This Will Only Hurt for a Second

What do you get when you have a roll of tape, a book about muscles, a goniometer (not that that is a big clue since I had never heard that word until last week) and a flat table to lie on??  Range of motion testing!!  Partner up kids, it is time to palpitate on your classmate and find all of their nooks and crannies.  Today was 7 solid hours of Biomechanics and Gait lecturing.  That is a lot of information on walking, how people walk, how they should walk and what makes them capable or incapable of walking.  And that was just the Gait portion.  The Biomechanics of it all is where the masking tape and prodding came into play.

Dan and Sarah working on their upper extremity points.

Erin finding Horace's olecranon something or other :)

Taylor and Salim clearly enjoying their time palpitating.

Me and Erin locating lower extremity areas like pros.  I think barefoot is normal office protocol, right?

For the most part, finding all of these grooves and bony parts of each other's bodies was not a big deal.  Then we had to find the ischial tuberosity that is located on the bottom of the ischium bone.  For those of you are not sure where this is located, it is the bone that you feel on the top underside of your thigh when you are sitting down.  The one that is all up in your business.  I think our instructor traumatized every male in the class today when he snapped on his gloves and said he needed a volunteer to come and put his hands on the table in front of him so he could show us how we are to find the bone.  Needless to say, locating someone's ischium is a very personal and intimate experience and frankly, a little bit awkward to do on someone you have merely been sitting next to while taking notes for the last few weeks.  Hello, nice to meet you, please do not mind the hand that I am running up the back of your inner thigh...  After marking all of the spots, we then took the goniometer (it is basically an angle finder) and measured the range of motion (the angle to which a person can flex or extend a joint) on various joints in the body.  These are really important to test when making a specific device for someone because it tells you how far the device needs to compensate for someone who can fully extend their leg versus someone who has an extension contracture.  Plus, it was interesting to see what a full range of motion is supposed to be and how limited even those of us who are able-bodies are in some areas.

The other big thing that happened today was that I cut out my test socket!!  I was able to draw the trim lines and use the cast cutting saw to get my rough cut of my socket made.  The cast cutting saw still intimidates me, but I am learning that it cannot actually cut me...despite the whirring blade that runs awfully close to my fingers.  The hardest part of the whole process was actually once I had the cuts made and the socket trimmed out.  You are looking down at what looks like your test socket, but it is still filled with hard plaster and has a metal pipe sticking out of the top.  There is no fancy trick to getting that plaster out, it just simply involves a hammer and lots and lots of banging on the pipe.  The fear of breaking the plastic socket was so driven into me yesterday that I was not doing much more than tapping the pipe with my hammer.  I would have been there all afternoon working with my chisel and hammer, chipping slowly away.  Thankfully that did not happen and I had a few extra hands to help bang out and break up the plaster.

Victory!!  A check socket that simply needs a little washing out and some smoothing around the rough edges.  And hopefully a little beginner's luck in the initial fitting next week.

I Want to Love You, PIT

I am actually starting to believe the title of Prosthetist In Training.  Definitely felt like one today!  I spent so much time looking and modifying my mold today that I thought I saw flecks of plaster falling from the sky when I walked out of school at 5:00pm.  Turns out, that was just rain :)

After a morning full of lectures, we spent the afternoon working on our molds from yesterday.  Still adding plaster in order to make the future socket more comfortable, taking away excess plaster for a better and more snug fit and then sanding the entire thing down to end up with a smooth mold in which to pull plastic around.  This is me and my very smooth, professor approve mold!  Professor approved being the key term here - the problem with having multiple professors is that you ask one to look at it and he tells you it is just about right except for to add or take away one or two things.  You do those things and turn around to get checked and you catch a different professor, who in turn tells you it is almost perfect and good to go except for just one or two small things.  This happened to me a minimum of four times today.  Despite that it makes the process a little bit longer, I really do not mind because prosthetics is a field where every practitioner comes up with their own techniques that work best for them to get the job done as best as possible...and every single person has a different technique.  It is nice to get feedback from different instructors because it gives me a chance to see how they each interpret what we are supposed to be doing and their take on what works or does not work and how they would fix it.  Sometimes I have to hear something said about the exact same thing, four different times, before it finally clicks with me on what I need to do to get it right.  At the stage where I am, which is one of being unsure and really just trying to learn, I feel as though I am really benefitting from having multiple sources of feedback and input and teaching.

