Alpha Liner Problem--Responses

Alpha Liner Problem--Responses

Many thanks to all who replied to my Alpha Liner problem. Stated below is
the original post with replies following.

Fellow Practitioners,
>
> I have a 50 y/o active congenital B/K patient who I
> have tried to use 3mm
> non-locking Alpha Liners with over the course of
> about three months. She
> loves the comfort they offer, but after moderate to
> high activity or during
> warm weather, the Alpha will actually slide down
> her thigh and begin
> bunching up w/i the socket. This is obviously due
> to perspiration, which she
> can attest to. She has tried a plethora of
> anti-perspirants in an attempt to
> alleviate the problem: Dial, Suave, Arm & Hammer,
> and Mennon, but to no
> avail. Has even tried Goldbond talcum powder, and
> J&J Baby Powder with and
> w/o corn starch.
>
> The liner is used in conjunction with a pelite liner
> and laminated socket
> with standard PTB trimlines. The Alphas (size
> Medium) fit properly--I even
> had to customize them due to being excessively
> tight. The prosthesis is
> suspended with a Juzo sleeve. Her residual limb is
> mildly conical, bony
> anteriorly, and 4 inches in length. The Alpha is
> cut 4 above the socket
> wings. No air becomes trapped w'/i Alpha that I am
> aware of.
>
> I have resorted to using Silipos gel socks which do
> work, but given she likes
> the comfort of the Alpha liners better, I am trying
> to come up with a
> solution.
>
> Any suggestions?
>
> Paul Rieth, CPO
>

REPLIES:

  In my practice, your patient would be one of just a few that has a
perspiration problem. The antiperspirants usually resolves their heat and
sweating problems. The worst, during the day, she has to remove her system
and dry her residual limb. In the old days, all the system were very hot and
sweaty. As I, you are most likely providing more comfort, which I believe is
98% of what we do.

Part of your problem could be your shorting the length of your silicone
insert. I usually try and have my patient maintain the entire length and
height of any silicone system. I have fit Iceross, Alpha, Tec's, and now back
to Iceross Comforts. The increase length my not stop the heat, but would help
reduce the slipping of the silicone insert distally.

I hope this is helpful.

Jake C. P.

It could be the method of suspension that you are using that is contributing
to the problem. A suction suspension with a one way valve in the socket
combined with one of the many suction type suspension sleeves may help..Mike
Domenicucci CP

I believe the Juzo suspension sleeve is permeable to air. Try a suspension
sleeve that isnt- like the ALPS EZ liner. Do you have a one way valve in the
socket? These things don't necessarily prevent sweating but might provide a
tighter fit keeping the Alpha up. Some say that if you reduce the amount of
air in the socket you can reduce the moisture and sweating.
Mark Benveniste CP

If you read the Alpha liner guidelines carefully, you'll note the mention of
Alum as an antiperspirant. It is found in some pharmacies and most health
food stores. If you still cannot find it, I'll gladly sell you some. I buy
it wholesale!
It comes in a solid stick format, spray and roll-on as well as powder.
I give this to all of my clients and they love it without
exception.......................
Tony van der Waarde CP(c)

you may want to try an Alps as it rolls over the edge of the socket to make
a seal and cant roll down

the liner is thicker and the end pad absorbs a lot of the shock to the end
of the limb making it a LOT more comfortable that the Alpha - I speak from
experience on this

there is not one single amp that I know - and I know hundreds - that does
not have some sort of problem with the liners but would rather stay with
them because they are better than the alternative
Kimberley Barreda

Sounds like your socket doesn't fit well and/or the Juzo suspension sleeve
allows
too much vertical travel. I would try her with the alpha sleeve, they create
a
suction effect rather then relying on mechanical suspension. Had a similar
situation, turned out to be a socket that became loose through atrophy
Hope it helps
Morris Gallo, CPO

I had a phone call from a patient yesterday who was going to fill a
prescription for Dri-Sol through her local pharmacy. As I understand it,
this antipersp. is Rx only. I don't know how it's working out for her but she
seems to also have a difficult time with perspiration.

Karen

I have an AK true suction patient that had gotten an Rx for stay dry
which works well for him. He does not perspire at all now on his residual
limb.
Good luck,
M. Britt Spears CPO

 I too have had similar issues with a few of my active patients. The bottom
line
is that the synthetic gel (or mineral oil gel) in the Alphas
are not adequate to cling on to the skin with any perspiration, locking or
nonlocking, both fail. If she can tolerate silicone, change it to
a comfort liner or an affinity liner, or any other of the genuine silicone
liners.

