Day 22: 2nd Post-Op Check-Up

We had a great 2nd post-op check-up. Her femur bone and hip are in place as they should be and the cast is still nice and stiff.

We checked with the doc about her discomfort over the last two days from what appears to be gas. He didn't seem overly concerned about it. (We have been giving her gas drops and trying to burp it out of her before she goes down for the night.)

He also lifted all restrictions which means she can now sit upright (in a spica chair, in the lap, in my arms etc) and can go on her tummy for easier diaper changes. 

We are penciled in for March 16th for a cast change. The doc's office is going to place the order for the goretex liner (highly recommend it, it's not that expensive). But Dr Konigsberg also said that we can come in earlier for a change if she seems too uncomfortable. 

All in all a good check-up!

Day 15: Diabolical Diarrhea

Diarrhea and blow outs are a Parent's worst nightmare. But when your baby is in a hip spica cast, it takes on an almost calamitous quality.

After an 'easy' (?) two weeks period of straightforward (??) diaper changes, we hit our first hurdle today. I am kicking myself for thinking prunes purée a good dinner option for her. Those jars are going to be shelved until she gets out of that cast (sorry hon!). She had her first diaper blow out. We were getting by on a newborn size for the inner diaper, but not today. Given that she's still always at a less-than-45 degrees angle, the diarrhea rode up her cast, fortunately on the rear side. 

The clean up took forever. But with the help of a chopstick and lots of gauze sponges, we finally cleaned the inside of her cast and most of it out. The rest of it dried out over the next few days and was cleaned up during the next few diaper changes. I was careful to be very gentle and didn't let the area get red or sore. Phew! about sums it up!

Day 14: Entertaining My Bored Toddler

She is mostly recovered from her surgery, but still has restrictions. She is not allowed to sit up straight or be on her tummy. So her play options are limited. She was a very active toddler before the surgery, so keeping her occupied and entertained while she's in her cast is important and difficult! It's also important for me as her Mom to find ways for her to play by herself or with someone else without depending on me constantly for comfort. I think I've found a couple of solutions that work well for short periods of time that are not TV or iPad related (yay!). Admittedly though, we still spend a lot of screen time, and I don't see a way around it at least for now.

The Moms on the Hip Dysplasia USA support group pointed me to a couple of Pinterest boards for DIY sensory bins. They're great if your toddler is allowed to sit up straight by themselves. Plus I don't have the energy to contemplate the clean up required for a box full of sand - I'm a lazy Mom! I did use those ideas though to create a couple of colorful boxes to put things in for her to play with. All it took was a cardboard diaper box or a plastic wet wipes box and colorful duct tape. It's been quite the success!

Bonus points for leftover colorful duct tape rolls which make very pretty bangles :).

A chalkboard and some colorful pieces of chalk are always entertaining. Though she doesn't have the concept of drawing down yet, it provides an opportunity for a few minutes of independent play. It's not half as entertaining as the sensory box though!

Day 9: Washing her hair

The doc has said that she cannot have baths, but sponging is ok and so is washing her hair. Fortunately, both were easy to set up. 

We sponge her everyday using warm water and a Konjac bath sponge. Once in a while we wipe her down with the Mustela no rinse cleanser, which not only does a great job with cleaning her but also leaves behind a gentle fresh scent. We can do this at the changing table itself, so it needs no additional set up. 

Washing her hair is a slightly different story. In the master bathroom we have 'his and her' sinks and a just-wide space separating the two. We have a portable changing pad (part of a nursery essentials set that she got as a gift at birth). So i laid that down between the two sinks, tucking one end under the tap of the first sink to secure it. I put her down on it on a bath towel and had another towel at hand to help dry her hair after washing. I secured her to the pad using the straps that come with it and handed her a bottle or tube of lotion of some kind to play with. I pulled her head slightly out holding her head securely with one hand. Then running the hot and cold water and using her bath mug, I shampooed her hair as usual. It was pretty straightforward and simple once I got down to it. Here are some pictures to show you how it was done.

