Mar 20, 2012

I Was MAFO'ed

Do you recognize this script?

Mr. McQuire: Ben.
Ben: Mr. McQuire.
Mr. McQuire: Come on with me for a minute. I want to talk to you.
A woman: Excuses, John.

(Mr McQuire and Ben step away from the crowded room).

Mr. McQuire: I just want to say one word to you, just one word.
Ben: Yes, sir.
Mr. McQuire: Are you listening?
Ben: Yes I am.
Mr. McQuire: Plastics.
Ben: Exactly how do you mean?
Mr. McQuire: There is a great future in plastics. Think about it. Will you think about it?
Ben: Yes, I will.

The 1967 script was from a scene in "The Graduate" starring Anne Bancroft and Dustin Hoffman (no relation). I love that movie because it's about "coming of age" and, of course, you-know-what. That movie made me think of the MAFO.

What does MAFO stand for? You have three guesses. Is it a) Muslim-Americans for Obama, b) Midwest Association of Farmworker Organizations, or c) Molded Ankle-Foot Orthotic? Of course, you know! I gave you a great hint with that script. Plus, as is this is neither a political or farming blog, it must be "c"--Molded Ankle-Foot Orthotic. But some of you don't know what an "orthotic" is. That's why I'm here, to explain it to you. For those of you who do know, bear with me. We've come to background time.

A MAFO, generally known as an ankle-foot "orthotic," is a molded, plastic, supportive aid to the upper or lower limb that makes improved movement do-able. People who make orthotics are called orthotists. Orthotics, coming the Greek word to straighten or align, is a specialty within the medical field concerned with the creation, manufacture, and application of the aids. The acronyms started in the 70s to define in which sub-specialties the orthotist functioned, like MAFO, TLSO that stands for thoracolumbosacral orthotics for conditions like scoliosis, and WHO which represents wrist-hand orthotics, just to name a few.

Foot drop (dropped foot and foot drop are interchangeable terms), what I have, is a symptom of the greater problem, not a disease in itself, characterized by the inability, or sometimes difficulty, in moving the ankle and toes upward. The dropped foot can range from a temporary loss to a permanent condition, all depending on the muscle weakness or, at worst, paralysis. Foot drop can be caused by spinal nerve trauma, an anatomy anomaly, toxins like lead or mercury poisoning, disease, or nerve damage.

My foot drop was caused by the nerve damage when I had the stroke, specifically to the peroneal nerve, the one that broadcasts to the muscles to lift the foot, and that nerve wasn't working. The classic foot drop is characterized by dragging one's toes along the ground. To accommodate patients whereby they lift their foot higher than usual to avoid dragging, they should wear a MAFO, which raises the foot high enough to prevent the toes from dragging.

Functional electrical stimulation (FES) using electrical currents to activate the nerve is an option for some, depending to what degree the nerve damage is. But if the nerve is dead, like in many stroke patients, a MAFO is the best and only bet. Wearing a MAFO causes a person to lift the foot in a process called dorsiflexion. A cuff is placed around the patient's ankle, and another one higher up under the knee, causing the patient to lift up the shoe when walking.

Ten weeks after my stroke, I had a MAFO, and still do. And now begins the MAFO story.

When I came home from the four nursing places I had been, I was wearing the MAFO. Some people asked me if I took it off, once in a while during the day, but they didn't know what you know now, that I couldn't take it off. Foot drop is foot drop. There's no way around it barring a miracle. Miracles are hard to come by. Winning a lottery is easier.

When I got home from the nursing fiasco, I noticed some red marks on my foot, even though the MAFO has to be worn with a high sock, high enough to cover the brace. Being the A-type that I am, I saved the orthotist's card when I met him at Rehab Y and called him to make me a new MAFO, or adjust the old one. He came to the house, wearing a suit (he was a proper kind of guy) and got to work with his apprentice. The two of them were using saws, sanders, and pliers (at least they resembled them) on my MAFO in the kitchen, and when they were finished, I was good to go.

But my foot was swollen after I came home from Rehab Y (I must have been retaining fluids), and in three months, the MAFO was too loose for my foot, risking a fall. So the orthotist came back again and fit a new one while I waited in the living room. This time, to my epic dismay, he decorated it with flowers on the whole back side of the MAFO. It was really silly and child-like. Why would he decorate the MAFO? I mean, why? So I asked him.

"What's with the flowers? I use the MAFO because I have to. If it was for a small kid...."

"I know. I know. I thought you'd like the flowers." I saw his jaw twitch, but he didn't say anything nasty. He was too dignified. He twitched his jaw again. "I can't remove them because the flowers were put on with permanent markers. So keep this MAFO and I'll have to make you a new one--plain, this time."

He returned a week later with the plain one, and since he had measurements from the second one, the MAFO was already prepared.

It was now Fall. I went through the seasons and Summer came, but the MAFO got too hot in the sun, even with the socks. I felt like a wet noodle. I called the orthotist back, but I didn't want a new one since the MAFO fit fine.

"The MAFO is unbearable. It's just too friggin' hot." The orthotist was so distinguished so I cut him a break by not using the "f" word. Even so, the jaw twitching was still there.

"I have an idea which I've never done before. I'll drill a series of pinholes over the whole thing so it can release the heat somewhat. Let's try it. It can't hurt," said the orthotist.

And so he did, and when I put it on and went outside, I was cooler after he drilled the holes. I started to feel rotten about the flower decorations that he applied with good intentions but great about the pinholes. And great about molded plastic. Mr. McQuire was right on. There was a great future in plastics.