No Tricks and A Nice Treat

As an adult, Halloween is pretty much an non-existent holiday.  At least when you are in Prosthetic school.  There were no costumes, no candy and thankfully, not a lot of tricks today.  I did wear black pants and an orange (more like copper) sweater and fun Halloween socks to get into the spirit.

My treat of that day was that I was able to get Norma up in my leg and walking fairly well.  I say fairly well because she is 75 years old and I think that has to be taken into account when judging her on her walking skills in general.  She does not walk with perfect gait in her current prosthesis and she uses a roller walker to get around...so, getting her walking in the parallel bars perfectly is an unattainable goal. I was very pleased to get her up in the socket and feeling comfortable and walking back and forth with no issues.  She is not one for a lot of fuss and readjusting so I was lucky enough to get it pretty close on the first couple of tries.  I had to make some minor adjustments in height and trim lines, but as far as the socket (the most important part of these trans femoral legs), she said it felt really good.  She was not crazy about the knee or foot that I had attached to the leg, but to be honest, we were not really given a lot of options and I am not that crazy about the knee or foot that I attached either.

Tomorrow is a full day of critique - I am actually looking forward to it because I feel as though I know very little about trans femoral gait and I really need the exposure to seeing 18 different legs walking back and forth to help me learn.  I am up first in the presentations which also makes the day easier - I can get mine over with and then be able to focus the rest of the day on analyzing gait.

The last two weeks have been moving at a slower pace at school (because we started a new topic), but the schedule next week looks like we are back to running at full speed.  Casting and leg making and critiquing all in a matter of days again.  It is hard to say which pace I prefer - getting to leave earlier than 5:00 every day is pretty nice and the stress level is way down, but the days tend to fly by much quicker when we are under the pressure of a much smaller time window.  I am sure by this time next week, I will have decided for sure that I prefer to slower pace :)

Move and Be Moved (CAF Weekend Part 2)

7am...drizzling rain, cool temps and a beautiful backdrop for the start to the CAF triathlon.  Although we were exhausted (which I know sounds terrible considering we are sitting here staring at triathletes beginning their race), we managed to haul ourselves up and out of bed to get down to the start of the swim.  I am SO glad that we did.  I have heard from people that this is one of the most amazing sights to see and they were dead on.

The first round of athletes to go out in the water are the challenged athletes.  The most inspiring round to watch for sure.  I have never attempted a mile swim in the ocean, but I know that it cannot be easy and to see these men and women get carried into the ocean because they are missing one or two or even three limbs and start swimming against these waves...it is impossible not to feel emotional.  It was just a swell of pride about the human race in general.  It was so exciting to see people pushing themselves, going beyond what physical limitations might have been set upon them and accomplishing this giant athletic feat.  There were hundreds of people watching the swimmers get ready and it is almost impossible to set the scene...giant crowds gathered around, overlooking the bluff, still and silent.  The sun just trying to peak through the clouds - giving us some relief from the constant nagging rain and the cold wind.  A calm giant ocean and a beach full of wetsuits and pink swim capped heads all stretching and rolling about in the sand and water...anxiously awaiting their signal to start.

My favorite part about getting the chance to watch the pre-race happenings on the beach was watching the camaraderie between the athletes.  They are all competing against each other, but at the same time are all competing on the same team.  I love to watch them encourage each other, push each other into the water, carry a friend in with them.  As humans, we are naturally drawn to those who have similar situations to us and the bond that these athletes share is unmistakable and quite an honor to observe.  The crowds were gathering and more volunteers and athletes were making their way down to the beach to get started.  The rain had stopped momentarily and everyone was buzzing with excitement - these guys just wanted to get into that ocean and get going!!  Everyone was hopping (quite literally) with energy and it was impossible to not get caught up in the feeling.  I could not wait for them to get started either!!

And, oh my, what a sight it was when they blew the horn to begin.  Everyone in the water, everyone swimming and my eyes were teary and my heart was full.  What an incredible thing to witness...I know that I am not doing it justice, but I hope you are able to get a small sense of what a beautiful morning this was.

And it was a surprisingly short amount of time before the first group was swimming back and exiting the water.  The first person out of the water was a woman who had competed in and won many Ironman competitions.  The first challenged athlete (and second person) out of the water was a man named Rudy Garcia...a bi-lateral amputee who just brought home medals for swimming in the Paralympics.  Watching them going into the water was pretty amazing, but watching them come out....now that makes your heart stop.  The volunteers typically rush over to help the challenged athletes out of the water, but 9 out of 10 of them refused the help and just scooted or hopped along the sand themselves...then of course they used their arms to get all the way up a long flight of stairs and tag their team member to start off the bike portion of the race.

