Wednesday, June 17, 2015

Malcolm and the Mean Muscle Spasms

I last left you late Saturday night, which was Malcolm’s second night home from the hospital. Little did I know that it was going to be the worst night yet. Jordan offered to take couch duty again, knowing that I would be sleeping with Malcolm the rest of the week so that he could rest before work. Malcolm is having muscle spasms that are causing his entire body to seize up. Some of them are more like small shivers or tremors, but with others you can see his entire body jolt, from curled toes to balled fists. Some of the smaller tremors he can sleep through, but the large jolts wake him violently and you can feel the tension in his limbs for maybe 30 seconds.

On Saturday, he was averaging a small tremor every minute, but the larger spasms were coming every three to four minutes, and with each one he was crying out in sort of a scream. I could hear him crying from our master bedroom upstairs, and finally, I came to relieve Jordan because Malcolm was calling out, “Momma, Momma.” I laid next to him, he squeezed my hand with each spasm, and we just cried together. Around 3:00 a.m., I decided to call the hospital hotline number they had given us upon discharge.

When the orthopedic resident on call returned my message, he said that spasms are really common because the muscle can’t get tension on the broken bone. He indicated that the whole-body reaction is just in response to the spasm in the leg. He told me they generally don’t like to give medication for spasms in children Malcolm’s age, but that the spasms could also be an indicator that we’re not staying ahead of his pain. I told him that we’d been alternating the prescribed hydrocodone with acetaminophen, with Motrin at the recommended four hour interval. He said they sometimes prescribe an additional medication, but he would need to consult directly with Malcolm’s orthopedic surgeon on Monday. He also said that his exhaustion may be exacerbating the issue. It's a viscous cycle where the spasms themselves are keeping him from getting the rest he needs to minimize their occurrence. 

The orthopaedic resident asked if we thought Malcolm’s leg was swelling in the cast. I told him we had no reason to believe that it was because he’d been consistently moving his foot (tapping it to the music of Blue’s Clues when he was watching it earlier in the evening). He said that if we do feel like swelling is causing him pain, that we could come into the emergency room and they could slit the cast, but otherwise there’s not much they can do. As you can imagine, none of this was particularly comforting to me when I’d been listening to my baby scream in agony for hours on end. 

My parents live in Scotland, which is a six hour time difference, so I called them just to vent my desperation after hanging up with the hospital. My Aunt and twin cousins are visiting my parents next week, and my mom is meeting them in London before touring several other cities, which is why she didn't originally plan to come. Before any of this happened, Jordan’s brother had already planned a visit to arrive here Tuesday afternoon and leave on Friday morning. I knew Ryan would be a big help, but I was explaining to my parents how stressed I was about being on my own on Monday and most of Friday, since we clearly don't have a handle on managing Malcolm's pain.

I truly didn't expect my mom to alter her plans and was just venting my helplessness and frustration. She called me back within minutes and had found a ticket for a flight that literally took off less than two hours from that moment. When she offered to come for the week, I felt a wave of relief rush over me and just started bawling (happy tears)!

On Sunday afternoon, Jordan and I each took turns holding Malcolm in our living room recliner so that he could have a chance to sit up a bit, plus it seemed to soothe him being in our arms. Jordan had a little luck holding Malcolm’s hands in place on his chest to minimize his reaction to the spasms and help him rest. He took two naps this way, each lasting around an hour. The orthopaedic resident called back during Malcolm’s second nap to see if there had been any improvement, and I was able to pass on this report.

In the evening, things had cooled off outside enough to take a dusk ride around the neighborhood in his wagon. He seemed to enjoy getting outdoors and even fell asleep in the wagon for a bit. We think the bumps in the pavement may have distracted him from his bodily tremors. Unfortunately, since then, it’s either been raining or way too hot to take him out!

My mom arrived on the scene around 11:00 p.m. on Sunday night, and immediately crawled into Malcolm’s bed in the living room floor. Sleeping on either side of him, we found that if we adjusted his body when he startled, it seemed to buy us more time before the next large jolt. Malcolm continued to spasm and startle, and I don't know if he's just getting used to it, but it didn't seem to upset or disturb him as much as it did the night before. I am just so thankful for her comforting presence.

