Cosi Talks with Special Guests Mike Marten, CPT, and Brendan Tuchowaski, CPO – How can RevoFit®, RevoSurface® and RevoLock® make life easier for arm AND leg amputees

00:12

Hey guys, welcome to cozy talks live. All right, we have got a very exciting show tonight, and I just want to start off by saying that we do have a third person that will be jumping on board, but he is in the Upper Peninsula of Michigan, the up beautiful, beautiful country, but not so great on Wi Fi. So if you guys see a gentleman popping in and out throughout the feed, speaking of which, which, hi, Brennan. Hi, Brennan. Here we go, here we go. All right, we good? Are we good? Brendan, I think you need Brendan. I think you need to lower the Alright, so why? So while we’re sorry, guys, we’re just sorry. Audio, real here. I Okay, so we’re going to say, start by saying, Hello guys. You know it’s not a cozy talk show unless we have a gremlin living in the computer somewhere. So we’re just going to say a prayer, and I hope that Brendan can make it back on and we also have Mike on board, so we have two amazing brains with us this evening to help us answer questions about Click Medical so in the meantime, we’re going to say hello to someone. We got Emily coming in from Central PA with her Iced Cappuccino. She’s always had the best drinks. We got Mary Ann coming in from South Dakota with her power aid and tuna sandwich that smells pretty good right about now. And Tom coming in from Maryland. Good evening. Chuck from Wyoming, Chuck, you’re not listening to me from YouTube. Usually you’re on my YouTube channel. Guys, just so you know, I am broadcasting from YouTube, Facebook and Instagram. We got Francis coming in from Orlando. Bill in from Arizona with air is with his water and his job. We got Tom coming in from Canada. We are from all over the place. John from Pennsylvania, Ben Gregory howdy from Texas, and, of course, grant from Salt Lake City with its Diet Dr Pepper. Let’s see. On our Instagram channel, we have, I always love reading out these handles, the accidental pirate, that’s a really great handle. We also have the trauma translator room, 10 toes, and all sorts of fun people coming in from Instagram as well. So I do want to take this chance now that Brendan is on board to officially welcome Mike and Brendan to the cozy talks live show. Guys, thank you so much again for sharing, sharing with us your expertise this evening. And I do want to give a shout out to my sponsor for the evening. Click Medical. They have been with me now, supporting this show for several years now, and I am truly, truly grateful for all the support and all the behind the scenes folks, Jamie and Jackie, who are helping out with tonight’s show as well. Hey there, David, we got Jamie there from Click Medical alright. Guys, raise your raise your mugs. I got my Click Medical mug. And guys, this is a really nice Yeti mug that we are going to be giving away a couple of these tonight. So stay tuned. Cheers. For those of you who are new to the coci talk show. Welcome. My name is cosi deoso. I’m a physical therapist here in Tampa, Florida. I’ve been a PT now for a little over 23 years, and my passion is working with the limb loss community. So like I said, Tonight, we’ve got here some prosthetic experts in the house, Mike and Brendan. So I’m going to let them tell us a little bit about themselves. Brendan, let’s start with you while we still have a nice, clear picture and hopefully audio coming in for you.

03:46

Yes, I can hear you now, so hopefully we’ll be good. Tell us

03:49

a little bit about yourself, and hopefully we can, we can get the whole

03:53

story. All right, I’ve been a prosthetist for nine years now. I was working out in Colorado. Now, back in Michigan, I met Mike back almost nine years ago. We worked together. He was technician at the shop I was at, and since he’s moved on to Click Medical, we’ve worked quite a bit and done a lot of adjustable sockets together. Very

04:17

good. And then Mike, your turn. Let’s hear a little bit about your story.

04:20

Yeah. So I’m a certified tech, and started out as is a lowly plaster mixer at this facility in Colorado, and really just fell in love with the industry, and really just fell in love with the opportunities to interact with patients at that facility, you know, so So going from mix and plaster all the way to managing the lab there building a lot of adjustable devices at that facility, I really got to see how effective Click Medical products were. And through that, I’m just really passionate about the product, so I have the privilege of working for Click Medical now, and shared the good news about, you know, the quality of adjustability for everybody.

05:07

Yeah, absolutely. So we got Steven coming in. They’re they’re giving you salutations. He’s also from Michigan, harsh coming in, and he’s asking, Where in Colorado are you?

05:19

I am in Windsor, Colorado,

05:22

okay? And then we’ve got Bill Astley, and I’m also originally from Michigan, so we’re gonna have a lot of nice, nice fun here on the show tonight. So guys, just a quick poll before we get started. How many of you use some flavor of the Click Medical adjustable pocket system, whether you use the RevoSurface or the RevoFit or the RevoLock? I want to see it in the comment section. So I know we have a lot of Click Medical fans on board tonight, so start putting those in the comment section. Instagram. I want to hear from you guys too. You guys seem to be a little bit more on the quiet side, but I want to hear from you guys this evening. So let’s see. Hey Steve, glad you could join in. Yes. So guys, the show for this evening. A while since we’ve done like a good live show with Click Medical. So we’re going to review everything that Click Medical has to offer, and we are going to pick the brains of these two gentlemen. So guys, any questions that you have on adjustability, start putting them into the comment section. And one of my things that I’m really excited about this evening is we’re going to talk also about upper extremity, about arm amputees and how they can use the RevoFit systems as well. So as you guys know, I talk a lot about our lower extremity, our leg amputees, and I don’t show enough love to our arm brothers. So hopefully we will get some of that in tonight. So yeah, we’ve got a lot of fans here. Mary Ann says she uses this. Scott is using it. Scott just got in, so he just got his RevoFit system, and then we’ve got gene on board. We’ve also got Chuck. Has used it in the past. Now he’s not okay. We’ve got Dismas with the Revo. He’s in the Revo as well. Alright, so let’s talk a little bit about how Click Medical came about. And you guys need to keep me on track and correct me here. So the founder of Click Medical, Joe Maho, he was out snowboarding with his wife, you know, on vacation snowboarding with his wife, and he got a call from one of his patients, and they needed what was presumably to be a simple adjustment, you know. And he felt bad that he’s just like, oh gosh, I wish it was just a simple adjustment. I wish there was something I could do for my patient. And he just looked down and saw his wife adjusting for snow boots with the BOA dial, and that’s kind of how the Click Medical world began with that idea. So since then, they’ve exploded, over the past few years with adjustable socket technology, and are one of the biggest players in the field. So this is really into I really love being able to bring this into here. Let’s see, harsh is asking and the questions are starting already. I love this so harsh is asking. I recently came across another adjustable socket which allows to swim with it on anything similar from click Brandon or Mike. Want to take that one.

