Pre-op assessment tomorrow

We're off to Oxford for the pre-op assessment tomorrow, meeting with the consultant and anaesthetist in preparation for the actual casting under General Anaesthetic on 21 March. We will continue soft casting at Birmingham until then.

I hope we'll finally get some x-rays too. The last ones were in October and I am desperate to know what the state of J's back is. However, I'm not sure we will get x-rays tomorrow as I haven't been able to get hold of the right person to ask. If we don't get them, then we'll have them next time we go to Birmingham for soft-casting (the consultant there has now amended the form to say to do them out of cast).

My questions:

1. What General Anaesthetic will they use? What side effects / after effects does it have?
2. What will the day of the casting be like (schedule)?
3. What effects will it have on J? How heavy is it?
4. What are the risks of having General Anaesthetic - especially repeated so often (every 3 months)? What about neurotoxicity?
5. How can I prepare J best for the treatment?
6. What about colds/coughs etc - under what circumstances will we not be able to cast?
7. What kind of correction can we expect from the first casting [impossible to answer I think, but I need to ask]? And overall??
8. What is the post-casting aftercare? eg skincare.
9. What do I do if the cast gets wee on it (no matter what nappies I use there are days when he is drenched in the morning...)? I've heard on message boards about using ductape (sp?) round the bottom. What do they recommend?
10. If we do get x-rays - what is the curve? How does it compare with October? What's the rotation?
11. What happens if there is an emergency on 21 March and the appointment is cancelled? (how much of a wait...)
12. If we do get x-rays - how long is it ok to leave him without cast now? I normally remove the cast at the most 48 hours before re-casting. I need to ring Birmingham to book the next "soft" cast when we finish the pre-op assessment and could take him in Friday, but that means we don't get to swim etc... If the consultant thinks it'll be ok, I'd like to recast on Tuesday as usual, but if it's too long, we'll go in asap of course.
13. What is their usual way of monitoring the curve - will there be x-rays each time? In cast or out of cast?
14. Can I remove the cast myself (if yes, then how?) and get a day or so to enjoy a cast-free child before the next one is put on? I know that at Alder Hey, they remove one under GA and put the next straight on, which means the mother I spoke to never saw her child without a cast for 18 months :-(     If I have any say in the matter, I want to have time with J without the cast.
15. What is the aim of this treatment as far as they are concerned?
16. At what point do they stop casting and start bracing? (he said 18 months when we saw him in December, but I'm not clear what the rationale was behind that)
17. Do they measure height etc too, so they can track growth spurts? (the whole point of Mehta casting is to use growth as a corrective force... but this isn't true Mehta casting).
18. What is his opinion about the spina bifida?


The appointment is at 9.30am, so it's going to mean a joyous very early start to beat the traffic (leave house by 7am I reckon). J is now having full-blown "terrible two" episodes (all entirely age-appropriate behaviour, but boy is it wearing...) so I'll need to factor in extra time, for example 15 minutes for nappy changing and getting dressed (it used to be 5 max). This morning I made up a whole song about his penguin socks - they did a little dance and tried his head, hands and other body parts before deciding to stay on his feet (at which point he stopped being amused and kicked up a fuss... literally). Hey ho!

At least I know the route there now and there is a good cafe and children's waiting area (fab toys). All helpful for planning.