Monday morning, Jordan had to return to work, and our sweet pastor’s wife and her daughter came by to visit and bring us an amazing salad and grilled chicken for dinner! Monday was a decent day for Malcolm, but Alice was fussy and surprised us all by cutting her first tooth. I thought I felt a bump, and I could hardly believe my eyes when I saw the tell-tale little white dot that is the top of her lower right canine – of all the first teeth to come in! She is truly her own person, and will not be completely outshined by big brother!

The orthopaedic nurse practitioner called Monday afternoon to check in. We reported that his night was better, but still not great, but since there had been some improvement, we felt comfortable keeping our appointment for Wednesday morning, rather than moving it up. The biggest hitch we had on Monday was a tornado warning issued at 4:51 p.m. with orders to seek immediate shelter. Fortunately, Jordan had moved Malcolm’s wagon to the basement after our walk on Friday, so we were able to get him settled in it, then pull him into the basement bathroom! He actually fell asleep while we were waiting for the “all clear” and Alice seemed to think sitting in her bouncer in the shower was kind of exciting!

 This picture and the one below it were taken seconds apart!

Mom volunteered for Malcolm-duty Monday night so that Jordan and I could both get a little rest. We went upstairs around 9:00 p.m. and were planning to watch Games of Thrones together, but I don’t think I even made it through the first scene before I just couldn’t hold my eyelids open anymore. Mom said Malcolm slept pretty soundly from 9:30 to 11:30 p.m., but woke just about every hour after that. Although, even that was an improvement from previous nights.

 This is how Malcolm flexes when we ask if we can have tickets to the gun show!

 Malcolm needed a Band-Aid where they had his IV on his left arm, but he wanted an extra one for his right hand!

Tuesday morning both kiddos seemed comfortable enough to let me pick up the house just a bit. One of my mom’s group friends dropped by with her two kiddos to deliver a present for Malcolm – a fun remote control car he can use while stuck in bed – and enjoy a Chic-fil-a lunch while visiting with us. Malcolm’s appetite has been almost non-existent (about the only thing he wants to eat is applesauce), so I was thrilled to see him gobble down his chicken nuggets and ketchup (with fries on the side ;)). He’d also managed to eat an entire banana at breakfast that morning!

 We made a paper chain to count down the days remaining in his cast!

Right as our friends were leaving, Malcolm’s Uncle Ryan arrived in his cab. After getting him settled in, my mom took the opportunity to rest since she had been up most of the night before. We tried to get Malcolm to nap at the same time, but it was short-lived thanks to continued spasms. Instead, Malcolm taught Ry about all his favorite shows – Blue’s Clues, Wild Kratts, and Super Why. Ryan is going to be an expert in children’s programming by the time he leaves.

Unfortunately, Malcolm’s appetite didn’t last until dinner and, other than a few strawberries, he mostly picked at his food. To get a reprieve from non-stop Blue’s Clues, Jordan and Ryan watched the basketball game in the basement, while mom and I got Malcolm and Alice tucked in for the night. Mom took night shift again, and unfortunately, experienced a night similar to the one I had on Saturday when I originally called her. She reported that he startled almost constantly, that the spasms seemed to last a long time, during which he would hold both hands above his head and ball his fists. She said, even if you added each of the catnaps together, she doubts he slept more than one hour the entire night.

Malcolm had his follow-up with his orthopaedic surgeon at 9:30 a.m. this morning. Since my mom had been with him the last two nights to witness exactly what was going on, I asked if she would accompany me to speak to the doctor, and Ryan could stay with Alice. Before seeing the doctor, they took new x-rays to check his progress. The good news is, the doctor came in and said that the x-rays looked good. She said they always expect a little shifting, but it was well within the acceptable levels for his age. Then she asked us how he’s doing, which is where the appointment went downhill and got frustrating…

We started to explain, as I did above, that he had a really rough night, and truly hasn’t had a stretch of sleep longer than two hours at a time since this happened a week ago, other than the anesthesia-induced sleep immediately following surgery. My mom tried to show her what his arms look like when he spasms, but she immediately seemed to get combative. She said that it couldn’t be that bad because she’s had her nurse checking on us. She made it sound like her nurse has been calling every 30 minutes, when in reality, we hadn’t heard from her since the one time on Monday! I responded that when we spoke with her nurse, it seemed as though there had been an improvement, but that last night it seemed like he had regressed.