After getting the final okay and confirmation that my mold was looking good to go and ready to be used as the template for my test socket, I was able to go get my plastic ready.  Here is my Vanna White impression showing you what the "before" sheet of plastic looks like.  It is a 16x16 square inch of plastic that is placed into an oven that is set to about 350 degrees and becomes very pliable.  The type of vacuum forming we were doing today involved creating a "bubble" form in the melting plastic.  You place the sheet of plastic in a square frame and put it high enough in the oven that the plastic can drop down when it starts melting, forming a giant dip in the plastic (the bubble).  Once the bubble drops down to about half the size of your mold (in my case, this was about 6 inches) then you have to yank this huge square contraption out of the oven, flip it over so the bubble goes on top of your mold (covering it like putting a hat on something) and start working your way down the mold.


Just another one of those aspects of the prosthetic industry that has a short time frame to accomplish a number of things.  You have to be quick enough getting the plastic out and onto your mold before it decides to cool down enough to get hard.  Not only do you have to get it onto your mold, but it has to be centered and then worked down the mold slowly as to not create wrinkles.  Once you have tucked all the plastic around the bottom of the mold and feel as though you have created a seal and you have hand pushed all of the wrinkles out, you then step on the pedal and initiate the vacuum to start doing its job.  It sucks all of the air out and within a few seconds you have a sealed up, air tight plastic covering around your mold - your future test socket!

That big smile is relief at having successfully done a few things - most importantly, getting a smooth and thick piece of plastic onto my mold, but also - not burning myself during the flipping of the giant metal contraption holding my melting plastic, not going nuts on the vacuum activating pedal (in practice I had a bit of a lead foot), and knowing it was 5:00 and this was my last activity to complete before getting to go home and wash all of that plaster off my body.  As you can see by the pictures, this is not a clean and neat job... and regardless of the fact that I much prefer getting my scrubs and a t-shirt dirty as opposed to yesterday's required patient professional attire, I am always ready to get home and de-plaster.  It is also very hard to do things with those giant gloves on - they definitely protected my arms from getting burned, but made me feel very clumsy when trying to do anything that required any amount of dexterity.  Despite having said that I know I can make mistakes doing all of these things and I know that they can be corrected, I still stand in front of the oven watching my plastic drop feeling so nervous about getting all of the actions right on the first time.  I am looking forward to some of these things become routine and habit for me just so I do not feel so stressed before doing a task that takes less than a minute to complete!  I spend far much more time thinking about it while waiting to do it then I do to actually get it done!

Today was a good day.  I do not hate my mold, I do not hate school and I am fully worn out enough to probably sleep without the aid of any medication this evening :)  I feel accomplished and like I have learned a lot and am excited to keep making things and keep getting better.  Next on my to-do list, banging on that metal pipe with a hammer to break up all of the plaster inside that plastic so I can set my mold free and start the ever-so-infamous grinding process!  One crystal clear, silky smooth plastic check socket coming up!!

Patients and Patience

Today we got to see patients!!  And wear lab coats!!  And pretend to be prosthetists!!  We thought we were pretty special in our lab coats (I obviously just grabbed someone else's for this photo op, it is clearly way too large for me).  Seeing patients was definitely the best thing we have thus far.  These sweet veterans came in and let us practice on them for about four hours this morning.  I was very nervous going into the day, but after meeting my patient...Mr. R, I knew it was going to go smoothly.  Mr. R is older than my grandfather and despite a few bumps in the road - mainly me trying to be super cheery and friendly and him thinking I was giving him the grand inquisition when I was just trying to obtain his patient history - we had a nice time.  Well, I had a nice time, I am not sure being casted by three different students for a total of six times in a four hour period is nice for anyone over the age of 85.  He was very patient as long as we kept the Diet Cokes coming :)  School takes on a whole new meaning when there are patients around.  It becomes a completely different environment where we, the students, are expected to be in control, and we do our best to pretend that we are!  The truth of the matter being that we were nervous, anxious, unsure, but certainly really jazzed to be allowed to touch plaster and people.  And did I mention the lab coats??

