Thursday 1 November 2012

Wonderful wonderful wonderful news

The consultant has said that J's spine is so much straighter that the current cast (his third, applied on 26 September) will be his last. Let me repeat that in case you missed it. HIS LAST CAST!!!!!!!

He can wear a brace in future.

The differences are:
1. a cast is applied under general anaesthetic and is made of plaster of paris
2. a cast cannot be removed day-to-day - just at the end of that cast's life (usually every 12 to 15 weeks)
3. a brace is just molded on with J still awake and is made of plastic with velcro strips to hold it on
4. a brace can be removed, so we will be able to have baths, go swimming, go in sand... all the things a 2.5year old wants to do :-)

I'm so happy!

We had been told probably 2 years in cast and then go to brace. He will have had less than a year in cast! His spine has responded really well.

It's funny how my attitude has completely changed. Someone asked me at another child's birthday party what J was wearing and in front of J I explained about his spine, his scoliosis and how brilliant the cast was. I said how pleased the doctors were and I'm sure J must pick up the complete pride and happiness I feel when I'm saying how much good it is doing.

He stood in front of the mirror the other day in just cast and nappy and said he was wearing a cast. Yes I said - a blue one this time. He pointed to the gap between his shoulder and the top of the cast and said that there was a lot of room this time. Such a sophisticated comment - it amazed me. Yes there is, I replied. He accepts it so easily and just gets on with life :-)

So sometime in the early New Year, he will go into a brace. Yippee!!

I haven't blogged in a while, so you don't know about the little incidents we've had. A couple spring immediately to mind:
About 2 hours after the last casting in September, J was watching television. He'd just eaten a weetabix and we were pretty much ready to go home. Then he vomited the entire weetabix back into his cast (I'd stupidly let him be in a more recumbent position in the bed than is wise after eating). A new cast full of vomit. He STANK!!!!! I felt incredibly guilty (shouldn't let him lie down, should have turned him quicker to his side) but that doesn't change a thing. You can't get stuff out that's down the back between his skin and the cast. Fortunately the smell subsided the next day and now you can't tell. Just as well when you think he's in the cast for weeks and weeks.

Each time we go for casting they put J in a different ward to recover afterwards. For his second cast, he was put in the children's cancer ward. It is unbelievably sobering and has left a big impression on me to be surrounded by very small babies and children who have all sorts of tumours and conditions and are facing regular doses of chemo etc. I'd like to write more, but find expressing it hard. Someone said to me that I must have felt glad that my child's condition is relatively "easy" (not her exact word - but basically "not life threatening"). No. How could I feel glad facing all the pain that was on that ward, sitting with other parents for hours and hours???? It was more the incredible vulnerability of all of us, the fact that "it could be any of us". Our health feels so random. That's only a little bit of what I could write. But I will leave it there and actually post (I've got umpteen unfinished posts from the last few months!).  


Tuesday 12 June 2012

Cast number 2!

Can you believe it - it's 3 months already and J will get his second cast in Oxford tomorrow!

We've spent the last 5 days trying to pack in as many things that take advantage of being cast free as possible (swimming, soft play (where J could climb easily for a change), baths...). There have also been a plethora of vehicle-related activities. Since Friday J has sat on: a fire engine, a fork lift truck, a landrover, a go-cart, various trains and shuttle trains. Most of those it was in the driver's seat! We've seen all manner of diggers, dump trucks and cranes (they are replacing all street lights locally and so there are lots and lots of vehicles literally outside our door!).

I have lots to write. It's been such a long time since I've blogged - caused at first by a desire to forget the whole cast thing and just get on with "living". Then I did have blog entries to write, and several were started, but none were finished...

I need to get to bed now. It's such an early start tomorrow (and a long day).

J is now so aware of what's going on. He ran out of the plaster room on Friday shouting "GO AWAY" at the plaster technician who was about to remove his cast. Yet he had been excited about the saw and found the removal tickled at times (though it did seem to cause him discomfort at other times when it was nearer his lower back/tummy).

I don't know how much the fact he's 2 (and says "no" to just about everything at times) will influence proceedings tomorrow.

You have no idea how special the hugs were this weekend. Soft, squishy hugs. Totally totally different from holding a huge cast.

