Take Initiative...

This is a quick fundraising and awareness raising plug.  I could give you all of the facts about people with limb loss and their emotional well-being and mental health, but I highly recommend that you watch this presentation and learn these statistics for yourself.

Tonight I am attending a fundraiser specifically aimed at trying to not just raise money, but to raise awareness and aid for the mental health and care of people living with limb loss.  It is a truly great cause and one that hopefully begins to gain more momentum as more people become aware of how this really impacts this community.

http://prezi.com/uzqmc_60jac_/improving-well-being-program-general/?auth_key=377cc6691d1b5a64ff39821b64398fd129c2b61f

If you are inspired and feel led to donate - we are trying to reach a goal of $200k and have currently raised $170k thus far - any amount will be used and appreciated.  Here is the link for the donation page...

http://acoa.convio.net/site/PageNavigator/Effectiveness_of_Care_Campaign.html

A Farewell to Legs

The end is near!  I mean, like it is done - my school career in leg making has come to a close.  Insane.  I am not sure how it went by so quickly...I blinked and went from my first cast to laminating this last leg. After getting the lamination done, I trimmed my socket out and I was so excited about the way it looked!  The inner liner came out just as it was supposed to and having a pattern on the socket really makes it much cooler in my opinion.  When you are spending hours with this leg, getting to put a little bit of creativity and fun into it puts a smile on your face.  Everything about making a leg is about following a pattern, following a specific body or bone or alignment - getting to jazz it up and make it fun is more about you as a practitioner, and typically, most specifically about your patient.  As I mentioned earlier, these legs were about us because we were the ones taking them home, but hopefully in the future, my patients and I see eye to eye on all of the fun stuff we can do with their sockets :)

I put a different pattern on the inside of the leg and was actually pleasantly surprised by how cool it came out as far as looks goes, but I did manage to miss a few spots with the resin and therefore it was just some patches of soft fabric on the inside as opposed to all hard and glossy and smooth like it was supposed to be.  Oops.  Time for prosthetic problem solving - a little adjustment to the trimlines and a little extra fiberglass and resin and I was good to go.  Rookie mistake - I can guarantee you I will not "under-resin" ever again!!  What would school be if not for making mistakes and learning from them?  

After I got the socket smoothed and sanded down and dropped the outer hard layer down so the inner flexible liner would have room to actually be flexible, I was able to gunk on the components.  This part is always a little stressful to me because it has to be in the right angle and flexed and all of that, it just seems so final.  The flip side of that being that it IS final...and that means you are at the end of the leg making stage - attaching the components is just tightening a few screws!  (My professors would kill me for saying that, clearly there is much more that goes into it.)

Now it becomes one of those cooking shows where they magically have everything already prepared before starting and they just keep throwing ingredients in and pulling out beautifully cooked dishes.  I did a little gunking and fiberglassing and voila - here is my completed leg!  Everything attached and everything working and now I just need a patient to make it walk back and forth.  I always feel like a leg that stands up on its own is a good sign - at least I know it is all level to begin with.  So, this is all ready and good to go for Paul's arrival - I just need him to bring his shoes and a good attitude and hopefully some extra energy to do some walking.  Critiques for these last projects are supposed to be much shorter and much easier than the previous ones because with transfemoral sockets, it is mainly the socket fit that causes the problems, not as much the alignment.  And, according to our professors, will all of our alignment practice this semester (all 12 weeks thus far), we were not going to focus too much on that during critique.  And since we had all been able to make at least two sockets for these current patients, in an ideal world, our sockets should have been fitting pretty nicely.

The key phrase in that last statement being "ideal world."  Despite my addiction of the silicone pad and taking off a lot of plaster before creating this second socket, my socket was still a little too big on Paul.  It was not crazy, a simple pad made it much better, but I was surprised it was still big with the amount of material that I had added and taken off after the test socket.  Paul is also a little on the fleshy side and tends to go nuts with his diet (McDonalds for breakfast before the last fitting, chocolate cake for midnight snack this time around) and so it is hard to predict what his body is going to do in response to his diet.  Too much salt and he is swollen, one skipped meal and he is dropping down in size.  This is a common issue with a lot of patients so definitely something I will see again...good thing I love a challenge :)  So, here I am on critique day, proudly displaying my finished leg and dressed to impress.  My critique went well, Paul walked around and overall, the fit, like I said, was not horrible.  It is so crazy that this was my last big project of school and that I am going to be graduating in four weeks!!  We do a couple of upper extremity things in the next couple of weeks, but nothing really major like these legs we have been making.  It is all coming to an end quickly.  

