What Every New AmputeeNeeds to Know with John Hattingh

In this episode we welcome prosthetist, John Hattingh, of Prosthetic Care of Virginia to the show. With 45 years of experience, John and his team create some of the most technologically advanced prosthetics in the world.  From customizing hip and hemi prosthetics,  myo and neuroelectronic arms that feel objects and temperatures through sensors, to osseointegration that truly rivals Hollywood cyborgs. Tune into this episode to learn more about Prosthetic Care and what every new amputee should know!  See links below for images.

To Connect with Prosthetic Care of Virginia:

Website: https://www.prostheticcarefacility.com/
Facebook: https://www.facebook.com/prostheticcarefacility
Amputee Support Page: https://www.facebook.com/groups/AmputeeHelp
Neuro prosthetic image:  https://images.search.yahoo.com/search/images;_ylt=A2KLfSwov1Bg9KEAB3NXNyoA;_ylu=Y29sbwNiZjEEcG9zAzIEdnRpZAMEc2VjA3Nj?p=graphic+of+neuroelectronic+prosthetics&fr=yset_ff_syc_hp#id=4&iurl=http%3A%2F%2Fmedia.ottobock.com%2Fprosthetics%2Farms%2F_general%2Fimages%2Fabove_elbow_tmr_prosthesis_graphic_16_9_teaser_onecolumn.jpg&action=click
Osseointegration image 1: https://images.search.yahoo.com/search/images;_ylt=AwrEze1MvlBgYAEABLFXNyoA;_ylu=Y29sbwNiZjEEcG9zAzIEdnRpZAMEc2VjA3Nj?p=graphic+of+osseointegration+prosthetic+connector&fr=yset_ff_syc_hp#id=16&iurl=https%3A%2F%2Fmedia.springernature.com%2Flw785%2Fspringer-static%2Fimage%2Fart%253A10.1007%252Fs11999-014-3695-6%2FMediaObjects%2F11999_2014_3695_Fig1_HTML.gif&action=click
Osseointegration image 2: https://images.search.yahoo.com/search/images;_ylt=AwrEze1MvlBgYAEABLFXNyoA;_ylu=Y29sbwNiZjEEcG9zAzIEdnRpZAMEc2VjA3Nj?p=graphic+of+osseointegration+prosthetic+connector&fr=yset_ff_syc_hp#id=23&iurl=https%3A%2F%2Fimage.sciencenordic.com%2F1397253.jpg%3FimageId%3D1397253%26width%3D353%26height%3D265&action=click

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Transcript

Intro: 0:03

Welcome to DisAbility Talks, a podcast produced by Abilities in Motion. I'm your host, Shelly Houser. Join us for real conversations and no nonsense. Talk from everyday people with disabilities, living their most independent everyday lives. Tune in for the latest news surrounding disability, accessibility and independence, where conversations aren't dissed and stories that need to be told aren't missed. So let's talk.

Shelly: 0:28

Welcome back listeners. I'm your host Shelly Houser and today's guest is prosthetic genius, John Hattingh, who's originally from South Africa. John and his team now reside in Leesburg, Virginia, where they create some of the latest technologically advanced prosthetics at Prosthetic Care of Virginia. Good day, John. Thanks for being here with us.

John: 0:48

Good morning. Thanks for having me.

Shelly: 0:50

Absolutely. Now I need to start with our listeners to preface that I think John is a prosthetic genius because he is my prosthetist for, I think six, six, seven years?

John: 1:10

Ten years! Yep.

Shelly: 1:10

I forgot how long it was. Okay. So I have, I have made friends through this office and we have a loving community on one of their Facebook pages to support each other as amputees. John for starters, tell our listeners more about yourself and how you got involved in prosthetics.

