Spica cast - what to expect: The big day - the cast comes off

Again, I can't thank other parents enough for their wisdom. We were told BEFORE we went to the hospital to give JT some Motrin because it would be very painful when he got his cast off because of the stiffness and soreness. 

We were warned that he wouldn't be able to really move much for a few weeks after the cast came off. We headed to the hospital and took JT to the office via wagon. 

We didn't want to use our stroller because we knew we would want to hold him and he wouldn't be so heavy after the cast came off. The nurse practioner was great at explaining everything. We held JT's arms tightly so he wouldn't fighy the saw and I kept my face right up against his. I am not sure if that was so he wouldn't see the saw or so I didn't have to see the saw. After his cast came off you could tell he was in pain and he didn't try to move his leg at all. He would cry if we touched it. Luckily, we had given him some Tylenol to help with that as well. 

Once we got the all clear, we were able to wash him up and get him dressed with REAL PANTS (not sure who I chose green if all colors!!!)

It was very exciting and the best part was to be able to wrap our arms around him and hold him close. He laid around for several hours in his favorite spot on the air mattress. It wasn't until late that evening that he attempted to crawl. 

We were lucky and within two weeks, he was taking his first steps again. It was as if he had to learn to walk all over again. His siblings would scream and squeal in delight everytime he took a step. I can report that we are 2 months post cast and he is running circles around people. He still has a bit of a "clunky" gait, but overall you would never know he had broken his femur.

Spica cast - What to expect: Scooting

I had read that many kids start moving around, flipping themselves over and scooting around like crazy. It wasn't until the week before JT was scheduled to get his cast off that he even attempted it. He was able to roll over and then began scooting himself backwards as quickly as he could go.

It was a funny, funny thing to watch.

Spica cast care tips: Hair Matting

While having a girl would be nice for the clothing part of the puzzle (it would have been great to put JT in cute dresses), it was definitely nice to have a boy when it came to the hair matting issue. JT had his fine, bright white baby hair still and we quickly found that it matted horribly from him spending so much time on his back. 

We were able to buzz his hair, but before my husband made that choice WHILE I WASN'T HOME... we had figured out we could put some conditioner in it and comb through it during bath time.

Spica cast care and tips - the Must Haves list

We scoured the internet for any help and advice we could get on caring for our toddler in his Spica cast. We found that the best advice came from parents who had been there and knew our concerns, fears, hopes and exhaustion. Here is a list of items that we consider MUST haves when caring for a toddler in a Spica cast (keep in mind we had a stability bar so the bean bag was not much use to us but is highly recommended by most): 

Must haves: 

Air mattress with raised edges 

Memory Foam pillows 

Umbrella stroller 

Poise pads - preferably the Ultra kind because they are longer and can be tucked inside the cast 

Diapers 2 sizes larger than one child was wearing pre-cast 

Large plastic bibs with catcher trays Hippo Snug Seat car seat (most hospitals have them for rent, don't leave without it) Medicine log - keep track of medications Children's or infants motrin/tylenol to rotate 

Patience/love/strong arms 

Nice to haves: 

larger shirts (2 sizes bigger than child was wearing before cast) 

leg warmers 

movies 

small, easy to hold action figures or play figures 

foam balls - JT loved throwing them and we would "fetch" for him, it kept him engaged 

books 

noise makers (as much as you can stand it) 

wagon - if it is nice oustide 

blocks 

TV tray for use as a table when child is in umbrella stroller 

From other parent lists: 

bouncy seat - we couldn't find one that would work with the bar 

Bean bags - again, they didn't quite work with the bar 

I hope this is helpful and perhaps that best help of all was that other families had been through this and survived. It was encouraging to read their stories of how their son/daughter was now walking and happy and healthy. This too shall pass.

Spica cast care tips: the UMBRELLA stroller

We went out and got a $15 umbrella stroller from Walmart. It was perfect. We could put a small pillow behind him and then set the bar on the umbrella stroller. 

He LOVED being pushed around in the stroller. It was as if he was mobile again and could see things and get from place to place. 

The Umbrella stroller also served as a high chair of sorts and gave us more freedom to take him to events and other places without having to carry him around everywhere. The SPICA cast gets heavy quickly! The Umbrella stroller is definitely top on the MUST HAVE list!