08:00

The RevoFit System is a waterproof system. We do recommend that if you’re going to go into, like, salt water or chlorinated conditions that you’re rinsing that dial out after you get out of those salty or like sandy areas. If you’re going fishing, something like that, make sure you get that mud out of the socket. But as far as wearing your prosthesis in the water, you could certainly do that. And as far as the attachment on the end, maybe, maybe he has a unique fin, or something like that, he’s attaching to a socket that he might tell us about here in a second. I’d be interested to hear more about that design.

08:44

Yes. And then Sydney is saying, so guys, Sydney has been on my show. She is an absolutely wonderful human being. She is one of the Adjustability Mentors with Click Medical. And you would, you’re going to get a chance this evening to be able to ask her questions as well. So she says that she has gone swimming with her RevoFit and it worked very well. Let’s see. There was another question here that I wanted to kind of So Emily asked a very good question, why do some processes seem to shy away from doing adjustable sockets? Emily, I can tell you from my own experience of talking with patients and viewers, I feel like a lot of it is some of them are not as familiar with the adjustable socket technology, and there are other adjustable socket options out there. I know some of the processes perhaps did not have a positive experience with some of those other technologies, so they’re a little hesitant to try again, or they simply just don’t know enough about it. So this is one of the reasons for this show is so that you all can take this information back to your processes. So Mike or Brendan, Do you guys ever encounter that hesitancy in the community?

09:49

Yeah, definitely. It’s a little bit harder to use. The fabrication takes more work. It takes more skilled technicians. It’s you got to learn more with it, but the benefits really outweigh it, but there’s going to be some trial and error in it, for sure, and a lot of people don’t want to kind of go down that road. They know what they can do. They know it works, and you can argue on how well it works, but that it’s what people know and what they’re comfortable with. So it’s kind of getting people outside of that comfort zone.

10:23

That’s right. And with the RevoFit, for a very long time, clinicians, there’s no way to get reimbursed to make money for that added work with that adjustable system. And now that there are new l codes, codes that are specifically for adding this adjustable system into a prosthetic device. It allows these clinicians to get reimbursed for all that time they’re spending to learn that product and how to apply it correctly, and then become experts and come up with really creative ways of making these unique sockets. Just there you go.

11:03

That’s a big point too, because a lot of times if people we weren’t getting reimbursed for so if you did it and experimented, it was coming out of your bottom line. And some officers just can’t afford to do that.

11:17

Mary Ann says, I begged for mine and Chad made it for me. MaryAnn is saying, I haven’t had any prosthetics yet, but I want to try Click Medical someday, because it seems like the sock changing, no nonsense problems as a bilateral BK, yes, and that’s exactly it. MaryAnn, so you know, one of the things we’re going to talk about this evening is, you know, why is it that somebody would need an adjustable socket as an amputee? And a lot of you amputees are going, yeah, it’s kind of obvious for us, right? But for many folks, especially folks who are new to being an amputee, it comes as a shock to see just how much your limb volume changes, right? So we’re going to talk a little bit about that. You know, for the first one and a half to two years after your amputation, your limb is undergoing so many dramatic changes, right? Initially, it’s because you had a limb removed, and there’s a lot of inflammation from that surgery. We call that the inflammatory phase, right? So the limb is all puffy and huge, and then over the next few weeks and months, that swelling starts to subside as the body starts to heal itself from the inside out, okay? And along this time, many of you start using a prosthesis, right? And it comes as a shock to so many, and I know so many of my patients, that why does the limb change within minutes, right? You guys put the leg on for the first time. You take a few steps in those parallel bars, and all of a sudden the socket is swimming on you, right? And it can be incredibly frustrating learning how to manage the socks, how to adjust the fit, right. And I know from a prosthetic standpoint, it has to be kind of crazy too, because you’ve worked so hard to make a beautiful socket of your patient, and you think you got it, and then the patient walks, and all of a sudden they’re like, I feel like I’m hitting the bottom of my socket right and having to go through that whole process, okay? And then if we move along to the after the first one and a half to two years, right, your limb volume is still going to be changing throughout the rest of your life, perhaps not as dramatically, but it’s still going to be happening. Why? Because our bodies never stay the same. Our bodies are constantly changing. So Mike or Brendan, can you kind of, you know, reiterate on on some of your experiences with your patients and the frustrations they might be having with limb volume?

