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September 18, 2018. Its Tuesday, and my life it’s about to change forever… but first sorry for the delay in posting new stuff, the last couple months, were busy, hardcore and full of work. Its’ been a while since my last Post (VET Prosthetics… Still coming up to publish the entire Process…). Between some Consumer Products Design ( a bottle) and full time Prosthetics design has been too difficult to keep track with the blog.
After my former apology, let’s begin…
This very week my life has changed forever, honestly, I didn’t realize the outcome or the significant impact of technology until the last Tuesday. 3:00 PM was the time for the surgery, her name is “Adriana”, and my relationship with “Adriana” until this day, was entirely based on CAD, Why? Because for the past two weeks, I spend at least 120 hrs. with her Skull, (a Digital One & 3d Printed One) to be more explicit, a CT Scan, an STL File, and a 3D Surface Model, was my entire connection with her. By the time I was thinking about tolerances, 5 axis machining, boundary conditions, endmill & ball end cutters, 3d Printing, cutting compensation, fixture design, tolerance and fitting, G54, axis interpolation, coordinate systems, and how to connect 5 different design stages in a very unique way to make a design possible for manufacturing. (3D CAD / CAM Jargon). This very Tuesday my insides just change forever.
“Adriana” survived a cerebral aneurysm, her blood vessels inside a vain rapture in her brain, which led into a serious condition called subarachnoid hemorrhage, producing a massive cerebral edema. She was taken to ER and during the surgery, the doctors had to practiced her a decompressive craniectomy to save her life, but during the procedure she lost ¼ Skull bone from the right hemisphere, after 1 year with no bone, (she rejected her first PMMA Implant ) she suffered collateral effects, the Atmospheric pressure directly in her brain caused part of the right hemisphere to collapse, she lost the ability to speak and control the left side of her body, “Adriana” was tired and don’t want any other treatment. Her only choice was a custom-made Implant. But again her choices were limited, today only six companies in the world manufacture this sort implant.
2:50 PM arriving to the OR, I saw 3 surgeons holding up what will be “Adriana’s” head implant in their hands, and suddenly the real meaning of what is about to happen just “click” in my mind. 3:00 PM sharp. She arrived at the OR, It’s the first time we met, I saw her arriving with the nurses, just wave my hand to her and said hello, she didn’t replied, I don’t blame her (another surgery and by the time I didn’t knew she can’t speak). But she was there, not a CT Scan, not a 3D model, I saw “Adriana”, the wife, the mom, the daughter, the person itself, and I just realized this is it “It is for real”, in the computer world we have the blessing of the Undo command, in the real life there is no Undo, you have one shot… so make it count. Suddenly a nurse turns the litter and saw the damage in her skull, I was speechless… (I saw her skull digitally a million times before, I know every little detail, every curvature degree, every angle, but seeing her for the first time… the practice is over, and I just keep telling to myself… It is going to work, it is going to work, We tested a million times in the computer, (In GRANTA, theres a big sign in the wall that says: “In CAD we trust!”). Imagine design something with 0.05 mm tolerance fit, with no access to the part itself, imagine driving a car as fast as possible, just with instruments and data, there is no room for error, one mistake and it’s the end, it’s the human skull, you can’t just cut the tissue and take measurements, we depend entirely of digital data.
