Thursday, December 12, 2013

A Necessary Break

October 28.

We went down for another casting appointment.  It was the day before Max turned one month old, and I didn't really expect anything out of the ordinary.  My dear friend Becky went with me, and my dad wasn't able to meet us that time so Becky went back with me to the exam room.

A different lady took Max's cast off that day.  It was the first time I had met her, but she was one of the two people I had been told to request, and she did a great job.  But when the casts came off, we saw this:

See that dark spot of skin right above his foot?

 I hadn't seen any sort of discoloration of his skin until this point.  I thought it looked odd, but didn't really know what to think.  After Max was born he had tons of dry skin that peeled off.  I remembered that when he had his first cast put on, I thought, "How is all of that dry skin going to peel off if its under a cast all of the time?"  On this day, I thought perhaps that's all it was- dry skin from after he was born that never had been able to come off.

Third cast off.  4 weeks old.

Once Max had the cast taken off, he was very unsettled.  He cried, a lot, for most of the time we waited.  That appointment was hard- we had a long wait for the doctor and it was cold in the room.  I should have wrapped Max up sooner than I did, or gotten him dressed, or something.  But I held him and walked with him.  I tried nursing him and burping him.  Nothing seemed to settle him down.  He seemed more upset when I touched his leg or his foot, so I tried not to touch it much, which wasn't easy.

Dr. Kayes and his PA came in and noticed the spot right away.  Immediately he said, "We can't cast over that.  We need to take a break."

Max was still crying.  Did I hear him correctly?  Wait, why is the PA putting all the casting supplies away?  What's going on?  Why is my baby still crying and I can't figure out why he isn't being casted?!?!

Sweet foot!

Dr. Kayes explained that we shouldn't cast over a spot like that.  To do so would cause further irritation, and if it became an open wound, we have a whole host of other problems to deal with since we definitely couldn't cast over an open wound that size.  Max also had a small blister at the top of his leg where the cast had rubbed.  I almost always kept a legwarmer over the cast and tucked it down around the edges, but it must not have protected it enough.

All I could think was, he can't be out of a cast.  He just can't.  What about all the progress we will lose?!  Dr. Kayes and his PA both assured me that we would pick up with casting and all would be okay.  Sometimes these things happen, and while it isn't common, occasionally it does occur.

We could barely talk over Max's crying, and Dr. Kayes seemed genuinely concerned that Max was so upset.   He said sometimes babies get so used to their casts that they don't like to be out of them.  I was told not to put any ointment or anything like that on the spot so that the skin could heal on its own.  It was a Monday, and he said it things looked a lot better in a couple of days we could come back on Friday.  Otherwise we would just pick up again the following Monday.  He told us some stretches to do and I felt comfortable with that because we had done so many stretches with Oliver's feet as a baby.

And just like that, the appointment was over.  I was taking my baby back home without a cast.  It was so strange.  I was somewhat dumbfounded by the whole experience.  I tried calming Max down, but he wasn't having it.  Finally, I just decided to get him dressed and we would leave.  I couldn't take being in the room anymore with him crying like that.  Thankfully, once I got him dressed, he settled down more.  I wonder if it was a combination of being out of the cast and being cold that made him so unhappy.  Then I felt terrible that it was something so simple as being cold that made him cry; I could have easily fixed that earlier had I realized.

Becky and I left, and I sent Jay a text.  I really didn't know what to say.  "Hey the appointment went well.  Actually, no it didn't.  He is coming home without a cast.  But the doctor says it'll be okay.  But I'm totally uneasy about the entire thing."

I should clarify.  I absolutely believe it was the best decision to leave Max out of a cast to let the spot heal.  Causing further damage to his leg by re-casting could have made things so much worse.  But when your baby has clubfoot, you get so used to having him or her in a cast.  Its just part of your everyday routine.  You can't wait for it to be over, and when that day comes I will be elated.  But to have a week of no cast in the middle of the process?  The whole thing felt so very, very strange.

Telling people that Max was taking a break from his casts felt very awkward.  Most everyone assumed it was a nice thing- gosh, isn't it nice having his legs free for a week?  You can enjoy his time without the cast, you can give him baths, etc etc etc.  And all of that was true.  It was wonderful to cuddle my little guy and give him real baths that he didn't cry through.  But it just felt wrong.  It felt like this long, drawn out pause on the whole procedure.  I felt like we were already living it week by week to see how much progress he was making, and now we were just pausing.  It was the week of Halloween and it lasted forever.

Some Halloween fun.
Its tiring being such a cute little pumpkin!

I was so ready to get him back in a cast.  Like I said, I really hate dealing with the casts, but when you know its what your baby needs, you just want it done.  It just felt so strange.  One thing about clubfoot is that you generally do not want them out of the casts for long.  That is why his cast gets cut off at the doctor's office and in less than an hour (usually less than 30 minutes) he is re-casted.  When Oliver was a baby I had to take his casts off the night before, and that is actually not advised because you don't want to risk losing progress.  So a whole week? I dreaded going back and seeing what progress we lost.

The first night home without his cast was rough.  He would cry and just kick and kick that leg.  He was very unsettled and you could tell he wasn't used to having the cast off.  Thankfully, he settled down as the week went on and his skin healed beautifully.

Just 24 hours out of his cast and the spot was drying up nicely.

 Although the spot looked healed by Thursday, I did not feel comfortable calling and making an appointment for the following day for another cast.  As badly as I wanted him to get back into the cast and be on our way again, I didn't want to risk putting him back in too soon.  I wanted to make sure he was fully healed.  When we did go back the next week, his foot looked great and we were ready for another cast.


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