13:33

No. Limb volume is a huge issue that we constantly face. Like you said, in newer amputees, it can change within minutes to where you put the socket on. You do two laps in the parallel bars, and socket fits great. You get two laps, four and five, and all of a sudden, sock is too big. Yeah. Now, what do you do? And being able to type that and adjust makes it easier, and we have the

13:57

ability to use amputee socks, and that’s a tool that we’ve used, I know, for forever and ever. I feel like, right? I cut my teeth learning, as a therapist how to teach my patients to add or take away socks. But there comes a point in time where you just can’t add any more socks. You just stop fitting into your socket. And then you run into the problem of trying to get that socket, you know, getting a new socket, or through insurance, and that whole rigmarole. And then after the two year marks, I’m going to dive a little bit more into here, because this is where I kind of want to hold feet to the fire of some of my viewers. You know, after those two years, if you’re still experiencing some of these dramatic limb volume fluctuations, it’s time to really start to take a look at your medical conditions, right, especially those of you who had a vascular related amputation, right? So I always say when the surgeon amputated the leg, unfortunately, they did not amputate the diabetes or the high blood pressure or the autoimmune disease, and all of these things can contribute to the body fluctuating with limb volume, right? So for some folks, these fluctuations can continue throughout their life and be very frustrating. So Beth, you know, you mentioned that you don’t have any issues with volume changes. I would call you the unicorn. So there’s it’s, I mean, yes, it happens where I see someone that they are a very stable volume throughout the day, but even folks who take very good care of their health. I know in Florida, with all the heat and humidity and everything like that, people’s limb volume changes on a regular basis. So Brendan, how often do you come across someone who has no changes in their limb volume at all? Is that something you encounter often? Or what would you say,

15:39

pretty rare. You’ll get it with people who’ve been able to use for five plus years. But normally what you see there, the limb volume still changes, but they’ve just gotten so adept to just pushing through. If they’re working they’ve got an eight hour shift, the limb changes in that eight hours, but they know, hey, I’ve only got about an hour to go. I don’t have time to stop and put on a sock. I’m just gonna keep going. And if you do that enough and enough, you just get used to it and you deal with it. But chances as a limit is

16:15

still changing. And then Beth, I would say, do I think everybody should have a Click Medical No. Why? Because there’s no one thing that will work for 100% of the population. But do I think that everybody should have a conversation with their processes to see if they’re a candidate? Yes. One of the things that I really like about click is that even for folks who perhaps are only wearing one to two ply socks, okay, and again, we’re in Florida, so for us, one to two wool and socks can make a difference in the hot summer months. Having something like the click real can really fine tune that adjustment. So again, even for someone who has a nice, super stable limb volume, I always just kind of ask them, like, is this something that you would potentially be a candidate for? And I’ve just learned to just always kind of have a conversation about it. There’s some people who don’t need it, but again, so Mike, what are your thoughts on folks who perhaps have a stable limb volume?

17:12

I’m jealous that they’re so stable because as someone with no amputations, you know, an able bodied individual, when I’m traveling, I’m on flights, and you know, when I’m sitting for a couple hours in the air, I need to loosen up my shoes. I need to maybe loosen up my my belts, because I’ve been eating too much on the road. You know, my body’s still changing. We, as we, as humans, change in volume. So to Brendan’s point, it’s, it’s so common for a mature amputee to kind of become hardened to some of these discomforts, just because that’s the way that’s you know, you’re used to a rigid system, and you’re going to apply stocks when it’s convenient, but you’ve never experienced those advantages of that On Demand, volume change, and I think lots of times people think about our systems as compressing when people shrink, they don’t always think about the opportunities to expand the system for increases in volume.

18:15

And actually, Jamie brings up a good yeah, and Jamie brings up a good point with the airplane, and this is something especially now that we’re heading into the travel months with summer, when folks get on a plane. I don’t know of anybody who doesn’t puff up just a little bit when they’re on a plane, and also just getting the the socket on and not having to do the amputee dance and jig into the socket to get themselves in there, especially for our folks who are needless articulations or sign disarticulations, where they have a more bulbous end, right? So there’s a lot of applications for the RevoFit socket. We’re going to pause for just a minute, because I love to give away stuff to my viewers. So I’m going to throw up a QR code, guys, because, you know, I’m getting all fancy on the show with my QR codes. And Brendan, I apologize, it’s going to cover your face for a second. Okay, so guys, one of the things I really love about the Click Medical team is they have a lot of resources you can go to. I’ve had people where they come to me with an issue that they might be having, and I’ve been able to connect them directly to Joe, the owner and founder of Click Medical and he’s helped them out. They also have these wonderful human beings called adjustability mentors. They’re just, you know, they’re they’re amputees like yourselves, who have used Click Medical to live their lives fully. And both of these individuals, Lou and Sydney, have been on my show to talk about their stories. Okay, so the giveaway part, some of you have already entered this giveaway with my crazy, real and crazy music that I had going on in a post from yesterday, but you have a chance to do it again if you haven’t had already click on this QR code. And I believe that Jaime is going to throw up the link just in case you guys can’t do the QR code, and I want you to pick a mentor so you can fill out the form, and you can choose who you would like to talk to and ask questions from Click Medical. So if you click on the QR code or click on the link that Jamie is going to post, and you kind of scroll down a little bit, you fill out the little form, and you can ask them your questions directly. Because guys, you know, I’m not an amputee. I’ve got lots of experience working with amputees, but I will never be able to truly relate to you as an amputee, but these folks, they’ve been there, done that, and gotten, gotten the t shirt several times over. So I’m going to leave that QR code up for another minute. So start clicking. I want to see you guys. Guys. I can see, by the way, when people click on the QR code. So you know, watching you go ahead and start clicking. There we go. Thank you guys. All right, so let’s get to the fun stuff. Let’s talk about all the toys I have. My one Old Faithful I’ve had this socket here for a long time. So let’s talk about the different products that Click Medical has to offer. We have the RevoFit, which is this one, okay, and this is a demo socket, guys, by the way, you know your sockets don’t come with this much action on it. One of the things I love most about Click Medical is that your processes can use a lot of different strategies to add in the adjustability, right? So you can see here, there’s a panel that can go in and out. I have a smaller screen, so for me trying to make sure I can get everything in. Then you have something called the gap design, where self explanatory, right there, and you can see where it can tighten up here, with the cording here. And then there’s something called a hinge design. The socket does not have the hinge design, but it’s one that kind of opens up like this. Okay, so I love the fact that this is there because everybody is built differently. Everybody is shaped differently, and this can accommodate to the shape of your limb as to where you need the compression and the adjustability. So I know, for my above the knee folks, having this gap design on the back part makes it a lot more comfortable to sit down. Okay? So as you can see, there’s I loosened it up for you guys, the dial. And I do have the older model. This is the BOA dial. Now we have a Click Reel, which Mike, I think you have a sample of one. If you want to throw that up

