Has this ever happened to you?
You're standing in a public place -- let's say a bank, maybe even your new bank branch, and maybe it's the first time you've ever been in there -- and you're chatting with someone -- let's say the teller, and let's just suppose, arguendo, that this teller is young and attractive and that even though you're old enough to be the teller's parent and have been in a stable, committed, satisfying, and monogamous relationship for over a decade some part of you still wants the teller to like you, maybe even to think you're both cool and a little hot, you know, for an old person. You've been leaning up against something -- oh, I guess the counter in front of the teller's window -- exchanging pleasantries and laughing and, incidentally, putting most of your weight on your organic leg, not your amputated one.
Everything is going great. You like everybody and everybody likes you, even the people behind you in line. You turn to leave with a big smile, and suddenly, as you step onto your prosthetic leg, -fwATTTT!- your (perhaps flabby and middle-aged) stump ripples with friction while forcing air out the top of your socket. You know what this sounds like. You have not in fact done what this sounds like, and to prove it, no hideous smell ensues. Nevertheless, you flush as red as you possibly can and stammer to no one in particular "Oh, uh, sorry, uh, that was my leg," which is the elephant in the room which everyone has been ignoring and which you often forget tags along with you until someone else mentions it (or until all on its own it does something like this). Then you leave as quickly as you can, meeting no one's eye, and maybe you wonder how you can get away with never returning to this establishment, and maybe as you flee you even grab a brochure from the vestibule which lists all the other branch locations.
Here's another one that may seem familiar. It's summer, and you're wearing very few clothes. You're in shorts, a bathing suit, or a light breezy skirt and going about your business all footloose (so to speak) and fancy free, when suddenly you realize you're making unaccustomed noises, and that everyone around you -- even friends and neighbors who are obviously pretending not to notice -- can hear it too. You sound like this: step, phlurrTT, step, phlurrTT, step, phlurrTT. It's not just farting; it's wet farting. But it's not coming from anywhere stinky or nasty. It's just your leg, yet you just can't point it out to everyone and then explain it with every step in every venue -- even though that's just what you find yourself trying to do.
What is a person to do? How can you avoid this kind of embarrassment?
Well, my friends, I have good news. Thanks once again to the makers of all-natural feminine hygiene products, you may never have to experience these kinds of incidents again. Here's why:
Your stump and socket will make mortifying music together whenever the following conditions exist:
- your stump moves excessively within your socket
- an excessive amount of moisture (sweat and/or lubricant) is present in your socket
The first condition occurs either because of the second condition or because your socket has grown too loose, sometimes both.
There are acceptable degrees of moisture. You're supposed to sweat; it's very, very bad for your skin and even for your body at large to suppress sweat. Some amputees try by applying antiperspirant to their entire stumps. I don't recommend this. Antiperspirant really isn't that great a substance to be putting in your armpits, let alone elsewhere. We all use some form of deodorant, just so we can spend time together without offending each other's nostrils. Some of us resort to antiperspirant as well to avoid unsightly wet spots or outright staining of clothes we can't afford to wear once and throw away. However, antiperspirant is not exactly nourishing to the skin or easy on the lymph system. Many of its common ingredients are allergens for many, many people, and others are even believed to be quite dangerous.
Depending on your circumstances, you may also decide that there are acceptable degrees of looseness for the fit of your socket. Unless your stump is all muscle (unlikely since amputation usually causes certain muscles to become disused, atrophy and shrink), and assuming it's been a long enough time since your amputation that all the swelling it caused is long gone, your stump is not exactly solid. (I liken my own to a loose sack of meat with a stick in the middle.) It is likely to change form at least a little bit every time you move or change position, and unless you've just been to the prosthetist recently, the socket probably doesn't fit the stump like a glove every minute of every day. If it's summer or you're an athlete, a lot of sweat is going to encourage your socket to move a lot more. If you're a woman still of childbearing age, especially a large woman like me, you might also find that you -- including your stump -- are a different shape every day of the month as you gain and lose water. So although our prosthetists are correct in telling us that the most intimate fit possible is highly desirable, unless you have the unimaginable (to me) amount of time and money necessary to work with your prosthetist to create tools to accommodate every discreet change, it is practical to expect that some days your socket is going to fit you better than others. This is just a fact of life.
