X-Ray Vision

Even though this was a short week, it seemed to have very long days - so I was very happy that today was only a half day at school.  We are out early on most Fridays which gives me a little something to look forward to at the end of the week.  My motivation for getting out of bed this morning was knowing that I only had to focus on learning for 4 hours today.  The first part of the morning was spent looking at x-rays to determine what type of amputation we were looking at and the details of that particular amputation.  Through an x-ray you can tell if it is a congenital amputation or an acquired one.  You should easily be able to note where the amputation is on the body and then you can get more information by looking into it further and figuring out what kind of surgery was performed (if any) and what kind of bones you are looking at under the amputation. It was very interesting and a fun challenge in human anatomy.  You think you know the body until you are looking at an x-ray that does not look quite right and then trying to figure out what the particular person has going on with their body.  Knowing what you are looking at on an x-ray will greatly help when making a device because you know how long the bones are and where there might be overgrowth or a sharp edge so you know where to accommodate for those things in the device.  It is crazy how many different things go into making these sockets and how many things have to be taken into account to get it just right.  Then we had a three hour lecture on how to perform research.  I know research is a very important part of this career - without it, we would not be able to give amputees nearly the quality of life they have now, but writing a research paper is about the last thing I want to do at the moment.  Luckily, I have till December 7th to get that done :)  I have a lot of topics in my head that I am curious to learn more about, I just have to get motivated to put in the time to get the research done.

I am also celebrating another week of school on the books!!  Two weeks down and only 15 to go.  The number said aloud sounds like a lot of weeks, but oh my goodness, only 15 more weeks till I am supposed to be super confident and really know what I am doing!?  Seems crazy to me.  When the day comes (and it is going to come faster than I think) where I cannot hold up enough fingers to count the weeks completed, I will be looking back thinking how I am shocked that it is almost over.  It is going to be exciting!

And in other exciting news, I found a site to start getting some preceptorship hours in during this semester at school.  We are required to have 250 preceptorship hours (working/observing under a Certified Prosthetist) before being granted our certificate.  The hours can be completed immediately after the program, before you start your residency, or concurrently and after.  I am trying to get some hours in before I end the program in December because I am hoping to get into the Orthotics program that starts in early February and I don't think there are enough hours in the month of January to get them all done before Orthotics starts.  I met with a really great CPO today, Chad, at a company called Southern California Orthotics and Prosthetics (SCOPe) and they are going to let me come in and learn from them about 5 hours a week - mostly on Fridays and Saturdays.  I think it is going to be such a great learning experience!!  I have heard wonderful things about this group of clinics and I think it is going to be really helpful to apply what I am learning at school in a real life clinic setting.  I am looking forward to seeing more patients and the extra hands-on experience.  When I was there today they were making a prosthesis for a dog!  My first day is next week so I kind of hope the dog has to come back for an initial fitting :)

Death by PowerPoint

Take a good look at this and imagine looking at it for 8 hours and then you will have experienced my day.  I mean, how many lectures can a person be expected to sit through in one day!?  And retain!?  I can say for sure that I managed to sit through (with some long, slow blinks) all of the lectures, but I cannot guarantee anything on the retaining information front.  The material is interesting and something I need to and want to learn, it is just a lot to handle in one day.  The room is freezing, the chairs are uncomfortable and the clock seems to forget to keep ticking.  My secret for making it through these days?  Keep refilling the water bottle - not only is hydration a good thing in general, but it also gives you valid reasons for having to step out of the lectures every hour or so.  Hey, a bathroom break is a break nonetheless.  So, needless to say, not a lot to report today.  Spent the morning in lectures, broke for lunch and spent the afternoon in lectures again.  We convinced one of our instructors to stay late and let us work on our liners so I was able to get caught up from yesterday.  Although, I must just be having an issue with liners because I managed to tear my liner, yet again!!!  And burn the first layer of skin off my hand, but that is secondary to the fact that this liner is getting the best of me.  More skiiving, some gluing, lots of cutting with a razor edge (also a very unsafe activity for me) and I at least have what resembles a completed liner that is ready to be laminated.  Yea, me!!

I think I might have to take this and frame it when this is all said and done...although I don't think that is how it works.  I cannot even imagine what it is going to feel like to have spent so much time and put in so much work on a leg and have the opportunity to fit in on a patient and give them back their mobility.  I am an emotional basket-case, I have a feeling I will get teary-eyed many times throughout my career.  Back to my current leg, one that is just for learning and not walking...I have such a love/hate relationship going on with this socket.  I was actually loving it when this picture was taken...I was hating it shortly thereafter when I could not get the tape off or the edges smooth to save my life.  I am hoping we make up soon and the relationship goes back to hearts and flowers by Monday because that is when I am supposed to be laminating this to make it look official and professional and real.  We had a two hour lecture/demonstration on laminating today - it looks very intimidating!!  Let the learning curve continue to expand and pass the epoxy acrylic resin, this socket is rounding the corner on it's final lap!!  The homestretch feels pretty good :)

They're Baaaaack!!

