This week Maura has officially been in the outside world as long as she was inside me. I’m
sure you’ve heard 9 months on, 9 months off referring to allowing yourself 9 months after baby is born to get back to your pre-pregnancy weight and feel like your old self, I gave myself an extra week or so since Maura did the same for herself on the inside, haha.
I’ve been eyeing my weight, but not focusing on dieting or losing it. I also had to take quite a lengthy break from formal exercise. I can finally say that I’m feeling pretty good! It took 3 different doctors and 7 months of physical therapy…. but I feel good. Maybe the 9 month wait has some truth to it after all. The one thing that all three doctors told me was that a woman is considered postpartum for a full year, not 6 weeks or 12 weeks but an entire year. This was so important for me to hear! There is so much pressure to jump back into a fitness routine and lose the baby weight immediately and I felt awful about myself that not only could I not start running again at 6 weeks, I could barely get through the day without feeling terrible.
Since my 6 month update, things have improved tremendously. At 6 months, I was feeling really frustrated with the lack of improvements to my pelvic floor and prolapse issues even with physical therapy. I was pretty much told there was nothing left for me to do, and I couldn’t except that. I ended up making an appointment with a specialist in urogynecology. (Basically a GYN who also has specialized training in pelvic floor organs, not just tissue). I was SO glad that I kept seeking answers because my appointment went great. Which is so weird to say, haha. My appointment was around 7 and a half months postpartum. The Dr. did the exam and immediately said that the prolapse was very minor. This confused me because I had been diagnosed with stage 2 bladder prolapse by two separate people… and I was still experiencing a lot of discomfort. She then explained that I had a ton of scarring and inflammation, making everything so sensitive that I was feeling symptoms from the level of prolapse that most women who have it don’t even know. She prescribed Estrogen and it’s been helping a lot. I won’t need it forever, and chances are once I stop breastfeeding my hormones will recover on their own and I’ll be able to put this behind me. She also sent me back to physical therapy after taking a month or so off because my pelvic floor muscles were extremely tight – we still aren’t sure why they became tight when they weren’t before – but I have a feeling it’s a combination of desperately attempting kegels (which I still can’t do). I also don’t know why the prolapse got better. The only thing I can think of is that I was slower to recover/heal than most due to the anemia and what takes most women 6 months, took me closer to 8. I debated not writing about this again… it’s so personal, yet if it helps one other person going through similar, I’ll risk it. Women’s health needs to be discussed, even if it does feel embarrassing. The message I want to drill into others is that you can and should get help. There are doctors out there who want to help you, you might have to see a few… but it’s worth it in the end. Don’t be embarrassed, don’t suck it up because you think it’s just part of having a baby, just go get yourself back to feeling good.
*If things had NOT gotten better on their own – for anyone who is looking for a story with a different ending – the specialist said that there are hundreds of types of pessaries, and that she often sets up whole afternoons for women to do fittings – and try and try until one works for them. Other Drs who don’t specialize in this may let you try one or two, but a specialist has more available. She also said that unless symptoms are severe, they do not recommend surgery for younger women (meaning non menopausal). My other tip is do not google. Google had me in tears almost every night until I got things figured out, just stop searching for answers on your own and see someone who is trained to help.*
The past 9 months (closer to 10) have been about getting my health back, the next 3ish months are going to be about getting my fitness back.
Cast Change Day – the half way mark for many hip babes is a big DDH miletone. I wan’t quite sure what to expect, so if you find yourself in the same boat: here is our experience.
The cast is changed very much like it was put on – in the operating room, under general anesthesia. We were called two days in advance to set times for our procedure. We again had the first procedure of the day – our hospital does it in order of age. We had a 6am check in time, and an hour and a half drive to the hospital meaning we had to leave the house around 4am (to be safe… you know 4 am traffic or an ocd mom…). Lucky for my husband, he was returning from a work trip at 1am – plenty of time to rest up 🙂
I woke Maura to get her last feed in at 3:30am, and we took off shortly after. We were taken back pretty quickly, and the routine was the same as the original Closed Reduction. The main difference for us, was that this time there would be no arthrogram (dye injected to see the joint alignment). They would cut the old cast off, check the stability of the hip, do an MRI, and put the new cast on. Easy peasy.
