The University of Southampton

Author: Jazmine Thorne

More metal than Terminator – the story of my nan

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Growing up I spent a lot of time with my nan – something I always noticed was a faint ‘tick, tick, tick…’ coming from her. As I became older, she explained to me this was because she’d had some big surgeries and part of her heart was now made of metal (we used to joke that she was like iron man or the terminator). Her heart valves had become leaky, meaning they had to be replaced with mechanical valves in an open-heart surgery at Southampton General hospital. Because of my nan, I’ve always had a personal interest in how we use prosthetics in the heart.

Prior to the surgery, my nan was given the choice between mechanical or biological valves, each with their own pros and cons. Biological valves typically last 10-15 years while mechanical valves can last a lifetime, making mechanical the go-to for patients under 65. Her team opted for mechanical valves so she wouldn’t need yet another risky open-heart surgery later down the line. 1

Figure 1: Diagram of the heart valves, alongside biological and mechanical valve replacements.2

Biological 0 – Mechanical 1

Figure 2: Video showing how mechanical valves work.3

Despite this clear win for mechanical valves, they come with a major drawback – being prone to causing blood clots, which could lead to heart attacks or strokes. As such, patients with mechanical heart valves must take anticoagulants for the rest of their lives.

For my nan, this meant she had to take warfarin and required blood testing (by INR) every week to maintain the right ‘thickness’ of blood – too thick and you risk blood clots, too thin and you risk uncontrollable bleeding.4

Biological 1 – Mechanical 1

Biological valves not needing anticoagulation is an obvious score, however, there’s issues with xenotransplantation to consider. The majority of valves come from pigs or cows, meaning concerns are raised for animal welfare. To ensure the animal is healthy enough to provide a ‘safe’ transplant, they must be kept in sterile and confined laboratory conditions. In some ways this may be better than the conditions livestock have, but it’s still lacking for the animal’s nature. Having ‘good ethics’ is absolutely a requirement here.5

Figure 3: Video showing how a biological valve works. 6

Biological 1 – Mechanical 2

The future of prosthetic heart valves

Figure 4: Video showing the TAVI procedure7

These are only a few of the positives and negatives for each traditional type of heart valve. It’s a complex decision and will depend entirely on the patient. However, in the time since my nan got her valves replaced, science and medicine has advanced. Open-heart surgery is still the norm for valve replacement, but transcatheter aortic valve implantation (TAVI) can now be used to avoid the obvious risks of open-heart surgery.

Another development is tissue engineered heart valves. This involves taking a scaffold which is seeded with stem cells and then then grown in a bioreactor before implantation. This would avoid the hazards associated with anticoagulation for mechanical valves, and the ethical issues of animal biological valves – and could grow along with the development in paediatric patients. Tissue engineered valves have not yet reached the clinical trials stage, but research is developing every day.8

Figure 5: Comparison between native, biological, mechanical and tissue engineered heart valves9

With the heart being such an important organ, any improvements to the current procedures for replacement heart valve prosthetics are hugely beneficial. I’ve loved finding out more about how research is advancing in an ever-present field in mine and my family’s lives. One day I might be telling the future generations about how scientists grew new heart valves in a lab for me!

References:

  1. BHF. How do replacement heart valves work?, <https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/replacement-heart-valves> (2019). ↩︎
  2. Image source: https://heartsurgeryinfo.com/types-mechanical-heart-valves/ ↩︎
  3. Video source: https://youtu.be/hmU7UtzxowU ↩︎
  4. Catterall, F., Ames, P. R. & Isles, C. Warfarin in patients with mechanical heart valves. BMJ 371, m3956 (2020). https://doi.org/10.1136/bmj.m3956 ↩︎
  5. Rollin, B. E. Ethical and Societal Issues Occasioned by Xenotransplantation. Animals (Basel) 10(2020). https://doi.org/10.3390/ani10091695 ↩︎
  6. Video source: https://youtu.be/ojW7wZRF7Cg ↩︎
  7. Video source: https://youtu.be/q6erYCbZGMQ ↩︎
  8. Mendelson, K. & Schoen, F. J. Heart valve tissue engineering: concepts, approaches, progress, and challenges. Ann Biomed Eng 34, 1799-1819 (2006). https://doi.org/10.1007/s10439-006-9163-z ↩︎
  9. Image source: https://mirm-pitt.net/tehvalve/ ↩︎

ProstheTikTok – Social media as a tool for prosthetics education

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For many, their only exposure to prosthetics has been from film, such as Captain Hook in Peter Pan – however, reality is far from fiction. I feel many people don’t know the truth of prosthetics and orthotics; but they’re not the mystery they seem! I myself have used an orthosis, needing a knee brace after a figure skating injury. 