22:14

there, I do. This is the new Click Reel. And this socket even has a supplement to the dial, which is a grip ring, so that the new Click Reel has this, this plastic finish to it. It’s textured. You know your your average user, you’re not going to need this, this supplement to to the Click Reel, but if you do have some type of upper extremity involve, involvement where your fingers just can’t grab onto the click reel, you can add these, these grips, to the Click Reel, and manipulate the dial even with just kind of the palm or the flat of your Hand. It opens up the adjustability opportunity to even more folks in this sock. And I’m showing you is that that hinge design that you’re talking about so this, this is a fantastic expansion element for folks that have all this distal ends that traditionally would struggle to kind of get through a narrow midpoint in the socket by being able to expand the posterior, the back of this socket outward. Now the patient can fully see into the device, and then with the click reel a few turns, you’ve closed the system back up, and you’ve got a nice, secure socket.

23:42

So it works pretty. It’s a pretty it’s a very simple and elegant design. And this is kind of what I like about it, is it’s not bulky. I’ve seen other adjustable designs that are just they’re very bulky, and you can see it through the pant leg. This one, obviously it’s a lot more low profile. The click reel. What I like about this particular click reel is that you can adjust it. I call it adjusting it forward and backwards. So with the BOA dial, you have to release it to get it to loosen up. So then you’d have to release it and then re tighten it. With the Click Reel, you can just do these little micro adjustments, which for me, is so key, because sometimes you just need just a hair more tight or a hair loose, and you can do that with the clip reel much more efficiently than you can with the sock. Alright, guys, I’m leaving this QR code up for another 10 seconds. 987654321, okay. Y’all had your chance. There you go, okay. So Emily asks a very good question. She’s saying, what happens if your volume is down when you are casted for the adjustable socket, but when you get the socket, your volume has come up again, and now it’s too small the life of someone with lymphedema. So Brendan, I’m gonna throw this one to you.

25:02

You so the hinge design works great. Did see that comment in there and wanted to comment on it, because you can get that whole back to essentially open. Even if you do gain in some volume, you can still, you can loosen that socket, still get your leg in, get it tight enough to where you’re getting your pressure all the way around, but you’re not dropping down and bottoming out. And it gives you that chance to get all the way down without being stuck an inch or two off the bottom of the socket, and that being uncomfortable. So the hinge really gives you really great adjustability on that, and I’ve had really good success with that. Okay?

25:47

And then what I do want to add Emily is, you know, and I’ve seen, just from working with my local prosthetists, when they know that a patient is shrinking right as part of the normal healing process, sometimes they’ll cast their patients a little on the snug side in anticipation of it shrinking. But for someone like yourself, where you have chronic lymphedema, meaning you know you’re going to go up and down. And that is, that is your story, right? You need to make sure that you let your prosthetist be aware like today, today on a small day, today’s a small day for me. Do I need to come back, perhaps on a day where I am a little bit puffier, just and see what your prosthetist has to say about that. And that’s actually a very good point, because there’s some folks that you know they do have issues with lymphedema, and this is something that might be a chronic issue for them, okay, and which, by the way, Click Medical, it’s just like, yes, checking off all the boxes to why they would want to use a Click Medical socket Sydney, saying, power grip.

26:46

Go ahead. Go ahead. Lymphedema or dialysis patients, yes, is great for so we see very big swings in volume every other day you’re dealing with that. So yeah, works really well there too,

27:00

yep. And actually, we’ll throw in CHF patients. That’s another one that I always say, Forget about as well. So Sydney is saying power grip is my favorite guys, another feature. I know I’m like, throwing everything in the kitchen sink at you tonight about Click Medical, but I just gotta you can adjust it through the pants. And that’s really kind of nice. Because one of the things I hear from some of my patients, especially when they go for work, they’re just like, it’s embarrassing that I sometimes have to take off my socket in front of my co workers to add socks or take off socks, and, you know, everything there. So again, this is something where it’s low profile, so it’s not like sticking out of your pant leg, but at the same time, you can grab it and twist it and adjust it through the pant leg. And I think that’s kind of a really cool feature. Mary Ann says she’s a BACA, and her sockets each have two on the leg. So Mike, can you comment a little bit on folks who might be using two click reels or dials on their socket?

