Cast Issues when You See a Different Doctor

 

The fun never ends around here.  Today Mason went in to get his cast changed because his leg was slipping out of the orange cast after 4 weeks.  Unfortunately his surgeon was doing his job - performing surgeries - so we had to see one of the other doctors in the practice today.  It was a bad idea.  Let me back up and share updates as we go. 

First, here is a picture I got of Mason with the hard orange and soft brown casts off!  Those sweet little legs look so tiny and thin.  The skin on the right leg (hard cast) is showing some wear but no pressure sores yet.  The skin on the left leg (soft cast) is breaking down in two large areas. 

The saga began when the doctor we came to see called a second doctor in because she's not one who usually works with the Spina Bifida patients.  Neither was the other young doctor.  They decided to cast Mason with a bent/angled knee to keep the cast from slipping off.  I objected, explaining that Dr. K had not casted Mason that way originally (which they knew because they took off the orange cast).  The decided they knew better than Momma. 

Then instead of wrapping his left leg with cotton and a ace bandage to keep it on they did a loose stocking layer, then the cotton, then a loose stocking.  They don't want to aggravate the skin that is breaking down.  However, in the 3 hours we've been home Mason has had that white soft sock cast slide off 3 times, basically every time he moves.  Which means the skin is being rubbed by the stocking as is slides off and is slid back on, and it rubs against the green cast if we don't catch the slip right away (difficult to do because it is all under the merman ace bandage wrap).  This doctor's plan was for Momma to remove the cotton sock creation daily to check the skin.

We've found multiple issues with the hard green cast setup too (two I warned the doctor about before we even left, one I didn't forsee). 

1. First issue, Mason hip is not in a straight position when lying down on his back.  This is bad for the hip surgery healing.  It needs to spend a large portion of time stretched out straight each day and all night.  The doctor we saw said we should put Mason on a bed with his legs hanging off at the knee so they would go down enough to let his hip stretch straight.
2. Second issue, when lying on his belly the cast is too heavy and the knee acts as a pivot.  As the foot tips toward the ground due to weight the hip is flexed.  Mason can't straighten it because he lacks the muscle use to do so.  Again, this is bad for recovery.  The doctor's solution - a thick roll of towels under his ankles to keep the legs up in the air enough to stretch the hip straight.  While that is possible to do, the moment Mason stretches forward, sideways, or crawls away he loses the towel and the hip is flexed.  And if you know Mason you know he is rarely still. 
3. Third issue was totally unexpected but is one of the most worrisome in some ways.  When Mason sits up on just about any surface (which he is allowed for part of the day) the cast angle prevents him from sitting evenly on his bottom.  Instead he is tilted back on the area of his butt that was split open for months and had two surgeries as attempted closures.  We don't want that torn back open and 2 weeks of pressure would do it. 

Ahh, the craziness!  The plan at the moment is to call and get Mason's actual surgeon or surgeon's nurse practitioner tomorrow morning.  I'll leave a message explaining what was done and the problems, explaining that I want him recasted with a straight cast the way he was originally, then wait for them to call.  They'll schedule that, hopefully quickly! I am pretty sure his surgeon will be unhappy to leave him in this angled green cast because the area he was most worried about healing (the whole reason for the merman getup) is the hip, and the cast is directly affecting the hip pretty much all the time.