Get Your Tickets to the Gun Show

"Great ideas originate in the muscles." - Thomas A. Edison

Look at those biceps!!  From this picture, it should be plainly obvious that I passed all of my manual muscle tests with flying colors.  5 out of 5 in all categories...thank you very much.  Okay, I will be honest, a 5 out of 5 is pretty much what every functioning human being scores.  It is actually only described as normal, there is nothing there that indicates superhuman strength.  It was a very short day of school - which was such a nice break from the crazy, long week we have had.  A two hour lecture explaining the importance of performing these manual muscle tests on our future patients and then spending another hour performing them on each other.  The tests are pretty basic and pretty self-explanatory.  I hold your arm and you try and straighten it while I try to keep it bent.  You flex your knee while I do my best to keep it pushed down.  The toughest one seemed so silly, but it was to test plantar flexion of the foot.  To be considered normal, you have to stand on one leg and fully raise up onto your toe 25 times in a row!!  I managed to do it, but I have a feeling my right calf is going to be sore tomorrow - I really gotta start working on those!!  I think it seems a little crazy that doing that 25 times is the minimum to be considered normal.  Try it tonight, it is tougher than you think.

So, all in all, a pretty basic day - nothing crazy to report and not a whole lot of prosthetics information.  The update on Mr. R is that he finally decided to answer his phone this morning and we are hoping he will come in at some point next week and I will be able to have him walk in my leg in front of my professors to do my critique.  Today definitely was a nice mental break from the stressful week and just the craziness that ensued every single day.  The schedule for next week looks insane and we are casting new patients to start making more trans-tibial sockets...only this time around (because we are very experienced in having made one socket already) we do not get three weeks to get these done.  We cast next week and then the following week are presenting them in critique.  Sounds like a lot of long days, a lot of plaster and many hours spent in the grinding room for me next week.  Oh, did I mention I have to complete my 22 hour online clinical education unit test this weekend?  No rest for the weary.

More Patience, Less Patients

After all the hype and studying and cramming information about gait into my brain...after working on my presentation and trying to make it sound casual, cute, funny and informative all while seeming natural, confident, and knowledgable (I know, a lot to get across in a 10 minute speech), Mr. R did not show up for my critique appointment today.  Wah wah.  There I was, sitting in a freezing cold training room, staring at parallel bars in my freshly pressed linen pants (sidebar, what is the point in even ironing linen?) and 10:00 came and went with no sign of Mr. R.  The critiques were taking much longer than planned so I was not too worried when there was no sign of him at 10:15am, but by 11:30, it was starting to look a little dicey.  Three phone calls later and it was 3:00 and Mr. R was officially a no-show.  Needless to say, I watched 17 critiques today and no one watched mine.  And everyone else has been able to disassemble their legs and mine is still sitting in one piece on my workbench.  Fingers crossed that someone is able to get ahold of Mr. R and he is able to come into school tomorrow so I can get my critique done and get a grade for this leg that I have spent three weeks working on.  I am chalking his absence up to the fact that yesterday was his 86th birthday and he was obviously out late last night celebrating until the wee hours of the morning :)

Overall, it was a relief to see the critiques happen because the professors hyped them up to be this huge, stressful event that made it seem almost impossible to succeed at, but it was not like that at all.  I actually learned a lot from watching all of these trans-tibial amputees walk in the parallel bars.  I started understanding (and even being able to notice on my own) the different issues with their gait and how to make the adjustments to correct the problem.  During the critiques, no one in the audience is safe.  We were called on all day to make adjustments on other people's patients and I was relieved when I knew what was wrong when I got called on.  I got down on the ground and used my handy-dandy tools to add flexion to a socket and to slide a foot posterior.  A big part of our grade is participation and answering questions aloud during other people's critiques - I think I did really well in that area today.  It is good to know that these critiques are not worth getting so worked up over the night before!