She was taken to the OR again without a fuss at 7am, and we were called back by 8:30 I’d say (I can’t remember exactly, but it was short). The first procedure, Maura woke up a bit ‘drunkish’ from her anesthesia, but not upset. That was very different this time. Maura woke up inconsolable. She cried for about 40 minutes straight and wasn’t soothed by anything. This caught me off guard… they told us it was a possibility the first time around, but because the first time went fine we didn’t expect it. The nurse explained that typically it takes 30-40 minutes to wake up out of anesthesia, but Maura seemed to force herself half way awake within 5 minutes. This was most likely due to not having any pain meds for the procedure, the pain meds slow the waking process. She was awake, but had no idea where she was and didn’t recognize me. This crushed me. Finally she started to calm down and because her old self around that 40 minute mark. She nursed, and then was fine, and even playing peek a boo and giggling as we went through the rest of the routine.
This time, I brought my duct tape and moleskin with me. As soon as we were able, I broke out my own diapers and got her set to a degree that I felt comfortable driving the house and a half home! Unfortunately, I found a lump in her cast that I wanted taken care of before we left. We had to wait for the surgeon to finish his second procedure of the day before coming back which ended up to be about another hour or hour and a half. The OTs came to re-fit the car seat, which took about 20 minutes instead of the 90 that it took last time. I spent the rest of our waiting time putting duct tape and moleskin on the cast – the parts I was satisfied with. Maura was back to her self, so she read ‘Where is Baby’s Bellybutton?’ in her hospital crib for a while, waved to the staff as they walked by, and played some peekaboo with her blankey. While I did that, my husband took the car seat down and had it reinstalled with the Safety Center. (Our hospital has a Safety Center, they loan out car seats and help install them, they also sell baby proofing gear for a low price.)
The surgeon finally came back out, and sawed off the end of her cast to remove the lump and give her foot full range of motion since I had explained how mobile she had become in her first cast. From check in to check out we were there 4 hours, which it could have been much shorter. All in all, it went ok. I’m glad to have made it across the hump! And, since I’m writing this weeks later… we adjusted very easily to cast #2, and are even more mobile in this one – crawling, rolling both ways, pulling up to stand!
Basic Spica cast care isn’t quite as complicated as I originally thought – you really just need to achieve two things and however you do it is fine. 1) Protect your child from the cast, and 2) Protect the cast from your child. The following steps are how I did those two things…
First: before you even leave the hospital – touch and get to know that cast the best you can. Don’t be afraid of it… it’s coming home with you, and once you’re home your stuck (unless you go back). Run your fingers along the edges, run them around the inside as far as you can touch. Can you get a finger in the whole way around? Are there any pressure spots that could rub? Is it sharp!? Does it look uncomfortable for your child? I have heard horror stories about casts being too tight to eat or grow in… you don’t want that at all and if you have any concerns, voice them before you leave. We had a lump inside our cast at the bottom neat Maura’s ankle. I knew she’d be crawling, and I knew if she moved that foot around the lump would hurt. We had to wait, but our surgeon came back into our room with a cast saw and cut the leg shorter for us. You couldn’t see the lump, but I checked and they were glad to fix it. If there are sharp edges that touch your child, moleskin them immediately – before you leave! (*** I actually emailed my Dr. in advance and said something to the extent of “I’m concerned about hygiene, the health of my daughter’s skin, and her growth during this time, is there a way to address these concerns when you apply her cast?” He called me, and went over his way of putting the cast on and leaving enough room etc. all Dr’s are different, but talking to your Dr. in advance is a good thing if you’re worried about anything***)