She then asked when he’d last had medication and we said that we’d given him the hydrocodone at 6:30 this morning. She jumped on that and said that we should save the hydrocodone until we want him to go to sleep and that now his body is fighting the sedative effect of the medication during the daytime. We tried to explain that he was so uncomfortable and exhausted after getting no sleep last night that we wanted him to have some relief this morning. I’ve been keeping a record of when we’ve administered medication in my phone. I told her we gave him the hydrocodone at 6:40 last night, but he was still having trouble sleeping, so we went ahead and gave Motrin at 10:40.

She asked how he does during the day, and I said that he does pretty well until he tries to nap. One of Jordan’s aunts is a physical therapist and had mentioned that Malcolm’s spasms should decrease as he actively wiggles his feet more and improves his circulation. On the way to the appointment, my mom and I had commented that this seems consistent with what we’ve observed – when he’s active during the day, the spasming happens less, versus when he’s trying to relax and isn’t moving. As I started to mention this to the doctor, all I got out was what Jordan’s aunt had said before she jumped in and said that she disagrees and didn’t let me finish my thought as to why I brought it up in the first place (just that it was consistent with our observation). As I left the appointment, I started to wonder if she thinks I’m moving his feet at night or something and that’s keeping him awake. I just felt like she wasn’t listening!

She then went on a rant about how if he’s doing well during the day we don’t need to be giving him medication. She didn’t even give me the opportunity to tell her that we haven’t been dosing him unnecessarily, or bother looking at the record I provided to see that before the 6:40 nighttime dose, he hadn’t had anything since 11:00 a.m. and before that 4:30 a.m.!

She agreed that what we were describing did sound like muscle spasms, and said that we can treat the spasms separately from the pain, which I agreed was good. She prescribed Valium for the muscles spasms, and instructed us to give the Valium with the Motrin just before his naptime at 1:30 and his bedtime at 7:30, and to just use the hydrocodone if he wakes up in the middle of the night to help him get back to sleep. As she was explaining this, Malcolm, who was sleeping in his wagon, seized up with a spasm. I pointed and said, “oh, did you see that?” and the doctor pointed at her eyes and gruffly said, “stay with me here.” By that point I was pretty fed up.

I honestly think a lot of her poor bedside manner had to do with overscheduling. As we were checking into the appointment, three other patients checked in to see her as well. We were literally with her for less than five minutes. She just seemed like she was in a hurry and couldn’t be bothered to actively listen to our concerns. Instead, she just picked up a few pieces of what we said that she seemed to disagree with, rather than getting the big picture. I know that she sees a lot of patients in a day, and probably deals with this all the time, but I’m Malcolm’s mommy and he’s my top priority, and he deserves her full attention when we’re there for his appointments. I know I look young (but even young moms deserve respect), but I’m an attentive mother and I’m the one laying with him, stroking his hair, holding his hand, listening to him scream, and feeling his pain 24-7. I have two advanced degrees and I’m not a complete idiot and am capable of carefully listening to and following her instructions AND noticing my son spasming without being reprimanded like child.

That’s another unfortunate aspect of an emergency situation is you don’t have the opportunity to go shopping for physicians. This is the first negative experience I’ve ever had with a Loyola physician (I love, love our pediatrician and the pediatric urologist who performed Malcolm’s two previous surgeries), so I’m going to try to give her the benefit of the doubt and assume that next week will be better. At the end of the day, she did prescribe a medication for the spasms, which was my main concern, so the end result was what I wanted, but I would’ve appreciated a bit more sensitivity on her part.

I am happy to report that we filled the prescription, gave it to Malcolm, per her instructions, before his nap this afternoon, and he is STILL sleeping – PRAISE THE LORD! He’s been asleep now for about two and a half hours, and only spasmed three times, but they haven’t been bad enough to fully wake him! Thank you all for your continued prayers!

Also – Happy fourth monthiversary to Alice Jane!!! One of these days I’ll write out her birth story!

