...and wool felt cushions in the bottom of my socket.  All of that, though, generally goes on when I'm nearing the end of a particular socket's lifespan.  Your socket seems like it's too new for that...and after all that time as an amputee, I'd think your volume change issues would be minimal.  That "crevice" sounds like it can be a challenge!

All the best to you!  :biggrin:

  • Like 1

Share this post


Link to post
Share on other sites
10 hours ago, cherylm said:

The little "cup" thing looks interesting...at various times, due to a long, long history of stump shrinking, I've worn assorted lengths and thicknesses of socks...and leather pads...and wool felt cushions in the bottom of my socket.  All of that, though, generally goes on when I'm nearing the end of a particular socket's lifespan.  Your socket seems like it's too new for that...and after all that time as an amputee, I'd think your volume change issues would be minimal.  That "crevice" sounds like it can be a challenge!

All the best to you!  :biggrin:

The cup worked good for me with my last leg, also a Harmony, but my prosthetist said he didn't have any. Yes, volume change is minimal anymore, although, I had my last leg for 8 years, and was just wearing a thin sock and two of those short socks OttoBock provides with the unit, with this one, I've gone up too two one ply socks... I solved the catching the tube problem with a velcro strap! Im feeling a little better today, I have a feeling leaving a gauze pad on the sore, may have made it linger! I've had issues like this before, and it would last a day or two at the most, we'll see how I do!

Leg.jpg

Share this post


Link to post
Share on other sites
12 hours ago, cherylm said:

The little "cup" thing looks interesting...at various times, due to a long, long history of stump shrinking, I've worn assorted lengths and thicknesses of socks...and leather pads...and wool felt cushions in the bottom of my socket.  All of that, though, generally goes on when I'm nearing the end of a particular socket's lifespan.  Your socket seems like it's too new for that...and after all that time as an amputee, I'd think your volume change issues would be minimal.  That "crevice" sounds like it can be a challenge!

All the best to you!  :biggrin:

Oh, and that little cup actually has a bit of a pad in it too, I used that when I had to have a new liner cast, I didn't know OttoBock only kept the custom liner specs for two years, so now I get a liner cast, and it wasn't perfect fit with the existing socket.

Share this post


Link to post
Share on other sites

Well, after trying different things, I am feeling it is actually hurting on the end of my tibia. When I used to have issues like that on the old PTB's, they'd pour a new pad, and have me push to the back, so some of the pad went up the front of the socket. I know the Harmony is a total contact socket, but I wonder if trying something along these lines, using one of the tech spots OttoBock provides might help. 

Share this post


Link to post
Share on other sites

It could  help...I mentioned all those various "accommodations" in my last post, and I've used a number of them in my "total contact" socket.  My best guess is that any type of non-porous padding, either permanent or temporary, would work, as long as it kept the opening for the pump tubing clear.  The only one that might be problematic would be massive thicknesses of socks, as that also adds a lot of trapped air to the socket interior. 

Share this post


Link to post
Share on other sites
6 hours ago, cherylm said:

It could  help...I mentioned all those various "accommodations" in my last post, and I've used a number of them in my "total contact" socket.  My best guess is that any type of non-porous padding, either permanent or temporary, would work, as long as it kept the opening for the pump tubing clear.  The only one that might be problematic would be massive thicknesses of socks, as that also adds a lot of trapped air to the socket interior. 

I'm beginning to wonder if I tried to hard to remedy this, I've gotten sore there from time to time with the Harmony, and it's always cleared up okay, this time I was trying adding a sock, fooling around with the little pads, etc. I also was in for a skin exam yesterday at my dermatologist, and I talked with her about this, she said it sounds a lot like a diaper rash, which makes sense since it is moist inside the liner a lot. Right now, I've gone back to the socks and a small pad, that I had before, and trying that. I've learned over the years to experiment myself when I've had issues, so lets see!