27:55

Yeah, that’s that’s an advanced design. So your prosthetist, he, he must know his stuff. You know, we showed you kind of these three foundational designs that we talked about with the repo, fit the panel design, which, which can be very targeted for expansion or compression. And then there was that, that gap cut out, that cozy. Showed you all with that, posterior cut out there, and that gives a more global expansion or global compression of that socket. So by combining multiple dials, it gives you the opportunity to kind of control different areas with accomplishing different goals that your processes might be trying to accomplish with his design. So maybe your socket rotates a little bit. So we want to add targeted panels to that socket. And then on top of that, you experience those, those daily global volume changes. So instead of, you know, doing those, doing that sock management, now we can have that that that brim adjustment on that gap design to allow for that more global change. So, yeah, get on your your process for getting fancy with it. Those must be pretty cool, yep.

29:17

And also, I know that the dials, two dials can also be applied. Out of you mentioned this, it can be applied also when you have someone who is perhaps over the weight limit of the one dial. So we do have some folks on our show that exceed the weight limit, and they are able to use two dials and be able to take advantage of this as well.

29:37

Yeah, that’s correct. That is a good strategy to kind of distribute the energy forces from from walking to multiple dials. So if you are over the weight limit, we can, we can spread that weight out across the whole socket with with two systems.

29:56

Hey, Jeff, thanks for jumping on board. I appreciate the support. So Bill’s asking a great question, and I do like to touch upon suspension. So they’re asking, Is this compatible with elevated vacuum and with suction? So let’s just talk a little bit about how suspension works with the Revo fit Brendan, you want to

30:17

grab this one few different ways. The elevated vacuum does make it harder. Depends on if you’re using a ceiling sleeve or the ceiling liners, and it depends on limb shape and whole host of factors. It’s from a fabrication standpoint, it’s much easier to do with a pin, but it easily can be done with suction or vacuum, either one. And then actually,

30:43

we can go ahead and segue into the next part, which is the RevoLock. So that is one of the suspension that is the suspension system that Click Medical has to offer. And I’m sorry to say I don’t have my liner to show, but basically you guys can see, sorry, let me angle this the right way so you can see, it’s a lanyard type suspension system. And this is screws into the liner. And I think, Mike, you have a full version right there. So it screws, you show it, yeah, you got it way better.

31:15

I was just going to show you that. So we do have two different attachment options. You have what we call the fixed threaded insert, so the lace connects to an attached piece that the user will be threading onto the locking umbrella. We also have a two part system, so this is what we call our fixed threaded, or, excuse me, threaded insert and then snap, which connects to the lace that gets drawn in by our boa dial controlling the lanyard system. And all you need to do is just simply slide that those two pieces together, and you have that nice, secure connection. There’s a little spring loaded square that gets depressed to release those two elements, and then you’ll be turning a dial to draw the locking liner down into the socket. If you aren’t fully seated into the socket, you’re still fully connected. So this is great if you’re sitting down to don the prosthesis. If you’re swollen in the morning and can’t fully get into your socket, you’re still connected. So as you go about your day and start to shrink down and settle further, you can continue to turn that dial and get seated further into the socket.

32:42

That’s a really good one, right there. Let’s see. I’m just kind of flipping through these questions making sure we are good there. Robert, I’m glad you could join us this evening to listen to all this really amazing information. And then Sydney brought up another good point regarding click real is how it’s good for folks with dexterity issues with that ring that you mentioned, right there. Mike, absolutely. All right, let’s see. Jerry Ann is asking, do people need to start with a regular socket before you try a click. That’s a good one. Brendan, you want to take that one or you got

33:14

a Mike? Happy to take that. You don’t have to start with

33:20

a regular socket. I’m sorry, go ahead. Brendan,

33:24

either way, go for it. Mike, yeah,

33:26

you know if, if you’re a brand new amputee, you’re going to be casted, and sometimes there’s a IPOP socket or a socket that you’ll start walking on that’s kind of like a post op socket, and it’s kind of gonna be your your training wheels type socket. Even those can can be adjustable with our RevoSurface, which is our Surface kit that we can use for multiple reasons. So we attach this one with just some screws to the outside of the device. And we also like to use this during the diagnostic phase. So when you’re casted for a device, your prosthetist is going to put you in some type of clear socket like this to make sure that the overall fit looks good. There’s no pressure points. And then they can also add this RevoSurface confirm that the design that they’re coming up with and creating is actually going to work for you. And so yeah, right out the gate, if, if you’re interested in adjustability, certainly worth mentioning to your process and

34:41

guys with the dramatic limb volume fluctuations for new people, it can be it can help again, buy time between sockets. We’ve done that. We’ve done this poll before, but I always like to ask again, how many sockets did you guys how many check sockets? Or how many, how many sockets did you guys go through before you kind of settled into your permanent socket, right? So those of you who have been, who’ve been amputees for a while, how many sockets did you have? Let’s just say that first year alone. Let’s, let’s see in the comment section. So one thing again, with the Click Medical, it can, it can accommodate up to 10 ply, right? So if we just do a little bit of simple math, if your socket is swimming loose on you, and some of you get upwards of 1518, ply, and sometimes even more, subtract 10 from that. So you went from having to wear 1015 ply sock down to five ply, right? So that buys you a lot of time in between sockets. Hey there, Earl, good for you to be here, Larry. We’re gonna get to that question in just a minute. Yeah. So Mark had two the first year. Mark, you are actually so Robert had three molds, but one socket working on my second socket. Larry’s had three. Kim had two in the first year. I’ve seen some people that they told me six to 10 sockets in that first hero is just insane, the amount of sockets that they would go through. Another thing to consider guys and again, going back to the RevoSurface, because that has become one of my favorite go tos. A lot of people are like, Well, I love the shape of my socket. I love how it fits, and I’m superstitious, and I don’t want to recast because it might change, right, but they just need that little volume adjustment. And I’m just like, well, slap a RevoSurface on it, and you are good to go. So Mike, can you hold up the RevoSurface again for a second so people can just see the difference between the RevoSurface and the RevoFit? Okay.