Saturday, June 13, 2015

Malcolm and the Hip Spica Cast

Most of you know by now that our lives changed on Wednesday. Malcolm, Alice, and I participate in a “mom’s group” Bible study through our church. We are officially on “summer break” and forgoing the study in favor of outdoor fellowship activities. Wednesday was a beautiful morning, so we’d met three of the other moms and their kiddos at one of the girl’s houses in University Village and walked the mile and a half to Ping Tom Park in Chinatown. After about an hour and a half at the park, we started walking back to the car.

We have a Graco Ready2Grow stroller and had it set up in the Stand and Ride configuration, so that Alice’s car seat was clicked into the front and Malcolm was standing on a built-in platform on the back, both facing me. The platform is set up so that it’s inside of the stroller handle and he has the option of sitting on a jump seat with his back to Alice’s car seat. Malcolm was standing in this position as we were walking when I realized that my shoelace had come untied. When I bent down to tie my shoe, Malcolm stepped off of the platform with his right foot. When I stood back up, I didn’t realize he had done this and immediately started to push the stroller again. This caused him to go into a split. His left foot remained on the platform and his leg twisted around behind him in an unnatural way.

He immediately started crying and I picked him up to console him. After, “oh my gosh, oh my gosh” I think my next words to my friends were, “I think he just broke his leg.” One of my friends was standing right next to me when it happened and said she also noticed that how his leg twisted looked particularly bad. I stood for a few minutes trying to comfort him and deciding what to do. He actually did calm down somewhat and it wasn’t immediately swelling, so I second guessed the severity of it and we did decide to go ahead and walk to the car, rather than try to get one of our other friends to drive us or call an ambulance. In hindsight I’ve second guessed this decision, but when I verbalized this to my cousin and mother they were both quick to point out that his leg wouldn’t have been any less broken either way.

I strapped him into the jump seat for the 20 minute walk, and he wasn’t crying, but he did quite a bit of sniffling as we made our way. When we got to my friend’s house, she ran in to get some ice and I took him out of the stroller to see if he would stand. I noticed even carrying him that his left leg seemed completely limp and sure enough he would not put any pressure on it and began shaking. I called his pediatrician’s office, gave a brief explanation of what happened, and asked if I should head straight to the emergency room or come see them. This was about 11:40 a.m. and they said they could get him in at 12:40 p.m. As I was downtown and his pediatrician’s office is by our house, this timing sounded just right, so we loaded up the car and headed directly there. I think Malcolm was in shock, and he actually dozed off for a few minutes on the way there.

I really have to hand it to Loyola for the way they handled the whole thing! They called us back to see the doctor almost as soon as we walked through the door! I held him so he could be weighed by the nurse (although, sidenote, at first she asked him to stand on the scale, and I was like, “you know why we’re here, right?”), and the doctor came into the room just moments after the nurse took his vitals. I recounted the story to her and she suggested we take his shorts off to get a better look at the leg. That was the moment I knew without question that it was broken. His left thigh was literally bent. The doctor said that based on what I told her, and looking at the leg, she suspected that he had a spiral fracture in his left femur. The x-ray technician was already with another patient, so we had to wait just a few minutes before they took us back. Naturally, Alice was getting upset. I managed to feed her while we were waiting and then passed her off to a nurse so I could take Malcolm back to be x-rayed.

I had called Jordan on the way to the pediatrician’s office to let him know what happened, and fortunately he wasn’t teaching a class this week, so he was able to head home immediately. We share a car, but our pediatrician’s office is only one mile from our house, so (also fortunately) he was able to run over (not so fortunately – in 90-deg heat). Jordan arrived on the scene right as Malcolm and I were going back into the exam room after the x-ray and was able to take Alice from the nurse. (Jordan adds – Alice was crying inconsolably in the nurse’s arms, and he followed the sounds of her cries to our room. He also added that there were multiple babies crying, but he recognized her cry specifically.)

The doctor came in to tell us that the x-ray confirmed her initial suspicion. She had called ahead to the orthopaedist at Loyola hospital in Maywood and they were expecting us at the ER. Jordan and I had to decide who would take which child. Alice is not quite four months old, and still exclusively nursing, but fortunately, I have over 300 ounces of pumped milk stored in our freezer (a story for another time) and she will take a bottle if needed. The pediatrician cautioned us that, although she completely believed, based on the way I had recounted the events and my responses to her questions, that I was telling the truth about the injury, spiral fractures are often indicative of abuse and someone else could potentially feel the need to report it. Since I was the one that witnessed the whole thing, I wanted to be the one to explain what happened to the medical staff (and holy moly – I had to tell the story at least two dozen times). Also, my scared mommy instincts were running full force and I just plain didn’t want to leave him, so we decided to drop Jordan at the house with our girly.