John: 1:28

So I'm been in the field for 45 years this year. I got my Master's in Environment, Chemical Engineering, and one of the, chiefs in charge at the research center was an amputee. And that's how I got involved with prosthetics. I did an internship in Germany and then, w ent back to South Africa. I had to go back to school in South Africa because in Germany it's a, it's a technical course. They call you a Orthopadischemiehankemeister and in South Africa you had to go to school. So al though I had already qualified in my internship, but when I went back to South Africa to go back to school, write the exams, and we have a medical and dental board in South Africa, and I ha d t o register with them before I could ac tually p ractice clinical prosthetics. We immigrated in 1990 and our port of entry was Seattle. I did research at the University of Washington and also, i n stitution called Prosthetic Research Foundation. And once that was done, I started in as a clinical prosthetist in a private facility. And we stayed there for 26 years before Michelle got sick with rheumatoid and we had to leave the very cold and wet climate. So one of the big corporations bought me and I had a continental non- compete. Aft er my non-compete had expired, we looked for a climate that was similar to Cape Town. And Northern Virginia was as close as I could get to Cape Town. But overall it's not too bad. Yeah, it's working.

Shelly: 3:19

So Michelle for our listeners is his lovely, very talented wife who has her own non-profit that she started with her equine therapy, right?

John: 3:33

Correct. Yeah. So she rescues horses and then she trains them and they become therapy horses. And mostly what she does is if one of my patients is interested in getting back in the saddle or trying to get onto the saddle for the first time, they can go over to the farm and she'll get them in the saddle and I'll adjust the prosthesis so that it can accommodate riding and she really enjoys that.

Shelly: 4:05

I think Michelle rescues every animal that needs to be rescued.

John: 4:09

No kidding.

Shelly: 4:14

So what are your most unique prosthetics, kind of prosthetics that you work with is osseointegration. And I did a little research on this thing and it seems like it's new technology for the United States, but it's been developed years ago. So how long?

John: 4:32

That goes back years in Europe. I think Invar Brennamar and R icard Bennamar's father, he did the first implant. The first implants were dental implants and the dental implant surgery is huge. I mean i t, and it w orks so well. Dental i mplant surgery has very little contra indications because we've g ot so much bacteria in our mouth that f ight any viruses that come along. And he did that 50 years ago. I mean, it's, it's been going on forever. And then R icard became an orthopedic surgeon and he was g oing t o work with his dad. And then, a b ilateral above-knee amputee from England wrote him a letter. And you know, this is about 25 years ago. She wrote a l etter to Ri card a nd said, Hey, if you guys can do dental implants, why can't you do prosthetic implants? So that's when the penny dropped. And then Ricard started doing research, t hrough his research company, c alled Integrum. And she was the first amputee that they did implant with. And in fact, she's st ill wearing them.

Speaker 1: 5:51

Okay. Explain to our listeners what osseointegration is. Because I know I have friends that have had this done, and I think you go into the surgery with the doctor sometimes.

John: 6:01

Sometimes I do. It's really not that necessary, but it's always just good to see what they're doing and what they're putting in, because then I have a better clue as to what I need to do to attach a prosthesis to the skeletal implant. So what they do is there two different thought processes. The first thought process is the Brennamar procedure, which is a two-stage procedure. So what he does is he reams the femur or the tibia or wherever they go, they ream, they tap it and then they screw the implant in with adhesive and then they close the surgery back up. And the patient normally waits about three to six months, depending on the patient's physiological c ondition. And then once the implant secures into, the long bone. Then they go back in and they open it and they either put the stoma in or the tapered sleeve or whichever system they use. And then they bring it through the s kin. And the most important part is that the soft tissue myodesis has to be done really well. So what that means is they is they have to trim all of the tissue and fat away from the skin. They have to anchor the muscle to the end of the bone and they have to anchor the skin tightly to the end of the bone. The first procedure is the Brennamar one, tw o s tage, normally a t hree to six months before between stages. Th e o nce, once th e s toma comes through the skin, then they, they have to teach that bone to do weight loading. So you don't get the prosthesis coming out of the gate. You have to do weight loading through your physical therapy department. And they started with 20 pounds. They increase it by 20 pounds every week until you can get 50% of your body weight. And if you can put 50% of your body weight through the bone and you don't feel pain or d iscomfort, that's when th e p rosthesis is attached. And that's when the prosthetic rehabilitation starts.

Shelly: 8:18

How do they attach the weight to the arm or the leg? Do they hang it off the metal rod that comes out?