36:39

Yeah, this one has a flexible inner liner in it. Sometimes people are going to do their diagnostic fitting or trial fitting, with or without one of these flexible inner liners, both ways appropriate for that fitting process. But I’m going to take it out just a second so you want to see this. This, this gap design cut out, and then the lace is going to be connected to the click real collar, just there’s Chicago screws that are holding that collar in place. And then you can simply route the lace through these surface guides and orient them in a way that you have kind of an effective line of pull. And this socket is made for compression in the posterior, just underneath the kind of the knee, in the fold of the knee and the posterior, you can also get expansion. And I’m going to loosen this up just a little bit to get that expansion going, that you can also expand out with this design.

37:46

So Robert, to pick up your question, can current sockets be retro fit with this technology? Yes, and that’s why I want to show so this one is the RevoFit. You can see the cording is inside the plastic, right? So the one that my CAD is the RevoSurface. So that’s something, it’s basically the cording placed on top. So for existing sockets, a socket that you already have, and maybe all you need is just a little volume adjustment. That’s where you would use the RevoSurface. Robert, okay, and then let me see if I have in my bag of tricks. Give me one second, guys. All right, I had to go digging through my toy chest, because you all know that Bob here likes to go playing with all my toys and move things around. Okay? So just to clarify, because sometimes people are just confused, like, Well, does this mean that my process isn’t making the socket, or what’s involved? So if you and your prosthetist decide, yes, we want to do the RevoFit, or we want to do the RevoSurface, they’re going to get a little box, and it has all just the little tools that are needed, all the processes, toys and tools that are needed to build the adjustability into the socket. Okay, your processes is still the one making the socket. They’re just getting the kit that allows them to do the adjustability. Okay? Because some folks are just like, does this mean my process? Because I like my processes, I like how their socket fit? No. So I just wanted to clarify that part. Let me grab there was a couple of other questions here. So MaryAnn is asking, how about if you have a tender tibia bone, can you put padding into your socket? So, you know, I can do the PT response, but I’d much rather hear from the prosthetic side of that.

39:38

You can if we’re talking with using the adjustability, instead of putting padding on that tibia bone, you’d be better off to pad on either side of it, and be able to push in on either side that way you leave space for that tibia bone in between. Adding padding is just going to add pressure. So if we can pad on both sides and push you back and off of that tibia, it’ll be much better off

40:08

and then so just going back here, Bill says it’s been called processes. I’ve had as many as six sockets. Lou saying three for each leg within a year or two, and Larry saying insurance only pays for 50% so yeah, you know, this is definitely something that could potentially save you some money down the line and extending the life of your socket there. Let’s see, there was one here. Ben Gregory says only one socket in the first year, but had multiple paddings and wore shrinkers day in and day out. So Emily is asking, how do you find a prophetess who uses adjustability like Click Medical. I mean, we have a lot of process. Usually it’s a lot of word of mouth. I do know this, Emily, if your prosthetist is a little gun shy when it comes to it, first of all that they have an incredible team that they can reform, refer to, and have resources. And then Click Medical also has what’s called Click Academy on their website, and I’ve actually been able to take a lot of those courses and learn about it myself. And it really does do step by step instructions on this is how it’s done, and there’s so many videos there to help with troubleshooting, not to mention just direct access to the Click Medical team. So you know, any prosthetist is willing to give it a try, they’re going to find the support that they need for that. Steve is like, I like Mike’s socket. Like that socket. Let’s see. Alright? So guys, we have the winner for our first giveaway, and it’s Larry Acton, so Larry, congratulations. We are going to be sending you a yeti Click Medical mug, and then actually, let me just go ahead and type out, let me just take this moment. Alright, so this is not just for Larry, but Larry, I want you to take my email address, and you need to send me your address so that we can Click Medical click. Can mail you your prize. But guys, especially for those of you who are new to watching the show, that is my email address. I look at it every single day. I’m the only one who answers it. Any questions that you have, whether it’s about Click Medical or any part of the recovery process as an amputee, please feel free to send it to me. I just answer all the questions within 24 to 48 hours, and if I don’t know the answer which that does happen quite a bit. I will go find credible sources for those answers for you. Alright guys, stay tuned. Jaime, saying, Hold it up again. Mike, all right. So we’re going to go ahead and do our next giveaway, because we like giving stuff away. Oh, that’s right, you got the new one.

42:38

I got the new one this. This this is the version I’m pretty sure we’re giving out right now.

42:43

I mean, I like my OG because I’ve had this one for several years now. But can I have one of the new ones? I want to get

42:49

one. We could probably work something out. And yeah, it was Larry that won. Yes, the new version that has our, our L codes, those billing codes on the back. So Larry, if, if your prosthetist forgets those billing codes, you can take your Yeti mug in and remind him what he needs to use to get paid for adding that adjustability to your sockets. Yes.

