Friday, January 27, 2012

Fibular Hemimelia: Cast On/Cast Off

 For those of you following the leg lengthening journey take heart!  Casting is quite easy --especially in comparison to the fixator!  Ethan spent 27 weeks with the external fixator --13 of which were spent turning and 14 of which were spent allowing the bone to consolidate. 

The morning of fixator removal, we saw Dr. Standard only briefly and Ethan was swept off to the OR  I got to accompany him, once again, into the OR until he was under anesthesia.  The procedure took less than 2 hours --and we were soon able to visit him in the recovery room.  He was a bit groggy and complained that his leg "hurt," but the pain must have subsided quickly because after we left the hospital, he didn't need even a single dose of pain medication.  He was released from the recovery room --with instructions to keep the cast dry and no physical therapy until after we returned in a month.  By the time we made in over to the Hackerman Patz house, via his wheelchair, he was ready to attempt walking.  In fact, with his walker, he was perfectly fine walking the evening of the surgery and had very little complaints.  He was a bit shaky and unbalanced --and the walker became a necessity again for a couple of weeks.

Ethan kept grabbing the oxygen mask, acting like he was hyperventilating.  They let him bring it home~    

His first few steps were shaky, but exciting!

 Ethan's cast came up to the top of his thigh --and was quite an orange looking monster.  It make bathing hard --we opted mainly for sponge baths as opposed to trying garbage bags in the shower --and walking a bit cumbersome and awkward, but overall, he did great!  I was most afraid of the pin sites underneath the cast causing some sort of nasty infection, but that did not happen.  What did happen, though, was that the first night following surgery, he bled through the bottom of the cast --at his heel --just a few dark blotches showed on the cast and a few drops on the bedsheets.  Dr. Standard assured us that this was normal, and this didn't happen at any other instance.

Everyone seemed excited to sign Ethan's cast --and among the signatures were a few Ravens' cheerleaders!  Yep, that's right, cheerleaders.  We met these "cheerful" purple and black clad gals on Saturday night following his surgery at a local eatery.  Although we thought such signatures were at least pretty "cool,"  Ethan was none too impressed and opted not to have a picture taken with cheerleaders!  He was quite happy, though, to oblige the Mascot!  I was quite happy myself until the cheerleaders began handing out autographed bikini shots --which I soon confiscated much to the chagrin of my thirteen- year- old who thought they'd look awesome in his locker!

Our cast experience couldn't have been better timing --thank you Lord (even though I was sure anxious to get that fixator off when I thought was best)!  Ethan had two weeks of Christmas vacation before he had to return to school and attempt the classroom and hallways.  It took a week or so for him to learn to balance and ambulate without the walker.  We were super happy that "real" clothes fit again --at least wind suits and carpenter jeans!   And we were blessed with snow which cut out about 3 days of school.  All in all, he was only in the cast for 6 school days before we made the trip back to Baltimore.

If you look closely at the cast removal shots, you can see pure terror in Ethan's eyes.  You can't hold a miniature saw blade in hand and tell a seven- year- old, "It won't hurt a bit."  Freddie and I were super anxious to see what that leg would look like --and it was actually much less gruesome than we expected.  Now, it certainly looks war torn or at least battle scarred (much befitting a soldier of Christ), but much better than clad in a metal fixator or heavy cast!  The nurse simply cut the cast down the front in two places, put in new lining, and attached velcro straps.  Voila --removable cast!

First peek at what was underneath! 

Dr. Standards's instructions were to resume therapy and continue 2-3 days a week for the next six weeks until we return yet again for another follow up.  Ethan was more than happy to get into the shower that first night --free from fixators and casts --but I will admit that rubbing my hands over what is essentially small holes or divots in the skin turned my stomach a bit!  The old pin sites have to be rubbed out --basically when the pins are inserted into the bones, they take skin with them, and this skin can permanently adhere to the bone.  So, we're busy rubbing lotion --to help with the itching that came as soon as the cast was lifted off his leg --and to help break up the scar tissue.  We've been home only six days and things are progressing.  He is understandably reluctant to walk on his leg, but is being brave and taking steps throughout the house.  He has restarted therapy at school and at home --most of which consists of exercises to regain range of motion in his leg and ankle and to simply build back lost muscle.  His favorite thing so far ... a nice, hot tub bath ... with no parents lingering near to help wash!  I didn't think we'd coax him out the first night (after all, it had been 7 months).  The last procedure (we think) will happen this summer when the 8-plate is removed from the knee.  Hopefully, it will do its job and straighten out his leg --as far as his knock kneed problem goes.

You can see that the left tibia is now straight, but the leg is veering in the wrong direction from the knee!

I'm sure there's lots more lessons to learn and trials to come, but we're enjoying what we hope is the last few weeks of this one.  Ethan's perseverance and general attitude remains a blessing to me.  I'm looking forward to the simple things now ...  seeing him curl up on the couch, holding him tightly in my lap, watching him run...