The patient appointment involved a half hour conversation to get the patient's history - how did they become an amputee, do they have any other health issues, are they currently experiencing any issues with the prosthesis they are wearing - those sort of things.  Mr. R was a little short with his history, claiming he does not remember the details of events that happen 4 decades ago, but I managed to get enough information out of him (with only mild prying) that I felt as though I had a decent grasp on everything.  Although, there were definitely surprises that came out during the assessment phase, but I guess that just keeps it interesting :)  Assessing the patient means taking off their prosthesis and making general notes about their residual limb.  We measure circumference of different places on the limb, find all of the anatomical landmarks that would be affected in a socket, measure their range of motion.  It is just basically to get an overall idea of the limb you will be casting and to make note of things that could possibly need attention or modification in your cast or mold.

Then it is go time!  Ladies and gentlemen, get out your water buckets, roll up your sleeves and lets get down and dirty with plaster!  Is there a way to do this in a neat fashion?  I do not think so.  I think even when I am casting for the 300th time, it is going to be just as messy as it was today on my 3rd time.  Professional attire is fun to put on in the mornings, but a bummer to look down and see your nice pants covered in crunchy white flecks of plaster.  Not to mention spending my lunch break picking it out of my hair.  Still...totally worth it.  Casting is FUN!!  I got to make two casts today and although Mr. R mentioned something about peeing on me during the second round, I still really enjoyed it (and thankfully, did not get peed on).

After casting, we thanked our patients profusely and sent them on their merry ways.  The next step in the process is to make a mold of your plaster cast.  This, of course, involves more plaster.  A bucket of plaster to be exact.  And sticking a metal rod down into your mold.  We poured our molds and were free to rid ourselves of plaster and take a mental break for lunch.

Ahhhh the modification.  My kryptonite at the moment.  Making this darn hunk of plaster look like the beautiful limb that I cast is the most tedious task you can possibly imagine.  You have to go through and find all of the things that you tried to mark when you were casting - fibular heads and patellar tendons and somehow they all seem to magically disappear into this giant plaster mold.  It all kind of looks the same when you are staring at it in this form.  After much examination (and strong guidance from my professors) I began to shape out the form of the limb.  It even started looking like something resembling what I was aiming for :)  I am finally getting the hang of using the Sureform (essentially a giant nail file type of thing that shaves off your plaster) and adding on the extra plaster today did not give me near the trouble that it did last time.

So, we spent the last four hours of the day standing over these molds and trying to get them down to a perfect shape.  Making them smooth, getting the same measurements on them that we got on our patients actual residual limb earlier in the day and adding plaster to create reliefs for specific muscles or bones that tend to be poked or pushed on by the plastic of the socket once it is on their limb.  Tomorrow we will continue working on these molds and eventually sand them down to a smooth, shapely hunk of plaster :)  We will then do the whole hot plastic vacuum thing over them again to create the socket.  The rest of the week is dedicated to making these sockets and going back to the grinding room (which I will conquer and defeat) and completing a finished test socket that is worthy to be fitted onto our patients again next week when they come back.

I learned a lot today - about interacting with patients (this is a new age group for me and I definitely have to adjust my pediatric mindset and disposition to accommodate that), about time management (it gets stressful to keep looking at the clock and panicking because you have so much to accomplish and an end time in mind), about having the confidence to just go for it when working on your mold (plaster can always be taken away and can always be added...mistakes can easily be fixed so it is okay to make them), and about myself in general as a practitioner.  I felt natural sitting with my patient, that part does not stress me out or make me nervous or anxious in any way.  I felt much better about my casting techniques so I know that the more I do it the better I will continue to get.  I felt like I at least had some idea of what I was doing when it came to modifying my mold.  I definitely feel like I have made big strides even just from last week making my first project to this week.  Stay tuned tomorrow after I spend another 6 hours with this mold and I might feel a little differently...or I might just have a beautiful socket on my hands.  Let's hope for the latter!

Fake It Till You Make It

"We can rebuild him.  We have the technology.  We can make him better than he was.  Better...stronger...faster." - Opening to 'The Six Million Dollar Man'

This is Scott.  Scott is one of my professors at school.  Scott showed us how to cast a transtibial amputee today on a volunteer patient.  Scott expects us to do this tomorrow.

No, but seriously, he does.  And I expect to be successful at it - because that is the attitude I am going to have going into it.  I am so ready to see patients, so ready to give this plaster casting business another go and I know I can only get better the more I keep practicing.  Luckily, we get two chances tomorrow.  Even if our first cast is the most perfect piece of casting in the history of transtibial casting, we have to do a second one.  Frankly, I am relieved - I think the pressure will be a lot less if I know that I get a second chance without even having to ask for one.