43:13

And guys, last year, actually, April of last year, guys, I did a huge show on L code, okay? And I know, like, insurance is kind of like a little bit of a dry, you know, subject and topic to talk about, but we need to know about it, right? So guys, first of all, go back and watch that show. At some point, it’s on my YouTube channel and it and I, we explain, like, what is an L code? Basically, it’s that magical code that your process needs for your insurance to pay for a particular device. So it is a huge deal that Click Medical got not one code, but now they have two codes. They have one for their leg, RevoFit system, and now one for their arm, RevoFit system. So those, those are magic numbers right there that you will want to have on hand for your process. All right, so let’s do another giveaway so you guys can get another mug and go show those l codes. Alright, so click has a lovely website, and it is literally chock full of so many people that have been using the Click Medical revote fit or RevoSurface system. Okay, so I want you guys to click on this QR code. Look at all the amazing people that are on there and tell me who inspires you the most and write that name in the comment section. So go in there, and you guys might have to listen to some of these stories later. Don’t click out on my show, right? But go in there, pick someone or pick someone that you’re gonna you’re gonna listen to their story and put it in the comments section. All right, I see some people starting to scan that QR code. I need to see more people, man, because we got some good mugs here. Got some good mugs. All right? And my Instagram, folks, I want you guys clicking on this as well, as well as my YouTube folks. All right, so Well, we’ve talked, I wasn’t saying my cheat sheet notes that I’m looking in here. I say I have to talk about, who is the Click Medical socket meant for which? I think we’ve, we’ve covered quite a bit of that tonight, this evening, and it’s, it’s safe to say again what I echo and what I said earlier. You know, should everybody have one no, because there’s no one thing that fits everybody. But should everybody have a conversation about it? Yes, yes. At some point in your life as an amputee, you should be asking your process, Hey, should I think adjustability in some way, shape or form? So let’s talk a little bit about upper extremity applications. And this is where I am going to be the student for sure this evening. So Mike, you want to show us some of the cool things that you have there for our upper extremity folks.

45:37

Absolutely. So I was referring to those, those three kind of basic design elements that that we approach prosthetic devices with, with RevoFit, and that’s panel gap and hinge design. And I have a trans radial so below elbow device here that has a floating panel that provides suspension just behind the elbow. We call that an electron on suspension. And this is connected to a RevoFit with a lovely hidden door. Shout out to 14th element for making this really cool device, they’ve created this nice hidden system to hide away this this click reel, but lots of times with controlling a trans radial or below elbow device, we want to create a lock underneath The elbow so it’s nice and snug and secure, but if someone wants to reach up high and get something off the shelf, that elbow lock just prevents that from getting into full extension. So by being able to loosen in this elbow area right here with this electron on suspension. It allows for the wearer to get that full range of motion, make that movement. Once they’re done, they can just tighten that system back down, get it nice and snug. Now they have that that nice control with with their elbow, and that more flex position that’s going to be what they’re using the prosthesis act more often than not?

47:22

I love how they were able to hide it with that panel. It looks like something like data from Star Trek, who was one of my favorite characters. That is so cool. Sorry, guys. I’m a Star Trek. Yeah, that is really cool.

47:34

And this is where I nerd out a little bit. Is fabrication, this, this company, and in that Dallas, Texas, 14th element. They’re making some really cool creative devices.

47:44

All right,

47:46

Texans here,

47:48

okay, there’s no prosthetists on staff, so prosthetists would be sending a device to be fabricated there.

47:57

Okay, that is very cool. So I see you guys popping in some names, so once again, I’m going to leave the QR code up for another minute, because it keeps covering up Brandon space, and I don’t know how to change it, but click on that code guys and pick out who is the person that most inspires you from their ambassadors and who or who you want to learn more about when you and reading their stories. So what about for transhumeral How does that work?

48:23

Bring my transhumeral device with me. Unfortunately, I was going to pivot to showing you hinge design for trans-radial patient and this one. Because sometimes when we want to control the prosthesis, we’re going to over these bony prominences of the elbow. We got to get it really tight and really snug so that we don’t that that wobbly motion back and forth with with our click reel, we can create an expansion with a hinge design so that you can get your arm all the way down into the prosthesis, and then with that click reel, we can close that system back up and again, make a nice rigid socket that’s that’s nice and snug and secure. It’s not painful to go through those those narrow areas with those bony prominences. So it’s

49:18

interesting, compared to someone who has a leg amputation, someone with an arm amputation is not going to maybe have as dramatic as those volume fluctuations as someone with a leg, but certainly that fit needs to be even more precise. I mean, the leg, the leg fit has to be precise, but the arm even more so. So you can see how there’s slightly different applications. With using something like the RevoFit for the arm,

49:45

that’s exactly right. And you know, with with the above elbow patient, there’s generally going to be more flesh, and that’s where we’re going to see a little bit more volume fluctuation. And then we can start looking at doing things like adding those panels like you have in your demo socket to targeted areas around that that upper arm to help with that rotation or allow for that volume change to be controlled and managed.

50:13

Okay, so these people are flying here for this, whoever call it, I don’t think I’ve read Colin story. I need to go read Colin story, because Colin keeps coming. Up a lot in terms of the story right there. Alright, guys, we’re going to give you the winner very soon, actually, no, we’ve already got it, because Jamie is just awesome like that. All right. Chuck Williams, Congratulations, you won me next. Yeti mug, so cheers to you, my friend. Thank you for participating. Thank you guys for participating, and we’re going to throw up our third giveaway, because we just like giving out stuff, and that’s just how we roll this. One’s a lot easier. Y’all don’t have to click on you know what? I’m going to get rid of that QR code because we need to see core brand in there. There we go. All right, so guys, for this last giveaway of everything we’ve chit chatted tonight, even if you’re not necessarily a candidate or you don’t think you’re a candidate. What is your favorite feature about the Click Medical products, whether it’s the RevoFit or the RevoSurface or the RevoLock? So start putting that into the comments section. I mean, this one, the last one easier for you guys. All right. So with regards to the arm in terms of like the end device, do you guys have any any input like, you know, is it something that any end device can be used, any terminal device, excuse me, can be used with the upper committee socket, like that. Talk to us a little bit about the terminal devices. Brendon,

51:47

yeah, the using any rule of fade adjustability has no bearing, shouldn’t have bearing. I’m sure there’s some case that could, but really shouldn’t have any bearing on your terminal device. Should be able to use it with anything, and as Mike said, being able to get some compression, especially for your transhumeral you’re going to hopefully stop rotation, be able to get a better fit longer throughout the day, comes into play, especially if you have anything with myoelectrics, where you need to keep your electrode sites in very good contact to the skin, so I can really help in those applications as well. Brendan,

52:26

I think you and I A while back, actually built a device where we use the RevoFit system directly over the electrodes the the myocytes, so that the patient, because he kept losing contact with with those, those little electrode pads that would control that, that terminal device, when, when there’s no good contact, he couldn’t control that hand at all. So by being able to increase the compression with with really small panels, he was always in control of that, that terminal element. But there’s, as far as I know, and I should know as the technical sales and support specialist, there is no contract contraindications for terminal devices with repo fit in upper extremity applications.

