A Little Dirty Work Never Hurt Anyone

Just when I think I have mastered the art of plaster casting...they introduce what is called a 3-stage cast!!  That is two more stages than I would prefer!  And of course, I had not actually mastered any sort of casting, but at least I was feeling like I had a decent grasp on the whole concept.  I should have known better, I should have been waiting to be thrown for a loop today.  A 3-stage cast is exactly what it sounds like - casting a person's leg three different times.  It is three different plaster applications on the same casting.  That is three times to make sure to put pressure in the right places.  Three different "magic 90 seconds" to get it all right before it becomes a piece of hard plaster and the window closes for any alterations.  Essentially, three times the stress level.  I went from a panicking time frame of 90 seconds to 270 seconds to really worry that I was getting it all right.  The good news is, the 3-stage first time experiment was performed on a classmate...no patient was harmed during today's session.  Although, I definitely got plaster in a lot of leg hairs on Shaun (my partner) and apparently, as a male, that really hurts when it gets ripped off.  Oops.  Better him than a paying customer :)

Scott took the morning to show us how to perform this 3-stage casting.  It involves making a front plate to capture the bony areas in the anterior portion of the leg, then wrapping the entire leg (so you will have a stronger and more reinforced part over your shin) and then creating a second plate that covers the top half of your knee and around your thigh.  We left the back open because we usually end up trimming that part off when modifying the cast so the patient can bend their knee.  I thought that they were eliminating this so it would be less modifying and trimming down, but then when we have to add a flap on the empty part to fill the cast with plaster to make it a mold.  So, I am still not quite sure as to the reasoning for creating the front half of a cast and not wrapping the entire quad portion of the leg...but I can almost promise you that I will learn it by the end of the day tomorrow!  It is definitely a little different to do the cast on an able-bodied person and a full limb than on a residual limb (which was how Scott showed us), but we will be casting our patients later on in the week with this same 3-stage cast so I appreciated getting the practice in any way I could.

This is Joe casting Nate (they were my buddies next to me...which means I watched everything they were doing and then tried to copy it)!  Both of them have been through the Orthotics program so they have much more casting experience then me.  And this is Shaun making the markings to cast my leg.  If I have to hear one more comment about how knobby my knees are....

Here I am in all of my professional casting glory!!  In between stages 2 and 3 of the casting, you have to apply Vaseline to the top 1-inch of the cast in order to remove the part of the cast that you wrap around the thigh.  It is amazing that just a little Vaseline can cause that plaster to not stick together.  I am just learning all sorts of crazy uses for these every day items!  

After all three stages have been applied, and before the third stage "goes off" (this whole magic 90 seconds concept...before it sets and gets hard), the most important step of this type of casting (which is a SCSP type of cast for those wondering) happens.  I believe Scott called this the "vulcan death grip."  I also believe this is not the official name for it :)  You literally press your four fingers as hard into the cast as you can, right above the person's adductor tubercle.  This is basically pressing into the fleshy part on the inside of your thigh, right above where it dips in at the kneecap.  This is what causes suspension in the cast and keeps it from slipping off a person's leg.  It is ironic because those 90 seconds seem SO short when you are trying to get all of the things in the right place on the cast, but when you are attempting to hold your hand like this and press your fingers down as hard as possible into the cast, it seemed like the 90 seconds was never going to end.  Good news...it ended and I successfully made 4 little finger indentions into the cast.  Bad news...after showing my cast to Scott, he told me my hands were probably too small to be able to get the whole death grip thing just right and he should have showed me a different technique.  Too little too late, I will work with what I have.  He said it was no big deal, it would just mean I would have more to do in the modification phase tomorrow.  What a relief, you know how much I love the modification phase!!  I just bought myself more plaster and more grinding?  Excellent!!  Hey, I guess this is what the learning curve is all about, right?

And then finally, the end result of what a day of being casted looks like!  This is my leg that actually was used in the casting, but sadly enough, my other leg had almost the same amount of plaster on it.  I might be getting better at getting the actual plaster casts made, but I have yet to come very far when it comes to not getting it all over the place.  All in due time.