Today we spent the morning in lecture, learning the different types of transtibial amputations we will encounter in our careers and the appropriate way to cast them and what the best devices for these patients will be.  It was all very informative and the options for different legs for these patients is overwhelming.  There are apparently about 120,000 amputations done in the US each year and with diabetes on the rise, I am sure that number will not be decreasing for at least the next decade.  The history of where all of these prosthetic legs and feet and liners come from is fascinating and essentially all boils down to about 5 men.  Everyone just keeps building off of everyone else's ideas.  If I can come up with some great new prosthetic invention, I can probably just give my services away for free in some third world country :)

We also were able to watch the video of the transtibial (apparently this is the more correct way to say 'below the knee') amputation.  Wow.  I have seen surgeries before, but it never ceases to amaze me at how rough the surgeons are with the human body.  The surgery we watched was a man who was having crazy nerve pain and elected the amputation in order to improve his quality of life.  These surgeons can perform this surgery in about 45 minutes.  Is that not insane?  This man probably toiled with this decisions for days and weeks and months and then in 45 minutes, bam, it is done.  I know that his quality of life probably improved greatly because I have learned that many amputees have very little limitations put on their lives due to all the advances in the industry.  It is pretty amazing.  I am attaching the link for the website if you want to see a surgery for yourself.  These are not for the faint of heart, but I thought it would be something my dad might really enjoy.
http://www.ampsurg.org/html/amplevels.html

The afternoon was entirely devoted to learning how to do a patient visit and casting.  We learned how to get the patient history and what measurements and things we were looking to obtain in the first casting of the patient.  Then we observed Scott performing this on a patient.  There are lots of forms to fill out with lots of information to get before you can even begin to think about wetting your roll of plaster.  We have four hours with our patients tomorrow so clearly they aware that this is going to be a slow moving process.  Apparently I can look forward to being able to do these appointments in 45 minutes to an hour once I become a pro :)

I am so ready for tomorrow - we get to meet our patients and get going first thing in the morning.  I am definitely nervous about a poor innocent patient volunteer being subjected to my inadequate knowledge of exactly what I am doing, but thankfully, these guys are repeat customers and have been volunteering to be tortured by the hands of unknowing students for years.  The nerves mainly come from the fact that once you get the plaster on the patient, you have a tiny window of about 60 seconds to make all of the necessary markings and reliefs in the cast before it becomes hard and sets.  There are a lot of things to remember and do in that 60 seconds.  Regardless of the nerves or worries, tomorrow is going to actually mean something because it will be my first amputee casting and appointment and a chance to really feel like I am a prosthetist!  It is very exciting!!  I must iron my professional attire (I have yet to grasp the concept of wearing nice clothes that you know are going to be covered in plaster), but I do dig the lab coat.  After lunch we don our safety goggles and start modifying our molds from the morning casting.  By tomorrow afternoon, I might actually pass for a prosthetist...watch out!

Transtibial Beginnings...

Let the 17 week program begin!!  Today was the first day of strictly prosthetic learning and they were not messing around.  We started in immediately with transtibial amputation lectures and did not stop until we had gone through 134 slides.  I believe the picture above was somewhere around 110.  We spent the day learning what we will be doing for the next 6 weeks (all below the knee amputations) and went into detail about the exact anatomy of this area of the body.

We start seeing patients tomorrow!  Thankfully, we have a dry run with the instructors tomorrow and they are going to be the ones casting and taking measurements on the patients, but we only get a 24 hour pass with this one because on Wednesday, we have our own patients.  I am hoping my professional attire and lab coat will exude confidence to my patient and he/she will just trust that I know what I am doing.  That means at least one of us will ;)

I actually loved class today - sure, a 6 hour lecture is hard to sit through, but it was all interesting and relevant and things that I am actually going to be practicing over the next few days and weeks (actually, the rest of my career).  I am so excited to be learning the ins and outs of prosthetics and to start understanding in great detail the things that I have been observing and hearing about for the past couple of years.  I definitely feel like I have no clue what is going on half the time, or how to differentiate support from stabilizing, but I know that I am going to know those things because they are going to drill them into my head!  And because I want to know them of course!

Tomorrow is more lecturing in the morning and then the patients come in the afternoon.  We also get to start the day with a video of a below the knee amputation!!  I am probably the most excited about that...people have already been given permission to leave the room if they are squeamish, but I think it is going to be pretty fascinating.  Onto day two...

