My day starts as I drive around the back of the Rehab Centre to park my car, waving to patient number one who’s been sitting in his car on the corner as he usually does, waiting for his 7.30am appointment, a special arrangement that means he can still get to work on time. Usually I spend from 7.30am till around 9.00am on my e-mails, post, and last minute cast work and generally run around for an hour or so until the patients arrive. Today, though, John is here bright and early for his 7.30 appointment. I’ve known him for about 15 years, since we first moved to Dulwich Hospital. He’s a No.1 (That’s a Through Hip Amputee) and he’s here today to collect his leg. A nice bloke, very patient (thankfully, as he’s going to be here for a while).
In through the back door, coat off as I go along to my office, kettle on as I change into my whites, get his leg out of the rack, bench Alignment – check the leg over for quality of finish and make sure the locks work properly, add hot water onto my tea bag and take the limb into John. General chit – chat about what we’ve been up to since he was last here, John changes into his new limb and wants his old one overhauled – down to the Workshop it goes, quick slurp of my tea on the way.
On with PIMS to see if anyone else has arrived – I manage a team of six Prosthetists and we have 5 or 6 booked appointments each, every day. My next appointment will arrive at 10am. So, into the Cast room I go while John’s leg is being repaired. The Cast room is very therapeutic – much carving and building up of plaster casts goes on in here, a messy but exacting job that I rather enjoy. About 80% of the limbs we make start from a plaster cast of the patients residual limb, (what used to be called ‘the stump’), – that is the amputation site on the individual – though more often these days we are measuring our patients on Cad Cam Technology (Computer Aided Design-Computer Aided Manufacture) sending measurements by e-mail to the workshop to get the limb made. So, soon there will be no more messy plaster, or messy clothes! On the Cad Cam System we can generate a three dimensional image of the patients residual limb onto a television screen by stroking a scanner pen over it, looking out for any bony prominences or areas that cannot tolerate pressure. Still, just now I’m up to my elbows in plaster and the phone has just gone, Tanya says my 10.00 is in: – Back into the men’s fitting room with my 10.00 who is here to be traced for a new limb, which we do in the Cad Cam Suite. When I’ve modified the generated image, looking out for those bony prominences, I e-mail the file to our workshop – all clever stuff! John is walking up and down looking good, feeling fine plus his repaired leg is back now so, after just 3 hours he’s ready to go with both his limbs – see you in three months John.
I return to the Cad Cam Suite and make a follow –up appointment for my 10.00 am patient, for a fitting on his new limb in about 2-3 weeks.
I made the smallest pair of limbs in my career so far, for Chloe who I am expecting at 11.00. She was born without feet, as a result of Amniotic Band Syndrome. I first met her at 5 months and mum wanted a pair of legs to complete Chloe’s body image whilst she was carrying her in a papoose.
Next up is Hannah, she has appointments with four of our Multidisciplinary team – Myself, the Consultant, the Occupational Therapist and the Physiotherapist: she has suffered multiple limb loss, – all four due to meningitis – and needs input from us all to manage the replacement of these lost limbs. Hannah lost her legs through the knee and her arms below the elbow. She wears prosthetic lower limbs with articulated knees and energy storing feet. Because Hannah has lost both hands also, putting on her limbs is particularly difficult for her and she needs a lot of help. After I’ve checked the fit, alignment and comfort, she can do some more walking training in the gym with the physiotherapist and then work with her powered hand with the Occupational Therapist. It’s exhausting and loads of hard work for Hannah, but we try to make it fun as well.
I need a cup of tea after that, and I get a gentle wind down as I now have a lovely lady of about 70, a diabetic. She lost her limb because of poor circulation a couple of years ago. She doesn’t walk too far; potters around the house and uses a wheelchair a lot of the time. Today she has had a successful fitting to her below knee limb; she found it comfy and wants me to finish it .Which will take about two weeks and involve spraying the outside of the limb with paint, so we go outside onto the patio with a set of colour swatches. Its best to choose the skin tone in daylight as we can get a closer match to her own colour – everyone’s own idea of a good match is different – we even had one girl who asks me to respray her limb darker in summer to match her tan – then lighter in winter! My 70 year old chooses No.14, gets her calf and ankle measured and a photo taken of her ‘sound’ limb and goes on her way.
Last up today is Michael who was born with a congenital deficiency above the elbow, having one digit at this level that has very little function. We are fitting an arm with an electrically operated hand that Michael operates by pressing a switch in the socket – a quick press tells the hand to open and a long press tells it to shut. Matt also has an elbow joint that he needs to operate by stretching a shoulder strap across his back. Lots to remember for Michael, and lots of practice needed until he can perform functions easily and quite naturally.
Well, I’ve got about an hour left, so I write up today’s notes and confirm the follow-up appointments made throughout the day .It can be a demanding job, Prosthetics – we start the day with 5 or 6 timed appointments, plus walk – ins, as we have an open door policy – but due to the content of the work, these appointments tend to overlap. So, we mostly spend our day juggling the work, moving from patient to patient as their limbs are repaired and returned to us from the workshop. It is however, a very interesting and satisfying job, as you build up a working relationship with each individual, and help guide them through each episode of care, hopefully anticipating their needs.
Alan Tanner, Principal Prosthetist at Bowley Close.
This article was reproduced with kind permission from the Limbless Association. You can read similar feature stories in their quarterly magazine ‘Step Forward’. Please contact the Outreach Officer on: 020 8788 1777 to subscribe to Step Forward.