Otto Bock / Harmony System??

[cherylm]

There are always innovations in the world of prosthetics...in some ways you can say that this is a "golden age" to be an amputee. My own "state of the art" system from 2013 is now becoming quite out of date. my specific pump is no longer being manufactured...there are much smaller and quieter ones available.

I have a friend who has been a major fan of prosthetist Scott Sabolich in OKC. (See mitchee's comments, above: that prosthetics practice is truly cutting-edge and draws amps from literally ALL OVER. As in "all over the world.") Anyway, my buddy just wants to be sure that he has access to whatever is considered "the newest-and-bestest gear in existence. The last time I spoke with him, his "newest-and-bestest" was a suction system suspension featuring a pump that was built into his foot. No visible pump at all. No noise. Yeah...there have been massive changes in four years.

Now for your situation. First of all, if you're thinking about a suction system, have a good long talk with your prosthetist about a couple of matters. First, the actual activities you're hoping to get back to and any stresses those activities might put on the components of your prosthesis. In particular, anything that might puncture your suspension sleeve. A tiny hole in the suspension sleeve can completely disable the advantages of a suction system; you can't maintain suction if air can get into the system.

Secondly, ask how much post-op shrinkage you might be facing over the next few months and the odds of a suction system working well during that shrinking process. You've probably been told about the post-op shrinkage issue...but I can guarantee you that it will be more of an issue than you can imagine during your early months. A non-suction (read: pin-lock) suspension might be a more viable solution until the shrinkage stabilizes.

Then, be willing to listen and try out any variables your leg guy suggests. You have to start from somewhere, and in some cases your "ultimate" leg may be something you need to work your way up to.

Finally, just a word of warning. In the beginning, whether you're in the classroom or out on the field, make sure you have a place to sit down when needed. I know plenty of amps who work on their feet all day, but it takes building up to. A spot to rest, even for just a few minutes, can make a big difference in your endurance level. Remember--and I'm VERY serious about this--the "macho-push-it-to-the-limit" mindset can cause injuries that will set you back weeks or even months. Slow and steady will do you much better in the long run. You're basically trying to teach your remaining limb to be a foot and bear weight in ways it was never intended to. Give it some time and consideration in making that adjustment and you'll be happy in the end.

[bassett]

Thanks Cherylm. I have been reading quite a bit about the socket systems and their pros and cons. I feel very good with the 2 prostetists I am working with. Ryan Fann is closest to me, practicing out of the Mobile Institute in Savannah, GA. This is his own small setup where he is the owner operator and he works with the vascular surgeons in his building. Ryan is an ex paraolympian and runs the Blade Runner nonprofit organization fitting youth and prospective track athletes with high end running prosthetics. He is a friend of a friend. I coach track at Statesboro High School, its close to Georgia Southern University. Their track coach is Coach Carter, who was Ryan's para track coach for the USA team. And Coach Carter's track is getting repaired this season, so he is using my high school track to practice. I say all of that to explain that Ryan and I have developed a friendship through sports and amputation. He understands the activities that I will need to be able to sustain to be a productive track coach. So he is my sounding board. My actual prostetist is Steve Ehretsman, founder of Shamrock Prosthetics in Athens, GA. He was the captain of the Boston University basketball team back in the 90s, pre amputation. So he is approaching my case with sports in mind as well. The great thing about Shamrock is that they travel to you! So my fittings and adjustments will be in my house. He has a mobile lab that he takes on the road with his team. I'm using him because my surgeon, Charles Ogburn, has become like a brother to me and he highly recommended Shamrock. So, I have a good team and we are looking at all the new tech mixed with what my daily use will entail. My stump is huge right now. Only 6 days post-op and haven't fitted a shrinker sock yet. And, I read in another thread you posted on about cold stump problems. Mine is frezzing!!!! Thanks again for your advise.

[cherylm]

It does sound like you've got a great team, and having some history and background friendships should do you well. It can be a real advantage if your medical guys and your leg guys know and like each other and are used to working together, too.

Now for that freezing stump....does anyone in your family or social circle knit? If so, take some measurements, buy some nice warm yarn, and ask them to knit you a "stump warmer." I'm serious! Mine looks ridiculous...kind of like a rugby shirt for my left leg, with BOLD stripes, but it sure feels good when things get cold! It's basically a snuggish cone-shaped garment with a loose drawstring around the top. you can wear it either on its own or over a shrinker or stump sox.