Meet the Superhumans

In honor of the Paralympics starting this week, I thought I would post an amazing video that I saw on YouTube advertising these amazing athletes.  I definitely have a new goal of wanting to attend the Paralympics someday - maybe I will even be the Prosthetist of a competing athlete, who knows!?  For everyone who is lucky enough to be in London for this event, it is going to be the experience of a lifetime.

http://youtu.be/kKTamH__xuQ

(I had to only post the link because the owner of the video disabled embedding, but please click on it - it is definitely worth it)!

A Picture is Worth a Thousand Words

Since entering into this world of amputees and limb difference and prosthetics, I have seen so many pictures (some that I have taken, many that I haven't) that really just need no words.  Teenagers putting Harry Potter on their legs, triple amputees snowboarding in custom boards, wounded veterans walking into the ocean, toddlers running alongside their family dog.  There are athletes and soldiers, young and old, male and female and each of them inspiring me just because they refuse to lower their quality of life due to a little thing like limb loss.

This is Todd Love.  I met him when I spent time at The Walter Reed Medical Army Center in Bethesda, Maryland.  Todd is a triple amputee who was injured when he was serving our country in Afghanistan.  Todd made me laugh every day that I saw him and the kid had more energy than I ever have!  He zooms down the hall in his wheelchair, mainly because he always has somewhere he needs to be quickly!  Since becoming an amputee, Todd has been skydiving, snowboarding, surfing, and scuba diving.  I am sure his to-do list of things to do is even longer than that.  I met him for only a week, but have not stopped thinking about him since.  He has been one of my biggest perception changers.

Oscar Pistorius.  A household name since becoming the first ever challenged athlete to compete in the Olympic Games.  I have been lucky enough to be close to the company who makes Oscar's "blade runner" legs - the Ossur Cheetah leg, so I have known his story for many months.  Seeing a picture of Oscar crouched down in the blocks at the stadium in London gives me chills, but this picture makes my eyes well up.  Everyone is always telling their children they can be or do anything they want when they grow up and this picture says that to me.  This little girl running next to Oscar is running next to an Olympic athlete who looks just like her, she is going to grow up believing that she can dream as big as she want and she will accomplish those dreams.  I love this.

This is my friend Dan.  He is a wounded warrior too, and a double above the knee amputee.  He is at a wedding in Florida and I just love the simplicity of seeing him walking on those legs down the beach to the ocean.  No matter how many times I see the ocean, I am always in awe of the beauty of it and I think that is what this picture makes me feel.  You see this big beautiful ocean and a guy who lost both his legs at war and yet holds no bitterness, still wants to "feel the sand on his toes" and go stand in awe of the ocean.  No matter how powerful the ocean is, I am more in awe of Dan's strength and perseverance than standing in front of those waves.

This is just one of the many pictures from camp this year that melted my heart.  Just two teenage girl friends strolling down to our next activity.  There is nothing fancy about this shot, they are not doing anything particularly brave or ground breaking, but it just makes my heart smile.  I love the camaraderie and bond that having limb loss brings to these camp goers.  My thought is that they do not lack any confidence back in their real lives either, I was amazed at how self-assured these 16 year olds were - that was definitely not me at their age, but I know how much being around other amputees means to them and like I said in my previous post, it was just an honor to be a part of the whole experience.  

Lauren Scruggs - Lauren is a former model and current fashion blogger who just happens to be from my native state.  That is how I know of her - she attends a church in Dallas that a lot of my friends attend.  Lauren was in an accident last year where she walked into the propellor of a small plane and lost her left eye and left hand.  This is a picture of her on The Today Show in London a couple of weeks ago at the Olympics.  She has a prosthetic eye and a prosthetic hand and is still obviously very beautiful.  She has a new book coming out about her experiences and I am really looking forward to reading it.  I have followed her story for months, reading updates on her health and her recovery and have been moved by it from day one.  The grace and faith shown by Lauren and her family make you rethink the things that we all tend to place great value on in our lives - she is happy to be back to living her life and the injuries she sustained are far less severe than they could have been.

These are just a few of the people that I think have wonderful stories and something about each one of them has affected me personally - whether I actually know them or not.  I think it is worth taking the time to read their websites or look up their personal stories because they all have a story to tell.  Each one of them have families and they all had lives before living with limb loss...it makes me so grateful for today because you never know what tomorrow might hold and I want to live a life reminding myself of that every single day.