Share this post


Link to post
Share on other sites
On 10/27/2016 at 2:43 AM, cherylm said:

It could  help...I mentioned all those various "accommodations" in my last post, and I've used a number of them in my "total contact" socket.  My best guess is that any type of non-porous padding, either permanent or temporary, would work, as long as it kept the opening for the pump tubing clear.  The only one that might be problematic would be massive thicknesses of socks, as that also adds a lot of trapped air to the socket interior. 

I'm still having trouble, I tried adding a sock, but that was actually worse, this has to be a vacuum issue. I've been really taking it easy, take my leg off whenever I can. This is making me nuts, LOL. I mentioned vacuum to my tech on my last visit, and he seemed to brush it off. When I first got this leg, a day after wearing it, I had blisters from the vacuum and a gap in the bottom, and now when I remove my liner, the whole end of my stump is red, so.... You mentioned an adjustment in the suction, did the prosthetist do that? I'm curious, because I've noticed all along with this leg, when I sit it hurts from time to time, until I release the vacuum.... I thought this would feel better by now, just over 2 weeks!

Share this post


Link to post
Share on other sites

There's a "temporary DIY" solution you can try for the suction issue if you think that may be the root of the problem.  (It does sound likely from what you've said...)  First off, does your pump actually have a second "comfort fit" button on it?  If it does, try that mode for a bit and see if it feels better.  If a secondary setting on the pump doesn't exist, try a loose sort of "diffuser" stuck down into the pump hose.  I did this with the assistance of my prosthetist during the troubleshooting on my latest leg.  We used a small bit of wool felt...just cut a small square, rolled it into a loose plug, and stuck it into the end of the pump hose inside the socket.  Regular polyester craft felt may not work for this, but wool felt is fairly easy to find and you need only the tiniest bit of it.  It simply makes the draw from the pump a little less intense.

In my case, the improvement was immediate and let us know where to go from there.

Good luck to you!

Share this post


Link to post
Share on other sites
5 hours ago, cherylm said:

There's a "temporary DIY" solution you can try for the suction issue if you think that may be the root of the problem.  (It does sound likely from what you've said...)  First off, does your pump actually have a second "comfort fit" button on it?  If it does, try that mode for a bit and see if it feels better.  If a secondary setting on the pump doesn't exist, try a loose sort of "diffuser" stuck down into the pump hose.  I did this with the assistance of my prosthetist during the troubleshooting on my latest leg.  We used a small bit of wool felt...just cut a small square, rolled it into a loose plug, and stuck it into the end of the pump hose inside the socket.  Regular polyester craft felt may not work for this, but wool felt is fairly easy to find and you need only the tiniest bit of it.  It simply makes the draw from the pump a little less intense.

In my case, the improvement was immediate and let us know where to go from there.

Good luck to you!

Oh, that sounds like a good idea, I'm not sure if there is a comfort fit button on mine, is yours a Triton Harmony like mine? I have two spots I believe inside my socket, my socket has a "soft insert", and I think the second is under the insert, I remember when I got this leg, he had left a piece of tape over that one, and when I went back for a checkup, he removed it, not sure why there are two. Maybe I could try a piece of an old wool stump sock.I hate to remove that insert, it's hard to get back in place for me, then that would bring other problems. I have to go to Hanger on Tuesday, so we'll see. I've only been seeing this tech for about a year and a half, they had a big turnover for a while, so he doesn't really know my whole history, like he thought that crevice was a "split" in the skin. I wish the original guy I worked with was still there, he moved to CA! I'm trying Triamincinolone acetonide cream on the are, but can only use it at night, its kenalog. I hope this is resolved soon, I am getting behind in things I need to finish before it gets too cold! Thanks for the input cherylm! 

Edited by FordGuy48

Share this post


Link to post
Share on other sites

cherylm, Okay, I went to Hanger this morning, after examining my liner, he found two cracks in the bottom, let's see if that was the problem, makes sense since the skin is right against the liner, and would suck into the cracks. I've noticed that for a few months.I thought it was just discoloration, but never gave it a second thought until he examined it and explained t, I don't know why I didn't think of that as long as I've had Harmony systems! Hope this is it! The discoloration has been there for a while, not from this incident. Its impossible to clean, it penetrates the urethane.The liner turns yellowish after a few months use.