Because of the finality of the project, it was a big picture day at school - they even had professional photographers in capturing it all.  Everyone was feeling very accomplished and very pleased with themselves and it was fun to have everyone feeling relaxed and proud and taking a moment to celebrate our accomplishments so far.

The End is Near

Well, after the initial fitting and adding the silicone padding and tweaking my check socket a little bit, I filled it with plaster and set about creating a new mold to base my final socket on.  After getting the new mold as smooth as possible, I pulled a really flexible material over it to create an inner liner for the final socket.  It is thin and easy to manipulate and goes inside the final socket.  This provides more freedom and definitely more comfort, mainly at the top of the socket where it meets the skin.  It enables me to lower the trim lines of the hard outer socket and provides the patient with the same amount of support, but with more flexibility.  We treated this inner liner the same as any other socket made out of plastic and had to cut it off the mold once it cooled.  I left the flexible inner liner on the socket because the next step was to laminate the socket to create a hard and durable outer socket.  We have only done this one other time this semester and I feel like that was ages ago so it seemed a little bit intimidating!!  We were also encouraged to use fun fabrics in our laminations this time because it is our final big project and the one that most people take home with them as a little souvenir.  

You will be shocked to find out that I chose to use an Indian themed fabric print for my socket :)  It was total coincidence that this was one of the fabrics that happened to be at school and I actually really thought it was cool looking and different.  Laminating is always a crazy time, you only have a certain number of minutes before the resin you pour into the bag over the socket gets hard and there is a lot to remember.  I took the original mold with the flexible inner liner over it and then there was a long set-up process involved to get it to the point of lamination.  I used a different fabric print on my first layer, so when you look down into the socket, it is also patterned.  Then we alternated between nylon and fiberglass (for strength and support) until we had 6 layers of nylon and 3 layers of fiberglass before adding the final outer layer of pattern.  Once it is set up and ready to go, mix the resin and then pull a bag down over the socket.  You pour the resin into the bag using a funnel and draw it down into the bag with a string or your hands...once it covers the entire socket, you just have to sit back and wait and let it get hot and then set off and get hard.  Seems fairly straight forward, right??

The room is always a little nuts and a lot crowded when everyone is trying to get their socket laminated at the same time before the end of the day deadline...this always makes things a little more stressful for me, but I have to remember that in real life, I will not be competing for space with 17 other students!  Almost everyone managed to get their sockets laminated and done by the end of the day - always a huge relief for me when I make the deadline...makes going into the next day so much easier and less stressful.  

Respirators are a must when you are laminating - fumes and whatnot...I think it certainly does not hurt to protect all of my insides!  And like I have mentioned before, they just look so dang good on me :)  Now that the lamination is done and complete, I just had to wait for it to set off and then the next step in the process is to trim out the socket and smooth it down and get my flexible inner liner out and smoothed as well.  Once those two things are done, it is time to gunk and attach my knee and feet and hope my patient can walk in this leg!!  If he cannot...at least it looks really cool and gives off an air of peacefulness and harmony.  I figured a few meditating gods on the socket could only help me in having a good patient visit on the next day!  

Playing Catch Up

I know, I know, I am very behind on posting.  I am sure a lot of people could not even sleep this past weekend because they had no idea how my leg fitting with Paul went last week.  Never fear, I am here to start catching you up!

This is what the training room looks like on the morning of a patient appointment.  My station was all set up with my finished leg waiting and ready to go!  Paul came in and he did not seem like he was much in the mood for being there, but he was a good sport and let me and my partner try our legs on him multiple times in the four hour allotted time.  The first fitting is just putting the leg on, seeing what needs to be changed, taking the leg off, changing what you can, and putting it back on again to see if it is fitting any better.  At first it seemed as if my leg was not going to even fit on Paul - he was having a hard time getting down into it, but after a little tweaking and some lubricant, he was able to get all the way into the socket comfortably.  Phew.  I was able to get good suction (meaning the leg was not going to fall off of him when he started walking) and he said that the socket felt really good. The only major issue I had was that there was a big gap one the side and back on the socket.  It is just where a lot of fleshy tissue can go so it may have had tissue in it when I casted him and depending on the way he was standing during the fitting, it might have moved around...regardless, it was too big in that area and needed to be fixed.  The quick fix is to put silicone in the socket to see how much filler you need and to let it mold to the patient's body in order to be able to create a better fitting socket later.