By "they're", I mean the patients from last week and most importantly, the Dallas Cowboys.  Okay, football has nothing to do with prosthetics (except that I do tend to make the touchdown sign a lot when I accomplish something great in the plastics room), but it is impossible for me not to mention that the NFL season is kicking off tonight - and there is absolutely, hands down, no better way to start the football season than with my Cowboys!!  This posting may take the entire duration of the game (or might venture off into random football commentary), but I will do my best to stay on topic.

Our patients came back to see us this morning.  Mr. R was very sprightly and definitely in a feisty mood today.  By feisty, I mean, slightly inappropriate with my personal boundaries and his comments, but hey... all in good fun.  I think the beauty of being an elderly man is that you get away with those comments and girls just chalk it up to you being an old man.  I did have to tell him a few times that, although I was indeed cold, I did not need him to keep trying to warm me up :)  Nor did I want to share his breakfast sandwich, although I did appreciate the offer!  Oh, the initial fitting of a test socket.  There might be nothing more exhausting than the initial fitting.  First, you have the patient saying it feels great and before you can really get in a good pat on your own back, they change their mind and there are a lot of spots that are hurting them.  Thus begins the process of putting the socket on (in prosthetics, they call this "donning") and marking the painful spots, taking the socket off ("doffing"), making adjustments - via pads, heating gun, the grinder - and repeating the process.  And repeating, and repeating, and repeating.  Please do not confuse exhausting with annoying.  I want my patient to have a socket that feels very comfortable, has no hot spots and is something they can and want to wear all day.  The exhausting part was the path I wore walking back and forth from the heating gun to the patient treatment room.  Also, after four hours of fitting, everything begins to hurt on an 85 year old man so you eventually realize that you are chasing after pains that don't really exist.  Okay, that might be a little annoying.  Maybe moreso frustrating...I wanted to remind him of how great it felt 3 hours ago and see if we could tap back into those wonderful and fond memories and feelings.

At some point you have to let these patient volunteers go home and come to grips with the fact that you can only readjust something so many times before it is neither doing harm nor good.  Plus, I was starving and we had to refill our sockets with plaster before lunch ;)  That is what the top pictures are from - the filling of sockets.  My socket is right there in the middle of the three - looking amazing, I might add.  Off I went to enjoy my turkey sandwich while the plaster was setting.  Completely naive as to what the afternoon of making custom pelite liners had in store for me.  Thankfully naive, might I add....otherwise I am not sure I would have enjoyed my lunch!

Once our plaster set, we began the process of freeing our newly made molds.  Yes, that is right, back to looking at another big hunk of plaster in mold form.  I see a reoccurring theme here in my future career.  I will learn to love plaster, I will learn to love plaster, I will learn to love plaster.  Luckily, most of the adjustments and modifications to this mold had been made to the plastic test socket before pouring the plaster so there was not a whole lot of work to be done.  Seriously though, what would a day of prosthetic school be without at least a little bit of modifying and grinding?  After some quick reductions and sanding the mold down, it was time to start making distal end pads (a soft cushion for the bottom of the residual limb) and pelite (basically just a squishy foam-like material) liners.  Let me just say, custom liners are not the norm these days - you can buy loads of liners off the shelf and the new trend, gel liners, makes the need for prosthetists to create any sort of custom liner, really small.  Alas, still something we need to learn to do and that was the goal of the day today.  To put it in perspective, the demonstration from my instructor to teach us how to make the liner took over 2 hours.  Not exactly a quick and easy task.  It involves skiiving (this is a fancy word for grinding things with a nice graduated edge), heating up materials in the giant ovens, and per usual, tiny windows of time to accomplish something that can easily be screwed up.

This is what it looks like when you are taking a heated up piece of pelite and putting it down over your mold to create a custom-fit liner.  You have just a few seconds before it cools down to get it over that mold and then to vacuum suction it to fit the contours.  There are way more steps involved, making the whole distal end pad is a completely separate process and there is some taping and gluing stuff...amongst other things.  The end result though, is this whole pulling the liner and doing the vacuum thing.  I thought there was no way I was going to make it to this step today, but I actually managed to get in this exact position that you see to the right ---->

And then my liner ripped down the seam.  Wah wah.  Super sad moment for me.  Luckily it is not a problem that sets you back too far or put me in a place where I had to start all over with something that was going to take hours.  I just had to get a new liner and re-heat it and do it again.  Well, at least, those are the next steps I will be taking tomorrow - I ran out of time today.  After getting the liner onto the socket there are a few more things to do to finish the liner completely, covering the distal end pad and matching up the pieces so they all blend nicely, but first, I have to get through the liner step without it tearing at the seams again!!  I am thankful it was only a minor issue and a small setback - it could have been much worse!

