Archive for April, 2013

History Of and My Experience With The Orbital Fixator

When I decided to have foot surgery, an entirely new learning curve was about to take place. I was ready, but apprehensive. We had already checked my surgeon out and were impressed with his credentials even though he was only 36 years old (about the same age as our son). We were very comfortable with him. He was thorough, professional, knowledgeable, had a great sense of humor and explained things so we could understand them. In explaining what was to be expected, we were told he was going to use a device on my foot called the Orbital Fixator. This would04Bconfine my foot so it couldn’t move at all during the first two to three months after surgery. This was to help the foot heal.

The wires criss crossed through my leg bones allowing no movement of my foot and leg. I was shown the device, but I don’t remember holding it. If I did, it didn’t sink in how heavy the device was. Nor, did they suggest I tie a 10 pound weight on my right foot and practice playing hop scotch for a few weeks before. surgery. I truly thought that would have helped once I was ready to try to move around and wasn’t able to do anything, but scoot, or try to hop on my left foot.The Orbital Fixator was awkward and very heavy. I didn’t have strength in my hip or leg enough to lift my foot. So, I often needed help. It was, actually, exciting when I was able to lift my foot on my own. This came about because of the exercises that were given to me before I left the hospital.

The history of the Orbital Fixator is fascinating. In 1921, in Caucasus, in the Soviet Union, Professor Gavril Ilizarov was born. He had no formal education until he was 11. His parents were illiterate. Yet, he quickly went through medical school practicing in the Kurgan region of Siberia. He was having to deal with orthopedic problems. Though he wasn’t trained as a surgeon, he was the only doctor in the region. In the 1950’s he developed and created a method for treating fractures, deformities and other bone defects. It was called the Circular External Fixator (Orbital Fixator). It is said he was riding in a wagon and started studying the hub and spokes on the wagon wheel. This gave him the insight to create the Circular External fixator to stabilize the leg. He worked quietly and basically unknown until 1967 when Olympic high jump champion Valery Brumel sustained a non-union fracture. He successfully treated this infected fracture.

His methods were brought to the west in 1981 by an Italian doctor. Professor Ilizarov was the only orthopedic surgeon ever elected to the prestigious Soviet Academy of Medicine. He headed the world’s largest orthopedic hospital in, Kurgan, All-Union Scientific Centre for Restorative Orthopedics and Traumatology which has 1700 beds. He continued working and lecturing world wide in this field for 41 years until his death in 1992 at age 71. Because of his work, he showed that controlled mechanically applied tension, stress that there could be regeneration of bone and soft tissue. Various names of his Circular External Fixator have come about, the Orbital Fixator, the External Fixator and in the past decade the Taylor Spatial Frame has been introduced. It has been determined the external fixation devices disrupt the soft tissue less in patients whose healing potential is compromised in the case of those with diabetes mellitus and Charcot disease.

This weeks article was contributed by Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation

Care Giving

The person doing care giving requires excellent patience, a sense of humor and the willingness to do what is necessary to keep the cared for person comfortable and reasonably happy. This is even more important when the person is very independent and feels shut in when they are only allowed a limited amount of movement. Having to be in, or on the bed 24/7 except for the times in a sitting position during meals is even harder on those who are very independent. Seemly normal things require more effort than before because of the lack of movement. For instance, just brushing ones teeth requires having something to spit out the tooth paste mixture into, and at least one added container of water for the person to rinse the brush and their mouth. This is in addition to having a towel available to protect the bedding, their sleeping garments and to wipe their mouth after finishing brushing the teeth. There were other things which will follow.

Care giving for some one with limited movement presents a different set of solutions when bathing or trying to shampoo their hair. After getting the new mattress, Annita wanted a bath. She had had baths earlier, but this seemed more important. In the beginning, her bath consisted of using the wash cloths sent with us from the hospital. They were the type used in Iraq by the soldiers. I heated them, one at a time in the microwave for about 10 seconds. Annita would then use each one to take a quick bath to make her feel refreshed. Later on, we were given permission to do water bathing.