John: 8:26

There's a component that we make. And it's also commercially available that attaches to the stoma. And then we, we make the weight-bearing device with this scale and then they put pressure, through that pod, into the implant and they check the scale measurement and c ontinue to stay within the way that they feel comfortable. So, so back up a little bit. So the other system that is used, that was developed by a fellow called Munjed in Australia, and that's the press-fit system subsequently quite a few other companies have adopted the press-fit system. The Dutch have adopted it, the Germans have adopted it. Munjed still everybody flies to Australia and he does it in Australia and they fly back home. The press-fit system isn't a tw o s t age s ystem. They normally do both stages within a couple of weeks. And patients are actually ambulatory within a couple of weeks post the second stage. So those are the two trains of thought. They're both efficient, they both work well. It really is just who you prefer to have it done with. The way that you attach it depends on the implant. So the Australian system, the Dutch system, they have, a tapered sleeve with a collar. And there's a, it looks like a tube cl amp t hat attaches to this tapered sleeve.

Shelly: 10:02

Once they're ready for that prosthetic, how does it physically attach to that rod that comes out of their stump? I kind of explained it like attaching your beaters to your mixer.

John: 10:15

Very similar. So this is the press-fit system. You'll see at the distal end, there's a taper sleeve and then there's a collar. And then this is the tube clamp. It looks like a tube clamp and it just attaches to that collar.

Shelly: 10:34

So that abutments about a two inch steel or titanium rod.

John: 10:38

Yeah. And then the Brennamar system uses what we call an Exor, It's a breakaway system as well. So if the patients fell, this thing can actually breaking in half and swivel and it doesn't bend the stoma that goes into the implant. And then they have a different system that comes through the skin and they call it an abutment that comes through the skin and that Exor actually attaches to that abutment. The advantages of having Osseointegration is that, you don't have any socket i ssues. And we know that that's t he, Alpha and Omega of successful prosthetics. If the socket doesn't work, the prosthesis doesn't work. And patients struggle a nd struggle And there unfortunately are prosthetists that just don't have enough experience to make a socket that works well. And therefore, this is a very good system because you don't have ever have any s ocket issues. It connects directly to the, to the skeletal system and your skin is always free of any socket environment.

Shelly: 11:53

And that's good for diabetics.

John: 11:55

It is, but in the same term, it's bad for diabetics because you always have an open wound. So you, you always prone to infections. And in the majority of failures of the system is that patients constantly had chronic infections and then they would have the whole thing removed and they would go back to a socket system.

Shelly: 12:19

That's a shame. So let me ask you something. Sometimes when people get transplants, they have to be on medication the rest of their life, because their body's trying to reject it. Is that the same thing for when people get this kind of surgery done?

John: 12:34

No, this isn't, this is like your total hip replacement or your total knee replacement. Some people are allergic to metal though. I mean, you've seen so many hip replacements and knee replacements that fail where patients constantly get infections because they, they are allergic to metal. And certainly there's a small percentage of patients that's just flat out allergic to the metal that protrudes through the skin. But in the majority of cases, if patients have a sound hygiene where they wash this in salt water every day, they, you know, apply some Vaseline to keep the skin nice and moist and soft. And, and they watch where they go. I mean, you can't go into public pools. It's, I mean, it's a bit of a Petri dish, you know, you know, stuff like that. I mean, you, you just have to be conscious of your environment. Then you can keep this thing at Bay and sure, some your patients get infections, but able-bodied people getting infections from getting a cutting and getting germs in it. So, and wait, they're going on a course of antibiotics and the infection is kept at bay. The biggest issue is when the prosthetist makes the prosthesis and attaches it to the patient, he has to be sure that there's always direct vertical loading. So he c an't get all funny and creative with the alignment by putting offset perimits on and moving the knee out. And t he, it has to be a vertical loading. If there's an alignment issue, then the patient has to correct it through muscle t herapy. So muscle toning and learning how to walk w here this implant is really most patients don't have a problem. It's just intuitive. The line of progression of the femur or the line of progression of the tibia is normally exactly what you need and everything just falls into place. The other issue is that patients c an't be super active because the stoma or the part that that comes through the skin is sacrificial. So if patients fall or they, or they jump off a boulder or t ruck b ed or something, if they land o dd, then the stoma will bend because that's the sacrificial p art and it bends so that the implant doesn't fracture the whole femur. So, so you can't be super active with osseointegration. You c an't do the running and jumping that you would have done had you had a soccer. But so what? I mean, you know, that's just, you just have to live with the limitations of the system.