One blog entry I want to write is about the huge palette of emotions about the casting. Knowing (of course) that it's meant to be for the best and (we hope) will reduce the likelihood of problems from the scoliosis later. Yet being sad when I know we can't do the activities we would do (eg swim) if he didn't have it. I find it infuriating when people try to tell me that I "shouldn't" feel X or Y. I can feel what I damn well like. Indeed it's healthier to express the emotion than bottle it up or negate it. I think it has shocked a couple of people how deeply I feel the pain of knowing (and J not being fully aware yet) what impact this is having on our lives. They seem to feel the need to remind me of the good the cast is doing. That's not what I need. I chose to pursue this different kind of casting (and it took a lot of pushing!). What I really want is "yes, I understand [your pain]" and for someone to accept that I can feel lots of things at once. The negativity is only part of what I feel. Of course it is. For so much of the time I delight in J 100% and how he's enjoying his life and all he CAN do. I don't know how much this makes sense to you? It's hard to explain and it's very late at night. I'll write it again some other time.

Fingers crossed that when I write tomorrow, we will be home safe and sound and J will be back in cast without too much trauma.

Thursday 26 April 2012

Diagnostic booklet - early detection of Infantile Scoliosis



This is a link to an exellent booklet produced by the Infantile Scoliosis Outreach Programme in the US with tips for paediatricians and parents for early detection of Infantile Scoliosis

Thursday 12 April 2012

Good news :-)

Today I received a letter from the consultant at Oxford in response to my questions about how the casting went (we didn't get to see him after the casting). It's good news about the angles.

On 21 March:

The upper curve now measures 19.3 degrees in cast standing up.

The lower curve now measures 19.7 degrees in cast standing up.


In October the top angle was 36 degrees, the lower curve was 26 degrees  and the RVAD (rib vertebrae angle difference) was 13%.
In February the top angle was 29/30 degrees and the lower curve was 32 degrees.

______________________________________________________
Good correction
It is good news that there is progress with the cast. Some children I've read about don't get much progress - for some children it takes several casts to see a significant change.

NB There was a change between October and February that I don't understand (at the February appointment the consultant said the x-rays looked the same, but in this letter he confirms that there was a change between October and February. My guess is that it was because he didn't have both in front of him in February - he was doing it from memory, but for the letter he compared them all).

He wrote that the fact that a good amount of correction was achieved would suggest that the spine is flexible - though he is not able to make any predictions with any degree of certainty regarding how the casting will go.

He felt that J's spine was responsive to manipulation and that the procedure went well from his perspective.

All good.

It would seem that J's s-shape is getting more even (top and bottom are now more or less equal). To begin with the upper curve was much bigger.

I have to say that when I was on the ISOP message board earlier, I read about some children with angles of 80 or so degrees (over 100 in one case). I realise that J is very, very lucky. That can lead to terrible consequences for the internal organs especially the lungs. No one has ever said that J's scoliosis is progressive (the consultants say they don't know) and I really hope that with this new casting his angles are now under control and if possible we'll see even more correction in future. Under 10 degrees is considered "normal" and not termed scoliosis.
______________________________________________________

X-rays

I also asked about the x-rays. I am worried about how much radiation J will be exposed to over the course of the treatment (remember the casting is for a couple of years and then braces for years and check-ups until he's fully grown). I had been led to believe that he'd have x-rays every 6 weeks, but in today's letter the consultant says they're only done before each change of cast (ie every 3 months). I could swear they said they'd do more at each check-up (ie every 6 weeks). I've just looked back at the blog from Feb and that's what I was told (I copied up my notes onto the blog). Strange. I don't remember who said every 6 weeks.

From the letter it would seem that they're only done before the cast change. I wonder what difference it makes whether he's in cast or out of cast. I hope to get the cast taken off 2 days before the new one is put on. Fortunately we have an appointment mid-May to check how J is and I can ask about all this then.

I asked in my letter about protecting J from the radiation eg not the neck or gonad area. He says: "For optimum interpretation the whole spine needs to be imaged. I am not able to comment on inadequate x-rays of the spine. In terms of gonad and neck/thyroid protection the radiology department would be in the best position to advise on this as this is outside my area of expertise. At the present time and under the circumstances there is no other way of assessing the status of J's spine."

