Day 43 (Week 7): Recasting & The Half-Way Mark

Our second visit to Valley Hospital in Ridgewood, NJ was a little less eventful than surgery day. On the previous night, tried to keep her feeding times later than usual so that the last formula bottle she had was at around 11:40 pm to honor the fasting-after-midnight rule for anesthesia.

As on the previous occasion, we reached the hospital 2 minutes before the 6:10am scheduled time (for a 7:40am procedure) and registered at the front desk to get our visitors badges.

Once in, we settled into the pre-op room. The administrator saw us first and asked us a few questions and checked her wrist band for name etc. Interestingly, she also shared that she had been diagnosed with the same condition, same hip, at 6 months old and reassured us that later on in life she was an active participant in sports, jumped rope and had a pretty regular childhood. In her case too, there had been no family history of DDH and her two daughters didn't suffer from it either. It was nice to have someone share that with us and it definitely helps to know that in the long run getting it addressed early on really helps. 

Next we met the nurses and the hospital staff that would look after us during our stay there. We were scheduled for a 'same day surgery' so the facilities etc were slightly different this time (no pediatric ward). 

Then we met the anesthesiologist and he confirmed that she had no adverse reaction to anesthesia at the previous procedure. He also confirmed that she had been administered a pre-op medication the last time, so he would use a similar protocol. (Later the orthopediatrician shared that she would not be administered the same level of anesthesia - that is she would not be in as 'deep a sleep' because we were only recasting and cleaning this time around).

Then came the orthopediatrician. He confirmed the color of the cast and that we were going to use the Goretex liner. Also he had us sign the consent form. And we were ready.

She changed into her gown and diaper only, sat on the OR nurse's lap in a wheelchair (this time crying 😞) and was off. We headed up to the waiting area for tea and light breakfast.

The procedure was short this time, so the doc was done and up within an hour. He informed us that she was cleaned up and awake and that we would be called down to see her soon. We asked if she was sore and overly soiled and discovered (kicking myself for my ignorance) that there were three incisions and not two. She was a bit sore but within the expected range, and there had been some soiling (we had had one accident which was a beast to clean up in the 6 weeks period), but that too was within reason. He also mentioned that her hips were a little stiff from being in the cast, and that was also to be expected. Our next appointment was to be in three weeks' time. By that time we had to make a decision whether the cast removal was to be with or without anesthesia - the doc said it's easier to clean up under anesthesia and is less frustrating and stressful for the little one, but ultimately it was the family's decision. 

Soon after we got the call to go down and see her. By this time she was wide awake and majorly annoyed. She had pulled the IV out in the OR itself and was trying her mightiest to remove the sensor from her finger. She had already had 2 oz of sugar water, I fed her another 2 but she wouldn't calm down completely until she was wheeled back to the pre-op room where I could pick her up and hold her. She was also famished, so the first order of business was bottle feeding her whole milk. After which she was a happy camper again. We had to wait for a little while more until the nurses were satisfied with her post-op recovery. We were back home before noon and that included a 45-minute drive back.

The rest of the day she was back to her normal self. We were advised by the nurses to ease into feeding gradually. Which we did. But she had no nausea and was only a little tired after her day's adventure.

Questions For the Doc | Part II | First Post-Op Appointment

Our daughter had a femoral osteotomy and open reduction. Following is a list of questions we asked at her first post-op check-up which was a week after surgery.


1. Can she sit upright? Use a spica table? Go for car rides?

2. Can she take baths? Wash her hair?

3. Giving her pain meds as needed - any suggestions for how much to give or not to give?

4. Can she go on her tummy?

5. Copy of today's X-ray

6. Planning on nanny or daycare after cast change - what special instructions to give?

7. Cast change appointment - at valley hospital?

8. Can she be near cats? Dog?

9. What's next after cast change? Brace? For how long?

10. Planning an international trip at the end of the year - doable?

Questions For the Doc | Part I | Post-Diagnosis Pre-Op Follow-up Visit

1. Is there a need for a second X-Ray or confirmation test to determine for certain that surgery is needed and what kind of procedure is to be followed? (Especially, since the neurologist didn't find any muscle imbalance and said that brain function seemed normal)

Notes: At the first consult, the doc suspected muscle tightness and had recommended a visit to the neurologist to rule out Cerebral Palsy (Hemiplegia).