I am so glad we saw the pediatrician first because they were expecting us at the ER and I didn’t even have time to text Jordan that we’d arrived before they called us into triage. He seemed somewhat comfortable in the position I was holding him, and he cried a lot when he had to be moved for the orthopaedic residents to apply a plaster splint. We were told that the fracture would not require invasive surgery, but he would have to go under general anesthesia for the procedure to reset the bone and apply the hip spica (pronounced spike-uh) cast (the first time I’d ever even heard those words). The orthopaedist said that the first night is the hardest and they like to observe how the injury is going to swell before applying the cast, so we would be admitted to the pediatric unit overnight.

The nurses had been told a two-year old with a fracture was on the way up and had already supplied the room with a cute puppy pillowcase, a stuffed turtle ball, a Teenage Mutant Ninja Turtles coloring book, and crayons! When we first arrived in the peds unit, we were in a shared room, but when they found out I am a nursing mom and would need to pump, they rearranged things so that we could have a room to ourselves, and even provided me with a hospital-grade pump and offered to store the milk I pumped during our stay! Malcolm completely won the nurses over doing his dinosaur roar, and he didn’t even cry when they put in his IV, even though they had to do it twice since it slipped out of the first arm!

The friend who was next to me when the accident happened offered to come by and stay with Alice for a couple hours, so her husband could run Jordan up to the hospital to see us and get the car. (She actually offered to take Alice before we even left for the pediatrician, but I hadn’t figured out the breastfeeding logistics, so in that moment it seemed better to take her with me for the time being.) She sent Jordan to the hospital with an entire bag full of Panera food and goodies for us to enjoy! (I seriously have the best friends!)

The first night was extremely difficult, as promised. Malcolm woke up every 15 to 30 minutes, crying out in pain, discomfort, and/or frustration. By morning, he was completely hoarse from crying. He was frustrated by the television because he didn’t understand that we just had to watch whatever was on and the hospital wireless wasn’t strong enough to support Netflix on his iPad. The television actually had a VCR mounted below it, so we didn’t even have the option of watching DVDs (even though when we asked for movies, that’s what they gave us, so riddle me that one). He was also very frustrated with the foam cuff covering his IV, which limited the use of his left hand. I was encouraging him to eat and drink up to the midnight limit, and he wasn’t very interested, but naturally around 1:00 a.m. he told me he was hungry. We FaceTimed with Jordan in the morning and Malcolm told him he was “all done” and attempted to sit up and leave. Heartbreaking.

In addition to feeling completely helpless and heartbroken that he was in so much pain and has a long recovery ahead, I was feeling overwhelmed and in mourning for our summer. Malcolm spent the long Chicago winter stuck indoors, and now he’ll be watching summer from the sidelines. He just got a slide for his second birthday that he won’t get to use again for months! That may seem trivial, but it’s just one example of things my busy, busy toddler will be missing out on. Additionally, we had a trip to Dallas planned in a few weeks that is now cancelled because he can’t fly. I was also dealing with guilt because I’m the one who moved the stroller, causing him to lose balance. I’ve never wanted a do-over, so badly in my life! I would give just about anything to go back to that moment and say, “Look out, he stepped off the platform!”

Because we were an add-on to the schedule, we weren’t exactly sure what time Malcolm would be called back to the OR, but they assured me that they would try to get him in as early as possible. At about 7:00 a.m., the orthopaedic residents came in to tell me they would be taking us back in half an hour. We met with the orthopaedic surgeon for the first time outside of the OR. She said it’s like a 50-50 shot of the bones shifting in the cast and potentially having to reset it again. They expect that he will be in the cast six weeks from the date of injury, and during that time we’ll have frequent appointments with her to update his x-rays to check, and we’ll continue to see her for two years to monitor his development. She said that because his body will increase blood flow to the injury as part of the natural healing process, there is a chance that over the next two to three years, the injured leg with grow longer than the uninjured leg.