That's actually quite frustrating as it was the radiology department who said I needed to speak to the consultant. They said that if we use any lead protection for the neck, for example, the consultant won't get a full view of the spine.

What effect will so much radiation have on J???????? Am I reducing back problems but increasing the risk of cancer, infertility etc etc etc????? How as a parent without medical training can I get the best solution? The radiologists, when I was insistent, came up with a means of protecting gonads with a special lead fig-leaf. Are there other things I could get them to do? It was hard to get the leaf to stay put under his trousers - so maybe I need to find a pair of underpants for him for x-rays. It was a battle to get him to stay put, never mind in the position they wanted - plus I was trying to keep the fig-leaf from slipping!
 -----------------------------------------------------------------------

Shape of cast
I asked in my letter about the shape of the cast, especially at the top. It seems very high under his chin and J can't put his head down terribly well (though actually over the 3 weeks since casting it has become far less obvious because he just bends at the waist to look down). The consultant said that: "The plaster has been applied in such a manner as I have perceived to afford the greatest chances of controlling the curve."

Fair enough. You can't argue with that. I wondered about a small cut out under the chin (to my untrained eye, it didn't seem that a couple of centimetres just there would affect the spine) to give more scope for J to look down.

It's very obvious when J sits on the sofa because he can't use his bending at the waist technique- he just looks uncomfortable. I'll supply a photo if I remember.

___________________________________________________

Discharge arrangements
I wondered whether we might be able to leave the ward earlier (we'd been up since 4am, J was back on the ward having lunch about 12.30 but we left the ward after 6pm and got home after 9pm). He said to raise this with the ward manager at our next visit. I realised in writing it that it wasn't necessarily his remit, but I wasn't clear on the day exactly what it was we were waiting for. J had eaten, had a wee and had an x-ray and all those things I thought he needed to do to show recovery from general anaesthetics before leaving - perhaps next time I'll speak to the ward manager when we arrive and ask for help in getting away as early as possible so at least they might try and get us out earlier.

______________________________________________________

I hope to do another photos blog v soon - J is simply adorable at the moment. I will upload the video of him dancing though - sooooooooo cute :-)

Monday 2 April 2012

Don't sweat the small stuff

Sleeping: J has been happy to sleep on a mattress with pillows round it on the floor. So that has been no problem whatsoever. No need to buy a new bed or anything (I want to postpone that because a big bed would take up lots of room). I do find him in odd positions round his bedroom fast asleep by the cupboard or whatever, but so long as he doesn't wake up I don't care!

Washing: J is very willing to sit with his feet in a tub of water - so at least part of him gets a good wash regularly. He doesn't like me wiping his arms/legs/neck etc, but gets over it fairly quickly.

Hairwashing: We tackled hairwashing last night. I decided that as his hair is so fine, I'd just wipe it with a wet flannel and see how we went. J was NOT happy. I'm glad I didn't use shampoo as I'd not have been able to rinse it out. Anyway, it looks fine today even though it only had a wipe - so I don't need to worry about this. Once I'd finished wiping, he was right as rain - I just need the courage (and physical strength) to hold and wipe.















Thursday 29 March 2012

Deep breath - hairwashing (help!)

Right.

Deep breath.

Sometime very soon I need to tackle hairwashing.

I have deliberately avoided this until now, but the weather has been very hot (well, for March it has) and J is sweating in his heavy-weight cast.

I've investigated the trays that the occupational therapist mentioned:




I can't see how J is going to cope with any of those. It's like wrestling an alligator (a very strong one at that!) to clean teeth and he loathes lying on his back now (he finds it hard to get up with the new cast, though he's getting better).

He was never keen even in the bath because of the risk of water getting in his eyes. And yes, we do have a special jug that means that when he holds still it's unlikely to go in his eyes. Sometimes it was just easier to get it over and done with quickly with lots of water (including in his face) and then dry off the hair and tears at the same time.

If he co-operates then any of the above might work. But if not ("NOOOOOOOOOO"!!!!) then I may as well hold him upside down and dunk him in the bath. Yes I am kidding, before you start getting worried!