SocketLiner copy.jpg

 

Share this post


Link to post
Share on other sites

That sure sounds like a possibility for all your troubles!  I have a tendency to develop pinholes in my suspension sleeves...and even knowing that, I tend to think that any problems with my suspension "must" have something to do with my body rather than the sleeve.  As a result, it can take me a while before I visit my CPO...which is a foolish thing to do.

I hope that they can either repair or order a new liner for you, and that it will be enough to get your skin to calm down afain!

Share this post


Link to post
Share on other sites
4 hours ago, cherylm said:

That sure sounds like a possibility for all your troubles!  I have a tendency to develop pinholes in my suspension sleeves...and even knowing that, I tend to think that any problems with my suspension "must" have something to do with my body rather than the sleeve.  As a result, it can take me a while before I visit my CPO...which is a foolish thing to do.

I hope that they can either repair or order a new liner for you, and that it will be enough to get your skin to calm down afain!

I already have a new liner, I get two a year. Funny, I tried wearing the newest one for a short time when this first started to be a problem, but put the old one on so I wouldn't get any blood on the new one. Now I'll know to change out as soon as I see a crack or such. I'm noticing a difference already! OttoBock has really improved the suspension sleeves, my last one made it a year! I have to go to the VA Amputee Clinic Friday. 

Share this post


Link to post
Share on other sites

I went to the VA today, and they prescribed a new socket, they said something has to have changed on my leg, so... Also they asked to have a 2 way valve put on my vacuum to see how things go without the vacuum pump until the new socket gets created, takes a while for the VA to get the paperwork to Hanger. He also mentioned possibly a return to a PTB prosthesis if this doesn't improve things, I hope not, the vacuum has been great up until now, I really think it has to be my leg not fitting right from my years of experience being an amputee. He also told me the cracks in the liner are from too much pressure on the bottom, sooo, maybe just adding a sock will help for now. Its funny, in the 8 years I had my first Harmony, I just wore a thin sock the whole time, never had to increase except to add a couple of those small socks OttoBock provides with a new setup, and that was only because they had to cast a new liner, but not change the socket! 

  • Like 1

Share this post


Link to post
Share on other sites

I don't know about the current state of valves out there...I tried one several years ago, and it was spectacularly unsuccessful, but I'd guess that they've improved since then.  Maybe it will give you some good information.

After 12 years as an amp, I'm still slowly and steadily shrinking.  I have to go through castings for new liners and sockets about every two years.  One of my favorite things about my pump suspension is that I don't have to take time to add socks in the middle of the day...but I still change enough, over time, that I have to slowly add socks as I keep shrinking...it's just that it happens over the course of months, instead of hours.  Is there anything that's been happening in your life that could contribute to unexpected volume changes?  I'd guess that, after nearly half a century, you'd be so accustomed to NOT changing volume that you might not even recognize a change in volume unless you really sat down and thought about it.  Does that sound possible?

Share this post


Link to post
Share on other sites
5 hours ago, cherylm said:

I don't know about the current state of valves out there...I tried one several years ago, and it was spectacularly unsuccessful, but I'd guess that they've improved since then.  Maybe it will give you some good information.

After 12 years as an amp, I'm still slowly and steadily shrinking.  I have to go through castings for new liners and sockets about every two years.  One of my favorite things about my pump suspension is that I don't have to take time to add socks in the middle of the day...but I still change enough, over time, that I have to slowly add socks as I keep shrinking...it's just that it happens over the course of months, instead of hours.  Is there anything that's been happening in your life that could contribute to unexpected volume changes?  I'd guess that, after nearly half a century, you'd be so accustomed to NOT changing volume that you might not even recognize a change in volume unless you really sat down and thought about it.  Does that sound possible?