We did not see much of the bike or running portions of the race - they all started in the same place and then took off all over San Diego.  We did see people cross the finish line later in the day and it was just as exciting as you can imagine.  What a sense of accomplishment for these competitors.

The fight in these athletes, the will to prove the world wrong, to prove something to themselves, to go against all odds...it is inspiring.  The CAF had t-shirts at the triathlon that said 'Move and Be Moved' and there are not four better words to sum up the experience and feelings that I had over the weekend.  This is an event that I know I will attend in the future (I don't know that I will ever participate in the 'move' part of the event), but I know I will be at the starting point for the swim...and I know I will continue to be moved.

*For more pictures from the entire weekend, you can go to the CAF Flickr Page:

http://www.flickr.com/photos/challengedathletes/sets/72157631838442293/#2012SanDiegoTriathlonChallengePhotos

And the Ossur Flickr Page:

http://www.flickr.com/photos/ossurcorp/sets/72157631860249081/

Knees and Toes, Knees and Toes

I have officially completed my first "full" leg!!  In transtibial we were just attaching the pylons and the feet, but in transfemoral, we learned how to put a knee in between all of that!  Pretty exciting!!  I think I have mentioned this in regards to every single component or option that we have when we make legs, but the number of knee options is unreal.  There are knees that are called single-axis that simply act like a door hinge, there are polycentric knees (meaning they move all around), hydraulic knees and microprocessors knees...it is a lot to handle.  Thankfully, this is school, a place where you are given instructions and direction.  On our first project, we are all using single-axis knees.  All I have to worry about is this knee bending back and forth like a door opening and closing.  Well, first I have to worry that my patient will be able to walk comfortably enough in the leg to make that motion happen, but I am just assuming we will get there :)

The alignment process for transfemoral is a lot less stressful than that of transtibial legs.  This took me forever in previous legs and the measurements for transfemoral are all pretty universal and because you are controlling a knee and ankle and foot, you have a lot more freedom to move the alignment around once it is on the patient.  Transtibial is all about the alignment, transfemoral is all about the socket fit.

This week has magically worked out for me in regards to this prosthesis.  I know that it means I will probably struggle with the next project, but I am enjoying the calmness at the moment.  I was able to get all of my components together and attach them and "gunk" them onto my socket in a relatively quick fashion.  It is always such a cool feeling to look at a leg that you have completed from start to finish (I know this is redundant, but just looking at the picture makes me feel proud).  I will not get to try this on Norma until next Wednesday.  We are moving slowly through transfemoral, getting our feet wet and trying to learn as much as possible about the components and gait and alignment before we actually have to put the knowledge in action with our patients.  So, alas, now my leg just sits on my workbench waiting to be worn and walked in.  I have put all of my body weight on it, walked it up and down the halls of school (the knee successfully bending as it is supposed to) and cleaned it about 5 times since completion.  I guess the only thing to do now is to wait...

Earning My Own Trust

I mentioned a few posts ago that we have been taught to either trust our cast or trust our measurements and that I did not think I was at a point where I knew which one to trust (or if to trust one at all).  Today I learned that I should start trusting myself!!  This week it was trusting my measurements over my cast.  My patient, Norma, has a very "fleshy" limb with a lot of residual skin and tissue - this means my cast came out looking a little deformed...much harder to trust that shape.  My measurements, however, were dead on.  I spent the 9 hours last Thursday using those measurements to modify and honestly, I was a bit worried that Norma was not even going to fit into the socket.  Looking at my cast, it seemed as though the socket I made was going to be too small.  According to my measurements, it was going to be a perfect fit.

Thank goodness I trusted my measurements on this one!!  I went into this morning's fitting highly anticipating not being able to get Norma into the socket and prepared to do hours of modification in order to make a socket that worked...color me shocked when it went on perfectly the first time!!  I had to fix a few areas (lower some of the brims and trim up the wall in the back), but these were pretty minor.  I will take using a torch or a heat gun and a little more grinding any day over having to pour another plaster mold to modify again.

Norma said my socket was really comfortable (and as you may have deducted from the previous post about her, she is a tough cookie to please) and she stood in it for quite a while today.  It felt really great to have such a big success on my first trans femoral socket (it would feel great on any project) and I was high-fiving myself all morning about it.  This could mean that the next socket goes horribly wrong, but hopefully not :)

Because I did not have to re-pour and re-modify and re-pull another socket, I was able to take the afternoon off school!!  Three hours of freedom to run errands...the rewards of successful suction and total contact.