Second: As soon as you’re home, waterproof the entire diapering area with waterproof tape (I use duct tape). They say ‘petal’ – that just refers to a method of taping. I tape a small strip (3-4 inches long, and about 1 inch wide). I first stick it to the outside, then tuck it under firmly careful not to stick to baby’s skin. Overlap the next piece a bit to make a seal, and keep going until you’ve gotten all the way around the diaper area. You can have fun with colorful duct tape if you like – makes the cast look happier. ** You can see it below, the purple duct tape… I apparently deleted the photo of my pretty pink polka dot tape over our purple cast.. oh well**
Third: Moleskin any edges that will touch your child’s skin or rub. I usually moleskin the entire top edge around the torso, the bottom of the legs, and portions of the diaper area that a diaper doesn’t come between. (Maura gets a rash from duct tape, so anywhere the tape will touch her I cover… most of the diaper area gets separated from skin by a diaper, so it’s not the whole thing.) Now you’re set 🙂
Diapering in a Spica cast was by far one of my biggest concerns. Anyone with a baby knows that diapers aren’t completely reliable, even when worn correctly – let alone when ‘tucked’ in place and not velcroed. Add on the pressure of knowing that if poo escapes, the cast can’t be taken off and thrown in the laundry! The first morning in our cast, we got poop in it. Not a blow out, but a smudge about the size of a nickle right at the front of her hip (trouble zone number 1). The first several days after that, I constantly was thinking about poop… I couldn’t leave the house if I weren’t sure that he had pooped all she could possibly poop for the time being without being panicky the whole time spent out. What if she pooped when we were out? Could I bring the vacuum out in public to use our trusted Cast Cooler? No… Could I bring a hair dryer and enough wipes and camp out in a public rest room long enough to get her clean!?!? Probably if I had to, but I really didn’t want to! Ahhh. The only way to ease this fear was to come up with a method that worked several times in a row and I grew to trust…. So – here is my method and also the supplies I consider essential, and things I’ve learned. As of now – 10 weeks in, we have only had two minor poo escapes, both which were cleaned out successfully. At our 6 week cast change, the surgeon gave me a “Top 10% for Cast care.” Type A for the win!
Duct tape and Moleskin: for protecting the edges of the cast and for protecting your childs skin.
Diapers: One size for inside, 2-3 sizes larger for outside the cast. You won’t know exactly what sizes work with your cast until you try… The best you can do is have a couple different ones on hand for the first day or so. Your hospital will give you some, but they don’t always have the best ones for the job. We use her regular size 3, but switched to Pampers Swaddlers for inside the cast. They are the smoothest and thinnest, but still absorbent. The elastic waist of our usual Huggies little Movers prevented them from staying in place across her back because we CAN’T velcro them on… (some people say they can, our cast comes up too high for my hand to reach down that far on her hips, nor do I want to wiggle around an unstable hip).
Wipes: Just tons of them incase of a poo escape, you most likely have them anyways, just don’t run out.
Mini Flashlight: Since you won’t be plopping your kid in the tub for an extended period of time, you want to see any minuscule spec of poo that may have gotten tucked away in a little crease or on the cast. You also want to see any red or irritates spots on their skin before they get worse. Maura gets little rashes from the duct tape, if I see any pinkness, I cover the duct tape with moleskin on that spot. You can also get a good view of skin deeper under the cast once the cast loosens a bit. Otherwise you have no way of knowing if their skin is irritated or worse, breaking down (which would require an emergency cast removal).
Q-Tips: I can reach a bit deeper when needed with a qtip. Especially the hip creases, hard to get a finger and wipe inside for a thorough clean.
Cast Cooler: This is a plastic wrap that connects to your vacuum. When the vacuum is on, itsucks air through the cast drying in and cooling it. A warm wet cast (from sweat or urine) is going to allow bacteria to build up and stink. We love our Cast Cooler but some people say their babies hate it due to the noise of the vacuum. Only you know your child, but if you can get them used to it – DO IT! (you can google it). Maura loooooves it. We use it nightly and she ‘reads’ while I run it. The photos are from the very first day in our cast and she was exhausted.