Shelly: 15:24

Right. I don't think there's any one type of prosthesis that does every single thing you want your life to be. I mean, but it gets us, I think 90% of where we want to live our life.

John: 15:38

True, true. I mean, if you look at our Paralympic athletes, they have four or five different prosthetics that do different jobs. If you look at the combat soldiers at Walter Reed, each one of them gets four or five different prosthesis, one for swimming, one for cycling, one for running, blah, blah, blah. But because it's a socket system, they can do that. However, with this system, there are limitations to the level of activity and not severe limitations. You have to comprehend what you're going to do next, because the consequence can be that you end up in ER, and they have to replace the stoma.

Shelly: 16:19

So somebody with osseointegration, wouldn't be able to have a cheetah running blade.

John: 16:24

They can, but they have to understand that it's, it's purely just a linear loading. They can't do, they can't do the running and the jumping. And the thing that they wouldn't be able to do is do a Spartan race on a blade. You know, there has to be more stability in the prosthetic device to be able to do that. But then it's such a dirty environment that they most probably wouldn't want to do it because they're in mud and they do low crawls and all kinds of stuff. So it's, it's like a tough mutter. I mean, it's, that's probably not the best environment for an open wound.

Shelly: 16:59

It's just asking for trouble I think.

John: 17:00

It really is. You know? And I mean, when you choose to have osseointegration, you have to understand that those are going to be your limitation. If you want to do that stuff, then you need to stick with a prosthetic socket.

Shelly: 17:16

Well, with that, I think we're going to take a short commercial break and we'll be back to talk about myoelectronics with John Hattingh.

AD: 17:23

Abilities in Motion is one of Pennsylvania's premier Centers for Independent Living existing to educate, support and promote individuals with disabilities. Our programs are focused on providing opportunities for individuals with disabilities to live independent,self-determined lives. Abilities in Motion, advocates for local, state and national laws that protect the rights of people with disabilities. We are proud to create innovative and sustainable solutions and set trends using multi approaches towards shaping national education, employment opportunities, in-home supports and healthcare that affects the lives of individuals with disabilities. For more information about programs and services, Abilities in Motion provides Call(610) 376-0010, or visit our website@ www.abilitiesinmotion.org.

Shelly: 18:11

And we're back with John Hattingh, prosthetist from Prosthetic Care of Virginia. John, another high-tech prosthetic that you work with is the myoelectronics with electrical sensors that are embedded into patient's muscles. Tell our listeners more about how this technology works.