When giving a bath to a person who is basically confined to a bed, common sense, patience and careful handling of water is required. You do need to mop the floor because you were not careful. After getting several towels on the bed under Annita and others available for drying off, I would get a stool, placing it beside the bed. The a bowl of water was drawn and carried over to the bed and placed on the stool. Between the two of us, we would wet an area of her body, soap it, rinse it several times to remove the soap, and dry the skin. This required several containers of water. There was a type of wash cloth sent with us from Madigan which made washing private areas a quicker process. Washing her hair was another event.. The first time she used a head coveringP7100118 copyshampooer from Madigan which looked like a shower cap with shampoo and a little packet of water in it. After she placed it on her head, she broke the water/shampoo packet by massaging the cap she washed her hair. I had warmed it in the microwave preparing it for use. Once the cap was removed she dried her hair. She was tired and the bath taken earlier was a success. I took care of the wet towels, water bowl and other things needed to be put up. I think she really enjoyed her nap. Washing Annita’s hair with water was much more difficult. I did not realize until we were writing up these postings that there were times Annita felt she was vulnerable.P8110055

Each day, shortly after I got up and dressed, I began the ice pack on the right knee process on a continuing basis. The ice pack was placed above her right knee for 20 minutes each hour. The ice was used to control pain, she certainly had none from after the operation for Charcot even when back on her feet. None, not ever. After straightening the covers on the bed, I got the padded chair pillow and placed it behind Annita so she could sit up easily. Then put the necessary pillows under her right leg to elevate it properly and covered it with a blanket. We were required to keep the orbital fixator elevated above her heart. At first getting into or out of bed I needed to lift, or lower the leg because she did not have the strength to lift it herself.

I gathered up all the items she wanted and put it on the bed, or the table within her reach. There were newspapers that she went through. She was looking for recipes, possible items for art projects and other things of interest. This was in addition to a pair of scissors, pen and a journal she kept. In part, she was recording this ongoing process, as well as, keeping up on correspondence. There were TV game show programs we watched most days. Also, she had a soap opera “Days Of Our Lives”, she watched keeping up on what was happening. Friends who were a part of the aerobic group at the swimming pool would come by to visit. They always called and I am glad they did, as in this way, this prevented a communication mistake from happening. Then of course, there was the advice freely given and appreciated which in some ways helped although we did not have any serious difficulties. Thank Goodness.
Annita was very concerned about awakening me at night so that she could make a bathroom visit. . I got up as if I had been called when I was aboard ship. This was much the same as when I was aboard ship although those problems were a lot different. I helped her put a sock and shoe on her left foot as required by the doctor. Helped her get her right leg off the bed so she could sit up. The orbital fixator weighed about 10 or 15 pounds and she was not to place it on the floor, or put weight on it. I helped her stand and steady her as she slid and wiggled her left foot to be able to turn and sit in the wheel chair. Release the wheel brakes and move the chair to the potty and reset the breaks. I would help her get up and turn using just her left foot to make the transition. She then sat down. When she was finished the reverse process was used to get her back into bed. It sounds time consuming and complicated, but it really is not. I would then turn off the light and get back into bed. I wished her a good night. Laid back down and went right to sleep. The following morning it was get up. Sometimes as late as 9 am and begin again with the things needed to be done that day and repeat the daily process. The potty chair was near the bed. I emptied and placed clean water in it each day, sometimes several times It was several weeks before Annita could easily move the operated foot other than keep it off the floor. After about three months the surgeon removed the orbital fixator. Her right foot was then placed in a cast, then later in a walking boot. I provided care giving until she was able to get around without help.

This weeks article was contributed by Max Shaw, husband of the Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation

A New Mattress & A Good Night’s Sleep

Because Annita was going to do her after surgery recovery in the Art Studio and that part of our house had ground level entry, we moved the guest bedroom bed to the studio. Since neither of us were sleeping very well at night, the mattress had to go. We had had this mattress on that bed for more than 30 years. The mattress was not lumpy, but its springs had lost a lot of their spring-e-ness. The next day I went to get groceries and mattress shopped. Searching for a mattress to suit our needs was different than what people usually have when buying aP7260049 mattress. Besides being more comfortable to sleep on, it needed to be firm enough to allow Annita to raise her body off the bed. In getting off the bed She had to be able to raise herself with only her left foot supporting her without placing the right foot on the floor. She could not use the right non-weight bearing foot because there was an Orbital Fixator attached to it. Her surgeon told her she could not put any weight on that leg during the first six months of the recovery.