2. What is the procedure that will be adopted for her hip correction? Is it closed reduction?

3. At what angle will the cast be set and how will it impact recovery and care?

4. Will the cast cover both legs fully? Only her right leg is affected.

5. How often will the cast be changed? After changing, will it cover both legs fully again?

6. We want to order the Gore-Tex cover, how do we go about that?

7. What are her pain management options?

8. Will she have IV during/after surgery?

9. On the day of the surgery - will she have to check in the night before? 

10. After the surgery, will she have to stay there overnight? Or will she be discharged by evening?

11. Will her room at the hospital have beds for parents to stay overnight with her?

12. If she will be discharged the next day, at what time will she be discharged the next day? Will the hospital provide a checklist for checkout? 

13. Will the hospital provide a Spica cast compatible car seat?

14. Will the hospital nurses provide guidance on Spica cast care?

15. Will you be able to provide a List of local support groups for Spica cast/hip dysplasia in toddlers?

16. What preparations should we make at home for post surgery care?

17. If the incision is covered by the spica cast, how will we know whether it is healing properly?

18. What happens if the Spica cast gets damaged before the change appointment?

19. What preparations do we need prior to surgery (besides all clear from pediatrician the week before)? Is there a checklist?

20. How long will she be in the Spica cast?

21. What happens after the Spica cast is removed? Will she need Braces? Something else, etc

22. Will she need physical therapy after the cast comes off? How soon should we expect her to be able to start walking again?

23. Any diet restrictions after surgery? For how long?

24. What if pain medication not enough? How do we get a refill?

25. Can she sleep between us on a king bed after surgery?

26. How long after the cast comes off can she go back to daycare? 

27. What instructions if any should we give to the daycare providers?

28. What will be the schedule of follow-ups after surgery?

29. Please share the Neurologist's report with us.

30. If possible, can you share contact details of parents of other hip dysplasia patients operated by the doctor.

Day 31 (Week 5): The Jiggly Wiggles (Fighting That Itch)

It started about two days or so ago. We call it the jiggly wiggles. I noticed that she was wiggling her whole body and not looking too happy. Her grandpa pulled out a memory from his childhood when he was in a cast and noted that she was probably very itchy!

At first it wasn't so bad, occasional and passing. But today I spent a whole hour tapping/knocking her cast (it's supposed to help) and trying different positions for her to get comfortable enough to fall asleep. I also sent her Dad to the pharmacy to buy some Benadryl. The thing with Benadryl though, it's not recommended for children under 2. But we're going to call the doc tomorrow to get his recommendation. Until then tapping/knocking her cast and changing positions is all we can do.

I did some research and here's a list of things that hospitals recommend for itching when in a spica cast. Hoping that some of these tips work!

(The following passage courtesy of the Children's Hospital of the King's Daughters)

Itching: (Children with Gor-TEX lined spica casts usually do not have problems with itching.)

• DO NOT let your child scratch or put anything into the cast. This may cause a sore or infection.
• DO NOT use powder or lotion inside the cast.
• Keep your child cool. Heat and sweat can make itching worse.
• Blow cool air into the cast using a blow dryer on the "cool" setting held twelve inches away. Do not use the warm or hot settings, it may cause burns.
• Give Benadryl to your child for itching. You can find it at pharmacies and some stores. Follow the directions on the label.
• Gently tap/knock on the cast above the area that itches.

UPDATE

We got permission from both the orthopedic pediatrician and her regular pediatrician's office to use Benadryl Allergy. We had to get the dosage and directions from her pediatrician - once a day, 1.5 ml. I think it is VERY IMPORTANT to get the pediatrician's guidance, because the orthopedic SHOULD NOT (as good practice) advise on dosage etc since they do not know your child's history. 

We only had to use the Benadryl once - and frankly the results were a bit disappointing. She stopped itching so much in a couple of days. And the best remedy turned out to be 'distraction'.