John: 18:27

So previous years we had surface electrodes. So the mayoelectric systems were utilized using surface electrodes. So we would do a surface anatomical and neurological tests. We will see where we get the highest milivolt to contraction of the muscle underneath the skin. And then we would coincide the surface electrode with where that muscle fires and that gave us in most cases, it was a two electrode system. One electrode was four opening, and one electrode was closing. And then we, the, the, we develop devices that could move power from one device to another. So we called it a co-contraction. So if the patient's fired both the muscles and gave both the electrodes input, then the electrode would tell the electronic device to stop the power from going to the hand and redirecting that power to the wrist or to the elbow. But everything worked off two electrodes. So then a guy called Kaican at Northwestern University developed a system called TMR, and it was short for Targeted Muscle Re-innervation. So when they amputate the limb, the nerves that used to supply the forearm and the fingers, those nerves are still there. So what he did is he took those nerves that were amputated and he reconnected them into muscle lobes into the motor neuron of the muscle lobe. And so then you would get a extra nerve input. And then we could actually go to four electrodes, but it took a lot of physical therapy because the patient had to learn to redirect the power from where it used to go to the forearm or the hand to go to this muscle. And they had to fire that muscle to be able to run four or even six electrodes. So then we would have two electrodes for the hand, two electrodes for the wrist, two electrodes for the elbow, and the patient could actually do some of the simultanious function. So previously he could only do one function at a time. Now with these four and six electrodes, he could operate the elbow while opening and closing the wrist or rotating the hand. So it was a huge improvement. The problem was this, the physical therapy to teach the patient to fire the other muscle lobes was really intensive. And in some cases, patients would have a wonderful day where everything works and the next day they would have it dead day and they could not make a anything work. So then a guy, a fellow called Max Ortiz that worked in Gothenburg in Sweden, came up with neural electrodes. So what they would do is they would go and find the main branch of the nerve. And then what he did, if you can kind of think about it, he would take an electrode and he would roll it up like a piece of paper. But what this could do is it could expand, or it could retract around the nerve. So they would, they were going to do the surgical intervention. They would open up the nerve sheath. They would put this neural electrode over that. And then the patient could choose, thought, have multiple functions. But this only work with osseointegration because what they would do is they is the electrode would then come through the middle of the stoma. And so they would then attach the arm to the stoma and then they would attach the neuro connection to the arm. And then the patient would actually have multiple function through thought, through real thought. Because they got in at the, at the origin of the nerves, as opposed to at the termination of the nerve. And this was really the start of neuro electric function. It's, it's, it's really not myoelectrics anymore It's neural electrodes as opposed to myoelectrics. So then they started working on mapping and they call it nerve mapping. And there's, there's quite a few companies now that have a software where the software can actually indicate where the concentration of, of the stimulus is. And then the whole socket that attaches to the residual limb actually has multiple electrodes embedded in the socket. And then it can pick up a signal from anywhere and have multiple functions. And now they've actually gotten into neural attachments in the brain. So they go to the absolute origin and that gives them the, to have touch sensation. So now they can actually feel hot and cold. They can feel soft and hard. So this is really the next step. The problem is that it's so expensive that unless you become part of a research program, no insurance company in America will pay for this stuff.

Shelly: 24:09

They're not going to touch that. No.

John: 24:12

No insurance company will pay for this stuff, but Johns Hopkins has been really on the forefront of this nerve mapping and they have multiple subjects, you know, that they use to develop this stuff. And we're hopeful that as it becomes more mainstream, that it'll become easier for patients to afford. The terminal devices have become a lot more intelligent as well. I mean, you name it. Everybody has come out with an intelligent hand where we have multiple finger function. We have multiple rotation. You can actually flip the thumb and you can now insert a credit card into a credit card machine, which you couldn't do previously because you just had this function.

Shelly: 24:59

The pincher function.

John: 25:01

You only had opposition post previously, so you had multiple finger, but the main grip was opposition posts. But now what they've done is they've allowed you to flip the thumb this way, and you can actually do this now.

Shelly: 25:13

So when you swipe your debit card.

John: 25:15

Right, you can use a credit cards. You go into, into a parking area and insert the ticket. So this function it's really improved a patient's overall function, but again, we're talking of of$150 to$200,000 for the prosthesis. And it's still TMR. It's not even neural connections anymore. The awesome with nerve mapping that, that falls into that price category. So it's a little bit cost inhibitive at t his t ime as is osseointegration. Now that the FDA has accepted that the Integrum system has now been FDA cleared. So there i s insurance coverage, but it takes a lot of legwork to get insurance companies to pay for this. But then once they pay for the implant, then they still have to pay for the prosthesis, which is$50,000. I mean, y ou k now, it's j ust, it's just huge amounts o f numbers. But then, I mean, so is medicine today, you know, m edicine in America is t his i s expensive.

Shelly: 26:16

Are either one of these surgeries done in the United States yet, or no?

John: 26:21

So the neurosurgery at Johns Hopkins has done quite a bit of the neural surgery by implanting the electrodes neurally and the nerve mapping software is also freely available in America right now.

Shelly: 26:37

This is not done for lower limb prosthetics. This is just upper extremity?