[bassett]

That is hilarious! No one in my family knits, but my mother would take it up as a hobby if I asked. Hahaahah

[oneshop]

bassett. Like you I am bumping into this thread that seems to be pretty old. I have been using the Elevated Vacuum system with Harmony pump since 2013, although Im in need of a new socket I have had the same socket since March 2013. Yes, this system does have some downsides to it but It also has many upsides. I will agree, the liner is difficult to put on unless you use a substance such as jelly or odorless lotion which can be bough at your local walgreens. I usually but the large bottle and spray some lotion on the outside of the leg turned inside out, then slide the liner on and from the bottom to the top squeeze any air bubbles that may be there. Also, I have a custom made liner, I'm not sure if everyone uses custom made liners but after going from off the shelf liners to custom I never want to go back. Before putting on my liner I apply some aquaphor lotion to my residual limb which helps maintain the skin healthy and helps against creating friction. This system does take some time to put on in the beginning but after a while its pretty easy and worth it. It takes me about a minute or less in the mornings, I never take my leg off until Im ready to shower or go to bed, it doesn't hurt or cause any pain or irritation unlike the Pin system which I had for over a year and I hated it with passion. Some people like the Pin system because its easy and fast to put on and it also allows to bend the knee more, but those things are minimal to me since Im very active and prefer a system thats comfortable and will allow me to be on my feet all day. So there are pros and cons of to every system as you can see. Oh, another thing, If you're worried about spending so much time putting the leg on in the middle of the night to go pee, just get some crutches and clear a pathway before you go to bed. simple. :-)

[roadstarrick]

My .02 on the vacuum system I'm using...
I used a pinlock system for 5 -6 years and needed to because of volume changes. I had excellent range of motion but could not stay on it for long periods of time without pain/discomfort. During that time I had 2 different sockets to accommodate the change in limb size.
In January 2016 I wore my first test leg home using the Ottobock Harmony system. It took a long time before I could get to the stage of wearing it home because of so many intricacies in fitting. But my prosthetist and I persevered and got it going. A test leg is heavy. The thickness of the material, which is somewhat brittle, adds to the weight. For a short time I tried the manual pump, a P3 I think, but then got the E2 electric, battery powered, pump. 
After wearing it for a few months, and returning for a lot of fit adjustments, I experienced a huge loss of limb volume. I was wearing so many socks the thing could barely work. So I got a new socket fabricated and it was thinner and lighter this time, however still brittle. Within the first week it cracked. My prosthetist had a new one made but with the original thicker material. Again, this is still a test leg but with my volume change it was not as heavy.
As a result of the fit and lighter weight I started jogging some at the gym and even took a couple of tennis classes. I jogged and played tennis before my accident. There was essentially no pain from the socket. The only problem with the fit was perspiration. It was bad in the pinlock sleeve and equally bad in the vacuum sleeve. There's just nowhere for that moisture to go.
A year and a month later I got my final leg. This was the carbon fiber leg which was VERY light in weight and supposed to be very strong. It's still comfortable, but I have continued to have the problems with skin irritation that most amputees probably deal with. I do believe the vacuum is kinder to my skin than the pinlock was however. My leg size is stable and the biggest problems I have is with vacuum loss. 
I now have 2 custom liners $$$, and a drawer full of faulty sleeves. My prosthetist told me the sleeves were the weakest part of the whole thing and I have to agree. They cost $145 each and are supposed to last 2 or 3 months. I don't get 2 months of use and I don't do anymore jogging, tennis, or anything that would seem to stress them to that failure point. For the past month I can't find anything to sustain the vacuum but I have people working on the issue. New sleeves, new pump, still no vac. I change batteries all day, every day. I am hopeful that when this problem is solved things will stabilize. Bottom line, I still like it and have hope it will get fixed!
Also, it only takes me about 4 - 5 minutes to get the leg on unless I'm also dealing with some skin issues. Not as fast as the pinlock but not a reason to avoid the technology in my opinion. With that said however, the outer sleeve goes so far up your leg you cannot really adjust anything without a private place to take care of removal and donning.

[cherylm]

While my CPO and I have been working on my latest "post-revision" socket we've been chatting about new developments in the industry and what might be in my future. One of those new developments (and I have NOT seen this one in person yet) is an elevated vacuum suspension that does NOT need a sleeve to hold everything together. My guy has just fitted his first one of these systems, and he's promised to keep me in the loop on how it holds up. I don't mind wearing a sleeve after spending so many years in one, but it's tempting to think of not needing it any more.

For folks who wear out a sleeve per month, this might be a dream come true!

[slip2117]

I've tried an elevated system. I went from sleeve vacuum and stump changed shape so we tried the elevated and it was great. We are ending up having to go back to sleeves because I had a revision and since my shape is odd (distal tibia and fibula are extremely prominent) we are going to custom liners. Unfortunately the elevated system doesn't support custom liners so back to sleeves. Not a huge deal but it was nice stepping in and going versus rolling up. I love the vacuum system though I've never done pin and lock. I'm fine with that, why change a good thing.

