Thursday, August 15, 2013

The Most Awesome Post Ever (#NSFT)

Before you scroll down, I have to warn you.  These pictures of my June 14th amputation are extremely graphic.  And totally awesome.

As Dr. Attinger described these pictures, here are steps one through a thousand on how to perform an Ertl amputation.

My sweet epidural. 


Go TU! 


Measure twice, cut once. 



















It's like we're dissecting something in biology class. 










Please tie off that artery before I bleed out.



















Bonesaw!  Aubrey, if you made it this far, I am proud of you.












Another artery worth saving.








Measuring the length for the fibula bone bridge.



Just a quick game of tic-tac-toe.  Inside my leg.















It looks like a trauma. 



I like how they're treating my foot like a chunk of freshly caught fish with that massive hook in my fibula.








Peace out, dude. 






I'm being filleted.

















My leg is starting to swell.











The med student that did this is awesome.  He tried to show us what my ankle looked like.  Read my mind. 

If they dug deeper they'd find some broken screws sticking out down there. 








Cutting off the remaining fibula to form the bone bridge.















The fibula bridge keeps all of its blood vessels to keep it alive.












Perfectly beveled edge for a smooth and comfortable contour.


















My leg is starting to look like a stuffed sausage.







I will be framing this picture.  Amazing.












Footloose! 




Securing the headless screw to hold the bridge together.
















Reattaching the functional muscles underneath the bones to form additional padding.














This JP drain is gigantic! 



















If you made it this far, I must say I am impressed.  Of all of the pictures I've ever posted on this blog, these are the most gnarly.  Congratulations on making it all the way.

These pictures make me appreciate the work surgeons like Dr. Attinger do.  This surgery gave me my life back.  I'm so thrilled it was all captured with such amazing pictures!

Wednesday, August 14, 2013

Surgery Pictures Have Arrived

This is one of the best pictures I've ever had taken of me.

Dr. Attinger, seen here cutting my leg off, sent me about 350 pictures from my June 14th amputation today.

The pictures are extremely graphic.  It's awesome!  I'll start posting them later this week.

Tuesday, August 13, 2013

Two Months of Learning the Amputee Lifestyle

Top Gear's Jeremy Clarkson knows what it's like to go zero to 60 in a heartbeat.

Tomorrow marks two months since I amputated my leg.  I've tasted what it's like to have a normal ankle.  It's awesome.  My famous and distinguished pre-accident Tony stride has already made an epic comeback.  
While I'd love to dust off the old cliche and say never in my wildest dreams did I expect to be this far along at this point in time, I can't do it.

I expected to be here.


It was this stupid confidence that kept me perfectly calm, dude, just hours before my leg was amputated.  It's what will put me back on my snowboard this upcoming season.

It's also these high expectations that make going from 60 mph to zero so challenging.  I've been told by other amputees to expect a roller coaster ride for the next few months.  I live in DC.  I live and breath stop-and-go traffic.  But I had no idea how abruptly I'd come to a complete stop after dominating walking for three weeks.

I mentioned signs of a problem in last week's post.  I was losing suction as I walked.  This indicated my leg was continuing to shrink after the final socket was created.  I was unable to maintain a seal around my residual limb because my leg was smaller than my socket and liner.

My prosthetists have a tough job balancing this issue with keeping me active.  If you want to plan for a shrinking limb, you stick with a test socket.  But test sockets are fragile and can break, so you have to limit your activity.  If you're an active patient like me, this can be difficult medicine to take.  If you're in a carbon fiber socket, you can safely and dramatically increase your activity.  I was working out every morning in my final socket.  I was quickly up to 100 lbs squats.  It was great.

But I continued to shrink.  Over three days we tried to plug the holes and keep me in the socket, but on Friday we realized it wasn't going to happen.  I was wearing 12-ply socks to stay comfortable in my socket.  We planned on meeting Monday to create a new mold of my leg to start the process over again.

In the meantime, we had an awesome wedding to attend in Philadelphia in my now gigantic socket.  I was given explicit instructions not to walk all over the city.


I only walked one mile in the city, but it was enough to open up a superficial wound on top of my incision over the distal end of my tibia.  Because my leg shrank, it was banging around the socket during the swing phase of my gate.  Every step I took hammered this thin section of skin.

I also ran into an interesting swelling problem with my calf muscle.  Because I was no longer using the entire residual limb to bear weight due to the shrinkage, my calf muscle picked up the slack.  After walking for a mile, my calf muscle got very swollen.  I tried to balance out the weight distribution by shoving in cut-off socks around the distal end of my residual limb, but that ended up acting like a tourniquet and helped my calf muscle swell up.  It also made the distal end of my limb go numb.