This is what my giant clump of silicone looked like in my check socket.  This seemed to do the trick and I was able to get Paul walking back and forth (bending the knee and everything) for the last part of the appointment.  We are actually going to create a second socket for these patients - we have just been making test sockets and throwing them away after one time, but because this is our last big project, we are going to really make the whole leg and try and make it look somewhat professional.  The way to go about making the second socket is to fill this plastic check socket with plaster and create a whole new mold.  The beauty of making all of your modifications and putting the silicone in this socket is that when you pour plastic and pull out a new mold, ideally, it should be exactly the mold you are trying to achieve and not need any more modifications.  We will take the second mold and use that to create a flexible inner liner (for comfort) and then a more stable and finished socket.  This is the part where we get to be creative and use fun fabrics and make cool legs.  I cannot wait!!

I will post another update tomorrow and by the weekend, I should be caught up.  In real life (not in this catch up world on the blog), we are fitting our patients tomorrow with our finished legs and will have a critique on Monday.  By Monday, I will be up to speed on here so we can all experience the critique in real time together :)

The Best Vet

In honor of Veteran's Day (no school today) - I wanted to share a video about the only veteran I have really gotten to know on a personal level.  I met Dan at the camp I volunteered for this summer.  It is easy to become a person who feels little or no effects of the war when you do not really know anyone who is fighting in it.  That was me.  I had no friends or siblings or anyone really close to me who was fighting in this war...I only knew what I saw on TV or read in the papers.  Until I got to camp...and I met Dan.  I am including a video that tells Dan's whole story so I will not go into the details myself...but Dan is amazing.  His attitude towards life, his willingness to push himself and never give up - he is the kind of person who would inspire anyone.  He fought for his country and I know he would go back and do it again, even knowing the outcome.  (The video would not embed for some reason, but I am asking you to please click on the link - it is so worth it.)

http://www.komonews.com/news/local/Lewis-McChord-soldier-loses-legs---but-not-his-spirit-178718291.html?tab=video&c=y

*This video was shot in August - Dan is already accomplishing major goals - he just completed the Marine Corps Marathon last month.

I did manage to get one video of Dan to embed from YouTube and it is the perfect one for Veteran's Day...we should all be so thankful to these men and women.

Reunited and it Feels So Good

No post from last night because I was spending the evening with my camp co-counselor, Lacey!!  She was in town for the night and we had a slumber party!!  So so so much fun.  Loved getting to see her...cannot wait to go back to camp!!

1001 Ways to Bend a Leg

This was my view at 7am this morning.  The time change may make staying at school until it is dark a bit tough, but it makes my apartment light up at 6am (making sleeping past that almost impossible), but making it easier to get to school earlier and work on my leg.  I was pleased to see that the plastics room looked exactly as I had left it 14 hours previously - my leg in position on the vacuum ready to go.  All I had to do was turn the oven on and wait for it to reach 360 degrees.  (This happens much slower when you can see the oven digitally counting up the degrees).  The slow warm up was probably a good thing for me, gave me a chance to wake up and get ready for a long day of work.  Well, apparently it did not give me long enough to wake up fully - I messed up my first pull of plastic.  Cue the sad violin music.  It was slightly disappointing - mainly because I was geared up and beat the crowd to the plastics room and was ready to get a head start on the day.  This is a really big leg and I took too long pulling the plastic down over the leg.  The plastic began to harden before I could get vacuum suction around the bottom edge (really the top of the leg) sitting down on the wooden wheel.  It is a very sad realization when you have suffered through burning metal on your hands and sculpting this piece of plastic over your mold to find out that you have to redo it.

Alas, I kept a positive attitude and put a new piece of plastic in the oven and began the melting process again.  No coffee needed for this girl, messing up your plastic mold will quickly wake you up and really realign your focus.  There was no way the plastic was getting the best of me today - I had a leg to finish by the end of the day and I was going to finish it!!  Notice in the picture that the end of the residual limb is about the same size in circumference as my head :)

After getting the plastic done right (yes, the second time was the charm), it meant cutting and trimming and grinding.  The cast saw is now my friend and I use it with great confidence.  The sanders and grinders, while we have yet to reach friendship status, we are definitely good acquaintances and I do not mind visiting them every now and then ;)  It is not even that I am intimidated or bothered by the grinding anymore, it is just that I am not a huge fan of doing it.  It is a necessary evil and because of that I am happy to spend half an hour eating plastic dust, but of all the things that come with making legs, this is on the lower end of the totem pole for me.  This picture is what I call "grinding success!"  I used to take the pretty socket and get really excited about how nice it looked...take it to my desk and admire it.  Now I just go ahead and rough up the bottom (it has to be done before the gunking process) and do not leave the grinding room until there is no more grinding to be done.  It does not look that pretty, but the edges feel fabulously smooth and my valve looks and works perfectly.  Grinding is the step before aligning and gunking - I managed to get this much done before noon...time was on my side today.