A Meeting of the Minds

"Strength of mind is exercise, not rest." - Alexander Pope

Allow me to introduce the Fab Five of the CSUDH Prosthetic Program - Taylor, Erin, Dan, me, and Salim.  

Let's start with Taylor - Taylor is the baby of the group, at just 22 years old he brings out the matronly side of me.  Ha.  Not really, I am actually jealous of the fact that he already knows what he wants to do with his life and is actively pursuing it.  He is very confident in what he knows and has yet to learn to bite his tongue when it comes to arguing with professors.  It is refreshing and cringe-worthy all at the same time :)  Taylor looks a little like Dexter and reminds me of my little brother (both of these things probably stemming from the red hair on his head).  He is from Las Vegas and is super into cars - all I know is that his windows are very tinted and we lovingly refer to him as 'Fast and the Furious.'  He is a hard worker, great at explaining things (my turning the corner in the world of grinding can be mostly attributed to him) and I think he is going to be wildly successful long before he reaches my age.  

Erin - the native California girl.  She left behind her farmer fiance to come to school for a few months.  She was definitely the quiet and reserved one of the group at first, but we are getting her to come out of her shell...she did not have much choice after about the 7th hour of sitting in a tiny conference room together.  She either secretly studies way more than the rest of us or has an incredible knack for acquiring knowledge quickly.  I believe it is the latter - which makes her the one you want to partner up with in class.  Although she is only 23, she seems much more mature and I am sometimes surprised when I remember her age.  She is what I think of when I picture a California girl - naturally beautiful, blonde hair and light eyes, tanned skin, and an easy manner about her.  She is focused and funny and I am thankful to have her in the group - I needed help bringing up the estrogen level!

Dan is from New York.  I mean, really from New York.  He is one of those people who refer to it as "the city."  He is a prosthetic legend - meaning he has been working inside an O&P clinic long before I had ever even heard of one.  It is a family business for him (as is for Taylor), but he is not going into it because he has to...which I love.  He is the most animated of the group - and by animated, I mean, loudest/grouchiest/happiest/cockiest.  It makes study groups far more entertaining when someone is celebrating every right answer the way he does.  Dan gets into school-mode and it is hard to get him out of it.  When he sets his mind to a project, you can usually hear him talking himself through it in the corner behind you.  He shines when it comes to patient care and it is hard not to respect his work ethic when it comes to learning the material and putting it into practice.

And last but not least is Salim.  Salim might give Dan a run for his money in the entertainment category.  Salim comes from Arizona and as hard as this might be to believe, I think he actually talks more than I do.  Salim is the sleeper cell of the group, he skateboards around and is always on Facebook, yet the man knows every single answer to every single question - it is amazing.  We sometimes have to ask him to not speak up because he can give you the answer before you have even finished asking the question.  He makes jokes and is quirky enough to record podcasts of himself talking aloud the material we are supposed to be memorizing (think slow speaking with Enya playing in the background).  I will look over and see him working on a project with headphones in and just laugh because I know he is only listening to his own voice.  I joke, but this is clearly a method that works for him because he knows it all.  We have yet to convince him to send us the podcasts, but I have a feeling by the end of the semester, we will all be learning by listening to Salim as we are driving to school or running on the beach.

There have been pizzas devoured, far too much sugar consumed, 5 minute breaks that last for half an hour and endless quizzing and fighting over answers, but without these four people I would have lost my mind the past couple of weeks and gotten far less studying done.  They say there is no rest for the weary, but after three back to back finals, this weary soul is planning on resting as much as possible before getting back to it on Monday morning.

Head, Shoulders, Knees and Toes

<---- This guy, the way this guy is standing right now perfectly exemplifies how I am feeling.  We have the exact same body language at the moment.  Head hanging, shoulders slumped, dangling tired arms.  We are both exhausted.  And he is to blame.  I am exhausted from trying to cram the name of every single bone in the body, every muscle and where they originate and insert and what they do, not to mention all of the things that can happen to your body and degrees of flexion and rotation - into my overworked brain.

Tomorrow is the final for Applied Anatomy and after hours and hours of studying, I still manage to feel very unprepared.  There are many people who can relate - learning anatomy is like learning a new language.  These are not real words!!  I do not use the word olecranon or suprapatellar in real life...I think I am supposed to be using them in my new real life, but I also took 4 years of Spanish and still struggle to get through the menu at many Mexican food restaurants.