Not much else to report, the entire day was spent watching people walk back and forth across the room.  Tomorrow is a gloriously short day of only 3 hours!!  A 3 hour day at school sounds amazing - the fact that we were told to wear shorts or lycra to get our muscles tested makes me a little nervous.  If you recall, the last time we were testing things on each other, it involved a lot of up close and personal touching of my fellow classmates.  Could make for a very uncomfortable 3 hours...

Here is hoping Mr. R shows up tomorrow (maybe he was confused on the dates) and gets me out of my muscle testing duties :)

Learning to Walk Again

Today was a big day - it was the day to see all of my hard work come to fruition and hope that the leg I made for Mr. R was going to be one he was able to stand up and successfully (and more importantly, safely and painlessly) walk in.  And...it was a good day!!  After yesterday's lecture example on how to fix someone's gait, I was anxious going into the patient visit today.  I was worried that if my alignment was off by very much or my fit was not right, I was not going to have the knowledge or skills to get it where it needed to be.  I think I lucked out in a couple of areas - first, my fit was pretty great and his first turn down the parallel bars was fairly successful, and two, I actually was able to recall a few things that I was able to do to help correct the issues we were having when he was walking.

 

Erin and I feeling excited and successful after a day of helping people walk.  (Due to patient privacy I was not able to take any pictures of my interactions with Mr. R so I will do my best to just give a quick rundown of the appointment.)

Today was Mr. R's birthday so I brought him a little cake and we all sang to him - I could not tell if he liked it or not, but I think maybe once you have celebrated well over 75 birthdays, you might not really care anymore.  The morning started out with just making sure he could stand up comfortably in my socket.  There had to be some minor adjustments made in the height of the leg, but for the most part, he was feeling steady and looked to be comfortable in the leg.  After making sure his hips were even and the leg was securely on his limb, I had him walk back and forth in the parallel bars to observe his gait.  This is where it gets tough for me and I worry about struggling.  It is easy for anyone to notice a person with a big issue in the way they walk, but detecting very small things (complete toe clearance, driving your heel into the ground, a little foot outset) is extremely difficult.  I know that it is going to just take me doing it over and over again to start being able to see it more naturally.  And I know my alignment was not perfect today, but when Mr. R was able to walk back and forth without any major issues, I was thinking - look at you, a very well done leg!  Then my professor came over...all my bubbles were burst as he was able to quickly point out some alignment issues he was able to spot.  I was able to adjust some things and got to a place where I will be able to go before the entire class and panel of instructors tomorrow in the critique and present a patient with an almost normal gait.

Apparently, the critiques are very intense and people get really stressed about them so it is looking like tomorrow will be another long day.  I am feeling fairly confident going into the day because I feel as though I know a lot about my patient (as much as he was willing to share...including the eulogy from a funeral in 2003) and I can fully explain all of the steps I took in making the leg and then in making different changes and adjustments to the leg throughout the initial fittings and into today's visit.  I think I am more bothered by the fact that I have to iron more clothes than by the idea of being publicly critiqued!

The afternoon was all about the feet.  Tables full of all different kinds and styles of prosthetic feet.  I had no idea how many different ones there are to choose from!  There are feet for all different activity levels, for running or climbing up things, for wearing house slippers and for wearing heels. I knew there were options, I just never knew how many!  It was pretty interesting to learn about the history of prosthetic feet and what goes into choosing which foot is the right one for your patient.  As with all other things in prosthetics, you have to show evidence based reasoning for why you put a certain foot on a particular patient.  So it is crucial to know all of the different feet and what they can or cannot do for someone.

Then came the second best part of the day...the first, of course, being able to see Mr. R walking around in my leg.  We were able to strap on these walking boots (the kind you use for broken feet) that had prosthetic pylons and feet attached to them and walk around to get a feel of what different feet felt like.  It was awesome!!  I think it was such a brilliant idea because, as an able-bodied person, it is impossible for me to relate to an amputee and to explain to them how a component should feel (besides what I know from books).  This gave me a chance to try out actual feet that I will be fitting on patients in my future.  I could have walked around in those things all day!!

I think my favorite thing about them was that I was so tall while wearing them!!  And amazed that this is how Chad views the world every day!