After the procedure, the surgeon told me she was very pleased with the way the bones reset and that he even has a little “wiggle room” if they shift slightly. She said that one of the trickiest things about this type of cast is keeping it clean, particularly with a child in diapers. The cast covers his entire left leg above the ankle, connected to his right leg with a fiberglass bar, casted just above the knee, and reaches all the way up his chest, stopping just below his armpits, except for a hygiene opening in the groin area. We have to lift him up and tuck a diaper into the edges of the groin opening. The surgeon recommended reclining him so that urine and waste doesn’t go up his back and seep into the cast. She said that because a child has to go under anesthesia to apply this type of cast, she will not replace a cast just because it’s stinky (adding that she doesn’t have to smell it and the kids kind of become nose blind anyway, so it’s a sort of penance for lazy parenting). The nurse recommended lining the diaper with ABD pads as another moisture-absorbing layer to prevent leaks and so far that is working like a charm. The surgeon told us that the best way to minimize the risk is changing his diaper by the clock every two hours while we are awake. Obviously, he can’t have a traditional bath, so she also recommended that we take baby wipes and rub down as far as we can reach into the cast through the openings once a day to clean him.

I think maybe the hardest moment of this entire experience, so far, was when they called me back to see him in recovery, and the first thing he did was reach out to me, but I couldn’t pick him up. I truly felt like I was failing him. The nurse did adjust him so that I could lie down next to him, and then he fell asleep while they continued to monitor him. After being intubated, and already being hoarse, he was making a somewhat croupy/wheezy sound, so they gave him a breathing treatment. When they got him settled back in his pediatric room, I called Jordan to meet me at the hospital with Alice, so we could trade off for a bit. I hadn’t been home since we left for the park, so I was still covered in sunscreen and dried sweat, and wearing a tank top and shorts!

Alice, bless her little heart, cooperated so I was able to take a quick shower and nap before my sister Sarah arrived! My angel of a sister offered to come for a few days to take over infant duty, so that Jordan and I could both be at the hospital and focus our attention on Malcolm. She took a cab from the airport, and when she walked through the door I immediately bombarded her with instructions for Alice and then left her high and dry to go back to the hospital ;). Fortunately, Malcolm slept almost the entire time I was gone and was just waking up to eat a little dinner as I walked in the room.
 Alice crashed on Aunt Sarah's shoulder after a bottle.

The second night was a slight improvement. He still startled frequently, but I think he was still groggy enough from the anesthesia that he fell back to sleep faster. I was also able to lie in the bed with him now that he was in the cast rather than the plaster splint, so each time he startled I would run my fingers through his hair or hold his hand, which also seemed to help him relax. The only trouble we ran into is the croupy wheezing seemed to come back in his sleep. The nurse brought a pediatrician in to examine him, and they decided to administer an oral steroid, which seemed to do the trick.
 Project Linus gifted Malcolm this precious blanket!

The physical therapist came to see us in the morning and instruct us on how best to manage him. He’s already doing a great job of moving his uninjured leg and wiggling the foot of his injured leg, but if we notice that he’s not moving enough, we’ll need to bend it for him. She talked to us about lifting him, changing his position frequently to avoid pressure ulcers, particularly on his heels, checking his skin around the openings of the cast for irritation, and positioning him in a wagon for transport. She said she obviously can’t do a full evaluation of him in the cast, but when it is removed we will be following up with outpatient appointments to work on regaining mobility (we’ve been warned that walking may not happen for a few months after the cast is removed even).

The biggest hurdle from being discharged from the hospital was obtaining a special car seat approved for use with hip spica casts from social services. We were very relieved to find out that they were able to track one down, and it would not delay him starting his recovery at home. The social worker who delivered the car seat and instructed us on its use was amazing! He was so upbeat, knowledgeable, and clearly deals with this all the time! There are two different types of spica restraint: the car seat, and a harness. The car seat is preferable, but all spica casts are different and they don’t all fit. We were thrilled that Malcolm fit in it like a glove. The only drawback was the positioning of his injured leg did not allow for rear-facing, which would’ve been even more ideal, but the surgeon had already said that we shouldn’t be driving other than to doctors’ appointments, so he won’t be out often as it is. The social worker helped Jordan install the car seat, the nurse brought in a wagon for us to load him in, and we were out of that joint!