To deal with the sweat problem a little bit in a fairly unintrusive manner, I have previously suggested applying winged panty liners (or very, very thin pads) to the lip of your socket. Although this only blocks some of the sweat which can accumulate and cause problems, I limited the application just to the lip of the socket in order to avoid encouraging people to stuff things into their sockets, which is usually a bad idea. (These ain't toe shoes, people.) However, even though my socket fits me well enough, the belated onset of our warm, moist summer got me a little desperate, so I was forced to reexamine the problem.
I studied my stump and my socket and determined that most of my sweat was coming from the back of my thigh. I already had a Natracare Ultra Pad with Wings applied as described elsewhere. I peeled another one and opened it up completely, then pasted it into the inside back of my socket, vertically. The liner/pad is so thin (about 2mm when not compressed) that I was able to slip my socket right back on and go about my day. Unfortunately, while the problems of both sweat and sound were reduced, they were not eradicated. So the next day, I applied a third pad, again totally peeled and fully unfolded, only this time pasted into the inside front of my socket vertically.
This, my friends, has done the trick. I've gone a whole week this way, and not only do I have far, far less pistoning movement of stump in socket (which means dramatically less discomfort of many kinds), but the movement I do have is painless against the soft cotton and paper of the liner pads, virtually silent, and never offensive or embarrassing in any way. The already thin pads compress even further under the pressure of my flesh against my socket, while all the time absorbing sweat. Since they are all-natural, they have no nasty layer of some kind of plastic "leak guard." Therefore, I experience no allergic reactions, and my skin continues to sweat and breathe naturally, like it's supposed to.
First, carry extra pads/liners with you. Depending on how much you sweat, you may want to change them as often as every three hours. (I usually change mine every four to six, depending on when my bathroom breaks arise.) These puppies soak up a lot, but even they have a limit, and you don't want your skin sitting up against not exactly sterile wads of moisture.
Second, I really do not recommend using any kind of liner or pad which is not made of completely natural, undyed, biodegradable materials. It's not just about the planet, though I'm all for that, too. It's about your health. What might work great to protect your undies during your period might not be so good up against your skin, stopping air and moisture from flowing naturally and adding yet another layer of heat retention inside your socket. To visualize what I'm talking about, think about how much more you sweat in a polyester dress vs. a cotton one. Then think about which one you'd prefer to wear inside a skin-tight Tupperware container. See what I'm saying? You really don't need any extra plastic in there.
Another thing: You will have to personalize this technique a little bit. I am tall, so having two thirds of my leg amputated still left me with a relatively long stump, about thirteen inches as the miniature crow would fly from the bottom of my butt to the furthest point distal. The liners/pads I am using to combat sweat are about 8-7/8" in length. I'm also large in other dimensions. Suffice it to say that two pads completely opened up do not exactly cover every bit of my stump, not even half. This is important because I have a suction socket, which means that it stays on by forming an airless seal against my skin. In spite of my prosthetist's goals, it really is impossible for any firm carbon fiber or plastic socket to form an airless seal against all of my skin because of all my previously described shape-shifting characteristics (which is why I also rely on a fantastically good silesian belt I'll review in another post), but there still needs to be enough uncovered skin available, especially over the last third of my stump at the end, near the valve, for the socket to stay sucked on every time I lift my foot and kick forward to take a step.
The same is probably more or less true in some way for you, too, though your type of socket and amputation may include other considerations. However, we are unlikely to be of the same size and shape, especially if more of your limb was amputated. Fortunately, because these pads are thin and made of soft stuff, you can just cut them to fit your own needs. I recommend going about determining the appropriate sizing the way I did, by starting with a little and working up gradually -- whatever that means for you -- until your baseline needs are met.
Finally, please remember that I am only advocating the application of a very small amount of thin, absorbent material to the lip and sides of your socket. Under no circumstance (except the advice and supervision of a professional trained and licensed to help amputees successfully wear prosthetics) should you stuff things into the end of your socket. If you are experiencing some kind of problem other than sweatiness that makes you want to do so, you should contact your prosthetist. Otherwise, you can injure yourself. Likewise, if your stump still moves around a lot in your socket, even after applying liners on two inner sides, your socket is probably too large and you really need to make an appointment for an adjustment. Again, in real life, there are acceptable degrees of variance which a few simple adjustments here and there, from time to time, can make perfectly comfortable. (I suspect that people who use lanyards and socks instead of suction sockets know all about this.) However, if you cannot make yourself perfectly comfortable without significantly more effort than I've suggested here, you should consult with an expert who can help you devise a real and lasting solution.
Good luck, and do let me know how this works for you.