We do not see our patients again until next week - that is when we will be getting them up and walking on these legs - we will be attaching all of the knee and feet components tomorrow.  I am just keeping my fingers crossed that next week's walking goes as well as today's fitting, but for now, I am taking one victory at a time...this was a nice one.

*Part 2 of CAF Weekend still to come...

Redefining Ability (CAF Weekend Part 1)

My apologies for lack of posting the past few days - I was drowning in modifications and then I went to San Diego for the 19th Annual Challenged Athletes Foundation Triathlon.  This is the the first event since camp this summer that I have had a chance to do some volunteer work and get involved in the amputee community...I had been really looking forward to it!  This blog will be a two-parter because there were so many amazing things happening that each day (Saturday and Sunday) deserve their own post.

Friday night we had a meet and greet dinner - a kick off to the CAF weekend activities.  There were tons of people and it was fun to meet all of these names in the industry that I have been hearing about for so long.  There was also an awards presentation with inspiring and heartwarming videos and speeches.  Just another one of those times I get to sit back and be thankful I have found a career that really touches peoples lives.

Saturday morning I was up bright and early for the CAF/Ossur Mobility Running Clinic.  This clinic is put on for people with amputations, of all ages, who are interested in learning to run for the first time or improve their running technique.  Bob Gailey, the master of all things gait related to amputees, runs the clinic and he is just fun to watch.  He has the energy, the knowledge and the passion to inspire these people to get out and run and give them the confidence to know that they can.  There were about 100 participants - from age 2 to 70.  It is hard to even describe what it is like to watch a field full of running legs doing marching drills and running back and forth.

I, of course, chose to work with the children who attended the clinic.  The difference between adults learning to run and children learning to run is that children already instinctively know how to run.  And that have a very, very hard time being told to not do so.  The goal was to teach correct running gait and this means doing it in various steps, working up to running, but many of the kids just kept wanting to take off down the field.

Case in point :)  The little guy in red was all over the place all day...the most energy and just loving getting to run around with no abandon.  

This was my kiddo and partner for the clinic...is she not adorable??  I got to spend 3 hours holding her hands and helping her march down the field and take long strides and shuffle sideways and kick a soccer ball.  This was her 4th year attending the clinic so she knew way more than me!  

One of the drills was to have the kids march like soldiers down the field, saluting with the opposite hand per the leg that was taking the marching step.  (This is much tougher than it sounds, regardless of how many legs you have!!)  They were all very good listeners and I am always amazed when you can get a group of children to do anything all at the same time, so I had to capture it on film!

Let me introduce you to Cody.  He is one of the CAF sponsor children (on all of their posters) and is faster than you can possibly imagine.  He is not even 4 years old yet and he was zooming down the field faster than most adults at the clinic.  They might have to invent a faster running leg just to keep up with this guy!!

At the end of the clinic, there was an obstacle course and a giant relay race for all of the participants.  Everyone was divided into two teams and it was all split up evenly with both children and adults on each team.  Then two giant teams, about 50 people each, went through the obstacle course, tagging each other back and forth for the next relay person.  Cody was our lead guy on our team and Blake Leeper (Paralympic medalist from this year) was our anchor man.  It was a little tough to say who won (I think they kept it a politically correct tie), but it was definitely a lot of fun.

Another girl that I got close to at the clinic is an amazing young lady, Haven.  She was awarded the most inspiring/promising child of the year (something along those lines) at the CAF awards dinner on Friday night...and when I saw her in her tutu and sequined Converse sneakers, I knew we had to meet at some point this weekend.  Her background - that she was born in Vietnam, got caught in a bomb explosion where she lost both of her legs, and was adopted by a family in America.  She is tenacious and a crowd pleaser, she is smart and funny and has a very infectious smile.  It is impossible to not hear her story, see her run and be inspired.  And to also be thankful.  This clinic was about redefining abilities for these athletes...for me, it also helped continue to shape my perspective and reenergize me.  I have 9 more weeks of school and weekends like this make sitting through all those lectures and coming home covered in plaster totally worth it.  It was cold, it was rainy, but it was life changing and I am already looking forward to going back next year and continuing to watch the abilities of these athletes grow.

It's Not a Man's World Anymore...