So, another day of prosthetic school down and another new thing learned.  Tomorrow is a day full of lectures.  8 hours of lectures to be exact.  I much prefer the days where we get to be hands-on all day and get down and dirty.  I have finally learned to bring a change of clothes on patient appointment days because, although the morning with them is clean and professional, the afternoon becomes one giant cloud of plaster.  I got home today and discovered that I was not the only person giving myself a pat on the back at school today...

Back to the Grind

Quite literally.  After a wonderful three day weekend, it was back to real life this morning.  And by real life, I mean that plastic socket sitting on my workbench waiting for me to show up and spend some quality time with it.  The only quality time needing to be had today was in the machine room...with the infamous Trautman sander (aka the grinding machine).  There are still bits and pieces I struggle with to get perfectly smooth and even and rounded out, but for the most part, I feel like I have become somewhat adept at using these guys and getting clean edges on my sockets.  The main thing being, I am finally not scared of them! Ha!  I have learned that although it does not feel nice when it catches the back of your pinky, there is not a lot of actual physical injury occurring.  Okay okay sure, maybe it has caused me to drop my socket on occasion out of fear and being startled, but I only dropped it once today so I am making improvements :)

Also, to anyone who has actually used this tool before, you know these pictures were staged.  I would never have my hair loose when working with this machine - there are horror stories of scalping and I really do not want to be one of those stories...not to mention the fact that I really like my hair.  I take my grinding very seriously so I cannot have people taking pictures of me when there is actual work involved.  You mess up these sockets and take too much off, you cannot put it back on and I would cry if I had to start from the beginning.  This is a room filled with numerous machines so we all just stand in single file formation, working and grinding away.  And on a side note, I think the safety goggles are quite the fashion statement.

Tomorrow we get to see our patients again, another morning spent in fancy clothes with Mr. R!  We will be putting our test sockets on the patients to see how successful we actually were in creating a socket that fits - the bottom line being, it is far more likely that I created a socket that somewhat fits, but will have to be modified all over again in the afternoon.  If at first you don't succeed...

I, personally, think this guy looks like a winner.  Tune in tomorrow for the results show...

Click and Learn

A three day weekend that only involved prosthetic learning in an online forum (talking a LOT about partial foot amputations) does not really leave much room for blogging about the life of a prosthetist...and since I am trying to keep this blog related to all things prosthetics (as opposed to my actual life outside of prosthetic school), I thought I would provide a few links to other sites that give great insight into this world.

http://limblogger.wordpress.com/about/  - this is a blog written by a guy named Dave McGill.  Dave works for Ossur Americas and although our paths have never directly crossed, I know a lot about him and his story and I think he is an incredible writer.  He gives such a funny, real-life perspective on what it means to live as an amputee.  Dave provides readers with a chance to experience his every day life situations (the blog about trying on pants at the department store made me laugh...and then think) and also discusses things like phantom pain and so many other real issues that amputees find themselves confronted with on a regular basis.  I think Dave is so relatable, he lost his leg because he pulled over to help a woman with car trouble on the side of the road.  He is a dad who is an obvious family man, he is smart and well-spoken and I have only heard wonderful things about him from those who know him on a personal level.  It is more than worth it to take the time to read his blog when you get a chance.

http://www.amputee-coalition.org/  - this is the website for the Amputee Coalition.  This is the organization that put on the camp where I was a counselor this summer.  This is a great website if you are an amputee yourself or are looking for ways to get involved in the community.  If you want to read about events, find local volunteer opportunities to donate your time or money, this website is full of information.  I think is a great resource for anyone involved in the prosthetics industry to take advantage of - you can use it to give to your patients if they are looking for support groups or people to relate to, you can use it yourself to find out all kinds of information.  The Amputee Coalition has a blog that you can access through their website, as well as links to current news topics and up to date information on all things related to amputations and prosthetics.

http://www.amputeemommy.com/   - this is another great blog to read if you are looking for relatable.  This is written by a woman named Peggy Chenoweth about her journey into motherhood as an amputee.  She writes in such a honest way about her decision to amputate and the lack of resources she found when trying to relate motherhood to being an amputee.  She obviously lives a very full life and I always love to read about people who do not let limb loss affect the way they live.  It is a great read, especially for mothers.