I have been locked in a room with my study group (who felt they needed a shout out on the blog - Taylor, Erin, Dan and Salim) and my brain is too tired to continue.  I want to blog about my awesome study group in a whole separate post - I need to get a picture of the group (okay, I am trying to get us all to wear matching shirts to school for that photo op) and then I will introduce them in a proper manner.  It is nice to have the accountability of other people...we all get excited when we get something right and equally all throw our papers to the floor when we get something wrong.  There is pacing, lying on the floor, loads of candy, energy drinks, various interludes of music and at some point, we actually go over our notes :)

I am so thankful that this is where my career path has taken me, but I will definitely be happy to not be in school anymore.  As much as I enjoy the process of learning new things, I had no idea that my life would be that of a perpetual student.  Next week we start our official 17 week course and I am sure it is going to fly by, but I am definitely ready for new material and more getting my hands dirty.  If you would have told me last week that I would be dying to get back into the rooms with the grinders and band saws I would have laughed (and maybe cried), but these 30 pages of lecture flashcards have me waxing poetic about safety goggles and closed toed shoes...

Blood, Sweat and Plaster...

I have officially made my first mold, cast, and device!!  Let me tell you, it was SO much harder than I thought it was going to be!  We started our project last week with casting a classmate - we used plaster rolls to cast their knee area...coming from a girl who has never worked with plaster and especially not been responsible for rolling it wet onto someone else's body...it is a messy messy job.  I came home covered head to toe in plaster and despite a long hot shower, I kept finding it in random places - my hair, in the grooves of my watch...my poor sneakers will never look the same.

After taking the plaster mold, we cut it off our patient and then filled it with plaster to create a plaster cast.  I have really got to keep up with my arm weights because I was lucky enough to have a small girl as my patient and trying to lug this big chunk of plaster around with a metal rod sticking out of it is not the easiest thing in the world.

The hardest part of this whole process for me was modifying the plaster cast.  The trick is to find all of the anatomical landmarks and account for them, making room for the patella and and bony prominences that a person might have.  There is a lot of shaving down of the plaster and sanding it and smoothing it and adding extra plaster when you accidentally take off too much (I became really good at adding plaster).  It is amazing how repetitiveness in this industry gives you the ease to do these things without thinking.  People were telling me to take off 1/8 of an inch on one side and I kept thinking, how on earth when you are sanding this down do you know how much 1/8 of an inch is!?  I am confident I will be able to have that innate knowledge someday...

When all the modifications are done and you are looking at a beautifully smooth plaster leg, you get to take it and cover it with a giant sheet of melted plastic.  Fun right?  Except for the 350 degree giant sheet of plastic melting in your hands!  The fact that this part is pretty time sensitive had me a little stressed, but as it turns out, I am a pro at plastic pulling :)  It was definitely nice to feel like I accomplished something quickly and on the first round of trying, it gave me a morale boost for the day.  Then we drew trim lines (the area that you want to cut along to give you the shape of your brace) and took a saw and cut the plastic off the cast.  Bam!  You have what looks like the start of a decent bracing device.

Don't be fooled...I said you have what looks like the start...then begins the grinding.  Oh the grinding - I thought in the war of me versus grinding I was going to lose.  It was looking fairly grim on the first day.  I almost threw my knee brace out the window and headed to the beach.  I took a break, came back the next day and at some point turned the corner in the world of grinding and polishing.  My brace came out smooth as could be, providing the most comfortable plastic surface you could ever imagine pushing into your flesh.

Next up, the sewing machine.  I have never used a sewing machine in my life and now have so much more respect for people who are exceptionally skilled at using them.  This whole clutch and pedal and turning the wheel and feed dogs thing...whoa, it is a lot to try and do for a little 8 inch strip of velcro on cotton!  I managed to somewhat get the hang of it and sew two successful straps, rivet those to my knee brace and voila - a completed project!!

I had to then fit my patient, modify yet again because the first fit is never the right fit (more grinding, more polishing, adding pads for comfort).  It seems so silly, but this piece of plastic with two little straps in the back made me feel so accomplished and so proud.  I was just staring at it on my workbench today thinking - okay, I have come so far since last week, I can only imagine what I am going to be creating over the next few months.  I am so excited!!