One of the things I have learned at school is you either trust your cast or you trust your measurements.  I am not at the point where I trust either of these things (certainly not one more than the other), so I do my best to keep up the accuracy all around.  Taking measurements is a very serious business.

 And often involves help from a partner...a second opinion never hurt anyone.

Casting day!!  Always the busiest, most stressful, and hands-down dirtiest day of the week.  My least favorite part of casting day is the massive clean up that is required afterwards.

Something fun and different happened today in regards to my patient assignment - I had a woman!!  This was the first time we have even had women patients come into the school for a project.  I think the ratio of men to women patients was pretty equal.  It was a nice change...and a smaller patient means less plaster :)

I will refer to my patient as Norma - she is a feisty 75 year old woman who brought in a reusable grocery bag full of cookies (not to share) and her own towels from home to cover our chairs.  She has been a patient model at the school for the last 10 years and knew far more about what to do than I did.  This was a blessing and a curse...she would either give me a helpful tip or glare at me and tell me I was doing it wrong.  Norma speaks her mind, told me about the previous "idiot" students she had had in the past (namely a girl who did not speak English as her first language) and previous patients that she did not care for either (namely a man who wore a diaper).  I have a henna tattoo on my hand from the wedding I attended last week and she told me it was ugly.  I have to respect a woman who speaks her mind...and she was my patient (just like the customer, they are always right), so I just smiled and continued taking her measurements and prepared to cast her.

This picture tricks the reader into thinking I was having a really really fun time palpating Ms. Norma's ischium.  I was smiling through the awkwardness.  I also believe this was right after Norma reached around and grabbed my hand and placed it in the right spot.  (One of the blessings I was talking about earlier of a well-versed patient.)  I do feel for Norma, she had to endure four hours of this and four different casts being made.  That is a lot of poking and prodding (often in the wrong places) and a lot of up and down from sitting to standing.  I was exhausted before noon so I know she must have gone home and taken a long afternoon nap.  I did the first cast on Norma and felt okay about it, but there is always room for improvement and, as to be expected, my second cast was much better.  These castings are so much harder to do than they look when we are observing them being done by our instructors.  Before lunch we filled the cast with the plaster to make the mold.  A little lesson I learned about trans femoral today (and another reason to be thankful for a small patient) is that you have to lug this giant plaster mold to and from places and if I had had a patient that weighed more than Norma's 125 pounds, I might have needed a second set of hands.  There were legs in the room that were far bigger around than my waist.  I am going to have to go into pediatrics simply to be able to carry my molds around!!

These casts and these molds are not nearly as pretty as the ones for trans tibial.  In trans tibial there are more bones and therefore more definition in the cast...in trans femoral it is just a big mess of skin and muscle that is very indecipherable when it comes out of the mold.  I would be lying if I told you that I did not spin the mold around in my vice grip about three times trying to figure out which side of the leg I was looking at.  I ended up marking the sides just so I would not get them wrong later on in modifications.  We had a little bit of time at the end of the day to begin the modification process.  The good news is that there are only 15 steps to be done to get this leg modified and ready to pull plastic over it (insert dripping sarcasm).  We are used to about 5 steps in modification...I would be right on track if this was the case, I left school today at step 5.  Our instructor only walked us through the first 9 steps today so we have not even covered how to finish it!!  Tomorrow is a full day of only modifying and trying to get our molds to something that resembles an ischial containment socket.  I think the goal is to get the plastic pulled and have a check socket by the end of the day, but I am setting my expectations a little lower - essentially, just being more realistic about the amount of progress I can make in 8 hours.

This is how I left my mold this evening.  If you cover them in plastic bags it keeps the plaster from getting too dry and hard and makes it easier to make the modifications.  I will take all the extra help I can get so I use every trick in the book!!  I am still amazed that this ugly thing covered in a plastic trash bag is going to become someone's leg.  I am even more amazed that I am the person turning it into a leg!!  I really do not think this will ever get old for me - it is quite indescribable.  This socket is definitely going to be the most challenging thing we have done thus far, but if I think back, everything previous to this has been the most challenging thing up until that point.  If I can get through the modifications tomorrow I will feel really good going into the patient fitting next week.  And if not, it is plaster - it can be added, it can be taken away, it can be re-made.  It is all about failing forward and learning, both of which I plan on continuing to do :)

I leave you with a glimpse of what I look like after a day of casting (at least from the waist down).  Although my actual casting technique has improved, I do not seem to have grown in the area of making any less of a mess.  I tried to outsmart the plaster today and wear white pants, but it is plain to see that it got the best of me anyway.  This is why I am currently doing all of my laundry - I need fresh, clean clothes that I can get plaster on tomorrow :)