To find an appropriate mattress, I had to look in several different stores. After entering the last mattress store selling quality mattresses, I located a firm mattress. Then I did the following: sit on the bed, once seated, use my arms to raise my bottom off the bed to get into a standing position on my left foot without placing my right foot on the floor to assist me in getting up. (Try it, you will be surprised how awkward it is.) Then there are the firm mattresses, just choose the right one. Not many firm mattresses were useful in getting me into a standing position. The Temprapedic type, advertised as being very comfortable to sleep on, but would not work. My arms would have to have been twice as long to have gotten me up off that mattress and into a standing position. Of course, the sales people must have wondered what I was doing. They probably wondered why I was doing this particular exercise. In any event they gave me some strange looks until one of them came over to find our why I was getting off the mattress so awkwardly. She did after I told her why I was doing what I did.

I did find a mattress that day, however, the person for whom it would be most useful had to agree with my choice, my wife. After our third trip to MAMC (Madigan Army Medical Center) for bandage changes, we stopped on our way home to see if the mattress I chose was the one. It wasn’t. The clerks in the business finally understood as Annita got out of the wheel chair and hopped from mattress to mattress trying them out. Finally she found one that was acceptable. We got it a few days later and, was it ever appreciated by both sleepers.

This weeks article was contributed by Max Shaw, husband of the Founder Annita Shaw

Brought to you by Charcot Awareness Education Foundation

What’s That on Your Foot?

(While we wait for the information on Bonnie’s wheelchair, I will continue with my esperiences with Charcot.)

When I am out and about in public wearing the bone growth stimulator, even now, it is a conversation starter, a another chance to talk about Charcot Foot. I have worn it at least 3 hours a day on my right foot since surgery. That was three years ago. I was told to wear it for three hours a day for three years, or until it quit. I have done that, missing only a handful of days. I truly believe this device has been a big benefit in helping my foot heal. Artificial bone was placed in three different areas in my foot during surgery. It is my understanding the artificial bone is eventually replaced by your own bone.The bone growth stimulator is a electro magnetic device that was to help my body accept the artificial bone and stimulate bone growth. This device is strapped around the area to aid in healing for the period of time determined by the surgeon.Let’s step back a bit. In the hospital, after surgery my left leg was Leg missagerwrapped in a device that was to prevent and reduce atrophy, increase blood circulation and stimulate the muscle since I wouldn’t be moving much the next few days. This was called Electrotherapy. In 1855 the developer, Guillaume Duchenne, explained alternating current was superior to direct current as there were fewer complications. During the 1940’s, the US War Department investigated the application of electrical stimulation not just to retard, or prevent atrophy, but to restore muscle mass and strength. On my right foot was a bone growth stimulator. There are three categories of electrical bone growth stimulators: invasive, P9220003semi-invasive, or noninvasive. Mine was noninvasive and I will give you some information about it. Mine was a Pulsed ElectroMagnet Field (PEMF). This device uses low-energy electromagnetic fields promoting healing by creating electical currents to stimulate bone formation and calcification. The currents stimulate bone cells changing the cell wall structure enhancing bone union. I was able to wear it on the Orbital Fixator, casts, the boot and my shoes. It was pretty easy to use as it had a strap that was placed around my foot. I wore it three hours a day which was an automatic setting. It beeped when it was done. Once done we merely took it off and plugged it in for recharging. The FDA approved ultrasound bone growth stimulators in 1996. I am pleased my surgeon chose to add this to my recovery plan.

by Annita Shaw, Founder of Charcot Awareness Education Foundation

Brought to you by Charcot Awareness Education Foundation