Chad

How about Drysol??
Vikki Stefans, pediatric physiatrist

could she use a locking system & do away with the pelite liner ?
if nothing else this will reduce the heat factor as she could also do
without the juzo sleeve
i am not a fan of alpha liners in general but if she likes the comfort
then you may have to stick with them
good luck - Heather.

I have had the same problems with the Alpha's and exhausted every idea that I
could think of. I switch the patient to the TEC liners with a distal pin and
a RMB. The patient is very active, short fleashy B/K. She has been on this
set up for 3 months and she loves it. We ended up with 2 liners and she
keeps one on ICE and changes liners after 6 hours. We also tried the Otto
Bock Gel liner and gave up after 4 liners in 2 months, Otto Bock was great
about giving us new liners at no charge but we could not keep up with the
ripping and tearing.

Good Luck

Pete Abbott, C.P.

You might try converting the existing socket to suction. Idea being
distribution of suspension forces throughout the RL and thigh, rather than
just the thigh. This may help with the distal translation tendency of the
thigh section of the alpha. I have had good luck with TEC's expulsion valve
(it's also quite cheap!), and the Alps easy sleeve. If your coupling system
allows you to drill completely through the distal end of the socket and into
the pylon, the valve will be protected and invisible. If this isn't
possible, locate the valve as close to the distal end as possible. Also,
you will need to put a small hole in the distal end of the pelite liner to
expel air. The drawback of the alps sleeve is durability. Provide two.
You might consider adding 1/8 pelite externally on the trimlines to protect
the sleeve. Be aware that you will have quite a lot of bulk around the knee
with these mods! Make her aware of this to cover yourself.

Good luck!

Barry Jones, CPO

I think the problem is in part due to the liner being so thin. I use a
9mm Alpha and have never had this problem. I also use the liner direct
onto the skin and direct against the inside of the glass/acrylic socket.
I never have to use socks of any type, perhaps in part due to the
spring against volume changes the thicker liner affords.

The thicker liner is substantial and stable. The thicker liner also
requires no other liner supplement, such as Pelite. Friction with Pelite
plus a thin liner may be moving the Alpha. As for heavy activity, I
especially like my Alpha because it tends to stay with my skin better
than silicone or other liner materials.

I use alternately an Ossur Comfort Plus silicone liner. Much better than
the old, thin Iceross. It slides on my skin much quicker during sweaty
activities, but is fine otherwise. Hope this helps.

Chris (CJ) Johnson, Director of Engineering,
College Park Industries, Inc

Have her talk to a dermatologist about the perspiration problem or any doctor
for that matter. Have her ask for a prescription for Xerac AC, aluminum
chloride hexahydrate in anhydrous ethanol. It is the active ingrediant in
most anti-perspirants and being an Alpha liner user myself I know it will
stop the problem.


                                                Good luck,

                                        another amputee

                Wayne Dees

May I also suggest that you use a thicker liner and I would suggest
the medium-plus size. This size will give a little more room on her
thigh and make it less likely to slide down when it gets wet. We do
not suggest the use of the use of powders inside the Alpha Liner as
they will destroy it. I would suggest that you consider at least a 6mm
liner and depending on the shape of her residual limb you might
need a contoured or tapered style. If you care to call me at The
Ohio Willow Wood Company (the manufactures of the Alpha Liner.)
I will be happy to go over her measurements with you and help you
decide on the best size. May I also suggest that you try and attend
one our hands on seminars on the Alpha Liner as it will help you
much more than you would think in fitting and dealing with the
problems that you describe. Also, we have prepared a Video that
covers much of what you ask and would be happy to send you one
at no charge if you would like. (the seminars are however, much
better than the Video.) I hope you will call and we can talk as one
prosthetist to an other about this case.
Raymond Francis, C.P.
Chief Prosthetist
The Ohio Willow Wood Company

I have had patients with similar problems use Drysol effectively. This is a
prescription antipersperant that is applied at night. It has a cummulative
effect and should be tried over a period of weeks. I have had one
individual who developed an allergy to this, but for the others it has
worked great. Good Luck!
Wendy Beattie CPO

Have you tried leaving the liner longer on the thigh?

Steve Hartness, CP

We use Alpha cushion liners on a regular basis,but include a one way
expulsion valve(usmc) in bottom of socket in conjunction with a sleeve
suspension. Making sure the sleeve fits approx2-4 inches above the alpha to
create a seal on the skin. This has worked excellent for u our patients and
virtually eliminates pistoning and may help with your problem.

Glenn Wilson CP(c)

While I'm not a professional I am a b/k amputee around the same age - I had
a similar problem when I switched to a silicone liner. I tried almost
everything with no luck - I then tried a product called DRYSOL and this
seemed to work for me.