Makeshift Pants and Making Posterior Brims

I am posting the exciting portion of the day.  The first four hours were spent in lecture - learning about ischial containment socket designs and how to draw out socket patterns on paper to use in helping make modifications.  I have to tell you, it does not matter how many hours of sleep I get the night before - I always really struggle to sit through a 4 hour lecture.  Luckily, the afternoon was casting and moving around so I managed to perk up after lunch.  We watched Mark perform an ischial containment casting on a patient model today...we will be doing these castings on our own patients tomorrow.  I thought we were going to get a little more practice this week, but it looks like we are being thrown to the wolves :)

After Mark showed us what we were going to be doing, we all donned stockinette pants and casted each other, trying to feel out the ischium and capture that into the plaster cast.  This was so much harder than it looked when Mark did it!!  You feel as though you are literally cramming your hand and fingers deep into the upper thigh of the person you are casting and sitting there holding that position for the 6 or 7 minutes until the plaster dries causes quite the hand cramp!!  I am so glad that I got to at least get my first shot at it on Erin....who was an excellent patient and very forgiving and understanding regarding my fumbling hands.

Pretty attractive pants huh??  We literally took a big nylon stockinette and cut it up and the middle and sewed a seam to create leg holes.  I had to sew 4 of these for my patient tomorrow - we layer them up with two paris of pants per casting so their undergarments do not get dirty and we are supposed to make two casts each tomorrow.

This is Michelle casting me...notice the look of pain on her face while she is trying to get a good grasp on my ischium.  This was a few minutes in and I believe she had reached the point of the hand cramp...

This is just to give you a good idea of what the training room looked like this afternoon.  Now you can see what I mean when I talk about how you have to really get up close and person with your trans femoral patients when creating their sockets.  Looks fun, right??

Ta da!!  My completed ischial containment socket for Erin!  Sadly, this is as far as this socket is going to go - we are not filling the molds or making any sort of check socket.  This was just a quick hour practice at the end of the day to get a feel (quite literally) for how to make this type of cast.  It was nice to be able to cast again and get dirty and make something...I feel like it has been a couple of weeks of review and testing and not enough plaster!!  Tomorrow we have patients until lunch - we will each be doing two casts on our patients and then spending the afternoon modifying the molds.  I am sure the week is about to get crazy, we were told to be prepared for some upcoming long days in the work room.  I am looking forward to really starting trans femoral tomorrow and meeting my new patient and giving my first above the knee socket and leg a go!!  More ischiums and stockinette pants to come in the next few days... :)

Easing Back Into It

Someone is smiling down on me and giving me an easy start to getting back into school...well, minus the two online quizzes that I have to take this evening :)  But when I checked the schedule last night (thankfully), I saw that we had a 9:30am late start today...amazing news after I have been sleeping in for the last 5 days!  I got to school and the only plan before lunch was for everyone to modify the casts that they had made last week - since I was not here to make the cast, I had nothing to modify.  I was able to hang out for about an hour and then go run a couple of errands before coming back to school in the afternoon.

So, this is what putting someone into the jig for measuring and casting and fitting a trans femoral socket looks like.  Comfortable, right??  We spent the first two hours of the afternoon doing critique over the quadrilateral sockets that my classmates made last week.  It was a good learning experience for me to see the problems they encountered and what they had made, but I still feel like I will have no clue what I am doing when I have to actually cast someone.  I do not think that we use this actual casting technique on our patients so it may not be something I do again until I am in residency.  I felt a few ischiums today and got to experience a bit of what I missed out on last week, but for the most part, it was a really easy day for me.  Tomorrow we are casting each other in these same type of jibs for what is called an 'ischial containment' socket.  It is pretty self explanatory, a little more up in your business than these quad sockets.  I am relieved that we are casting each other tomorrow so I will get at least one practice run before having to use an actual patient.  We will then do the modifying and critique on these sockets just the way it was done today.

In other news, it was Horace's birthday today and someone was thoughtful enough to bring him a cake!!