John: 26:44

Neural implant. So again, Kaican, he has done research in doing TMR in thighs and, and they tried to develop a knee that could in fact and a knee and a foot, a symbiotic system. They ordered a symbionic system because they need the foot work in unison with one another. And they developed a symbionic lower limb part that was actually activated through thought. So the most important part of that research was that patients could actually walk upstairs because if they fired the extensors, the extensors would in fact, almost hoist the patient to the next step. So in lower limb, it has been done, but it's still sort of in the testing stage. And I'm sure that that, uh, the same neural electrodes that they do for upper extremity, they'll most probably start thinking of doing for lower extremity because with osseointegration and the electrode can come through the stoma, they can connect to a prosthetic knee and foot system as well. So I'm sure that's coming.

Shelly: 27:57

And we have larger muscles in our limbs, in our legs. But the problem is it's more weight-bearing than arm. Correct?

John: 28:05

Correct. Yeah.With, with arms the only time it would be weight bearing i s if the patient did p ush-ups or, you know, did exercise programs, but in most cases it's really dexterity in upper extremity as opposed to weight bearing and lower extremity.

Shelly: 28:23

I wanted to have you explain to our listeners about K levels, because I know I'm like a K three or four, but a lot of, especially new amputees don't know what K levels are. So could you explain what K levels are and why a certain amputee that's more active would be more appropriate for these kinds of myoelectronics than, than somebody else?

John: 28:47

Sure. So the insurance company and mostly Medicare started categorizing patients into K levels. And the reason for that was to try and save money, because if a patient wasn't going to actively use a prosthesiss, then it didn't make sense to give them a microprocessor component. So they categorize patients in K zero to K four. K zero means the patient purely is in a wheelchair. There's no ambulatory status. K one, they can transfer from the wheelchair to the toilet but in most cases they still wheelchair bound, but they use the prosthesis as a transfer component or a tool to transfer. K2 the patient can ambulate, but with an assistive device. So there's always upper extremity support for the patient to be able to get from point A to point B. K three, the patient can walk unassisted. The patient can walk on uneven terrain and the patient can walk at variable speeds. K four the patient can run, jump, shoot hoops, do what we do. There's no limit to what the patient can do. So, and then what the, what the insurance companies did is they assigned particular groups of components to these levels. So, K one, the patient could only get a very unsophisticated door hinge for a knee, you know, that could lock if they needed to. K 2, The patients, you know, would get, a non hydraulic non anything, but then some manufacturers started bringing out, not as sophisticated u nits for particular K t wo levels. And they got it p assed. Y ou k now, for those that don't know, everything that we do in prosthetics is durable medical equipment. We are unfortunately not a profession in this country. We fall under durable medical equipment, which means we fall under wheelchairs and crutches and everything else. It's unfortunate, but it's a system that we've had for 5 0 years when we get to a point where patients can now really, they are completely rehabilitated. They can use the device unassisted, they can do whatever they did prior to the amputation. Then we get to the K three and K f our level amputations, which means that you qualify for much more sophisticated and higher level dynamic activity in the components. The system is a little bit backwards t hough, because they really should have sophistication underneath them where there's a microprocessor that can determine whether this patient is going to fall and, and can do what we call stumble recovery or s tance flection features where they actually hold the patient so that the patient can catch themselves before falling down. Let me tell you something. If a patient falls, once they have lost complete confidence in that prosthesis,

Shelly: 32:11

It's over. It's game over.

John: 32:15

It's totally over. So if you can stop that catastrophic incident from happening, this will be a successful patient and they will rehabilitate and use the prosthesis to the max that they can. But you got to give them your best shot coming out of the gate. The system is a bit backwards, but it is what it is, you know, and, and it depends on the prosthetist on how he wants to treat the patient. If the patient shows that he is able to get to a K three level, then it would really be worth it for you as an individual. Remember my job, okay. I have to pick a patient up from his lowest point in life or her lowest point in life. She or he has lost her limb. They think their life is over and it's up to me to pick them up and put them back on their feet And the better, the job that I do, the higher, the success rate on that end. Granted if there's psychological issues and the patient just flat out says, you know what? My life is over. There's not too much that I can do. But if the patient says, listen, I really want to do this. I just need the right tool. Then it's up to me.

