Tuesday, December 14, 2010

Spica Casts: Lessons Learned So Far

Are you wondering how the Esqs are doing in spica cast world? We are two weeks into Ned's convalescence and are starting to get a handle on things. The first week was mostly about pain management and logistical challenges but we started coming out of our shell during Week 2 (including a trip to see Santa).

First let Ned explain what he did to himself in this short video:

I didn't teach him to say "femur" - he picked up on it when I was describing it to so many others.

1. Car Seat. There is an expensive Britax kind you can buy but we just bought this Evenflo booster seat one - and didn't use the back or arms, just seat base. It was $50 and we can use it when the kids are older as their booster seat. I didn't want to have to figure out insurance logistics since we were being released less than 36 hours after admittance. Husband picked it up on his way to fetch us. He isn't in a five point harness and that makes me nervous but we need to get up and out of the house once in a while.

2. Stroller. Our insurance does cover a huge wheelchair but luckily the Spider strollers Husband bought ages ago are PERFECT. We have two and were using one for Josephine already. Ned has been willing to sit periodically in his wheelchair but he won't let us push him up to the table for meals (more on meals below). We'll see how much we use it in the next week and if we are still only getting minimal use I may return it to save on some healthcare costs.

3. Clothing. Ned sweats a lot so thus far we've gotten some larger shirts - size 4T- boys small (size 5-6) (he's in roomy 2T pre-accident). We got two button down and two fun graphic Ts that are long sleeved and then a four pack of short-sleeved tagless shirts. The cast goes down so low on his ankles that we did buy moleskin to try to prevent bruising when he flexes his feet. I am going to see if they can shorten his right cast a little when we see the doctor on Wednesday because he does have scabbing on his heel. Currently he is willing to wear socks because he is convinced that he is wearing boots like Woody from Toy Story.

4. Seating. We tried to come up with many options. We bought bean bag chairs - two so Penny wouldn't be jealous and we have a couch in our playroom that we have converted to a comfortable nest for him. He prefers the couch in the playroom for morning and the couch in the family room for for afternoon, sometimes spending a little time in his beanbag chair at the train table. Unlike many spica cast kids he is VERY, VERY reclined so he can't really move on the floor and refuses tummy time.

Train Table

5. Lifting/Carrying. The physical therapist (I had to ask for a consult) assures me that I cannot hurt Ned so we are going with it - just lifting him up. He is heavy but we are managing fine. Unlike most people we do have Ned sleep in his crib. It gives us adult space downstairs and him a chance to be in a normal environment. He does wake up occasionally crying/upset but he was always a light sleeper. Some nights have been tough (last night he was up from 4 to 6 am and then Penny woke him up at 6:30 am).

6. Diaper changes/hygiene. Our highest priority is cleanliness - any redo of the cast requires him to go under general anesthesia. I had thought this was going to be my hardest task but luckily Ned has been pretty good about it. He hates having his diaper changed and whines/cries when I do it but he is getting better about it. We have had a couple of rough "brown" incidents but I wiped out his cast and he doesn't smell. We wash him down every other night, including his hair.
7. Pain Management. After 3 days we took him off the Tylenol with codeine to help cure his constipation. He's been fine on regular Tylenol and we stopped giving him it as often without any negative effect. He will tell me if his leg hurts and I wait for him to say it twice to make sure he isn't just parroting something he heard. Interestingly Ned complained about his teeth tonight and not his leg - it's probably his 2 year molars starting to come through.

8. Food. I was told that his appetite would decrease but actually it is about the same as pre-accident. And he is a neat eater! No joke! He was always neat and it has continued so we've been pretty daring about his food - meatballs (in sauce!), rice (!). But usually it is a sandwich for lunch and I keep snacks pretty easy (like goldfish). Since his "movements" have been regular (albeit a little liquidity from juice) I haven't been too focused on fiber but he does get whole grains and fruit (not much of a veggie kid).
9. Activities. Television. Television. Television. Ned loves TV and we've been indulging him way too much. Sometimes he'll look at a book or play with a car or other toy but it is pretty short lived. He's never been much for coloring but we are trying to encourage that. Nanny April even got Ned to do a craft and we took him to Chilis. Penny has been pulling out baby toys that Josephine uses and she and Ned have enjoyed using those. Penny will often bring Ned things but he does have a short fuse. As I discuss below at "Discipline" both Nanny April and I want to keep Ned's life as regular as possible.
We've been mixing up ways he can reach his food and toys, including tray table, a bopi with a circle mat.
Here is one activity sure to please every toddler - spinning!