Post-op Check-up: First Week

Today was the first post-op check-up at Dr Konisberg's office. The x-ray looks great, and the cast is still nice and stiff. The restrictions are still on - so no sitting up straight (no spica table), no flipping over on the tummy. But she can go for short car rides, so we may work that into our daily schedule. 

All in all a good check-up. To quote the doc 'It's great that her only complaint is that she's bored!'. Next check-up will be on the 23rd - which will be the halfway mark for her first cast!

Day 5 Recovery: A few lessons learned

She tends to have an accident in the middle of diapering on the changing table. But the goretex liner is doing its job in saving the cast hopefully. Since I can't flip her over yet, have been taking the weight of the cast on my upper body and using the mirror to do the diapering. Her swelling's down quite a bit, but we're still using the newborn size for the inner diaper. 

Brought the jogging stroller out into the living room, and her granddad has been giving her rides in it within the house to entertain her. It is the right size to help keep her supine. We also brought her folding papasan-shaped chair and bean bag out to the living room. Together they help keep her at the right angle (less than 45 degrees) with her smallest pillow to support her back. It's helpful when feeding. 

She's taking in slightly more food at a time. 4oz jar of baby food or a 4oz tub of yogurt - but not both in one meal. Strawberries about 3 + 3/4th of a cheese stick for breakfast - some examples.

She's still a bit clingy. She has this weird habit of needing to play with my hair to fall asleep. So often have to lie down next to her. Can't wait for the doc to ok sitting upright for short periods of time so we can use her borrowed spica table for playtime and meals. 

Her intake of Motrin has reduced as well and we seem to be waiting longer between doses during the day. These young children have magical regenerative powers!

Day 3: Recovering at home

Day 3 began rather uncomfortably but turned into a great recovery milestone. She developed a high fever in the night that the pain meds brought down, but it worried us as we weren't sure if it was some kind of infection that was causing it. The fever was gone in the morning and some of her appetite returned. Also she did well with just Motrin for the rest of the day, so we were off Tylenol Codeine already. Another big win.

During the course of the day (including midnight onwards) she had 3 bowel movements. The stools were hard, softening just a little every time. I tried to feed her papaya, but she wasn't interested. It's usually one of her favorite fruits. The swelling went down just a bit, but we were still using preemie diapers on the inside.

We had some of the strangest bed arrangements. Before the surgery she slept in the playard in our room. We were planning on continuing that arrangement with the addition of a wedge pillow. But the playard had to go, it was too low and the cast had added a lot of weight. We used the playard mattress as the base on our bed since our mattress had too much 'give'. We placed it against the headboard and changed the direction of sleeping to across the bed. Dad went down on the floor on an air mattress while I was next to her on the king bed. Then we used a lot of pillows to position her. Because of the femoral osteotomy, we weren't allowed to sit her upright. And her position had to be changed every few hours to give her relief. We were taught the 'turn and roll' method to change her position so her weight was properly distributed as we moved her. So she was allowed three positions: on her back and on each side, tucking pillows for supporting the leg that would end up hanging in midair. We used the same technique when we moved her to the living room floor and used the recliner couch's sides instead of the headboard for added support.

The turn and roll method:

Tuck one arm just under the cast of the torso and the other under the bum between the legs. Turn and roll towards yourself so that the leg closer to you rests on the bed and the other leg hangs in midair. Tuck pillows behind the back to hold the position. Then tuck more pillows under the hanging leg to ensure it is fully supported.

Lifting her also got easier but it was a workout nevertheless. Changing her diaper single handedly was still difficult as I wasn't allowed to flip her over to get to the bottom. So one person had to help with positioning the diapers, cleaning the bottom etc. 

I did sponge her exposed areas clean in the morning and tried to get the tangles out of her hair with a Mercier brush (those things are magic!) Changing her clothes was easier than I had expected, but I had to be careful not to lift her by her arms and shoulders so as not to have the weight pull down on her stitches.

She began to get bored due to the inaction. So keeping her entertained was tough. I think I'd invest in a lot more interactive book apps on iPad/iPhone. Apps by 'Fox and Sheep' are beautifully designed and the Stella and Sam story pack too. I highly recommend them. The highlight of our day was playing pillow toss with her, the grandparents and I. She had a complete blast!

