Making Up for Lost Time

This title is appropriate for many reasons - I went a little picture crazy today at school because I have not really been able to post many pictures on the blog lately, and also because I spent the entire day playing catch up with my leg due to not getting to work on it yesterday.

Plaster.  I had it in my hair before 9:00am today.  I had a mold waiting for me on my work bench when I got to school this morning and after I removed the plaster cast and began to start modifying, my professor told me that out of the two casts that had been made for me, the wrong one had been filled.  So, I had to go fill the other cast instead of using the one that was already done.  This was the first of many things that put me even further behind today than I had originally bargained for.  I actually liked the looks and landmarks of the second cast better so I was not strongly opposed to using it instead.  It was just the worry of about time...waiting half an hour for the plaster to dry into the mold before you are able to remove the plaster cast and get to work modifying.  I worked on some other various tasks while waiting for the plaster to set up (and by various tasks, I mainly mean getting the splashed plaster out of my hair and off my eyelashes) and then set about taking the cast off of the mold.  This is typically a fairly quick and easy process because you put baby powder into the cast before filling it with plaster so the plaster wrap from the cast is able to be cut and pulled right away from the mold.  Apparently I did not get enough baby powder into this cast.  The top half pulled right off and then I spent a minimum of 45 minutes trying to free the bottom half.  This was definitely the most frustrating part of my day, mainly because I knew it should not take long and this was the first step to starting my leg (after the surprise re-pouring of the mold) and it was holding me back!!  I will be honest, I was super frustrated and definitely got teary-eyed as I was just chipping away at the plaster with my screwdriver and hammer.  I wanted to throw in the towel and just use the other mold, but that was not what I was instructed to do.

An hour later, a few tears and very sore fingers...my mold was set free.  Then I had to modify it.  I am finally noticing that I am improving in this area because it did not take me that long to get this mess of a mold looking like a smooth piece of plaster that I could actually use for a check socket.  It was tough modifying someone else's work, but my instructor said that this was something that was going to be very common in practices in the future.  I am hoping this is not the case with my practice, but better to know how than not to know!  I took the measurements and got the mold ready to be vacuum pulled with my plastic.  At this point I was breathing a little sigh of relief (it was still before lunch) and wast thinking to myself, okay, I am going to actually get this thing done in the time span of just today.  Mind you, every one else in the class was done and were just sitting around chatting and looking at their legs - discussing what kind of feet that used and all of that.  For these sockets, some people are using a pin and lock suspension system (the one we learned how to cast for the other day with the pin at the bottom of the liner) and some people are using the seal-in suction that we used in the casting last week.  I was chosen to use the seal-in suction, so I just had to put a little purple dummy in the bottom of my mold that was going to be filled with a valve later.

I head off to the plastics room and get my leg set up on the vacuum and eagerly ran off to grab my plastic to put it in the oven.  I come back and test the vacuum to make sure it is working and the posterior shelf that I had created about 20 minutes prior (using more plaster added to the back of the mold) literally just fell off of my mold.  I have no clue what happened, but it just came off in one piece.  Okay, I now know what happened, I did not put staples on the shelf (I thought we had been using the staples as a guide for where to make the shelf and to get it the right depth...therefore I thought they were optional) and I guess I was feeling awfully good about myself and thought I did not need the staples to guide me.  I do not think it was well explained that the staples were more than just a guide, they actually hold the plaster to the plaster...lesson learned.  Rookie mistake.  So, the setbacks continue, as did the feeling of wanting to cry.  I actually managed to glue my shelf back on so I did not have to start over and make a whole new shelf, but it added more time and I was not able to get the plastic put on my cast before everyone went to lunch.  I needed a buddy to help me with this (it is really tough to do alone and I do not yet have those skills) so I had to wait until lunch break was over to enlist help.

Here is my plastic sheet in the oven.  It is like watching paint dry...same concept, just watching plastic melt.  You have your oven mitts on and you are just staring at this oven door waiting for your drop to form in your plastic.  I was also staring at my mold waiting for something else to fall off of it!!  Luckily, that did not happen and my plastic melted just the way it was supposed to and I was able to pull it nicely and uniformly over my mold.  This step made me feel much better because at least I knew I would have a socket to put on my patient tomorrow.  Even if I did not get as far as completing the leg, I would have something to try on him and something to show - I figured this was better than just standing in front of the room (potentially crying) and having nothing in my hands.


