How to Care for a Family Member with a Cast

How to Care for a Family Member with a Cast
by Patty

What to look for and when to call the doctor or go to the emergency room

The Broken Foot Necklace - Slashpile Designs
Most families have at least one member that has had the unfortunate experience of breaking a bone. Children can fall out of trees, off playground equipment, or down a rocky hill. Adults can fall in a variety of ways such as falling off a ladder, slipping in a tub, or on the proverbial banana. Whatever the cause of the fall or the age of the person, there are certain basics that are important to know when a cast is applied.

Sock Monkey Cast Cover - Darkhorse Artwork
As with any broken bone a trip to the emergency room is a must. With a fresh injury, a plaster cast may be applied first, and then as the swelling subsides, a fiberglass cast may be applied later. A stockinette is first applied over the skin to provide protection, then padding is applied next to pad bony surfaces and to help prevent pressure areas and skin breakdown. Plaster casts are not waterproof and therefore should not be allowed to get wet under any circumstances. On occasion a broken bone may penetrate the skin or is not reducible (put back in place) by external manipulation and requires surgical intervention. If this is the case, post-surgical bleeding would be expected. This may require a window to be cut into the cast in order to provide a way to change the dressing over the wound. Fiberglass casts are waterproof and won't disintegrate when wet, but do not get any cast wet without your doctor’s permission. The casting material comes on a roll that is dipped in water. This causes a chemical reaction, which may cause a warm sensation on the skin. Avoid putting pressure on the cast until completely dry. The cast needs up to 48 hours for the drying process. When a cast is applied, do not leave the emergency room if you have any sharp or rough areas around the edges that are causing irritation.All of the edges should be thoroughly padded to prevent redness or infections.

Typically, there is swelling present when a bone is fractured. This blog does not address emergency care of a fractured bone. After cast application, it is very important to keep the limb, arm, or leg elevated to help reduce swelling and to prevent further swelling. Swelling may cause very serious complications and must be managed correctly. Keeping the extremity elevated above the level of the heart will facilitate a reduction in fluid buildup. It will not take long to find out that hanging a casted leg or arm down (dependent position), causes swelling and pain. A sling will provide needed support and elevation for the casted arm. Multiple pillows offer a way to keep the casted leg elevated.

Arm Cast Cover - Coveroops
There are" five P's" to observe with any cast application:

PAIN - It is expected that intense pain would be present with any fracture. Casting the area and therefore getting the bone ends in alignment can reduce discomfort as the bone has been stabilized, but pain can still be acute for a couple of days. The physician may prescribe pain medication for a short period of time. More complex fractures may cause extended pain depending on the need for surgical procedures.

PALLOR - Pallor is an absence of normal color. Fingers or toes may appear pale, lacking in color. This may be an indication of poor circulation to the area usually due to swelling.

PARESTHESIAS – This is a sensory loss such as numbness or a tingling sensation. Paresthesias can occur from compression of a nerve, from swelling, or from pressure. These symptoms should be taken seriously and a doctor should be called.

PARALYSIS – This is an inability to move the extremity. There may be nerve compression and this should not be ignored.

PULSELESSNESS - When feeling for the radial pulse (at the wrist) or the pedal pulse (on top of foot approximately 1 ½ inches above the toes), no pulse is felt. Look for a bluish/gray color to the nail beds. If you press on the nail bed and it does not blanch (lose color) and refill with a nice pink color, this would indicate lack of circulation or at least poor circulation. This needs immediate attention. Note that sometimes the pedal pulses are difficult to assess unless you are trained to palpate (feel) these. In this case, look at the nail beds for that nice pink color. If the nail beds are pink, blanching, and refilling well, the circulation is most likely fine.