With the rise of social media, it’s becoming easier than ever to share your life with others – whether that be your opinions on the latest album release, or an account of your personal experiences. One use of social media that I find fascinating is how TikTok is being used as a tool for education on prosthetics – a tool I used when wanting to learn more following the UOSM2031 lectures.

Case Study 1 – Luke Tarrant

After a motorcycle crash in Columbia, Luke was left in hospital, battling sepsis, eventually having his left leg amputated. Even with these hardships, Luke is now using his voice for good – showing every up and down on TikTok, describing the page as his ‘open journal’. 

One obstacle Luke faced was returning to a wheelchair over Christmas. After using a poorly fitting prosthetic, swelling of the residual limb left his socket unable to fit correctly. To avoid further complications, he had to take a break, making him feel like progress had been lost.

Despite the challenges, Luke remains positive – sharing the excitement he felt after being able to wear the prosthetic again. After recovery, Luke plans to get back out adventuring, hoping to finish his motorcycle journey across South America – this time with a new leg.

Luke’s TikTok Page
@luke_tarrant

So the plan is this: enjoy the next couple of weeks over Christmas and new year with some selective prosthetic wearing. Then in January, have a full month of no walking (my worst nightmare). If that doesn’t chill things out a bit, it could be back onto the operating table for some more surgery on the stump. It’s an incredibly tough spot I’m in at the moment and without the @Dorset Orthopaedic prosthetics team and specialist doctors I honestly don’t know what I would do. This too shall pass.

♬ To Build A Home – The Cinematic Orchestra
@glamputee

Hopefully this helps show how my arms work! #amputee #quadamputee #prosthetic #prostheticarm #disability #disabilitytiktok #amputeelife #amputeegirl #howto #howtotiktok #ot #occupationaltherapy #fypage

♬ original sound – Glamputee

Case Study 2 – Erica the Glamputee

At 19, Erica contracted bacterial meningitis which ultimately led to sepsis. As a result of this, Erica is now a quadruple amputee. Under the name ‘Glamputee’, Erica creates informational videos on TikTok, which she hopes can be used an educational tool. 

As a quadruple amputee, Erica uses a full set of prosthetic arms and legs. She opts for ‘hook style’ prosthetic hands, as opposed to the new electronic styles. To some, this may seem confusing, but Erica explains that these electronic hands would be more restrictive for her as they can be slow and incredibly difficult to use – and expensive! 

These prosthetics make Erica more independent in her daily life, allowing her to work, care for her children and more – without prosthetics slowing her down.

Erica’s TikTok Page

Case study 3 – P&O with Mo

Mo isn’t an amputee like Luke and Erica – rather she’s a prosthetics and orthotics student at the Baylor College of Medicine. She started a TikTok page after feeling that there is a lack of understanding in what being a prosthetist or orthotist entails.

In the UK, to become a prosthetist like Mo, you first need to complete an approved degree in prosthetics and orthotics, then by law you must register with the Health and Care Professions Council. Only registered prosthetists can fit prosthetic limbs, and the devices are regulated by the Medicines and Healthcare products Regulatory Agency. 

‘Make it with Mo’ is a mini-series that Mo has created on TikTok. In each video, Mo shows the process start to finish of building the prosthetic or orthotic, with in-depth explanations about every step, something I’ve found to be incredibly informative. 

Mo’s TikTok Page
@pnowithmo

Patients can have a part in creating their prosthesis too! Laminations allow them to get creative and make their socket unique. Patients have brought their favorite tshirt designs, national flags or fun patterns they find in fabric stores to decorate their sockets. While some prefer to make sure the design can match any of their outfits, others choose to make a fashion statement. It’s a great way to help patients transition comfortably into this new lifestyle, especially if they are first time users! #prosthetics #orthotics #prostheticsandorthotics #transtibial #llp #transtibialamputation #amputation #limbloss #lowerlimbprosthesis #lamination #medicalschool #orthoticsandprosthetics #makeitwithmo #pnowithmo

♬ Hip Hop with impressive piano sound(793766) – Dusty Sky

While social media can be damaging, it can also be an incredibly useful tool for education. It is great to know there are creators out there dedicated to increasing the public knowledge of prosthetics – and I’ve loved learning from them!

What’s your favourite social media platform for educational videos, and who is your favourite prosthetics content creator?

All videos are sourced from TikTok, following the sites Terms of Service and Privacy Policy. All information on case studies is sourced from the individuals own TikTok page, as well as my own opinions.