After lunch, I spent some quality time putting all of my components together.  Although I did not get a fancy microprocessor knee for my patient like I was hoping, I did go ahead and use another Ossur knee we had at the school.  What can I say?  I am brand loyal :)  I actually think I picked a great knee for my patient, he does very very little walking and I think a fancy knee would have been too much for him and he would not have used it to its full potential.  I used an Ossur foot that I have never used before so I am excited to see it in action.  Using these fancier knees (we used really basic ones on the last leg) makes the leg look so much cooler and much more like the prostheses you see out in the real world.  That was exciting for me.

I aligned, I gunked and I fiberglassed.  I then reattached my knee and foot and the result is this beautiful limb you see here before you.  Is that not a nice looking leg?  It is going to be even nicer looking in a week when we make an inner liner for it and laminate the socket - there will be no grinding marks or messy stuff at the bottom.  I am still working on a fun pattern to put on it...I selfishly keep looking for one that pleases me and not really considering what my patient might enjoy.  Hmmm, I might need to factor that in...

It is just that I picture this sitting on my mantle...he will wear it for 15 minutes for critique and move back to his real prosthesis.  I think that allows me some artistic freedom when picking out the fabric pattern to use.  Besides...real mean love pink, right??

Today was a great day - I worked hard, I was very productive and I accomplished the set goal of having a completed leg by the end of the day.  I was even able to get out of school a couple of hours early (totally worth going in early this morning for).  I have a huge pile of school work to do tonight and have been plugging away at it since I got home - the blog is my break for the moment.  Tomorrow we have our patient fittings and, per usual, there is always the fear that my patient will not get into the socket.  I am hoping my beginner's luck does not run out by the morning and I am able to get Paul up and walking - you just never know which way a fitting is going to go.

Did I mention that my favorite part of making trans femoral legs is that it is really cool to see the knee bend?  I do not know why this amazes me so much, but I just love that I have created a leg that moves!!

Flying Solo

This was my view for the last 8 hours...watching this plaster go through various stages - I believe this was around 11am.  Because this is our last big project and they have really stressed that we should be doing these things on our own (and because I know that my hand skills are not thought of as being amongst the top in the class), I was determined to get through this modification on my own.  I was refusing to ask for help, only asking for guidance confirmation when I was at the endpoint and ready to pull my check socket.  I will admit, the first 3 or 4 hours looked pretty dicey.  I took my lunch break moreso out of wanting to get away from the mold than hunger.  Sitting at lunch I was really questioning if I was going to be able to do this.  I kept thinking to myself, I know all of the steps and what is supposed to be done, but getting it all correct on this mold is proving to be really trying.  There is no guessing or hoping you are right when making a socket - your measurements have to be on, your reliefs (for tendons and muscles and bones) have to be in the right places...otherwise the work you have done for the past 8 hours will be for nothing.  Without getting most of this stuff right, it will take about two minutes for my patient to tell me that this socket is not comfortable and there will be no way he can walk in it.

Ahhhh, progression :)  This was about 4pm...finally able to start smoothing the plaster out and feeling pretty good about the result of the long day.  I got all of my measurements down to where they should be, I put in plaster reliefs and built shelves and flared out walls.  If the picture in the manual is what I am supposed to be going for, I have a winner of a socket for sure!  In all reality, this literally did take all day and it was exhausting.  My back is hurting from hunching over this...my hands are completely dried out from being in plaster...and my clothes were so filthy that I took a towel from school to cover the seat in the car on the way home.  I was not sure how the day was going to go.  I can be honest and say I was not really looking forward to it.  I brought my headphones and put on music and just really focused on getting the leg finished.  We have a few hours tomorrow afternoon to work on our legs, but by the end of the day, it is supposed to be completed - knees and feet attached and ready to go.  We are putting these on our patients on Thursday morning.  It is shocking to me that I am supposed to be making four or five of these a day when I start working in a clinic!  There were people that were done completely - test socket pulled and all components attached before lunch...so I guess the expectation is not too high ;)