4:00 PM, surgery begins, around 1 hour took to prepare her for the implant, the surgeons start cutting the hair and scrubbing some antiseptic solution, she was in deep anesthesia and the procedure begin, took around 45 minutes to the surgeons to separate the tissue from the bone and expose the skull damage, I recall a nurse making a bet, “It won’t fit” she said… “It’s too small, bet you a Diet Coke in the MD Lounge that we are going to stay in surgery at least 6 hours, making the fit” , and the critical moment start… “ Pass the Implant” one of the surgeons ordered the nurse, so she took the implant from the sterile bag and what they call the “presentation” start, the surgeon just insert the implant in the skull and guess what…? the implant just fit perfectly… the nurse said. “I guess you won a Soda”. (Something I learned with the Doc. Carlos, Monroy, is never bet a soda with him, I recall a discussion making and adjustment in the cutting simulation…was about a wall thickness compensation and I loose 2 diet sodas for 0.015 mm instead of 0.020 mm… he won by a hair ) Rapidly and the surgeons started marking the perforation points in the skull to fix the implant, took them about 5 minutes to drill holes in skull to fix, 10 more to secure the implant and another 10 minutes to stitch the tissue around the defect… 2.5 hours to open and close and took “Adriana” to Intensive Care. A surgical procedure that take around 6 to 8 hours with regular PMMA Implants performed in less that 3 hours, they called up a new record. And everyone starts asking how that happened? (and certainly, describing it how to make that happen will take me an entire day to explain the process to the staff). At the end the nurses said It’s a beautiful thing “this custom-made implants you made” they called a piece of Art, and I’m telling to myself, “better called them a piece of fine engineering”. (Funny thing they keep calling me “Doctor”, and I’ keep telling them “I’m not a Doctor, I’m an Engineer”). Dr. CAM If you like. (Thanks for the cool nick name Daniel Huamani)
Friday After two days in intensive care “Adriana” was taken to her room, and we made a quick stop in the hospital today to see her, she was with her family and they ask her if she remember us?. She answer no, I don’t. Her mom replied; “They were with you at the surgery, they designed and manufactured your implant”. She just cries and keep saying… thank you!, (you could imagine the rest), one or two tears came from my eyes. She recovered the ability to speak and move her hands, recovered her face, and the most important thing she recovered her identity, as simple as hugging her husband, talk to her mom, watch her face again in the mirror and recognize the person in front. And I just keep thinking how simple things in life matter so much, and the rest of us kind of always take it for granted, for others like “Adriana” could mean everything…. just to see her smile is priceless.
From that moment my life changed forever, from seeing just 3D data, and thinking in CAD mode, to witness the power of technology and the impact in people’s life. After leaving the hospital I’m still shocked… can’t believe what we just did for her. In all my years of professional life experience (+10 Automotive, +6 Autodesk, -1 as entrepreneur) have never accomplish a project so significant and powerful than helping “Adriana” to improve her life quality. and i’m glad I’m going to have a chance to know her better when finishes rehabilitation therapy.
To “Adriana”, thank you for the greatest lesson in my life, and for giving me the chance to tell your story
To Ford & VW , thanks for all the training and experience accumulated all over the years in critical design & manufacture projects.
To Autodesk, thanks for all the access to groundbreaking technologies, the opportunities to learn from other manufacturing industries across the globe and all the friends I left behind. Special Thanks to Randy Twiddy , Andrew Ward , Cory Barrette, Matt Lemay & Lucas Ewing , you’re a big part of this. Without your help, non of this would be possible.
To Autodesk Foundation, HUGE ! thanks for helping fired up this amazing adventure, Ann Koh, Kellan Hays, Oliver Gould & Christine Stoner and rest of the team that I might be forgetting at the moment
To PhD Carlos Monroy, thanks for sharing with me your world’s vision about design & engineering, was my privilege worked closely with the great GRANTA TEAM in Mexico City, you are the Genius behind this amazing company, and a wonderful human being.
PD. Coming up the Spanish Version, I need some sleep !
Facts:
- Only 5 companies in the world manufacture custom made implants. GRANTA is the #6 in the world, #2 in America, and it’s based in Mexico City.
- Due to the costs, and high technical complexity custom-made implants may cost around 30,000 USD in Mexico, most of them were previously manufactured in Switzerland, Patients today have an affordable option. with a significant cost reduction since all design and manufacturing is made locally.
- 1 of every 3 patients with PMMA Implants will reject due to the material conditions in sanitization procedures,
- Most PMMA Implants are molded in the surgery rooms at the time of the procedure, exposing the opened body to long surgery periods and risking the patient to post surgery infections.
- More than 10 different Autodesk Manufacturing applications were used in the development of the Implant, from Fusion 360 / NetFabb/ Inventor/ Powershape/ Powermill /Nastran In-CAD among other technologies including 3D Printing with /SLA /FDM/PolyJet technologies, 3D scanning, Reverse engineering, CT Scan, & CNC 5 Axis milling were used during “Adriana’s” Implant