53:19

There we go. So MaryAnne is

53:22

no, it’s just a terrible routing, very good. So

53:26

Mary Ann is saying My favorite part is that I’ve been a year and a half in the socket, and they’re just now getting to work. I can’t tighten them enough. So I know that for Mary Ann, they’ve helped her a lot in that regard. Grant is saying, I find the surface intriguing. Got to have a chat with my lead guy. Yep. Have a chat. See what they have to say. Earl says, definitely. He likes the fact that you can extend the life of the socket. Emily says, I like how you can add adjustability to an existing socket. That’s one of my favorites there as well, and the fact that you can just kind of trial it out first rivers and snow. Says ease of adjustability on all of them. Robert says he likes the ability to adjust quickly and how nice the integration is. And it really is like, you know, one of Click Medical taglines is adjustability on the fly. And it really is just that easy. It’s just click to Click. And actually, if you guys have been watching my Instagram channel lately, one of my my patients that I’ve had lately. He’s a bilateral below the knee and PT, and he gave me permission, so he knows I share some of this information. He’s a professional ballroom dancer, and he’s a young guy, so those of you can just you know when you’re putting on one socket, how much time it kind of takes you to put that socket on and put socks on and all that. I mean, he just jumps into his sockets and and then off he goes. And there’s a couple of videos of him doing this. And in his particular case, because he’s so active, because he’s the dance professional ballroom dancer, his limbs are shrinking all the time, and we are waiting on new sockets, because he’s he’s due for new sockets. And the only thing saving his bacon right now is the fact that he can use the Click Medical to tighten it up enough so that he can get through his day. If he didn’t have Click Medical sockets, he would have been, you know, using his wheelchair for the past two months, waiting for the new socket to be approved. So you can, you can take that one for 1/4 right there. Let’s see. Kim says, as someone with fluctuation, it sounds promising. Steve likes the adjustability. Emily is asking, Can adjustability work with a hip disarticulation, or is it not as necessary? That’s a good question. Brendan, you

55:43

it it depends. It really depends on what the presentation of your what you have or don’t have on that hip. It really depends. Some people do still have a lot of tissue to where they’re seeing some volume change in the hip district ticks, I’ve personally worked with, we haven’t had a ton of volume change, so it was not necessary. And for we’ve done some, like adjustable, like hip suspension, but you needed more. We use, like, some more buckles, in a sense, instead of the BOA, just because you needed, you needed more than what the bow is going to give you. And usually, I don’t want to say higher pressure, but potentially a little bit higher pressure than what is easy to crank on a BOA. Could it be incorporated? Yes, I’ve seen some designs where they it has been incorporated. It just, it’s an as needed basis. At that point, Robert

56:59

is asking bubbles, asked if this can work on a puppet. Just kidding. So he has these wonderful puppets that he uses to tell stories about amputees to kids. So I’m sure we can retrofit one. Alright? So guys, if you want to hear a little bit more about Click Medical and just kind of get all the updates, which, by the way, you can also kind of forward to your process. If they’re just wanting to learn a little bit more. Needs a little more information. Jaime went ahead and put up the link there so that you can subscribe to their email list. What’s also cool is they also in that email list. They’ll put up the educational videos that they have for processes as well. All right, so our last winner for the evening is John Roman. So John, congratulations, guys. I’m going to go ahead and put up one last time for my winners this evening. This is my email address, so please, so I don’t have to hunt you down somewhere on social media, send me your addresses so that we can get your prizes sent out to you. And then those of you who have any questions, if you have any questions that come up after the show is over, for those of you who are watching the replay. If you have any questions that you want me to pass along to the Click Medical team, you can either contact them directly, or you can send it to me, and I will make sure that they get the questions. We will help you out. Alright, guys, as far as this evening goes, we’ve done a lot of talking and a lot of information. This evening. I think we’ve covered pretty much the whole body, head to toe and how can we can use Click Medical and Brendan, you stayed on the whole time. Your Wi Fi did not conk out on us, so yay. All right, so Emily, I don’t know if you saw Jamie’s message. She says, feel free to reach out to our team to get design ideas. Mike is a design genius, so Emily, take advantage of this. All right, guys, as always, I want to thank you all for letting us be a part of your lives this evening. Mike, Brendan, thank you for sharing your expertise this evening. Truly, truly appreciated. So cheers. We have to smile for Jaime because we told her we would smile for a nice picture. So far as a big, huge, thank you to Click Medical for your continued support. Jamie and Jacki, thank you, ladies, for everything that you’re doing behind the scenes and for helping this show come on and for all the other years that you’ve been helping. So guys, Limb Loss Awareness Month, I’m going live every night at 8:30pm I’m only doing one short question on non Wednesday nights, if that makes sense. So guys, I’ll see you tomorrow. Same that time, same bad channel, God bless, guys. Bye.