Crutch Pad Covers and Hand Grip Set - Myscap
Use common sense when taking care of a casted limb. Never put something down into the cast to “scratch” itchy skin. One of my former patients used a long comb to scratch inside of their cast. The comb fell down into the cast and they were unable to get it out. They ignored the problem and did not tell anyone. When the cast came off, there was a large ulcerated sore in the shape of a comb where the comb had pressed on the skin for weeks. As you can see, it is very important never to put any object into a cast. If an object does inadvertently become lodged in a cast, seek medical attention.

Crutch Pouch Purse - Bella By Mary Heath
If your child complains of itching, try using a hair dryer set on COOL to blow air into the cast. A fiberglass cast will allow the air to circulate soothing the skin. 
If the skin remains wet or perspiration causes too much moisture, this may result mold growth or a possible infection. If having a problem with wetness, call the MD.

Keep all doctors’ appointments as your MD may notice something that you don't notice that needs attention.

Never walk on a leg cast before the doctor gives permission. If you have a leg cast, a special heel is applied to the plaster (walking cast) or a special cast boot will be provided. DO NOT WALK on the casted limb without specific permission from the doctor. If the bone is not healed adequately this could cause major complications. Crutches or a walker would be necessary when the physician orders NWB (non-weight bearing) or PWB (partial-weight bearing). Avoid full weight bearing until given permission.

Crutch Necklace - Sterling Silver Charm - Treasured Charms
When it is time for the cast to come off, often people are afraid that they will get cut from the circular blade. It appears that the blade is whirring around in a circular motion, but in reality the blade does not turn in a circular motion, but vibrates at a very high speed side to side, thus making it very safe. Also don't forget that there is thick padding under the casting material. Once the cast is removed the extremity may look pale, thin, and have a dry or scaly appearance to the skin. This is normal as it has not been exposed to the sun, the muscles have not been used as normal, and there is an accumulation of dead skin cells that would normally have been washed off with bathing.
This information is not intended to replace your medical practitioners care. There are more in-depth complications that were not covered here. Always consult your physician with any concerns or questions you may have.


Staying in Love: Part 2

Staying in Love: Part 2

By Brooke Shambley

Jesus taught the disciples about faith in the parable of The Wise and Foolish Builders.  However, when Jesus speaks of building our house upon the rock and not upon the sand, I often think about how applicable that message is to marriage.  Here is the parable account:

Matthew 7:24-27
24 “Therefore everyone who hears these words of mine and puts them into practice is like a wise man who built his house on the rock. 25 The rain came down, the streams rose, and the winds blew and beat against that house; yet it did not fall, because it had its foundation on the rock. 26 But everyone who hears these words of mine and does not put them into practice is like a foolish man who built his house on sand. 27 The rain came down, the streams rose, and the winds blew and beat against that house, and it fell with a great crash.”

When it comes to staying in love, it absolutely matters what type of foundation our marriage is built on.

A beachfront house threatened by erosion - by Dirk Frankenberg
Type 1: Marriage Built on Sand

Many types of sand exist in marriages today.  Some have to do with the initial forming of the marriage, some have to do with existing problems in a marriage, and some have to do with marriage habits or lack thereof.  A marriage built on sand is unstable, unfulfilled, and when the storms come that marriage may not stand.

Sand of Selfishness - Why did you get married?  Ouch, that's a hard question, right?  Sometimes our motives aren't what they should have been when it comes to marriage.  Maybe our spouse was a major hottie or maybe they made us feel like a better person.  So many reasons to get married exist: to remove loneliness, to have companionship, to make our life better, to have children, to marry the hottest girl/guy, or maybe to be taken care of by someone.  While it might seem that most of these reasons are just fine (minus maybe marrying the hottie), they are all selfish motives.  We need to let God remove the sand of selfishness from our marriage.

