Well I've been trying to find time to post this for a couple of weeks now ...

To my delight, Alyssa's knee was NOT dislocated/ing when she walked. To my absolute HORROR, it turned out that her LEG WAS BROKEN! :-/ She must have cracked her upper Tibia at some point in the few days leading up to the day that her leg started bowing upwards, and gradually the fractured area continued to spiral round her leg ... until it had no choice but to give way completely! And that was actually what was causing her leg to bow outwards. Every time she put weight on her foot, her leg bone was coming away from the knee joint from the sheer pressure. To anyone else, that would have been absolute agony .... ! Alyssa on the other hand was still more concerned that someone with cold hands would want to examine her! :-/ A broken leg?? Sure, no problem! Touching her with cold hands? I don't think so!!! *sigh*

Basically; I got her up to the paediatric hospital the day I wrote the last post and we saw a really cool orthopaedic consultant (the one who was overseeing her Charcot foot was off on holiday). He asked her to stand and assessed her hips, knees and ankles, then asked her to walk back and forth across the room for him. He said immediately that her knee was not dislocated, but that he thought she had some sort of deformity ... but that I was right, and that whatever was going on, the problem was definitely at her knee. But being such a thorough guy; he wanted to check her entire alignment, so ordered knee x-rays but also a full scan of her legs from ankles to hips. And I saw the look of utter shock on his face when the registrar told him that there was actually a fracture just below Alyssa's knee, once the xrays were back. It probably mirrored mine! Although I was certain that it was her knee that was the problem, I honestly didn't expect a fracture. But the previous day's low-grade fever suddenly made sense ... especially with her having no other obvious symptoms! As did the completely random and (seemingly) insane comments made by Alyssa in the preceding days. Such as "muuuuuum! My leg is moving! All by itself!" :-? And "My ankle hurts! It's really itchy!!! (whilst tearing at her ankle) So presumably, some sort of shooting nerve sensation was being felt, when she was lying in certain positions.

NOTE TO SELF: PAY IMMEDIATE ATTENTION (WHILE HEART SINKS) THE NEXT TIME ALYSSA MENTIONS THAT SOMETHING IS MOVING ... ALL BY ITSELF!!! ESPECIALLY IF ACCOMPANIED BY A FEVER, HOWEVER SLIGHT!

After discovering that the leg was broken, the consultant and I had to have yet another debate on what we do about it. I voiced my concerns about casts and pressure sores etc (as well as my knowledge that kids who don't feel pain will almost always cause OTHER fractures, just because they are in casts ... because they don't favour them in any way. And stomp about on them!). The ortho pretty much confirmed what I already knew however; that because of where her leg was broken, there was unfortunately no choice. As her leg was snapped directly below the knee joint; it was extremely unstable (probably because she'd also walked about on it for a few days too!), and the only way to immobilise it so it could heal properly was to put her in a full-length leg cast. He immediately asked if I would be happier with weekly changes, to which I replied that I would. And that I would probably still be paranoid, but I felt that was best until we see how she gets on with it. We discussed her mobility and agreed that it was best - for THIS problem - that she not move about on it at all. Especially crawling (like she'd been able to do with the Charcot foot) because that would most likely result in pressure sores on the injured knee. Sadly; the longer she is immobilised the more likely it is that her joints/bones/muscles will weaken, leaving her even more prone to fracturing something else as soon as she is mobile again! And it's probably how this happened in the first place, by being immobilised to protect the Charcot foot.

The first week in the cast were a learning curve for us both. With me having mini heart attacks at her lying on her back on the floor, but slamming her cast down onto it at the ankle! Or swinging it about in order to turn round on the floor, and me wondering if she was going to dislocate her poor hip, with the speed and force she used ... ! It was a tad stressful! It was also very stressful for Alyssa. She hated the cast more than she ever even cared about the broken leg for a start! She didn't like getting it on (the water dripping on her while they cast it, the intense heat involved while it set! and it catching her in the groin area when she turned her leg inwards), but she didn't like how awkward it suddenly made her leg either. And - as she didn't feel the pain of the broken leg in the first place - she really didn't understand why she had to have it! She asked me repeatedly the day after the cast was put on if it "was all better yet?" and if I could just take it off now please! But she gradually got used to it over the first week, and we both began to calm down about it. She did love that the nurses had let her choose a PINK one! And she loved showing it off! Apart from some minor issues with it rubbing her groin and getting some extra padding, we escaped fairly problem-free. So although I was a bit freaked out at the suggestion this week that we change to fortnightly cast changes (my automatic panic response when I worry that someone isn't understanding ALYSSA properly), I understood why they wanted to do that. Partly because most children don't have them changed every week, but also because of how distressed she gets whilst having it removed. She absolutely HATES the sensation of the saw on her leg (and says it hurts!), then she wants to practally skin herself because her leg is so itchy when the cast and padding are removed. And I spend the entire time it airs while they decide on what to put back on it both trying to calm down what seems like the most hysterical child in the world, and simultaneously trying to stop her RIPPING all her leg skin off! And we KNOW she WILL do that, like she's done in the past to other areas.

However. Again; to my shock and dismay after a successful week, we discovered that she has pressure sores already after week 2 of the cast! :-( And that is despite NO walking on it whatsoever. She is standing on it briefly, but only when she goes to the toilet and she is physically unable to get up on it by herself so she can't be standing on it even once she's in her special padded bed. And she has still managed to get pressure sores. Her heel has the worst one, and the upper surface of her ankle has abrasion marks. So she must be wiggling her foot back and forth inside the cast, because that's the only way she could be getting pressure marks from her cast. Fortunately, they are both only surface wounds at the moment. And obviously she will now be back again next week for a recheck! She has had dressings applied over the wounds, fluffier padding put on, and a thinner overall cast layer applied. That was not only to help reduce the swelling whilst keeping the leg aligned, but also because the nurse was trying to reduce the amount of intense heat caused as the cast set on her leg. That nurse was brilliant, and really understood Alyssa's hypersensitivity to temperatures!

So now we have to just wait and see what Wednesday's visit brings, and hope that the wounds have healed, or at least are no worse. I'm going to be even more paranoid when Alyssa IS allowed to walk on her leg again now. And we still need to have the Charcot foot re-xrayed, to see if it has fully healed yet or not. Although she's not yet walking about or doing much standing, I'm reluctant to let her go about without her support boot on until I know it has healed completely. It's still a bit more swollen than it was before she injured that one, but for all I know that could be it's new normal. It may never get better than that. Hopefully we'll also get this one x-rayed this week and find out how it's getting on too. Then I just have to let her poor physio know about both! She doesn't know about the broken leg yet, because she's been on holiday since Alyssa did it! Oh the joys! ;)

Despite it all, Alyssa continues to smile, laugh and entertain us all with her wicked sense of humour and fabulously fun personality. She certainly is one very special little girl! :)