Ta da!!  Here is my finished leg - ready and waiting to go outside of the plastics room.  I could not believe that it was finally done and ready to make the check socket!!  And then I got into the plastics room and tried to put my mold on the vacuum, only to discover that my pipe was way too long.  Huge bummer.  The only upside to this was that I had to put it in this device and use a hack saw to cut a few inches off the pipe.  I call this an upside because I have never really used a hack saw before and it was kind of cool!  I felt very handy and kind of wanted to go cut more stuff!  This being said, because of the cutting of the pipe, I was not able to get my plastic check socket pulled today.  I put my leg back in the vacuum jig and set everything up and plan on getting to school half an hour early tomorrow so I can get it pulled before lecture starts in the morning.  I want to be able to go into the afternoon with the plastic done so I can start modifying and trimming that down and attaching all of my parts.  Waiting in line in the plastics room can take over an hour of your day and I do not want to spend most of my afternoon doing that.

All in all, I felt today was hugely successful.  I am beyond proud of myself for getting down to business and pushing myself to really do these modifications all on my own.  As I have mentioned numerous times, the thrill of making a leg has yet to wear off for me, but really putting all of the time and sole effort into this leg just makes it that much sweeter.  I wanted to run a victory lap around the school building at the end of the day today!!  I have yet to keep a socket or take home a leg when I am done with it (mainly because we have to tear it apart to put the components back at school), but I think this socket will be one that adorns my mantle for a while.  Such a great reminder for me today...I CAN do this!!

Sidenote, this time change makes spending all day at school feel even longer...it is tough trying to stay motivated to work when it is dark outside!!

The Last Leg

Today we began our last lower limb project.  Pretty hard to believe.  Granted, this is a two week project so we are not out of the trans femoral woods yet, but hard to believe that I spent the morning casting my last leg as a student.  And what a leg it was!!  Let me tell you!!  I could have easily taken up residence in my cast when it was done :)

You are looking at four hours of hard work laying on the floor of the treatment room.  These are the four casts that were made today by me and my partner, Michelle.  They look haphazardly discarded, but I can assure you they were placed on the floor with love.  We are instructed to finish casting and immediately focus on getting our patients dressed and cleaned up and walked to their car before we even start admiring our own work.  If you look around the room at the end of the patient appointments, it is just casts strewn about.

My patient today, I shall call him Paul - nice guy, not really interested in spending a lot of time at the school (which makes it tough on those of us who do not work up to the speed at which he prefers), and like most of the other men with amputations I have met this semester (and yes, I am generalizing) - a little inappropriate at times.  I do not mind an inappropriate joke or two on the occasion, but they are a little tougher to politely laugh at when you have your hand shoved in precarious places on the person making the jokes.  Needless to say, Paul and I plodded along and we managed to get through the morning.  My first cast turned out to be better than my second cast and I was able to get it filled before having to go to lecture in the afternoon.

Since this is our last big project of the year, we are being set free on our own - the instructors have told us they will be offering very little assistance, reminding us that we should know what we are doing by now and will be out in the "real world" in a matter of weeks.  Sounds like a good opportunity for a lot of the infamous "failing forward" if you ask me.

I am excited about this project because we get to spend some time on it and actually produce an entire leg - (finish it by laminating it) as opposed to just creating the plastic test sockets that we have mostly done.  Apparently this is the time to get creative and we can use fabric patterns to create fun socket designs - its is all free reign at this point.  We are allowed to use whatever components we can get our hands on (once again, I am counting on Ossur to pull through for me) and we are supposed to create a leg all on our own.  Seems a little out of reach for me at the moment, but it always seems out of reach when I am looking a 15 pounds of plaster that does not really resemble a leg at all.

Tomorrow is a full day (we are talking the entire 9 hours) of modifying.  I am planning on going in a little early - I have no clue how long this is going to take me (I am assuming longer than 9 hours) and I would rather have a surprise early afternoon than have them turn the lights out on me at the end of the work day.  We are doing the same modifications on this leg as we did on the last leg, but like I said, this time with no help.  I think this is going to be a struggle, but I am feeling really focused now - I have gotten a second wind in regards to school...this whole 6 week countdown has rejuvenated me and I want to go out with a really great leg (and also a cool one with a fun pattern, but I am trying to keep my priorities straight and focus on getting a great fitting socket first and foremost).

Pray that the plaster is kind to me tomorrow and that I am able to transport this giant leg around back and forth to the necessary rooms in the building :)