Looking forward to casting tomorrow - it has been a while since I have played with plaster and it always makes the weeks go by faster when we are busy doing things as opposed to sitting in lecture.  Speaking of lecture, I have to go take a quiz that was covered in the lectures I missed last week...should make it a bit more of a challenge :)

Vacation is Over

I am on a plane, headed back to California and back to real life.  It was so nice to escape for a few days and not have to worry too much about school (minus that whole Biomechanics final I had to take online at 2am after wedding celebrations).  I was able to hang out with my friends, see my grandparents, and dance the night away in my bangles and Indian attire.  Such a fun weekend!!  I imagine reality will set in quickly tomorrow morning - just thinking about all of the school work I have to get done is stressing me out.  For now, I am going to go back to looking at pictures from the weekend and reliving the fun...do my best to avoid the inevitable for just a few more hours :)

Getting a Good Grasp on Trans Femoral

Starting a new level of amputation means more manual binders full of lectures, articles, and things to be memorized.  This is what I was greeted with bright and early Tuesday morning.  I think we got through about the first three sections by lunch on Tuesday, but there are many more powerpoint presentations and weeks to come in transfemoral.  We learned that the alignment for transfemoral is typically the least of the issues you have when making a prosthesis for someone - it is typically in making a great fitting socket.  Because you are essentially putting in all of the components of the leg (from the foot and ankle and knee), you do not have to accommodate for as many gait deviations as with a transtibial amputee.  The flip side is that it is much harder to get a transfemoral amputee into a really comfortable fitting socket that they will want to wear all day.  We are creating a socket with a brim on it for them to sit on and that is essentially resting your sitting bones against a hard piece of plastic/laminated carbon fiber for multiple hours a day.  That cannot be nice for anyone.  After a few hours of introduction into transfemoral and a basic rundown of the anatomy and different socket styles we will be making for our future patients, we were able to observe a casting of a patient.

 

In order to cast a person with a transfemoral amputation, you have to put them in these jigs that provide a pre-made brim with which to mold your cast around.  You measure your patient and then find a brim that has been manufactured to that size and have them put their residual limb into the jig.  This allows the patient to already be sitting on the brim while you are casting and to create a better fitting cast because the patient is in the right place and the limb is in the same position it will be when they are wearing their prosthesis.  It is fairly hard to imagine what this feels like and how potentially uncomfortable it may be, but this is school...so we spent the rest of the afternoon putting our own legs in the jigs so we would not have to just imagine it.  You have to get the brim right up under your ischium (the infamous bone that we awkwardly were finding on each other a few weeks ago) and really get up close and personal with this casting.  It is definitely shoving a giant metal thing up further on your leg than one would prefer.  I would have been okay with keeping it in my imagination.

So, we spent the afternoon all trying out jigs and Mike was the guinea pig for the class.  Little did he know that he signed up for a chance for everyone in the class to have to go and find his ischium and see that he was sitting with it right on the top of the brim.  He did not look comfortable...and neither did any of the rest of  us who had to go check out his anatomy.  It did make for an entertaining few moments and a lot of really great pictures.  Potential blackmail??

That was pretty much how the first day of transfemoral went.  The first project is going to be putting all of our classmates into these jigs and making quad castings for them before we tighten any sort of metal contraption onto an actual patient.  I think this was a very smart move on our professors, risking each other's body parts first.  

I am taking a break from school and the blogging world for a few days to attend a wedding in Baton Rouge.  I have gotten the okay from my instructors to miss the rest of the week and I am so looking forward to having a few days off and celebrating with my friends.  I know this means I will show up next week and probably be behind and feeling a little frantic, but I think it is well worth it.  Also, I got to skip out on having to wear bathing suit bottoms and being jigged up and casted by a classmate...not so bad planning on my part :)

Final(ly)

Ahhhh...nothing like a good 6 hours of test taking to really make a girl feel like she cannot wait to go back to school tomorrow and start a whole new subject!!  I am just relieved that I survived the day and I managed to come out fairly unscathed.  We started the day with a two hour written final (100 multiple choice questions) that I felt went pretty well.  It was not easy and by the 80th question or so, it seemed as though I was just being asked the same thing over and over again in different ways, but it was a nice way to start out the day and feel like I had a pretty good grasp on things going into it.

The second portion of the test was the oral portion where we were individually taken back into the lab with one instructor and given two scenarios - each of which we had to give prosthetic causes and amputee causes for why the patient's socket fit poorly and then take the socket in front of us and align it to the correct position.  I was most worried about this part and it did turn out to be the hardest part for me, but I feel as though that was mainly because we were not really given great instructions on how to perform in this area.  Despite doing things right (such as measuring outset or making sure things were level), I did not mention aloud that I was going through my mental checklist and this was apparently something we were supposed to be doing.  Out of the 18 students in my class, I believe only 3 or 4 actually did this so I do not think it was communicated well to us when we were given our expectations of what they were looking for in the oral exam.  Overall, I did manage to stumble my way through the 20 minutes.  I am actually just glad to know what to expect for next time...the first time is always the most difficult.