I guess the key is distraction, distraction, distraction...

Wish me luck! (I'll report back!)

Wednesday 28 March 2012

How very young children adapt and "get on with life"

I am amazed at how adaptable very young children are.

J doesn't seem to view his new cast as anything that would stop him - he just gets on with what he wants to do and on the whole it's as if he isn't wearing the cast at all.

Yesterday he wanted to pick daisies. I would term that as "difficult" for J at the moment because he can't just bend over as he could without the cast. But he didn't hesitate when I said about picking them, he just carefully moved his legs further apart, very carefully bent his legs and moved his body forward (he's learning how to deal with the extra weight and knows he would topple if he were too quick) then reached out with his hand. I'll try and video it next time.

Adults might complain and moan and we would wonder when we'd be able to do things how we used to be able to. None of which would help.

On the odd occasion when he has toppled over or has got stuck on the floor, he has squawked for me to help, but once he's up again that's the end of the matter.

I'm torn as to whether to draw a lesson from that for us or whether to simply make it an observation for now. There is an argument that we can be *too* stoical when things are hard - but perhaps it's "living in the moment" where children are our best teachers.  

Wednesday 21 March 2012

The Big Day - in photos

Having got up at 4.25am and been on the go ever since (we left hospital 6pm and got home at 9.20pm after J got upset in the car and needed a break at a service station) this is going to be minimalistic but I hope to write more tomorrow.

The good news is that J is ok. The cast is on  and it's purple and blue - but he didn't get any say in the matter :-(

He was a bit wobbly after the procedure (the new cast is heavier and affected his balance) and found it hard to get up from certain positions. But he attacked lunch with gusto within an hour of leaving recovery and went off to play in the huge play area, running, climbing and everything with few signs of it having affected him!

5.55am and J is etcha sketching as we set off in the car

 J looked  v peaceful till he spotted the camera...
 J said no to everything until one of the wonderful nurses let him "ping" the thermometer caps. He did it again and again and was much happier after that!


 J didn't want an identity bracelet and was refusing when suddenly bubbles appeared - the play specialist is an expert in distraction and spotted that we needed some help. Fantastic!






 Playdo. Spot froggy in the background adorned with the stickers J "earned" for putting on the bracelet. Spot the said bracelet now taken off on the table...

 Stickle brix. J loved them. V glad I got some at the NCT sale the other day.




 We went to the pre-op room about 9.20 (there were problems with beds for post-op so we were delayed). J had had a syringe of pre-med already and was drowsy on the way down (looked drunk!). By this stage he's pretty much out of it. The idea is that he won't remember the anaesthetic next time so he won't remember to hate it!


 Receiving the gas



 This is amazing - they agreed to take my camera into the operating theatre. The pics below are of the cast being applied.





 This is on the frame- after the undercoat is stitched on they then manipulate the spine.

 Plaster of paris is applied



 Now the layer we're familiar with - the coloured part.
 They cut a hole in the tummy to allow for expansion when eating (in the past it was found the stomach was distorted permanently and there were big probs)
 Note the monitor on J's ear (I think heart)
 The felt edging is applied to make it softer on the skin.
 This cast has two holes at the side for rib cage expansion.

 All done and a hug from froggy :-)
 J was on a nurses knee for an hour before they called me (his temp had gone down to 34 degrees so he was wrapped up in blankets). Here we are up in the ward afterwards. Note the huge gap above the shoulder. I guess it's for movement - but it makes him look v american footballerish in clothes!
 Right as rain.


 Back to normal - if it's not plugs it's poking tubes in the v accessible holes by the cot
 I got him a lovely balloon while I was waiting for the call to get him
 In the play area in the afternoon
 Dolls house

 Getting weary



 J got upset on the way home so we stopped at a service station. This is about 8.30pm having been on the go all day...
 I told the photographer to take more than one because one or other of us would have our eyes shut and J deliberately closed his eyes and laughed. He has a lovely sense of humour :-)

I will blog the details tomorrow.
Good night
All is quiet with J, so I'm hoping for a quiet night...


[infantile scoliosis J's diary blogspot]
http://infantilescoliosis-diary.blogspot.co.uk/