We may have gotten married for selfish reasons, but God still has amazingly wonderful plans for our marriages!!!  Remember the verse Romans 8:28? "And we know that for those who love God all things work together for good, for those who are called according to his purpose."  As a couple, you have to seek God to renew the purpose of your marriage.  In Jeremiah 29:11-13 (NIV 1984) God says, "For I know the plans I have for you,” declares the LORD, “plans to prosper you and not to harm you, plans to give you hope and a future. Then you will call upon me and come and pray to me, and I will listen to you. You will seek me and find me when you seek me with all your heart."

Pray to the God who has plans for your marriage, plans beyond what you may have thought for your marriage.  Allow Him to hold the reigns for your marriage and see Him convert the sand of selfishness into the rock of his will.

Sand of Relationship Sin - The second kind of sand that many marriages are affected by is that their relationship is already in sin.  So many couples begin their marriages from a life of sin.  The movies show that living together is only natural and being intimate before marriage is merely a part of deciding if that person is right for you, but the Bible is very clear that this is not God's plan.

Let me let the Bible speak for itself.  2 Corinthians 12:21 (ESV) says, "I fear that when I come again my God may humble me before you, and I may have to mourn over many of those who sinned earlier and have not repented of the impurity, sexual immorality, and sensuality that they have practiced."  Also Hebrews 13:4 (ESV) states, "Let marriage be held in honor among all, and let the marriage bed be undefiled, for God will judge the sexually immoral and adulterous."

May I be clear that God is ready and able to take this sand of sin and turn it to stone?  God is a beautiful redeemer and can take a marriage that has been built on the sand of sin and bring it to stone that is mighty in His strength.  However, as 2 Corinthians 12:21 mentions, a couple that begins in sin must repent before God to be renewed.

Sand of Good Intentions - Just because we may have married for the right reasons and didn't have a sinful relationship before marrying doesn't mean we are still operating in the right spirit.  Often we go into marriage expecting ourselves to be the best spouse ever and one day the best parent ever.  We also expect our marriage partner to be everything we ever wanted from a spouse.  At this point, we are victims of the sand of good intentions.

We must sacrifice our good intentions to the cross as well as our expectations of our spouse.  A marriage doesn't operate on what should get done or the love we intend to show.  A good marriage happens because of what does happen and what love we actually show.  Let yourself be the spouse that God intended, not the spouse that you expect yourself to be.  In addition, let your spouse be the spouse that God intends, not the spouse that you expect them to be.

The sand of good intentions can be transformed into a stone of reality.  God can take our hurts of expectations not met and show us that He has met our expectations all along.  He also helps us to show our love, display our love, and be vessels of his love to our spouse.  Give up your expectations of yourself and your spouse and allow God to pour out his love into your marriage.

Dar al-Hajar - by Yemeni
Type 2: Marriage Built on Rock

Rock of Salvation - I will be completely honest with you.  You will not have a fulfilling marriage built on stone, if you have not given your heart to God.  He is the only one who can bring you fulfillment and if you are looking for emotional fulfillment anywhere else (including through marriage) you will never find it. 

By giving your life over to God and committing your marriage to his will, your marriage will become built on his purpose and his rock of salvation.  That's not to say you won't have issues, we all do.  However, if we stop relying on our spouse and rely on God as our source of love, the expectations that we have been laying on our spouse will become areas that God's grace can cover.  God is perfect, our spouse are humans and sinners.  Rely on God and minister to your spouse in love.  Amen.

Staying in Love on the Rock of Salvation

When we allow God to redeem our marriages from the sand of relationship sin and the sand of selfishness and we accept the salvation God offers for our hearts, God can be the power pack of our marriage.  Staying in love doesn't have to be a human effort, rather God can supernaturally work in our marriages!!!  I'm not saying it's going to be easy, I'm not saying it's going to happen in a day, but when we begin to let God build our marriage on the rock He can and will do miracles.

Staying in love means relying on the source of love, our God who is love.  Commit today to staying in love with your marriage partner by laying your life and marriage relationship at the foot of the cross.  Allow his redemption to redeem your heart and your marriage, his rock of salvation is the only foundation on which to build your marriage.