Well, I still think I notice changes in volume. I'm staying off the leg today, I tried adding a sock yesterday, and it felt better, but I found that it got sore again, so I wasn't making contact, I did get a little blood, so adding socks isn't the answer. I still swell a little at night even after all these years. You might be right about things happening in my life creating a problem with this, I first got sore three weeks ago after doing s project in my yard, and perhaps I've been trying too many fixes, maybe I just need to go back to where I was before this, and stop trying things to remedy this, like the sock thing yesterday. 

Share this post


Link to post
Share on other sites

Well, I haven't walked with the Harmony since Friday, been on crutches, but using my 20 year old PTB leg for balance, I didn't feel stable without a leg there to bolster me. I'm going to Hanger tomorrow to see what he can do, but I also have a letter from the VA requesting a new socket. I hope tomorrow I can once again use the Harmony, I'm hoping the cracks in my old liner were the cause of this issue. Oh, and by the way, be careful using a topical antibiotic ointment, Mupirocin, I got one of the same side effects I got from an antibiotic pill I took last year....not pleasant! LOL!

Share this post


Link to post
Share on other sites

Hope things went well with your Hanger visit.  This whole liner/socket sounds like a set-up that might be better off just being recast and replaced.  I had one socket in my life that was simply a disaster right from the start...we made dozens of adjustments and tweaks, and it never was right.  We just kept at it until my insurance decided that enough time (a little over a year) had passed and they authorized a complete recasting and new socket. 

In my case, a big part of the problem was that I was just feeling generally overwhelmed and depressed at the time, and I was just too darned tired to bother talking to my leg guys about yet another socket.  "You're the experts...just make it work" was my attitude........and I paid dearly for that!  Once I got my head back on straight and started communicating again, the replacement socket was a success.

So hang in there and keep at it until you get a leg you can wear and walk in comfortably!

Share this post


Link to post
Share on other sites
On 11/12/2016 at 1:09 AM, cherylm said:

Hope things went well with your Hanger visit.  This whole liner/socket sounds like a set-up that might be better off just being recast and replaced.  I had one socket in my life that was simply a disaster right from the start...we made dozens of adjustments and tweaks, and it never was right.  We just kept at it until my insurance decided that enough time (a little over a year) had passed and they authorized a complete recasting and new socket. 

In my case, a big part of the problem was that I was just feeling generally overwhelmed and depressed at the time, and I was just too darned tired to bother talking to my leg guys about yet another socket.  "You're the experts...just make it work" was my attitude........and I paid dearly for that!  Once I got my head back on straight and started communicating again, the replacement socket was a success.

So hang in there and keep at it until you get a leg you can wear and walk in comfortably!

I'm still having trouble with this, and am beginning to think it's a fungal issue like athletes foot. I do perspire a lot in my liner. I didn't use the prosthesis for 6 days, I was using an old ptb, not walking on it, and it was a lot better, I then got back into the Harmony, felt good for a day and a half, then, right back to square one. I am getting a new socket, was cast for the liner Wednesday. I'm using my previous Harmony leg, but I still have the "burning" and maceration and some drainage on the bottom.  I've always had off and on drainage like stains on my liner. Any ideas what I can use on this? My dermatologist recommended Desitin, but, that makes a mess in my liner. Oh, and any suggestions for removing stains from my urethane liner?

Share this post


Link to post
Share on other sites

Okay, over a month and a half now with this issue, in the process of getting a new socket made, had the cast for the liner two weeks ago, have to go Wednesday to cast the socket around the liner. I'm beginning to wonder if the soreness I'm experiencing is coming from the urethan liner, Thinking back, I have always had some skin issues on the distal end of my stump since using the Harmony, things like an occasional burning sensation when the liner is on. I think I'm going to try and wear a sheath inside the liner and see if that helps. I'm also wondering if my stump has changed gradually, and if so, a new casting might be the thing. I thought this had come on suddenly, but thinking back, over the past year, I have had some issues on the end, I know it the liner sticks to the distal end, even if I use the lotion OttoBock sends with a new liner, Hmmmm? Anyone have thoughts on the urethane connection?

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

×