Hair Dryer: Some people say they use a hair dryer instead of a cast cooler – it doesn’t compare. I DO use one daily, but more for damp skin and creases than the cast.
Toys/Books/Entertainment: Diaper changes can take much longer than they used to. Once you get the hang of it, they aren’t bad – however, if you need extra time to clean up or re-tape etc. Babies get bored. I watched a 40 minute youtube video (I fast forwarded some) in which a lady demonstrated changing and taping and this and that and her child just stayed there…. that is NOT my kid! I form a toy barrier to keep her entertained because within a day – our changes looked like her naked butt scooting away while I chased her on my hands and knees! I have a mat with a blanket over it on the floor. Her knees are too wide to put her on her belly on the changing table.
Now for the Method:
*We have a larger diaper area than many other casts I’ve seen. For smaller spaces, people recommend “Hip sticks” – basically a stick that helps hold the diaper smooth while pulling it through a tighter space. I can’t speak for them – but many do.
* As our cast has loosened, we had some leaks at night. Nothing major, I can prevent it by pushing diaper #2 over to the side we tend to leak on…
* You WILL HAVE TO IMPROVISE… no one else’s system is going to be perfect for your kid and your cast. Knowing what works for others gives you things to try until you do find what works.
This month you started pulling up to stand in your cast! If you had it on longer, I wouldn’t be surprised to see you walking in it. You also started dancing and clapping along to music.
You’re babbling all the time – You say ‘Dada’ and ‘Da’ – which might be ‘Dog’? We aren’t sure, and we’re not quite sure if you know what you’re saying yet either! When I ask you to say ‘Mama’, you either say ‘Dada’ or ‘Mmmm’ then laugh. I think you’re teasing me!
You love books and spend a lot of time flipping through the pages, studying the pictures You read aloud, babbling to yourself, humming, and letting out little giggles as you go. I’d love to hear the story you’re telling! You enjoy pop up books and books with tabs the most, but you also end up eating the tabs that you’re able to rip out….
You have discovered that our kitchen cabinets ALL open, and they all have different things to pull out! Luckily for me, when you see something exciting that you want to get into, you start laughing and crawling as fast as you can towards it – I know what giggle means I’d better grab you quick!
This month was your 1st Christmas, 1st New Years, and 1st Snow!
I absolutely love watching you grow and learn. I’m so lucky, and can’t believe you’re my daughter.
(Notice, I didn’t mention sleep in this post… I’m trying not to think about it. Ugggh. We’ve been up twice a night for weeks. I tried to night wean a little but really just don’t have the energy, and part of me doesn’t want to deny you the comfort if you need it…)
Wow. I know I’ve said it before – that you amaze me, but you really do. This month you have shown me what determination truly looks like. You’re my inspiration to keep moving forward.
You had your cast put on a month ago. Within 24 hours of being home from the hospital you were crawling around on the floor. You were frustrated, and grunting with every ‘step’, but you kept on lugging that cast forward. You haven’t let it slow you down at all. I’m in awes of your happy disposition – I don’t know where you get it from, but it certainly reminds me to smile and laugh all day long.
You re-learned to crawl, and roll over in your cast. Rolling took a little longer, but you’ve got it down now. The weight of the cast gives you some momentum, and often makes you giggle. Since we took a little break from gross motor development – you’ve really made leaps and bounds elsewhere. You can perfectly pincer grip little pieces of food (and everything else) and put it in your mouth (or the dogs). You like puffs, and yogurt melts. You’re eating three good meals a day now.
You love to play peek a boo, and you’ve started initiating the game by covering your face with anything you can, and tearing it away laughing. You do this with your food covered bib smushing food all over your face, you do this with blankets or clothes you can reach while I change your diaper, sometimes you even grab my shirt to play while we are trying to nurse. You crack me up.
