If at First You Don't Succeed...

Try try again.  This was my mantra of the day.  Today was the initial fitting of the check socket that I made for Buddy last week.  Let me remind you that I was super confident and feeling really good about this leg that I had made.  Buddy came in this morning, sprightly as ever and ready to get going.  I had to be at school an hour earlier than usual so I was not as cheery, but seeing him perked me up!  I was ready to get this leg on and admire him walking in it!  I got Buddy all situated, I put on his liner and then I attempted to put on his leg.  The key work here being, attempted.  As in, the leg would not go on.  No amount of Buddy cramming or standing and stamping would make his residual limb slide down into that socket.  I was silently pleading, but it was not working.  Alas, the socket was too tight.  I just kept staring in disbelief, I knew I had measured everything correctly, I knew I had made a really good cast and pulled a really nice socket - how on earth was this not even going to go on his limb!?  Panicked, but not down and out, I took off the leg (well, the half that was crammed on him) and sat down on my stool.  I was looking at Buddy and contemplating what could have gone wrong when I looked down at my progress notes and measurement sheet from our first visit.  Something had to have gone awry in the last 5 days!!  My instructor (probably sensing my confusion from across the room), came over and told me to remeasure him today to see if the measurements were different than what I had gotten last week.  Aha!!  A genius idea!!  Not his first time seeing this problem...

I re-did all of Buddy's measurements only to find out that he was measuring .5-1 centimeter over everything that I took last week.  If you take that into consideration and remember that we modified the casts down to about 1/2 inch less than the measurements to make it fit tight, I am sitting here with a cast that is about 5/8 inches smaller than what his limb is measuring.  Big sigh of relief from me...for a second.  I was happy to know that it was not me that had completely screwed this up, but that still did not give me a magic solution to get a "too-big" limb into a "too-small" socket.  Buddy informed me that he did not wear a liner all weekend and had spent most of the weekend sitting around watching TV.  Therefore, this meant his limb had a little more fluid in it today than it had last week.  No one told me to account for fluctuating limb volume when taking so much off the mold last week!!  This is a very common issue in amputees so I am glad I had the chance to experience it because it is something that is going to absolutely happen to me in the future.  (Okay, let me be honest, I am only saying I was glad to experience it after the fact, in the middle, I was unable to find the gladness in my heart.)

My instructor told me I could put the liner on Buddy and wrap his limb in an Ace bandage and elevate it for a little while to see if that distributed or reduced some of the fluid.  So, I set about doing that.  While Buddy was elevating his leg and thinking shrinking thoughts, I went ahead and modified my socket a little bit by heating it up with a heat gun and pulling out the little shelf in the back to give him more room.  I did not want to completely count on him shrinking in half an hour enough to fit down into the socket, a little heat flaring out never hurt anyone.  Thirty minutes later, we are back to trying on the prosthesis and seeing if we have any more luck.  This time, Buddy manages to get about 1/3 farther down than he had the first time, but we were still a good 2-3 inches from him being completely settled into the entire socket.  Stop and repeat.  Re-wrap, re-elevate, re-heat and re-flare.  Imagine me doing these steps another two times and then you will be 3 hours into the fitting and caught up with me to the point where Buddy actually managed to get his entire limb into the socket and achieve total contact.

Hallelujah.  We put a little silicone ball (sort of like silly putty) into the bottom of the socket so when the patient puts their limb in the socket, we can see if it flattens out like a pancake...thus, meaning they have gotten total contact into the socket.  I was so happy to finally see a flattened pancake shaped piece of silicone that I am almost broke into song and dance in the treatment room!  At this point, most every one else had their patients doing multiple walks up and down in the parallel bars.  The stress immediately left my body after finally getting Buddy down into the socket.  Alignment may not be my strong suit yet and it definitely makes me nervous, but I was far more concerned that I was not even going to have a chance to even try and align him.

Once the leg was on, I still had a lot of work to do.  The alignment was crazy off and I had to spend a good amount of time tweaking it to get Buddy walking with a decent gait.  He kept encouraging me by commenting on how comfortable the socket felt, so although I was on the ground and unscrewing and re-tightening the screws on the socket over and over again, I kept thinking to myself...hey, one out of two ain't bad.  A really comfortable socket seemed like an impossible goal a few hours before so I was thrilled with that news.  After many back and forth strolls, I managed to get Buddy walking really nicely and feeling really great in my leg.  Buddy only walks about half an hour a day total and today I had him walking for at least that amount of time just trying to get all of the alignment in the right place, so I think that was a definite success on my part.  We had to rotate his foot and slide things around and move the pylon back and forth, but by the end of the morning, we were in a good place.  Buddy was ready to take a smoke break and I was ready for my bologna sandwich so we both were ready to call it a day.  I accomplished what I went into the day wanting to accomplish...my patient felt comfortable, he was safe, and he was walking successfully and with no pain.  What started out looking very dismal at 9:00am ended up being very promising by noon.  I put my leg away and I feel like critique is going to go really well tomorrow.  I feel confident in the changes I made to get Buddy into the socket and now that I have been through one critique, I am not nearly as worried about the second one.  I know that regardless of if it is perfect or right on, it is safe and functioning properly and that is enough of a start where I can talk my way through the rest :)

So, a long day, a learning experience and a chance to feel triumphant at the end of it all.  I am excited to see Buddy walk again tomorrow and it makes me proud to know that he is going to tell my professors how comfortable the socket feels.  He is fairly particular about his socket fit so this a rare achievement!!  A socket being too small was not the only lesson I learned today...I learned a little lesson (and consequently a little class lecture) in sexual harassment!!  When I walked Buddy out to his car (which is a requirement at the end of a patient visit), he said to me, "Can I tell you something?  And don't take this as inappropriate, it is meant as a compliment...you havd a great butt."  Ummm, I did not really have a response for that.  I awkwardly stood silently or maybe gave a crooked smile and then was like, okay Buddy, drive safe and I will see you tomorrow.  Then I kind of wanted to walk backwards up the ramp for fear that he was watching me walk away!!  It did not offend me, I was not upset by it - I did not really think it was a compliment and I am sure it was more inappropriate than appropriate, but he is a 60 year old man and I have learned it is silly to be personally offended by a comment like that.  I mean, I would like to have a good butt so I do not think that is a bad thing, I just don't think it should be information being told to me by a patient.  And neither did my professors - someone else in the parking lot heard the comment and then there was a talk after lunch about appropriate language and sexual harassment and what to do if our patients were engaging in those things.  Needless to say, I know it was a harmless comment and after tomorrow, I will not have interactions with Buddy again so I am going to choose to take it as a compliment...and make sure that I wear those black pants next time I go on a dinner date ;)