By "they're", I mean the patients from last week and most importantly, the Dallas Cowboys. Okay, football has nothing to do with prosthetics (except that I do tend to make the touchdown sign a lot when I accomplish something great in the plastics room), but it is impossible for me not to mention that the NFL season is kicking off tonight - and there is absolutely, hands down, no better way to start the football season than with my Cowboys!! This posting may take the entire duration of the game (or might venture off into random football commentary), but I will do my best to stay on topic.
Our patients came back to see us this morning. Mr. R was very sprightly and definitely in a feisty mood today. By feisty, I mean, slightly inappropriate with my personal boundaries and his comments, but hey... all in good fun. I think the beauty of being an elderly man is that you get away with those comments and girls just chalk it up to you being an old man. I did have to tell him a few times that, although I was indeed cold, I did not need him to keep trying to warm me up :) Nor did I want to share his breakfast sandwich, although I did appreciate the offer! Oh, the initial fitting of a test socket. There might be nothing more exhausting than the initial fitting. First, you have the patient saying it feels great and before you can really get in a good pat on your own back, they change their mind and there are a lot of spots that are hurting them. Thus begins the process of putting the socket on (in prosthetics, they call this "donning") and marking the painful spots, taking the socket off ("doffing"), making adjustments - via pads, heating gun, the grinder - and repeating the process. And repeating, and repeating, and repeating. Please do not confuse exhausting with annoying. I want my patient to have a socket that feels very comfortable, has no hot spots and is something they can and want to wear all day. The exhausting part was the path I wore walking back and forth from the heating gun to the patient treatment room. Also, after four hours of fitting, everything begins to hurt on an 85 year old man so you eventually realize that you are chasing after pains that don't really exist. Okay, that might be a little annoying. Maybe moreso frustrating...I wanted to remind him of how great it felt 3 hours ago and see if we could tap back into those wonderful and fond memories and feelings.
At some point you have to let these patient volunteers go home and come to grips with the fact that you can only readjust something so many times before it is neither doing harm nor good. Plus, I was starving and we had to refill our sockets with plaster before lunch ;) That is what the top pictures are from - the filling of sockets. My socket is right there in the middle of the three - looking amazing, I might add. Off I went to enjoy my turkey sandwich while the plaster was setting. Completely naive as to what the afternoon of making custom pelite liners had in store for me. Thankfully naive, might I add....otherwise I am not sure I would have enjoyed my lunch!
Once our plaster set, we began the process of freeing our newly made molds. Yes, that is right, back to looking at another big hunk of plaster in mold form. I see a reoccurring theme here in my future career. I will learn to love plaster, I will learn to love plaster, I will learn to love plaster. Luckily, most of the adjustments and modifications to this mold had been made to the plastic test socket before pouring the plaster so there was not a whole lot of work to be done. Seriously though, what would a day of prosthetic school be without at least a little bit of modifying and grinding? After some quick reductions and sanding the mold down, it was time to start making distal end pads (a soft cushion for the bottom of the residual limb) and pelite (basically just a squishy foam-like material) liners. Let me just say, custom liners are not the norm these days - you can buy loads of liners off the shelf and the new trend, gel liners, makes the need for prosthetists to create any sort of custom liner, really small. Alas, still something we need to learn to do and that was the goal of the day today. To put it in perspective, the demonstration from my instructor to teach us how to make the liner took over 2 hours. Not exactly a quick and easy task. It involves skiiving (this is a fancy word for grinding things with a nice graduated edge), heating up materials in the giant ovens, and per usual, tiny windows of time to accomplish something that can easily be screwed up.
This is what it looks like when you are taking a heated up piece of pelite and putting it down over your mold to create a custom-fit liner. You have just a few seconds before it cools down to get it over that mold and then to vacuum suction it to fit the contours. There are way more steps involved, making the whole distal end pad is a completely separate process and there is some taping and gluing stuff...amongst other things. The end result though, is this whole pulling the liner and doing the vacuum thing. I thought there was no way I was going to make it to this step today, but I actually managed to get in this exact position that you see to the right ---->
And then my liner ripped down the seam. Wah wah. Super sad moment for me. Luckily it is not a problem that sets you back too far or put me in a place where I had to start all over with something that was going to take hours. I just had to get a new liner and re-heat it and do it again. Well, at least, those are the next steps I will be taking tomorrow - I ran out of time today. After getting the liner onto the socket there are a few more things to do to finish the liner completely, covering the distal end pad and matching up the pieces so they all blend nicely, but first, I have to get through the liner step without it tearing at the seams again!! I am thankful it was only a minor issue and a small setback - it could have been much worse!
So, another day of prosthetic school down and another new thing learned. Tomorrow is a day full of lectures. 8 hours of lectures to be exact. I much prefer the days where we get to be hands-on all day and get down and dirty. I have finally learned to bring a change of clothes on patient appointment days because, although the morning with them is clean and professional, the afternoon becomes one giant cloud of plaster. I got home today and discovered that I was not the only person giving myself a pat on the back at school today...
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