Spica cast care tips: Clothing

Obviously, with a large SPICA cast, clothing your child was wearing is no longer an option. We were able to get JT clothing that was 2 sizes larger than what he was wearing. We got large shirts and then used legwarmers or knee socks to cover the open leg. Because we had the stability bar, larger pants were not an option. We were able to find some cute leg warmers and got several as gifts from my sister as well. The larger shirts were nice because we could pull them down over the cast and it helped keep food and other items from falling into his cast. He found ways to shove things inside the cast, but at least the covered area kept crumbs and other small objects from falling into the cast. He seemed to like to not have a sock on the casted foot, but if we were going outside, we would either wrap him in a blanket or put a sock on the open toes. Dresses would have been a great option had he been a girl!

Spica cast care tips: Diaper changes

As I am sure you can imagine, it is difficult to perform diaper changes when the diaper area is a small opening from a cast covering the rest of the lower body. At the hospital, they suggested using a smaller sized diaper and putting it inside the cast and then putting a larger diaper outside the cast. This worked ok, but I had read online about using adult Poise pads. We found that the Poise pad soaked up most of the urine and other waste and we were able to change the outside diaper less often using those. The ultra Poise pad was the perfect size and we could push the top into the cast area and the bottom into the cast area so it was as if the entire opening was closed off with the Poise pad. The outside diaper rarely got wet or dirty. 

So, here is a check list: 

Wipes 

Ointment in case needed for chaffing Ultra Poise pads (they are longer) 

Diapers that are at least 1-2 sizes larger than what your child was wearing before the cast. This will then fit outside the cast area. 

We made sure to lay him flat and have all of the wipes and everything there ready to go before we started the process. We also tried to be sure to take a clean diaper wipe and quickly wipe any of the areas that were near the diaper area, even if they didn't look to be dirty. It helped us keep him cleaner over all.

Spica cast care tips: Bathing

JT had a SPICA cast with the special gortex liner that allowed us to at least reach into the cast with a damp cloth without ruining the liner. We found the best way for us to bathe him was to lay out a Towel on our kitchen counter. We filled two containers. One with baby soapy water, one with just water. We were able to sponge bathe him and wash his hair over the soapy container and then rinse him quickly with a cup of water from the plain or non-soapy container. I would lay out the following before we even brought him over for bath time: Large bath towel for him to lay on tub of soapy, warm water his tear free shampoo tub of plain, warm water cup (to use to rinse his hair) washcloth his clean clothes diaper Poise pad lotion We would wash him with the soapy water then pat him dry. I would hold his head over the soapy water and wash it and then rinse with the plain water. I would quickly pat him dry and put lotion on NON-CASTED area. It was important to not put any lotion or powder or anything inside the casted areas because it would irritate his skin. We found it was important to turn him over onto his stomach and clean down inside the cast area as as much as possible with the damp cloth. It was amazing the things that JT would shove inside his cast from toys to food to stickers. I also found that it I played music loudly, it would help him stay calm during bath time.

Spica cast care: Eating

JT wanted to feed himself. He didn't fit in any of the high chairs we tried. He couldn't sit up because of the angle of his cast, so we tried several things before we found a couple of decent options: 1) We propped him up with pillows on the air mattress and put LARGE plastic bibs with catcher trays on him - this could only be used with solid foods that we could easily clean up 2) we held him at the table and he would at least let us help him a bit more since he was with the family at least 3) we put him in an umbrella stroller and then set a TV tray next to him so he could reach his food, be in the kitchen for dinner time and mostly feed himself. 

 It was weeks before we got to this point and #3 was the BEST option for us/JT.

Sleeping arrangements for toddler in spica cast

JT spend the majority of his time in his cast on a twin size blow up mattress located in the main living area of the house. He was comforted to watch his siblings running around and being "part of the action". We borrowed a aerobed mattress that had slightly raised edges to help him keep in position. We had memory foam pillows and other pillows we used to prop him up during his awake hours and then position around him during his sleeping hours.