The final portion of the test was a lab practical where we had 26 different stations set up - different feet, sockets, liners, prosthetic components, bones and anatomy - and we had to go around to each station and name whatever was at the station.  Most questions had multiple parts...after naming the object you then had to state an indication for that particular foot or why a person would choose that type of socket suspension.  I felt really good about this part, I was able to answer everything and I think I will end up probably doing the best on this part out of the three.

All in all, it is just nice to be done.  I know I could have done better on the oral part, but I think my performance in the written exam and on the practical exam will make up for it and it will all even out.  I keep having to remind myself that graduate school is not about getting straight As, it is about learning as much as possible while I am here.  It does not make a bit of difference what my grades are when I leave here...I still have to go through residency and pass my boards - no one is going to care if I made an A or a B in Below the Knee Prosthetics...besides me of course :)

6 Weeks in 1 Day

I have spent many hours this weekend trying to make sure I remember everything that I have learned in the past 6 weeks so that I will be able to do well on my final exam tomorrow.  Not much to blog about, unless you want a rundown of all things transtibial, but if you have been reading my blog for the last 6 weeks, you essentially know as much as I do :)

As I have been reviewing I realized that I have retained more information than I thought...so as long as I can get it all out on paper and orally tomorrow, I should be fine.  I should be fine.  I should be fine...

Another Week in the Books

Well, I think it will be no surprise to anyone that I am happy to be done with school for the week. I managed to get everything turned in today survive the morning of research lectures. I am free of school for at least the day - Monday is an all day final exam (oral, written and practical) over transtibial prosthetics. I will need to spend some quality time studying this weekend to make sure I have retained a decent amount of information over the past 6 weeks. The written exam does not worry me, but the oral part in a room with a professor by myself for 20 minutes and the practical part of applying things and having someone watch me, both sound pretty intimidating. Like everything else that has happened at school, it probably won't be as bad in actuality as it is in my mind :)

It is hard to believe that we are done with 1/3 of our schooling. I cannot believe there are only 11 weeks left until graduation. Seems like I just started!! Next week is starting all transfemoral (above the knee) amputation information. No patients next week...they prefer us to cast each other first so we have a better chance of getting it right when the patients come in :)

Putting down the books for now...

As Luck Would Have It

I thought my week was taking an turn for the better after a great fitting yesterday with my patient.  We were not able to make all of the final modifications because his residual limb was starting to become painful after having tried on so many sockets and been walking for a few hours so we made plans to meet 45 minutes early this morning.  We were slotted to give the first presentation for critique at 8:00am so I told my patient that I would meet him at the school at 7:15.  This seemed like a terrible decision when my alarm went off this morning and had there been no patient responsibility, I would have turned it off and gone right back to bed.  I did manage to get up and look professional and presentable and get out the door on time.

10 minutes into my journey and my car breaks down on the side of the road.  No, I am not kidding.  Should it have surprised me after the week I was having??  It was driving a little strange this morning, but I kept thinking it just needed to get going...only after I heard a noise at a traffic light that I thought was a motorcycle behind me and smelled something funny did I realize it was my car that was being so offensive.  Luckily, I was able to get a ride into school - barely running in the door at 7:57am, but this meant that I had stood up my patient and not gotten to put the leg on him before critique.

I felt terrible about not meeting my patient, but I was able to get ahold of him at 7:15 to let him know why I was not showing up.  I have learned that it is not worth it to get upset about the things in life that we cannot control.  I did everything in my power to get there early and it just was not meant to be.  I was definitely feeling a little frantic trying to get myself together for critique and my patient's leg was smaller today than it was yesterday...meaning that perfectly fitting socket that had worked out so well yesterday fit a little big today, but all in all, the critique went well.  Frankly, I was just so happy that I had made it to school on time and was able to get through it all.

We spent the afternoon cleaning up all of the lab and machine rooms and scraping plaster off the floor in order to have a fresh start next week when we begin transfemoral amputations.  I am looking forward to the short day tomorrow...we had a midterm last night and an in-class quiz today...not to mention the three different assignments that are due in the morning.  I feel like every waking hour I have had this week has been devoted to prosthetics...not necessarily a bad thing, but I have also been swimming upstream doing all of it and I am exhausted!!

