Round two of serial casts

We went to see an orthopaedic surgeon yesterday about Kaitlyn's ankle contractures. Not knowing SMA he was pleasantly surprised at what we accomplished with only one casting so far, and even more pleased that we have been able to maintain what we gained for the past two weeks without the use of splints or AFO's. This he found encouraging and has decided to support our request to do serial casting instead of tendon release surgery. Although he did make his big speech about how the casting may have to be repeated and depending on how often, then we may still have to consider surgery at some point to cut the tendons. For now we are happy to avoid anything related to more surgery, more anesthetic (even if it is "only" a local), more scalpels, more stitches, more pain and discomfort!! Enough is enough, and this Kid has been through the wringer enough for the past two years of her life. It's time for a break and to minimize as much as possible everything that we have to do for her to keep her comfortable. It's time she started enjoying some of the life we have worked so hard to give her.

On a lighter note the surgeon said that he thought Kaitlyn's heels were healed enough to recast, so we had round two of serial casts placed yesterday. That's what I love about our children's hospital they will bend over backwards for us. If they can squeeze us in for a casting and save us a trip back in another day then they will! Even when it was a spur of the moment decision. We didn't want to overdo this casting as Kaitlyn had skin breakdown from the last casts. So they decided to take each foot only as far as they could without a lot of force. They still managed to get minus 5 on each foot. When we started with the last casts we had minus 30 one foot and minus 25 the other. So I thought minus 5 after a two week break was pretty good.

Kaitlyn hasn't minded round two of serial casting any more than she minded the first round. This is good, I'm glad that she is not in any discomfort! She still moves her legs about and swings them back and forth in her slings. She can even lift the casts off of the bed to squeeze her legs open and shut. She should not be able to do this without casts let alone with! SHHHH don't tell her!

We decided to leave off the proper casting sock that is usually the first line of defense in any casting. The socks are ribbed and very thin. But we think that the ribbing may have irritated Kaitlyn's skin instead of aiding skin breakdown. It may have increased the friction associated with the normal sheering force inside the cast. This time we went with an extra thick layer of fluffy cotton wrap, followed by a much thinner layer to hold this all together, and then lastly the casting medium itself. Her casts haven't got the nice smooth edge that they had the last time, as they roll the sock back and make a nice edge with a normal casting. But hopefully we have traded our nice smooth edge for not as much or no breakdown!

A pic of Kaitlyn sporting her nice new casts. Boy her legs look really chubby in this photo!