All in all, it was a very good day.  My patient was safe and happy.  I learned a lot and only failed a little.  I was able to put myself in the shoes of an amputee (quite literally), and I did it all on only about 2 hours of sleep.  That being said, I am exhausted and have loads to accomplish tonight before I present to the class tomorrow - there are progress notes to be written and gait sheets to be memorized.  And of course the biggest decision...what to wear for the critique...

I Make...Leg!!

It is official...I have made my first entire leg.  From start to finish - custom socket right down to the size 12 fake foot.  It is awesome!!!  I think I feel like the man who first discovered he could make fire...it is a feeling that catapults you to thinking you can accomplish pretty much anything.

The day flew by and, I hate to report, but took a 180 in terms of emotions after completing this leg.  I love the leg, but the 4 hour lecture after lunch about putting the leg on my patient tomorrow and having them walk around in it and having to change all of these little screws to get their alignment and gait just right, left my head spinning.  I hope my lab coat gives me its usual courage and confidence tomorrow because I left this afternoon definitely worried that I have no idea what to do when it comes to actually getting my patient walking.  Then I just had to remind myself that until three weeks ago, I had no clue what to do when it came to making a leg either.  My professor always says that, in regards to our learning at school, we are "failing forward."  I think a much more accepting to way to say we are learning from our mistakes :)

Today we got to put all of the components together to make this personalized and dearly loved socket into an actual prosthetic leg.  The first step of this is to make the bottom all messy and ruined and that was upsetting.  I mean, the stuff that you put on the socket to bind it to the pylon and the components is actually called 'gunk.'  That just doesn't seem right!  So after hours of smoothing this thing and being so careful to have it turn out perfectly, I was forced to rough up the end and tape it up and apply a thick layer of grey gunk.  Function over beauty in the world of prosthetics apparently.  After the gunk, we applied a fiberglass wrapping to add strength and support from the connection of the socket to the components on the bottom.  At least this just looked like casting applied to the bottom of my beautiful socket as opposed to all of that gunk...but I still prefer the "before" look.  The main reason I still love the "after" look is because it gave me the ability to attach the foot and have, what I hope to be, a functioning leg.  I am learning how to use even more tools and after attaching everything, I am learning to add flexion and extension and rotation and height to the leg.  These things will all be adjusted in the fitting tomorrow with Mr. R.  I need to spend some quality time with my leg, in fact, I am staring at it across the room on the floor of my apartment.  My goal is to be super comfortable with making these adjustments before having poor Mr. R be the guinea pig!

I really hope he doesn't mind the fact that my size 12 foot selection was limited to a color that is far better suited for me than him ;)

Lamination Station

Today I got called up from the minor leagues to the majors.  Whoa.  I mean, today they expected me to actually start making a leg...like one I would really make in real life in the future.  Third week of school and look at me go!!  It was a super long day and my entire body is exhausted and sore from standing in strange positions and leaning over equipment, but I cannot even explain the sense of satisfaction and pride that I have sitting here in my apartment right now.  This job is so gratifying!  And I have not even gotten to the part where I get to put this on my patient and give him the ability to walk!  You are in for a long post so I won't be offended if you just scroll down and look at the pictures without wanting to read in great detail the different steps in getting from point A to point B.

8am, get out your safety goggles and let's go!  The first part of the day was lamination, but lamination involves about 8 pre-lamination steps to even get your socket ready to go.  Most of the process is about pulling tight clear plastic bags down around your mold.  We all know that I have a history of ripping things when I pull them down over my mold so I was very much dreading the fact that I had to do this, not one or two, but three times today.  I will go ahead and encourage you to begin your applause because I managed to successfully get that darn PVA bag onto my mold every single time on the first try.  This is putting the first bag on to cover the end of the mold.  I held it there much longer than needed to, but I was not risking it moving or breaking on me.  Have I mentioned that we use A LOT of electrical tape in the O&P industry?  That and baby powder.  I encourage you to buy stock in both.  I got this cap on, gently used a razor blade (something which I have become surprisingly adept at) to cut off the tape and leave a perfect little plastic cap on my mold.  Step one...crushed.