 I would include the blow up mattress and memory foam pillows in our MUST HAVE list (more of that to come soon). Some blogs/tips/other parents said their child liked laying on their stomach. JT HATED it and would scream. We kept him on his back most of the time. He wanted to have a blankie with him at all times and seemed to like his special area (as much as a previously, extremely mobile kid could).

Medicine Logs for toddler in Spica cast

We kept an excel spreadsheet print out with the times and dosage of each of the medications JT was supposed to take. He was taking the Valium for his muscle spasms and then a stronger form of Tylenol rotated with Motrin. We found that we had to keep on schedule with the pain medication especially and if we went over the time allowed in between, JT was quick to let us know because he would start crying in pain. We had to refer to the medicine chart often and also used it as an area to take notes on JT's diaper changes and other helpful information (if he got a fever, etc). We would initial it so that we were sure to make sure the medication was administered and there was no doubt as to when or by whom. It was a helpful resource at the 2 week check up as well. We backed off the Valium after about 2 weeks and then started streching out the pain medicines around that time as well until he was fully off of them by 4 weeks after the break. He still needed them once in a while, especially at night time to help him sleep.

Transportation when in a Spica Cast ...Car seat woes

The first logistical issue we dealt with was how to get JT home from the hospital. There are car seats (HIPPO) that are specifically created for children in SPICA casts. The hospital was out of those and they were in the area of $500 to get new. We reached out to local medical equipment rental companies with no luck. We took JT home in a modified booster of sorts with blankets stuffed all over. It concerned us a great deal as I had to basically hold him up in the car seat for our hour drive home.

 We found quickly that this was not an option. We lucked out big time and the hospital had one of the Hippo Snug Seats units returned. It was amazing what a difference it made and we felt like we had some freedoms back and could get him out of the house.

The Green Monster AKA Spica cast

It was about 12:30am on November 6th when JT's cast was finally on. They brought him back to us and we waited for a room. We were going to be there at least overnight. The cast looked huge, frigthening. I didn't want to pick him up because I was afraid I was going to hurt him. 

 We shared a room with another family who was also experiencing life with a Spica cast and JT and their son took turns moaning, crying, whining throughout the night in pain. The only way to calm JT down was for me to rub his head continously and squeeze him a little when he spasmed, as if to let him know I was still there. We were up all night and the pain was still there. We had hoped once his leg was set, the spasms would stop and the pain would ease a little, but throughout that first night he was in horrible pain.

Muscle Twitches/Spasms

Throughout the ride in the ambulance to the hospital, JT would seem to relax a bit and then twitch horribly and start to cry in pain. The paramedics said she felt that he was having some muscle spasms because as he would try to relax, the muscles would tighten up because they were trying to hold onto the bone, etc. 

The spasms and cramps continued throughout the entire time we waiting for the cast. It was heart wrenching. They did start Valium which seemed to help him some. Now, our 1 year old was on Morphine and Valium. Crazy. We just wanted him to sleep, at this point it was midnight, it had been about 5 hours since he had broken his leg and we just wanted him to be....OK.

November 5, 2013 - The Bar Stool and the Broken Femur

I was in the kitchen, making dinner at the stove and JT was climbing on the bar stools at the counter. I had JUST gotten him down and told him NO. I heard a thud and then REAL crying. Crying like someone was hurt. I saw JT on the floor, ran to pick him up and felt crunching and clicking near his upper thigh/hip when I picked him up. His leg hung there. I tried to put him down to see if he would stand and he screamed. I drove him to the hospital and it began...the IV, the morphine injections, the x-ray after x-ray. The waiting. We were at the local ER for two hours before they sent us via ambulance to the nearest Children's hospital. At this point, we knew he had broken his femur from the knee area to close to the hip. It was the entire bone and it spiraled around the front to the back. We think he must of gotten his foot stuck in the rung of the stool that he fell off. I am not sure how else he would have broken it so badly. There were parts of the bone that were starting to fragment off of the break. Surgery was on the table, but we wouldn't know until we got to Children's.

Helpful Information

I decided to start this blog because of the enourmous help other parents who had experience with SPICA casts provided to our family during JT's time in his SPICA cast. The internet was actually my friend during this medical crisis. The more information I got, the better. So...here is our experience and if our family can help at ALL - even be a resource for questions, we are more than happy to help.