[cherylm]

Well, here's a frustrating little update on my post-revision-surgery prosthesis. With my incredibly short residual limb, I've been wearing an off-the-shelf hinged knee brace over the prosthesis while working on trying to strengthen all the surrounding muscles to hold that knee erect with only four inches of leverage below said knee. THIS HAS NOT BEEN WORKING.....(sigh.....) In fact, the off-the-shelf brace is mostly damaging my sleeve, which now needs to be replaced, because it's no longer holding suction. After I've been up on the leg for a few hours, it starts making lovely "farting" sounds, air bubbles start percolating, and if I can't sit down and re-donn the leg almost immediately, the leg falls off. Yeah...THE LEG FALLS OFF. Sooooooooo........back to the wheelchair AGAIN while we wait for new sleeves, a new liner, and an authorization from my insurance to add a permanent custom-made knee brace as part of the leg to hold me upright.

Meanwhile, I've been doing just about EVERYTHING that I caution new amputees to avoid. Pushing too hard, setting strict calendar-based goals based on nothing but a whim and a prayer and then getting mad and depressed when I don't meet the goals (even if I've made noticeable progress toward a goal), sitting around home alone and feeling sorry for myself...you name it, if it's a bad decision, I've made it. The only "good" thing I can think of that might come out of this is--maybe--it's giving me a good reminder of what it's like for a new amp.

I do still like my vacuum suspension system (until the leg suddenly leaves me!) and I'm hoping that we'll be able to pull together SOMETHING that works on that front. It's weird....when I was wearing a pin-lock suspension I really didn't mind it, but now I'm not sure if I want to go back to that suspension for the security's sake...mostly I just want to hold suction again! Sorry to unload on you guys...if there's anything in this little rant that gives you some insight into suction legs, please let me know!

[slip2117]

Oh, the farting sounds, ha ha ha!!! Sorry for laughing but I get those sometimes and yes, it can be a little embarrassing when someone eyeballs you thinking you dropped. Especially if I wear pants and they don't know I'm wearing a leg. Though, it can be good for a laugh. Sometimes I look at my kids with a weird look and say loudly "gross". I'm Minnesotan by the way so I really accentuate my o's. When the sleeves get stretched or liner is worn I've noticed it happening more. Or if my shape has changed. In that case I'd throw a 3-ply on.

As for the knee brace, I have a patella tracking disorder in my knees. My prosthetist took a small piece of hard padding and glued it to the inside of my socket to keep the knee cap on track. After a couple of test sockets we ended up flaring that part of the socket to compensate for the pad. Works really well and saves on liners. I don't know if your situation is similar but might be worth a conversation.

As for the secured fit, I've only known vacuum but have had the feeling of falling out a couple of times. It sucks!!! Nothing rattles my confidence more than that feeling of not being secured. Last year when I first got my leg I went to an amusement park here. One of the rides was one where you sit and your legs dangle. Being a new amputee I thought no problem. Scariest ride of my life. And no point did I lose suction but it felt like it at times and I was terrified.

I did try the elevated system and really liked it. It was definitely a more intimate fit and I really felt secured in it. Though there were times where I would lose suction but I just needed to throw a sock on or adjust how I'm seated. But since the revision, and stump changes, I'm going to custom liners so elevated system is out and back to sleeves. Bummer, but not the end of the world.

I did way too much in the beginning as well. Suffered skin breakdown, sores, and just overall very uncomfortable at the end of the day. It was nice my surgeon explained to me pretty well what to expect activity wise post amp. He wanted to make sure I understood what was a reasonable outcome and what wasn't. Not too much disappointment except for a couple of falls on my crutches.

[keano12]

Mar 19, 2017 13:38:44 GMT -7 bassett said:

I'm bumping this old thread because I found it while searching for reviews if Otto Bock EMS vacuum systems.

So, this thread being 3-4 years old, my question is; has the research and design of the newer vacuum systems solved the old problems of long donning time periods, hard to get on because it's so tight, "eating" away at the skin and creating blisters?

Thanks for any info guys. I'm 4 days out of BKA and really trying to figure out the best setup for my lifestyle. I'm a football and track coach and a science teacher. So I'm on my feet from 7am to 7pm 6 days a week usually.

I had a harmony system and when it worked it felt great. Secure. But it failed more time then not. Punctures to sleeve and sometimes vacuum not as tight as it should of been. It was hit and miss. Another thing was sometimes I had to realign the sleeve so would pull my down to get it right again. Which is a pain depending where you are. At the moment I wear a Seal-In® X5. Has pros and cons as well. Nothing is perfect. 

A lady at Ottobock is saying I should go for the harmony try again or new Seal-In® X5. When home I sit down and pop off the socket. Easier to use.