And finally, to continue in the way my week has gone...I opened my backpack about an hour ago to start working on the aforementioned assignments, only to find out that my spiral notebook (the one that has two of my three assignments in it) is missing.  I know I had it in critique this morning and somehow it did not make it back into my backpack.  I am still working on problem-solving how to get those assignments done before class starts tomorrow...they are papers given to us to fill out so I do not have access to them just on my own.  Looks like another day where I will be heading in early...anyone want to give me a ride??

Peaks and Valleys

After a frustrating day yesterday - feeling like the world was working against me...it all turned around for me today!!  (As I had assumed it probably would.)  Like I thought, just going to sleep and starting over on a new day really helped turn things around for me.  I woke up today and went to school determined to be successful with my leg!!  I was feeling a little nervous about the potential that the missing pieces to my foot might not make it in time, but I still set about aligning everything and trying my socket on my patient with confidence.  All hail the amazingly speedy and efficient FedEx!!  My foot arrived before 9am and did not set my back one minute in trying to get my patient up and walking. I let my other two classmates go and even after the arrival of the package, I was still waiting around most of the morning for my turn with the patient.

Ta da!!  A completed leg, fancy foot and all!!  The only thing that they have yet to figure out about these amazing motorized feet is what to do about that darn battery pack.  There is no way around it, you have to attach it to the socket somehow.  If this was a permanent socket, it would have a built in compartment in the back to store it, but the added bulk will definitely still be there.  Either way, it is the fanciest and coolest foot in the class and my patient was really excited about getting to try it out.  I got a quick lesson in all of the functions this morning (shout out to Chris at Ossur for all of his patience and wisdom) and I had this thing up and ready to go.  The amazing news is that my patient said my socket felt amazing.  A little side note about my patient, he completed the prosthetics program at my school last semester so he knows what he is talking about and knows exactly what we are going through and what we are supposed to be doing or not doing.  He is very good at giving feedback which makes fitting him so much easier.  He also is very good at giving tips to accompany the feedback...that also helps :)  The downside about him knowing the industry and being capable of making his own sockets is that he is very picky and particular about socket fit and alignment.  He should be picky about it...this is his leg, but it definitely feels like a major win when he kept repeating how great the socket fit and what a nice job I did and that he really liked it!!  I needed a win today and it was nice to know that all the drama and letdowns from yesterday still resulted in a great prosthesis that my patient was able to comfortably walk in.  We got to play around with the fun functions of the foot and he said it was fun to walk in and just felt really nice.  I think critique will go pretty smoothly tomorrow if he walks the same way that he did this morning.  I remembered to plug the foot into the charger before I left school so barring a power outage...we should be good to go first thing in the morning tomorrow.  It is so nuts that this is the final project in transtibial.  We are going to be responsible for making WHOLE legs in about a week or two...I mean, top to bottom - knee joint and everything.  I think I have a decent foundation for the skills needed, but it is going to be a different world and I am anticipating it being a little tougher.  Time will tell.

The other thing we did today was learn how to treat a postoperative amputation.  We learned how to cast them and wrap them to prevent them from swelling.  There are times where you have to scrub in and go into the operating room as soon as the surgeons are done amputating a limb to put on the postoperative cast.  I think this sounds pretty awesome!!  I will need to get better at casting before I am ready to even think about trying this (they probably frown upon plaster being tossed about in a sterile environment), but I think it is an exciting thing to look forward to in the future.  And I must say, my skills with an Ace bandage are second to none... ;)

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??

A Case of the Mondays...

Today did not go as planned.  I struggled with terrible allergies all day yesterday and ended up getting sent home from school today because I was appearing so sick.  I wanted to wear a mask and at least get my casting done, but that was apparently not in the cards for me today.  I am finally feeling better (after multiple showers and lots of OTC allergy and sinus medicine) so I will just start my week tomorrow.

Of course I am already stressed thinking about how far behind I am going to be with this finally transtibial prosthesis, but there is nothing I can do about it now...just going to have to show up to school tomorrow with a positive attitude and get to work really quickly.  I know most of my classmates are almost done with their test sockets after today, but the entire day's schedule tomorrow is devoted to working on them so I am just really hoping that I am able to get it all done in time.  

My professor told me that he had someone do a cast for me and that there is a filled mold waiting for me on my workbench...I actually think this going to make my job tougher because I am looking at someone else's work and going to try and modify it into something.  I have a feeling this week is not going to go as planned, but I guess this is a great example of real life and something that could happen. I will just have to explain myself in critique and hope my instructors take everything into consideration.