Tuesday, August 26, 2014

Post Op Follow Up

We had our two week post-op follow up with Dr. Magnabasco today.  I did an interview with a nurse while we went to the appointment.  (Ryan has been without his regular nursing care since the first surgery a month ago.  Bad timing.)  I usually do a 2 hour meet and greet/orientation at the house with nurses to interview them, but the agency has been sending out people are not even a close match and I just frankly don't have the extra 2 hours to spend with someone if they can't even work the necessary shifts.  So, I decided having them come along with me to appointments is a good way to see them in action, and I get the added benefit of having someone available to help me lift the wheelchair in and out of the van.  Thankfully, the interview went well and today's candidate may be a good option.

After a long wait, we were greeted in the hall on the way back to our room by Dr. M.  She always treats Ryan like a rock star.  She indicated we were removing the cast and I felt a small surge of panic.  Oh, my!  We were originally told 6-8 weeks, but since we're really good at following directions and he won't be weight bearing, she felt he could be out at 4.  That's just 2 weeks post-op.  I'm a bit nervous about it but she assures me it would take deliberate attempts to mess it up.  Okay, I trust her.

So the cast tech gave Ryan these cool headphones to wear so he wouldn't be bothered by the noise.  (Since he didn't have in his hearing aids, I don't think the noise would have bothered him anyway.)  He looks awesome, right?

Then the sawed through the cast...

.... and pried it open.

Dr. M was right the inside of Ryan's casts are really clean.  Excuse me while I pat myself on the back for that.

Then he cut through the thick layers of foam and lining.  The top part was pretty easy to remove.  Unfortunately, it wasn't as easy for the bottom piece.  It was very awkward and difficult to get the bottom piece out from under him.

I thought Ryan would be thrilled to get the cast off, but once we really started removing enough pieces to wear his legs were no longer in the supported angled position, he cried.  And cried.  And cried.  Apparently, all the kids do.  I wish I had known.  

(This is the hip incision that was done two weeks ago.  It's healing really nicely.)

Remember the purple triangle thing from the hospital?  Well, it was trimmed down to fit him and we're now to use it pretty much anytime he's sitting in his chair or lying down etc.  He doesn't have to have it all the time, but it will help support him and help with proper positioning of his legs for him to finish his recovery.

After Dr. M put it on him, she moved him to the chair for me.  He cried more. It was hard to tell whether he was crying because he was nervous about the movement or if he was in pain.  But, once we got him into the chair, he calmed (as long as we didn't go over any bumps).

Unfortunately, I had to lift him out of his chair and put him in his car seat.   He cried and cried, and this time I could tell it was a pain cried.  This was one of those moments when I really wish we had a wheelchair accessible van.  It sure would have made it less painful for Ryan.

After crying for the entire drive from downtown, I got him settled into bed and gave him pain meds.  He slept for most of the day.  Tonight as he's been waking, he's required more suctioning than normal, which is confirmation that he's struggling a bit physically.  So, I think I'll keep him comfortable with the pain meds tonight.  I thought diaper changes would be back to normal out of the spica cast, but I think it's going to take a couple more weeks.

Well, I'm grateful to be this far in the journey.  Another month will go just as fast, right?  Please pray that his healing will go well and that he'll be stronger when this is done.  And, if you don't mind, say a little prayer for me, too.  

Diapering with a Spica Cast

So, diapering has never been fun, but with a spica cast it takes on a new challenge.  Since it's really important to keep the inside of the cast dry, diaper changes need to happen frequently.   Even with frequent diapers, the risks of getting things wet or stinky and dirty are pretty high.  So, here's what we did this time.

We use an extra small diaper on the inside of the cut out and a really large diaper on the outside.  So, for Ryan who is about 33 pounds and 6 years old, we used a size 3 Pamper for the inside and a size 6 Huggies diaper on the outside.

The two diaper system works pretty well most of the time.  However, if his little boy parts were not positioned just right, we had an issue with urine going up into the cast.  To solve this issue, I used a maxi pad without wings to line the top front portion of the cast, being careful to only stick it to the cast  and not his wound dressing.  This created another barrier.

(If you look right about where the green bar is you can see the maxi pad around the edges of the cast.)

We also found that sometimes stinky and dirty "things" would get on the edge of his cast on the backside.  To make for easy clean up, we just lined the edges with mini pads.  This also helped to prevent the cast from bugging his skin.

I never thought I'd store maxi pads in my family room and I never thought I'd hear myself say to my 15 year old son, "No, that's a mini pad, I need a maxi pad."  And, I never thought my 6 year old son would need them.  But I sure am thankful for their helpfulness!