When we walked in the door of the house, I was immediately overwhelmed again! My sister-of-the-year had gone to the grocery store, cooked dinner, cleaned our kitchen, done two loads of laundry, made our bed, made a precious “welcome home” sign, AND taken perfect care of our almost-four-month old. I was already emotional and just broke down in tears thanking her.

After we unloaded the car, and got Malcolm temporarily settled in his bedroom, Sarah, Alice, and I ran a few errands to stock up for the long haul. We started at Buy Buy Baby to get some Size 3 diapers and overnights, which fit better in the cast. The nurse had also recommended covering the outside of the cast with a cloth diaper or diaper cover, so we picked some up, but unfortunately they’re just too small. If someone with sewing proclivities (I know, I know, I sew, but definitely don’t have time) is inclined to create some sort of snap-on or Velcro large diaper cover I would owe you one big, huge, giant, favor – and I’d be willing to pay too! We also picked up a travel magna-doodle, which has been a huge hit during our first full day home.
Here's Malcolm, clutching his magna-doodle in his sleep. 

Next stop was Bed, Bath, and Beyond, where I don’t think I’ve ever spent so much money on pillows! We moved our futon mattress up from the basement onto the living room floor, so he can watch TV, and we bought wedge pillows we tucked under a fitted sheet to create an incline. We also purchased an armchair-style pillow, and two memory foam contour pillows, which have been great to support his legs. We dropped off his prescription at Walgreens on the way home, where we also picked up the ABD pads.
 Here he is, settled into his living room spot!

He figured out that he can use the cast as a road for his cars.
In addition to his baby wipe bath last night, Jordan held Malcolm over a shallow bucket so that I could wash his hair, face, and arms properly. Malcolm cannot be left unattended in this cast, so Jordan took couch duty last night so that I could try and rest in our bed upstairs, since I bore the brunt of the sleeplessness the first two nights. His night was good, but not great. He continues to spasm and wake himself every two to three hours, and it was after midnight that he fell asleep at all. The spasms have continued to be a problem this afternoon. I read on a hip spica cast forum that some orthopaedists will prescribe something to help with the muscle spasms, so I went ahead and e-mailed ours to see if she has any suggestions. Our biggest prayer request currently is that we can get these spasms under control so that Malcolm can sleep more soundly. Rest is so important to healing and he’s hardly getting any!
 This was after his first bath.

 Alice and her favorite Aunt Sarah! The night I got home, she didn't want me to rock her to sleep, she wanted her auntie!

Our sweet friend, Amanda, was Malcolm's first visitor tonight when she delivered dinner for us and a cool sound book and car for him! 

So if you’ve read this far, you must really love us ;). We’re trying to look on the bright side and take things an hour at a time! We have been able to find a few blessings in this already! I’m so glad that Alice is SUCH an easy baby! She’s been sleeping through the night for quite some time and is generally entertained as long as someone is in the room and talking. There is still the challenge of nursing her every 2-3 hours during the day, and now changing Malcolm’s diaper and position every 2 hours, but it could be much worse.

Thank goodness I am a part-time-work-from-home/full-time-stay-at-home mom! I don’t know how you would do this otherwise without hiring a full time nurse or taking a major FMLA hit! I am thankful that we have great medical insurance, so that this injury is not going to bankrupt us. I am thankful that my husband works for a progressive, compassionate company, that hasn’t questioned his using sick days to tend to his injured child. I am thankful for our HUGE support network that has reached out with truly staggering offers to help and prayers. I am thankful for my parents who arranged for Sarah to come help me and for delivery of a spica chair, which will greatly improve Malcolm’s quality of life the next six weeks! I am thankful for my brother-in-law, Ryan, my Aunt Angie, my youngest sister Molly, Jordan’s parents and step-parents, all of whom are taking shifts to help me while Malcolm has his cast on. I’m thankful to my Aunt Karen, Grandma, and amazing family friend Jane, who have all offered to fill in if needed! And maybe the biggest gift in all of this is that Malcolm will fully recover, and probably have no memory of it! It is strange to think that something that happened in an instant will have consequences for 2+ years, particularly when he’s only two years old, but this is not a cancer diagnosis and the doctors have assured us it will not even affect his development!