10. Discipline. For the first few days we definitely coddled Ned. He got to pick what the twins were eating, watching, listening to, etc. But it wasn't really fair to Penny and Ned became a whiny mess. I TRY to be better about giving Penny a chance to pick too but I have to admit I tend to convince her to go with Ned's choices if I can. When he is grumping about toys that he is playing with I do count to three and then take it away if he doesn't stop whining. For the life of us though we cannot figure out how to stop one behavior that started pre-spica cast: food hoarding in his mouth. We have done 1-2-3 timeouts - in his crib if he is being really awful and otherwise we leave the room and let him alone. I do feel for him that this is tough but he has historically been a whiny kid and I don't want that to get out of control. Any advice on disciplining immobile kids is welcome.

Al Bundy In the Making

We are looking forward to this being over.


Les Jacobs said...

Regarding disciplining, we disciplined Akira in his cast the same way we did before he broke his femur: by withholding things he likes or denying him activities he enjoys. For example, if he misbehaved during meal times then he would get no dessert. Or if he did other things--like swing his cast around like a weapon (something Ned may do once he gets used to the cast)--then he wouldn't be allowed to watch his favorite video.

One problem we had with Akira was that he kept trying to climb the stairs. The bedroom he and his brothers shared was up there and he missed it, and missed being with his siblings at night (we had him sleep downstairs b/c it was safer and less of a hassle than lugging him up and down every day.)

I would get upset with him for doing that and would sometimes punish him. One day he got angry with me and, tears streaming down his face, he clawed his way across the living room carpet and began pulling himself up the staircase. By the time I got to him he was half-way upstairs.

I grabbed him and carried him back down, but it was impossible to be mad at him. He really missed the freedom of going where he pleased and it had made him miserable. All I could do was hold and comfort him until he stopped weeping.

This was hard to do because he weighed a lot in that cast, so what I did was lie on my back on the floor and had him lie on top of me, with my arms wrapped around him. After that day (week 4, I think), he never tried to crawl up the stairs again.

The Mommy said...

Wow, you guys are amazing. AMAZING. I can NOT imagine how this must be at your house. You guys are SMILING!!!! And so is Ned. Unbelievable. Go team!

A. said...

Love all the smiling pictures - counting down the days with all of you 'til the Great Orange Cast comes off! And can't wait to see your adorable brood again!

Anonymous said...

I have two friends who have had to do the spica casts (one did it twice!) due to hip surgeries, and it's definitely rough. Hopefully time will pass quickly!

As far as food hoarding, does he store it in his cheeks like a chipmunk? Caden used to do that. She would stuff bit after bit of food in her mouth until she had way too much in there. Or she wouldn't chew it all. What we did was ration the food we gave to her on her plate. We only gave her a few pieces at a time. Once she ate those and swallowed them, we gave her a few more. It only took a week of doing this, and the habit was broken.

ABS said...

I'm amazed by the smiling pictures and happy video moments! It's great that you've found ways to create fun. I'm sure it's good for all of you! Take care, Esq family!

Rick said...
This comment has been removed by the author.
Rick said...

Wow: We are glad to hear that Ned's spica cast experience is behind you all. What a great collection of spica cast suggestions and learnings. I wish I would have see your post earlier. We have collected a Top-Ten Spica Cast Care Tips on our site www.castcoler.com/spicacastlp.html We'd like to create a link to your suggestions/learnings if that would be aok with you.



aja said...

what a great blog post! we are at the end of week one after my 2 year old (also a twin) broke his femur. fox is also in a very reclined spica cast and it is tough.

DAYNSH said...

Thank you for sharing. We just brought our little one home from the hospital. He too has broken his femur. Your tips were fabulous and I appreciate your posts!! 6 more weeks to go...

Yahaira Gil Maestro said...

I also have twins, one of which is also in a spica cast as of Monday. Thanks for posting what worked for you and your family! Very helpful. :)

Yahaira Gil Maestro said...

Thanks for posting what worked for your family.

I have close to one year old twins, one of which is in a spica cast as of Monday. It is super helpful.

Anonymous said...

Thanks for sharing and seeing what others are doing. WE are about one week in on possibly 4 months.