We had to present our projects to the class and to our instructors for a critique - now, I may have had to cast my patient twice, I may have used more plaster than anyone in the class, I may have spent the longest time grinding that thing to perfection and maybe had to throw away a poorly sewn strap, but a patient presentation is where I shine.  Standing in front of the room of people and discussing my trials and tribulations in creating this device, explaining what I learned and where I went wrong and what I would change for the next time, I felt comfortable and at ease and was rewarded with the compliment of the program director telling me that it was the most confident presentation of the day.  Doctors, patients, people of the O&P industry, watch out, I am going to win you over with my smile and charm and then surprise you with a perfectly made prosthetic device :)

Make a Joyful Noise

"You are not disabled by the disabilities you have, you are able by the abilities you have." - Oscar Pistorius

Who knew one of the best experiences of my life would happen in Clarksville, Ohio?  Certainly not me!  I had the absolute pleasure and privilege of being a counselor at the Amputee Coalition's Paddy Rossbach Youth Camp a few weeks ago in July.  The camp is held on a campground in Ohio called Camp Joy.  I think the word 'joy' pretty much sums up the week.

Volunteering and being a part of the community that I work in is really important to me - it helps me feel more connected and gives me a chance to give back and see a different side to what I am doing.  I was involved in many things with childhood cancer and as soon as I decided to go into prosthetics, I quickly looked for opportunities to get involved.  Pediatrics is where my heart is so that is where I began my search.  Thankfully, the Amputee Coalition had a place that was exactly what I was looking for :)

I was chosen to be a camp counselor and lucked out enough to be assigned to the most wonderful cabin of 16 year old girls.  It is everything you are picturing in your head - eyeliner, loads of blow drying, ripped t-shirts, giggling, screaming, discussions of annoying boyfriends, outfit changes and lots of opinions.  It was perfection.  It was an extreme lack of sleep and worth every waking hour.  I felt so energized and so inspired by watching these kids (aged 10-17) with limb loss crushing every stereotype someone might put on them.  Does a quadrilateral amputee need my help getting water out of the cooler?  Absolutely not.  Does having an above the knee amputation mean you cannot complete a ropes course 35 feet of the ground?  No way.

There was archery and swimming, dance class and fishing.  There were numerous skits and meaningful late night chats in the cabin.  Rock climbing and arts and crafts, canoeing and a game involving a ball called 'Gaga.'  There was bacon every morning and debatable hamburgers, milk in individual cartons and rice krispie treats.  There are 4 different friendships bracelets on my right wrist and a piece of yarn that all hold great significance to me.

I could write for hours about my experience at camp and it still would not do it justice.  From dancing the night away and learning how to do 'The Wobble' to getting a cooler full of ice cold water dumped on my blindfolded self, the entire week was one of the best things I have ever done for myself.  It was uplifting, it was heartwarming, it was eye-opening and perception changing.  It's funny how I went as a volunteer and was there to be giving back to the kids in the amputee community, but I left knowing that I received more from them than I could possibly have given.

A Whole New World

In the past year of my life I have gone through major changes, one of the biggest ones was deciding to make a career change.  Instead of continuing on in the world of pediatric oncology, I decided it was worth going back to school to become a Certified Prosthetist Orthotist.  I was introduced to this world a few years ago and was relentlessly immersed in it to the point that I had no choice but to fall in love - with the world and the relentless one :)

And what a world to fall in love with.  Prosthetics is not something that most people even consider, not in their every day lives, not as a career path, not as something they even really know exists beyond seeing the first ever amputee Olympian this past month in London.  I have been blessed to have multiple experiences and opportunities in the field and have gotten a chance to really become quite passionate about the future I have with prosthetics.

I am currently in school at Cal State Dominguez Hills getting all of my certifications.  I have made major life changes - moving from Texas to California, leaving behind my comfort zone and my friends and family in pursuit of something that I know is going to be a new level of greatness for me.  I think dialoging this journey is going to be important for me and is a good way to stay grounded and remind me of the reasons why I got into this field.  It is so easy to get bogged down in life and in school and to be overwhelmed, but I want to be a prosthetist because I want to change people's lives.  I want to give someone a better quality of life and I want to always remember that is why I am going to do what I do.  Not for the money, not for the notoriety, but to be an impact on even one amputee's life.  I think when the going gets tough, it is important to reflect on the why of what we are doing rather than all of the nuances that might come with the hows.