Step two was to pull yet another plastic bag down the entire mold.  Done and done.  Step three was to apply felt around the entire mold.  This is just like wrapping up a burrito - and then using a lighter to make it stick together.  The heat/flame melts the felt just enough to create a little seam and the ends stay together this way.  This is the way you do it if you don't have the sewing skills to make a little slip cover - I do not yet have the sewing skills.  The fourth step was to apply strips of fiberglass to reinforce certain parts of the socket and add some extra strength.  This is what I am so focused on doing in the picture above.  Then there is the unsure/so tired/hopeful smile when I have it secured onto my mold.  Do you see that I am just powering through these steps!?  Let me be honest, as quick as this is going in two paragraphs, this was a process that took me two hours.

Alright, alright, I know that you were just waiting to see me in a respirator.  Hot right?  Between the safety goggles and the respirator, it is a wonder to me why more people do not meet and fall in love while they are working together making prosthetics.  I think I can really pull this off - I wonder if I have the right shoes to make this work on the weekend?  The respirator has to be worn because it is time to get serious and pour the resin in and laminate my socket!!  The fumes can harm me and any potential future children I might decide to have so it is worth risking sexy for safety.  Step 5 was to...wait for it...pull another plastic bag over the socket!  Step 6 was to measure out the epoxy acrylic resin (450 grams if you are super curious) and then Step 7 was to add a little bit of pigment to the resin to make the socket close to the skin color of my patient (again, if you are a details person, this is 2% of the amount of resin you put in).  Step 8, add the hardner (3%) and it is game time.  All of the steps are done, it is finally time to take the step (for me it was a literal step, up on a stool, as I am not tall enough to reach the funnel to pour the resin in) and make this socket lamination become a reality.  As awesome as these sockets turn out and as tough and amazing they look, it is pretty amusing to look at the tools that go into getting that finished product.  I cut a plastic bottle in half and it is rigged up to hang the plastic bag over my socket...then it just funnels down (with a little squeezing and stringing) and covers the socket.  All of which is hooked up to the vacuum to create a smooth seal around the socket.

This is me pouring the resin into the bag to get ready to have it cover my socket.  After squeezing the majority of the resin mixture to cover the socket, I took a string (as in a little rope) and went around the socket to get rid of any excess resin and to keep the entire thing smooth.  You have to spread it evenly, make sure it does not go down too far (this apparently clogs up the vacuum and is frowned upon at school), and then get the extra resin back up to the top (which is technically the bottom) of the mold to be cut off and discarded later.  Phew...exhausting and complicated huh??  I have seen this done and never actually done it myself so I was so nervous, but oh my gosh, it was so exciting.  I was so freaking proud of myself when I was done.  So of course I took a picture....

There ya have it...a few hours later, I have what is starting to resemble something that someone might actually want to wear as their leg.  This is a big deal!!

Did I mention that when I don't wear my respirator, I have to wear a cool mask?  Take your pick, I personally prefer the respirator because it comes with pink accessories ;)  After stripping the bags and using the cast saw (a little less scared of it today) to cut the shape of my socket out of the resin, I freed my liner that has been tucked away underneath all of that for the past few days.  You will never believe what I had to do after pulling my liner out of the socket...grind it down!!  Did you see that one coming??  Unfortunately, I did, but that means I was mentally prepared for it today.  I took that liner and made the edges smooth and pretty and it is going to feel so squishy and comfortable against Mr. R's skin that he is probably going to only come to me for his future liner needs.  I thought I had really begun to master the grinding - this liner only took me about 15 minutes and I definitely had a little strut going on headed back to my workbench afterwards.  Why would I do that?  I clearly had forgotten that my freshly cut out socket was waiting on my desk to be trimmed as well.  This, my friends, was not a 15 minute job.  This involved some serious dust, a terrible smell and me closing down the school with only one instructor left till 6:00pm.  That is what I get for thinking I was the queen of this socket today.  A little knock back down to reality.  Which is fine, keeps me humble and honestly made finishing feel SO much better.  Talk about a strut!!  You should have seen me sashaying out of the building today!