http://www.woundedwarriorproject.org/  - this is a blog about a wonderful organization called the Wounded Warrior Project.  I first learned about the Wounded Warriors when I was at Walter Reed and all of the guys we were seeing were wearing Wounded Warrior shirts.  I know there are commercials now so I think it is becoming a more common thing to the general public.  The website is worth a visit to read what their mission statement is and what they are trying to accomplish.  It is a great place to raise awareness about these 20 year old men coming home from war and how to integrate them successfully back into society after suffering major injuries overseas.  They focus on the mind and the body and getting these veterans to be financially stable and getting them involved with other wounded warriors.  The Wounded Warriors have many sporting events that raise money and to watch these guy go out and play a game of baseball with able-bodied people and beat them with ease is a pretty amazing sight to see.

*Permission was granted for use of both blog addresses.

Paralympics in Pictures

I have been watching loads of coverage of the Paralympics the past few days - it has been so exciting to watch these athletes in action.  I love seeing people with limb difference not letting it limit their life and seeing them excel in an event that involves so much physical talent.

I have also been learning all of the rules and special nuances that go into the Paralympics.  I kept hearing and seeing the athletes being listed in classifications - T44, T11, W1 - and having no clue what this meant.  The numbers and letters classify the athlete into a particular category based on his or her ability to perform a certain ability and based on what their particular impairment is.  They classify the blind players into one class, the wheelchair bound athletes into their own classes based on what part of their body is affected.  They see if a person with a unilateral leg amputation can compete on the same level as a person with a bilateral leg amputation.  It is very interesting to see how it all gets done, there is an official committee that, after assessing and evaluating each athlete, place them into their classifications.  So, in a run, you could see a T42 classification competing against a T43 because they have been assessed as having the ability to compete on the same level against each other, despite a person having two prostheses versus only one.

I watched blind men play soccer today, people with one arm throwing the javelin, amazing women racing in wheelchairs, the triple jump, sitting volleyball, cycling.  It is all very fascinating and I highly recommend sitting down and logging onto the computer to watch whatever you can.  Oscar Pistorius ran a world record breaking heat in his 200m race and then failed to defend his title in the final and ended up getting the silver medal by .07 seconds.  There is already scandal being talked about there, an emotional Oscar saying that the winner, Alan, had blades that were too long and too tall and that were impossible to compete against.  The IPC board of the Paralympic committee supported the winner and refuted Oscar's claims.  

All in all, thus far, it has been very exciting to watch.  The link that I have been using to watch the games is:

http://smart.paralympic.org/player/Main.html 

It gives live coverage as well as the schedule of events that are being shown every day.  I think the commentators have been fantastic and I think they are doing an incredible job of covering all of the events.  I am not sure how to get involved in the Paralympics in 2016, but I am putting it down on my list of goals.  I would love to not only attend the games, but in some way volunteer or be a part of the games as well.  Seeing these athletes winning medals for their country makes sitting in that room for countless hours a day, modifying that hunk of plaster, more than worth it.

Team Work Makes the Dream Work

"The nice thing about teamwork is that you always have others on your side." - Margaret Carty

Meet the Prosthetics Certificate Class of 2012!  These are the 18 other people that I spend the majority of my waking hours with these days.  One of the things that I have learned the past few weeks is how much of a team effort this industry is.  No one leaves you flailing alone when you need help or do not know what to do.  Everyone is willing to stay late and stop working on their own projects to give anyone else a hand.  There are a lot of people in this class (okay, the majority of people in this class) who have way more hands-on experience doing these things than I do.  I had never rolled on a plaster cast before 2 weeks ago, I had never done any of the specific grinding work or shaped out all of these molds.  Nine of the students have already completed the Orthotics program at Cal State and are returning to get their Prosthetics Certificate, they certainly know what they are doing when it comes to the making things portion of the class.  They finish at lightning speed!!  It is amazing.  I just think it is so awesome that, across the board, every single person in the class is willing to stop and answer a question or go into the other room and show you something and help out.  It makes it really feel like we are all in this together, regardless of skill level or experience.  Every person in the class wants every other person in the class to succeed and it definitely makes for a great sense of camaraderie in the group.

This industry is so small that I am confident I will be running in the same circles as the majority of these people for the rest of my career.  We might only be spending 17 weeks together now, but we will be lifelong members of a community that only has a few thousand people in it.  We will see each other at O&P shows and meetings, fundraisers and volunteer events and potentially even work together again in the future.  It is a great group of people and I feel really lucky and blessed that I ended up in such a great class.  I know that when I get to the place where I am one of the more experienced people in the group, I will remember it is worth it to someone else to take the 5 minutes and sit down and do my best to help them in whatever way I can.