These are all things that scream, "stop!"

So I was forced to attend the wedding without my leg.  It was heartbreaking.  My friends Lauren and Phil have been so supportive over the years.  Lauren is working on her doctorate in physical therapy with a specialization in amputees.

I desperately wanted to show up wearing my leg.  But Brooke and I decided that would be a bad idea.

The next morning, my leg felt better, so I was able to attend the morning after brunch without crutches in my sweet new leg.  Lauren immediately told me how happy she was to see me walking.  That was my single goal for the trip.



Yesterday morning I had a follow-up visit with Dr. Attinger.  He claims that the pictures from the surgery will be sent to me this week.  I plan on emailing him every night until we get them.  The x-rays of the leg look great.  You can make out the early stages of a bone bridge forming between the tibia and fibula.

Dr. Attinger commented on the wound and asked that I not overdo it.  I requested more specific instructions on exactly what he meant by not overdoing it.

After my appointment with Dr. Attinger, Brooke and I dropped by 6 Main to visit with a new below-knee amputee.  Walter had his surgery on Friday as a result of an infection from an ankle injury in May.  Walter had an awesome attitude.  He couldn't wait to get into his new leg and get started on the new chapter in his life.  We told him to keep that positive outlook.  It's exactly what will lift him and his family through this ordeal.

Tricia presenting me with my certificate of kicking ass at being a patient.

We ran into a bunch of our nurses while we were on the floor, including Allison, Lindsey, and Tricia.  It was a nice impromptu reunion, getting the band back together like that.  We all agreed it would be better to meet over beers than in the hospital again.

Later yesterday afternoon I had another cast of my leg made.  Today I picked up my third test socket.  It feels so much better to have a socket that fits.  I go back in Thursday to make more tweaks and possibly have another cast made.  We're also going to try an even smaller liner.  I'm currently at 28cm.  The game plan will be to go through a couple of test sockets before casting another carbon fiber socket the last week of August.

The last eight weeks have been a rush.  And while I've had setbacks, I couldn't be more pleased with my progress.

Monday, August 5, 2013

Test Driving My New Ride


Last Thursday I received my final socket.  It was an exciting moment as a new amputee.  I finally get to overdo it without worrying about breaking my socket.


It initially felt pretty good, but subsequently I've noticed I'm having issues maintaining the vacuum seal, even with socks.  We noticed it when I first started walking in the leg.  It comes and goes, but each day I've noticed it gets a little worse.  Today I went most of the day unable to maintain the vacuum in the socket.

When I walk around it sounds like I'm farting with every step as air escapes the one-way valve.  While that's awesome, I'm unable to keep an airtight seal with the addition of liner socks.  I've even tried adjusting my liner without any luck.

But, it's still been awesome.  Yesterday I walked just shy of two miles in my new leg.


Let's take a quick tour of my new ride.


Prosthetic legs are made of four basic components: 1) a liner that goes between your skin and the socket, 2) a socket, 3) a pylon, and 4) a foot.  My foot and pylon are essentially the same system.


My foot has a pump inside it that sucks air out of my socket.  This creates negative pressure between my liner and socket and better adheres the foot to my residual limb.  By using this system, we're taking advantage of the large amount of surface area in my residual limb to bear the weight of my leg.  This makes the leg feel lighter and more like a part of my body.


I have no idea why they make the foot shells realistic.


On the side of the foot is this shock absorber made by Ossur.  It's called the Re-Flex Shock.  This will help me with running later.  The pylon, which is the thing that connects the foot to the socket, telescopes in on itself, allowing the shock absorber to do reduce the energy transferred to my knee from each impact.


The carbon fiber foot is always covered with a thick sock.  This helps prevent the foot shell from wearing down the carbon fiber foot.


The foot is awesome.  It's a new system built by Ossur that contains a pump in the heel.  Each time I walk, my heel strike pushes a pump that sucks out air from my socket.



Here's the end of the pump over my heel.


The bottom of the foot is lightly padded.  This is usually the first thing to wear out in a prosthetic limb.




I really like this system so far.  It feels really comfortable when I've got a good fit in the socket.  I'm already walking better than I ever have since my accident, and I've got a long way still to go.


I took my new leg out for a test drive in the parking lot.  After a few attempts at running I actually had a good quick run.  I haven't done that since 2009.  When I woke up from surgery, I was told I'd be walking by August 1st.  On August 1st, I ran instead.

Also, I'm pretty happy with the random thumbnail YouTube picked for me.