This grinding is a messy, messy business.  My professor came and was like, oh my gosh, you look like you have walked through a snowstorm.  The little amount of dust on my face and shirt is what I looked like after I took the blower and tried to get most of it off.  A little dust is way more than worth it for the feeling of triumph that I felt when holding a completely ground socket with a lovely ground liner tucked nicely inside of it!  This job is going to be so ridiculously gratifying and satisfying - I cannot wait to continue making more legs and learning more things.  After today, I know I am going to be one of those people who truly looks forward to going to work every day and comes home and wants to talk about it with anyone who will listen.  I am currently paying for the privilege now (and it ain't cheap) and I still come out with a positive attitude and continually looking forward to the challenges that come with each day.  It was a long journey to get to where I am, and it has certainly not been easy, but I cannot imagine being anywhere else and I know that I am very, very lucky.  Tomorrow, this socket becomes an entire leg...that is right, I am going to attach a pylon and a foot to this bad boy.  Tomorrow, I can officially say I make legs...well, technically, I make leg.  Legs will come :)

I'll Give You a Topic...Prosthetics...Talk Amongst Yourselves

Something that I have really been learning since I decided to get into this industry, is that it is quite the conversation piece.  Whenever I tell people why I am in school and what I am doing, the response is always fascination and curiosity.  I love it!  I love then getting to explain how I got interested in prosthetics and where it has taken me and what I plan on doing in the future.  I love being able to tell people why this field is so amazing and why I am so passionate about it.

I get the most interesting and imaginative questions you can imagine.  Last night, despite the amazing surroundings of a hip downtown hotel in L.A., the main topic was amputees.  Everyone has an opinion on Oscar Pistorius...everyone has questions about the daily life of someone living with an amputation...and everyone is pretty surprised when they find out all of the things prosthetics allows people to do.  I love to share with people how surprisingly not limited people living with amputations are - this is something I was unaware of until I got more involved and I think it is important for people to know.  So I spent a lot of the night answering questions and getting to talk about a subject that I love.  Just another reason I know I have made the right decision in getting into prosthetics.  I am looking forward to it being the topic of conversation at many more dinner parties!

Tim the Tool-Man has Nothing on Me

This is my workbench at school.  This is where I have been spending all of my quality time with those plaster molds and it is where I will be hanging out for the next 15 weeks.  Those three little blue drawers contain all of my tools.  The fact that I have a workbench and drawers full of tools makes me laugh aloud.  The industrial size trash can, yep, that's all mine too.  If you would have told me a year ago that I would be proficient with a vice grip and regularly rummaging around a drawer looking for the specific angle finder I needed, I would have thought you were nuts.  I actually think it is normal to use a staple gun every single day now.  I am not sure if I have ever used power tools in my life, but now I use them almost daily.  Band saws??  No problem.  Drill press??  I can change a drill bit like it is my job.  Oh wait...I think it kind of is...

We use hack saws, we use cast separators, there are things called plumb bobs.  I am learning to eyeball what 1/16 of an inch is and I actually can differentiate between different types and sizes of screwdrivers.  I am getting used to the whirring, loud noises these machines make - although I am still not a fan of the noise of anything cutting metal.  I own a respirator (pictures to come during lamination Monday), I carry a tape measure in my pocket, and I have learned to choke up on a hammer.

The whole thing amuses me, but I am learning to enjoy it.  This is a picture of me drilling holes into plastic for the first time.  Notice the look of uncertainty on my face...I had no idea that making a drill go straight into a hole took some actual finesse (and arm strength)!  So, I am getting there.  I own some of my own tools, I am sure there will be more purchased in my future.  I am learning to clean them so they don't rust over time (rookie mistake made the first week of classes).  I often lose my safety goggles because they are always on my head - this is a good sign, it means that I am wearing them more often than not!  Overall, I have become quite the handyman (woman)...I think maybe I shall start offering my services to people...hanging their pictures in their apartments and whatnot.  I am excellent with a level!