Shelly: 33:18

Every new amputee will fall at some point.

John: 33:22

Correct.

Shelly: 33:22

And that's just the way it is. But once they get through that fear,

John: 33:28

Right.

Shelly: 33:29

You know, and there's the crossroads of, am I going to pick myself up and dust myself off and keep going and get better? Or am I just going to go back into that chair or that bed or that, whatever and just give up?

John: 33:41

Absolutely!

Shelly: 33:41

And working with new amputees previously it's I think sometimes more psychological than it is physical,.

John: 33:48

It is psychological, yes, right? I mean, you came into my office a couple of weeks ago and you were on crutches because you were fearful that your prosthesis was failing. And yes, it was one bolt that has failed, but still, there's an incredible fear that this thing will just collapse underneath me. And I need to get to John to have this thing fixed ASAP. So it doesn't matter how long you've been an amputee. Whenever you feel that something is odd being below you, you, you need to have it fixed. Otherwise you're out of sync.

Shelly: 34:17

It freezes you in your tracks. And I've been doing this since, since I was born, but I think you had me up and running in an hour. So I just had a few loose screws, right?

John: 34:27

Yep. Yeah, it is screw loose, but, that's, but that's really the psychological aspect of prosthetics. You know? I mean, you, you have to have the confidence that this tool, cause that's what it is. It really is a tool that this tool will get you from A to B safely and successfully. That's what it needs to do.

Shelly: 34:49

Eventually we have to come to terms that you will eventually decide to retire. And maybe get caught up on some sleep!

John: 35:02

While Michelle has horses, I'll work until I die.

Shelly: 35:08

You always have a project at the house or on the barn or in the field. So, but Darren will take over, your son, Darren will take over? Most probably. Yep. Most probably. Lastly, I want you to briefly tell us where on social media, our listeners can find you. Because we are in every continent of the world at this point. So we have a broad range of listeners. So where can they find out more about Prosthetic Care?

John: 35:38

We have a website, Prosthetic Care of Virginia, and we have on social media, we have Hattingh Inc. And I normally post stories on there. Good or bad. I mean, if I struggle, I post stories that I'm struggling and, and trust me, okay, this is the most humbling profession that anybody can choose because you can have 10 successful treatments. And number 11 will bring you to your knees! Because nothing that you do works and you just have to go in for a walk, shut it off and start over, and then eventually find the solution. Thinking outside the box is key for me. But so we have Hattingh Incorporated, which is social media. And then Michelle has a page, Amputee Help and Support that has 10,000 members. And there everybody asks questions and everybody helps one another. So that really works a lot. And when, and Jesse is one of the moderators, and if a question comes up that I missed, then he'll actually wake me up and say, Hey, John, can you just tell this person what to do? And in some cases, patients lose insurance and they need stuff. And you know, we get liners donated. We, you know patients have liners at home and they just send it to another patient on the page. So it's a really supportive page.

Shelly: 37:03

And it's not about how Hattingh prosthetics, it's more about that virtual international family. And that's one great thing about social media that I didn't have that growing up.

John: 37:16

Right. Exactly.

Shelly: 37:17

So we teach, we learn from each other. We really do. So it's extremely helpful.

John: 37:22

It really is. I mean, social media has really helped a lot of patients just by being able to speak to somebody else about it.

Shelly: 37:30

And no amputee would ever disrespect another human enough to say, do this or don't do this.

John: 37:36

Nope. Nope.

Shelly: 37:38

Okay. Well with that, I'm going to let you go, cause I know you have a patient coming in, right?

John: 37:42

Yes, absolutely. An out of state patient finishing off with her today.

Shelly: 37:46

All right. Well, that's today's episode of DisAbility Talks. Thank you so much to John Hattingh for educating us on this amazing technology and prosthetics. Thank you, John.

John: 37:53

Thank you, all the best! Bye!

Shelly: 37:54

And to our listeners. Thanks for listening and make sure you hit that Like and Subscribe button so you never miss an episode of DisAbility Talks.

Outro: 38:27

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