So, I was very relieved and perking up a bit at this point.  A vacuum pulled socket is a socket nonetheless so I was making progress.  That little purple thing is the marker for where I cut out and put the valve in later.  The next step was to draw the trim lines and get this plaster out of the way so I could move on to the grinding portion of the day.  I encountered another problem when cutting out the trim lines, I noticed that my cast was not nearly tall enough and did not meet the minimum requirements for what we have to provide in a check socket.  This is a huge bummer and something I should have noticed when I was modifying the cast earlier.  I should have added a plaster wrap to the top and made it another couple of inches taller.  Again, hindsight is 20-20.

What else was I to do but to continue making the leg the best that I could??  I set about to grind and smooth out the plastic.  Another area where I can feel a sense of relief about improving (and today, I needed a few areas where I felt like I was getting better at something)...this only took me about 15 minutes to get it ready to go.  It is a nice thing to not dread (or fear) the grinder anymore.  Also a good thing that I am getting better because the shortness of the trim lines meant that I did not have any extra plastic to spare in grinding off.

This is the time that I need to make mention that everyone else in the class is gone.  Even the professors have retreated to their offices.  I was literally all alone for the entire afternoon.  Kind of nice, but also a little stressful.  Again, a very "real life" situation, but on my third leg...I am not ready for that!!  It was nice not having to wait in line to use a machine, but the flip side was that I had no one to double check what I was doing to make sure I was headed in the right direction.

This is what it looks like when you have all of the rooms all to yourself.  There is my one little leg just standing by its lonesome in the alignment jig waiting to be gunked and wrapped in fiberglass.  Definitely a strange feeling to be in these rooms alone, usually you are fighting for counter space and bumping into people.  No one was around to help me so I just had to go for it and gunk it myself and make it a permanent thing.  I thought I did a nice job, I was feeling like I was making solid progress...probably should have known better with the direction my day had been going!!  Mark (my instructor) came wandering down the hall to see where I was in the process and looked at my alignment (which I had already made permanent by gunking the pylon on) and pointed out that it was too far adducted (tilted towards the body) and also that my pylon was not vertical.  I think I made another rookie mistake there because I had used my lever to make the pylon vertical at the top, but it was leaning at the bottom.  I looked at Mark as if to say, what are we going to do about this?  And he said that we would just put it on the patient tomorrow and see how he stands in it and go from there.  The good thing about these components is that they are meant to move and I have the ability to slide things out and tilt them in a way to make it all work...fingers crossed that this is how it plays out tomorrow morning in the fitting.

This was me before I had heard all of the corrections - completely oblivious to my crooked pylon (which the picture makes very obvious)!!!  Today was just not my day, I can run down a whole list of other silly mistakes that I made - put the pipe in backwards when I filled my second mold, put a screw in the wrong way and got it stuck when putting together my pylon...my brain was clearly not functioning at 100% - just one of those days...it happens.

Regardless, I got to the end of the day and a mostly finished leg...just needed to put my foot on - which would have been awesome if I had a foot to put on.  We were encouraged to try and get fancier feet then what we have in the bins at school, so I used my connections at Ossur (obviously) and got a fancy microprocessor foot to use in my last transtibial prosthesis.  The foot came to my doorstep on Friday so I had honestly not even thought about it since then.  Today, when I called the guy who had sent it to get a rundown on the foot and how to align it and whatnot, he said he had not sent the foot with all of the right parts because he thought it was just for show and not for an actual patient to walk in.  Just to continue down the path that my day had been going on :)  I must not have communicated it clearly so it was not his fault (he is doing my a huge favor by letting me borrow this foot worth thousands of dollars) and so I was kind of back to square one.  Unfortunately, my school has a shortage of left side size 27 feet and because I was the last one to finish the project today, they had all been taken.  So, I called the Ossur guy again and he put all of the parts I need for the microprocessor foot in an overnight FedEx box and I am just going to keep my fingers crossed that it gets to school in the morning while my patient is still there for his fitting.  There are three of us working with this one patient so I am hoping I can hold off and buy myself some time by fitting him last.

I have the foot charging at my apartment and now I am just praying that my luck turns a little bit and the FedEx man arrives bright and early at school in the morning so I can assemble my whole leg and make it walkable.

My leg...ready to go without a foot.  I have the manual out and I am ready to put it on in the morning.  I am also ready to start a new day and have things go my way a little bit.  I hate to end transtibial on a low note.  Tomorrow is a new day...maybe I will get out of bed on the opposite side and not step on any cracks on the way to school...just to up chances for better luck.  Anyone have a four-leaf clover or rabbit's foot laying around??