You’re beginning to wave Hi and Bye-Bye. You can sign milk, but usually don’t start the sign until we’re already having it. You clap along with music, especially ELMO. You Looooove Elmo. You only clap with one hand though, you hold one still and tap the other against it. Sometimes you kick your free foot to the music too. You ‘read’ to yourself often. You adore pop up books, especially ones that make noises. You were just turning pages and flipping up flaps, but now I’ve noticed you mumbling and babbling while you turn the pages. I think you’re pretending to read, and I love it.
Sleep has gone out the window with the cast, oh well. We’ll see how it goes once it’s off. For now, I’ll take the extra snuggles at night.
One week down, four weeks and 5 days to go… until the count down starts over for another 6 weeks. We scheduled our cast change for December 21st. At least we’ll smell nice and fresh for Christmas!
I’m trying really hard to embrace each day, and not wish it away, but people were right when they said this would be hard. It breaks my heart to see my baby frustrated or uncomfortable and not be able to do anything about it. I’m tired from the middle of the night diaper changes that I thought were over after the newborn stage, I’m sore from the constant holding of an awkward 20+ pound baby who doesn’t want to get down on the ground anymore, I’m tired from the stress and the emotional roller coaster of Spica life. At this point, the absolute hardest thing is not being able to snuggle. Maura usually lays on my lap, with her head against my chest and dozes into a nap. With the cast, we can’t get that close position down and trying usually ends up with an over tired, frustrated, screaming baby who just needs to be held tight – but can’t be. It is getting easier though.
After a little experimentation, and necessity, and buying a million different sizes and types of diapers, I have a system of diapering that is working for us. It’s held up impressively a few times, and makes me feel ok spreading out the changes a little bit longer over night. If she goes down at 7pm, I can change her once about 12:30/1am and then not again until 5:30/6 when she wakes up. I think I’ll do a full post on that soon, once I’m really sure it’ll hold up.
We purchased a Cast Cooler. It attaches to your vacuum, and basically sucks air through the cast to cool it and dry it. The idea is to reduce heat/moisture reducing bacteria and odor. I was nervous about the noise of the vacuum, but Maura didn’t seem phased. She actually smiled at me, and put her head down to relax!! I consider this a success AND it dried the cast well after our first accident.
Breastfeeding is NOT a comfy as it was. But it’s doable. I was worried about it pre-cast. So I’m including a photo, just to show those who are worried how we manage it. (haha the sock! We hadn’t yet figured out how to keep that leg warm… we’ve since gotten some better socks.)
Maura mastered the army crawl within 48 hours of being placed in her Spica. Although she tires very easily, it makes her happy that she can still maneuver around and find her toys. (I wrap a soft blanket under her legs when she’s on the floor, and she zips around really well – also saves the hardwood).
Every day, Maura acts a little more like herself. She’s regaining her confidence, she giggles often, naps well.
When we got news of Maura needing a Closed Reduction and Spica cast for 12 weeks, we were devastated, but we were also scared to death. We had no idea what to expect. Even after Googling like crazy and joining forums, I didn’t have a clear enough image of how the day would go to feel comfortable. If you find yourself in this same boat – hopefully this will help you prepare. And as others told me, the waiting is emotionally the worst part.
3:30am – I got up and fed Maura her last meal. We were instructed to cut off solids at 10:30 pm and breastmilk/formula at 3:30am. We also got dressed, got her changed, and started loading up the car. Our check in time was at 6:15am and the hospital is an hour and a half away – we left plenty of extra time in case there was fog or any driving/parking issues.
5:45am – We arrived a half hour early, but were able to park and find where we were going without stressing. We arrived to the surgery floor and there were a couple other families there already too. Surgeries were ordered by age, so babies go first. We checked in, and were given a pager and an ID number. We were told that when she was in, we would get texts so we knew to come back to speak with the Dr. or see how she was progressing. There were also big screens throughout the hospital that showed all the children’s ID numbers with a color coded status update. This way, even if we were in another area of the hospital we could see that she left the OR and was heading into recovery etc. We also filled in the blanks on a form on Maura’s behalf that had statements like “When I’m scared, ____ calms me down”, “I brought _____ today to keep me happy” etc. I thought that was great.