Experience at the hospital: Femoral Osteotomy & Open Reduction

We've just gone through an open reduction and femoral osteotomy on my 17-month-old. Happy to share any stories. Have tried to keep a record of the experience on Facebook intentionally.

Here are some of the potentially helpful salient points:

We were scheduled for a 7:30 surgery and had to reach the hospital for pre-registration at 6:10 am. To prep for the surgery, I made sure she ate later the previous night. 8:00 pm solids dinner, 9:30 bottle of 8oz formula, 11:45 another 8oz bottle. For some reason she woke up at 2:45 am and stayed awake until the car ride at 5:00. We should've gotten more sleep during the previous day.

We reached on time despite the inclement weather. She was in good spirits, my little curious girl. After registration, we went down to the pre-op area. We had the room to ourselves so she had fun exploring the odds and ends there. The anesthesiologist and the ortho surgeon came in to talk to us just before the surgery. We changed her into her very becoming hospital gown. They gave her what seems to be a stronger dose of Tylenol codeine. The OR nurse put her in her lap, in a wheelchair and my happy girl went whee-ing into the OR.

Prior to the surgery the doctor and the nurses confirmed the consent form we had signed at the doc's last appointment. The form effectively informed us that: the doctor would try the least invasive of procedures starting with a closed reduction, an open incision and/or an osteotomy to get the bone and socket to fit as they should, an arthrogram may be performed to check the tissues surrounding the joint, and it would be followed with casting that will be left on for about 6-8 weeks.

We left her and went to the waiting area. It had a phone where the nurses could ring up status updates - it was sometimes attended by a staff person and sometimes we had to receive the calls ourselves. The area also had a general status board indicating 4 stages: registration, pre-op, intra, recovery. Each OR patient was assigned a unique number that you could look up on that board. This was pretty much useless to us as we were going to be with her through all but the intra (in the OR) stages. 

Our optimism led us to believe we'd be out of there very quickly, that it would be a simple closed reduction. The surgery effectively began at 8:00 a.m. We received our first update call at 9:00 to let us know the doctor had to do an open incision. It was two hours later that we received our next update - by then we had guessed he had had to cut the bone. In the end, including casting, the procedure took about 4.5 hours, before the doc came out to see us. 

The doc explained the procedure he had had to use. It was an open reduction with femoral osteotomy. He also explained the she'd still be in the cast only for the 3 months. We would not be able to sit her upright for a few days to ensure there's no weight on the incision. And she couldn't be on her stomach until he cleared it too. But he was very happy with the outcome of the surgery. Usually even after surgery the femur bone can easily come out of the socket, but in her case it was sitting nice and snug. Also post osteotomy her leg lengths were good almost equal. So the prognosis was very positive. But given the invasive procedure she would have to stay overnight. 

At the Valley hospital you cannot 'book' a private room in advance. Though our doctor had informed them and reserved the potential need for one, when the time came it was a long wait before we were moved to the pediatric ward. Her surgery had taken place in the general OR and recovery was in the general recovery ward. So the nurses were not specialized. They were awesome and helpful, but no real help. I was beginning to feel concerned about receiving much coaching - especially with the diaper changes et al. Frankly I think the information I received from Moms on support groups has been more useful. Also, the UK NGO Steps has some of the best resources out there on the Internet. Their YouTube channel has highly informative videos by regular parents caring for babies in a spica cast.

I didn't get much sleep during the overnight stay. It took me a while to realize that she would find her own way to deal with the muscle spasms. It wasn't until the next day that I stopped jumping up every time she cried out in her sleep. Disney channel was a big help as was Stella and Sam on the iPad/iPhone. My iPhone 6 plus was the perfect size for her to maneuver herself. I've a lot of friends and family spread out around the world who were really concerned and wanted updates. I used Facebook very effectively for this, so I didn't have to give them individually.

I have to say my post emergency C experience from the time she was born was a huge help. The whole hospital stay experience seemed very familiar to me as a result, as did her pain management protocol.