6:15am – Right on the dot they called us back. We met with lots of people – a nurse took her height, weight, vitals, and got her into a little hospital gown. She let Maura watch cartoons from the hospital crib which made Maura happy. We met with the MRI tech and signed paper work, the anesthesiologist and signed paper work, the surgeon and signed paper work, and the OR nurses. Everyone went over the procedure and poibilitie (which were scary) I felt a little bit like our surgeon had skipped some posibilities when he originally told us about the procedure – like if they couldn’t get the joint in line, they’d go right to an Open reduction instead, or if the tendons were tight they may need to cut them…. Hearing those things really made me nervous. When I told the anethesiologist no one had told me those possibilities prior, he said that the surgeon must have felt that they were very unlikely in our case. They also offered anti anxiety meds for Maura prior to the procedure, but we all agreed that Maura didn’t need any. She hasn’t developed a fear of strangers yet and had no clue what was happening. (They could have offered me some! haha just kidding) I told them that singing the Alphabet slowly calms her down, the nurse tried and Maura smiled. The nurse let Maura play with her name tag and she happily went with the staff at about 7:20am. They also assured me that they would do the anesthesia prior to ANY pokes including the IV. Everything the littlest bit uncomfy would be done while asleep. ( I saw on other blogs that a parent was allowed to accompany their child until they were put to sleep… I asked, but they said no one was allowed in the OR).
7:30am – The waiting game began. My husband took her car seat and things down to the car. I went to go use the breast pump since our feeding schedule got wacky. At about 8am we got a message on our pager “Procedure is underway and she is doing great!” I’m sure it’s a generic message but it made me feel better.
At about 8:15 I went to walk and eat a granola bar (no eating in the waiting room since the kids are all starving pre surgery). within 10 minutes, my husband came running after me and I saw the surgeon behind him. My heart sank thinking something went wrong and they were unable to do the procedure. Nope! It was done already! We were notified that the procedure went as planned, her hip easily went into a great position, no cuts were necessary. Her MRI had been scheduled for 10am, but the surgeon called them to tell them she was ready. He said the timeline was dependent on them so he couldn’t tell us if they’d call us back in 30 minutes or an hour.
8:30-10…. Waiting, waiting, waiting. I made two beaded keychains with the craft group and kids waiting for their surgeries. At about 10:15 I was ready to pass out I was so hungry and thirsty but hadn’t wanted to go anywhere.
10:15 – I give in and ask/beg my husband to go find me some food. About 5 minutes later the nurse comes out and calls in another family. Before going back, she turns and tells me I can come back too… Maura is about to wake up. I text my husband who had gotten on an elevator that didn’t come to our floor! He had to run down 9 flights of stairs, cross a street, come up a different elevator to come back…. Ha.
10:20 – Maura was just fluttering her eyes from the anesthesia. She wasn’t crying, but was pretty out of it. She was mad that an IV was put in her left hand – that’s the finger she likes to suck on. She was a bit cold, so had heated blankets on her, but was doing great. Within 15 minutes she was up. She didn’t seem panicky as I expected. She was tired and horse from breathing tubes. They just gave her a little Tylonal.
10:30 – We met with more people. The nurses needed to weigh her in cast, take vitals. The
nurse showed us how to diaper her, how to carry her, helped me find a position to nurse her. We were almost ready to go, but needed to be fit for a special car seat. Holy cow it took forever. Maura was such a champ up til this point. The occupational therapist was the one fitting the seat. Maura’s thighs were too short to hang her casted leg over. With the first insert she was too tall for the head rest. After about 45 minutes, the woman found something that she felt was acceptable but wanted to supervisor to give the ok as she wasn’t positive….. The supervisor made her re demonstrate all the previously tried positions. Poor Maura was put in and taken out at least 10 times. After an hour we started melting down. Luckily, we got a position that works. They met us at our car and helped install the seat and sent us on our way!