Saturday, 2 March 2013

Getting the Plaster Cast Changed

If you've read the last couple of blog entries, you'll know that I had surgery at the end of January. It was a planned operation to fuse one of the joints in my left thumb (the metacarpophalangeal joint).

One of the thing that I mentioned beforehand was that I was trying to prepare myself for the pain to be more than I anticipated. Despite the preparation, the pain was still more than I had anticipated, not helped by the fact that I don't respond to local anaesthetic, which was the preferred method of pain relief for my anaesthetist that day.

The surgical cast (an untidy mix of plaster of paris, crepe bandage and lots of tape) was removed after 2 1/2 weeks so the surgeons could check the wound and check x-rays. I asked the plaster technician how long I had out of the cast. The answer? About a minute and a half. He advised that I get my 'kit' ready while he was cutting the cast, and he'd cover for me while I washed my arm!

My kit? The same kit that I use for all plaster changes, regardless of which limb is currently plastered!

- Simple cleansing wipes
- Liz Earle toner spray
- Soft cotton flannel (brand new or freshly-washed)
- Moisturising cream (the richer the better - Epaderm is my choice)

The plan:

I use the cleansing wipes to clean my arm, removing all traces of iodine, chlorhexidine, sticky residue from the dressings, and dried blood. After couple of weeks under wraps, there's plenty of dry skin too, and the chance to rub at some of the itchy parts is blissful! Alcohol wipes are good at removing sticky residue, but are harsh on the skin. There is a time and a place for harsh chemicals and violent scrubbing. In between plaster casts is neither.

Once the arm is clean, use the dry flannel to exfoliate and gently buff away some of that dry skin. I promise this isn't just a cosmetic exercise. The dry skin contributes to the itching, which can be intense. It's hard to explain how all-consuming this itching can be - it wakes me from sleep, and focuses my mind, diverting attention from more important things. I can't concentrate on anything except the need to scratch under the cast!

Incidentally, I don't recommend sticking anything down the cast, but if you really must, make sure you it's CLEAN; don't use anything sharp, anything that will leave telltale marks on your skin (using the point of a pen is not a clever idea), or anything that will remain behind in the cast. Apparently, the plaster technicians regularly retrieve pen lids from casts. Adults, my dears, not children - you'd think they'd know better! Anyway, I would recommend gently using a ruler with a flannel wrapped around it. You can dampen the side of the flannel that's going to be against your skin, or cover it with moisturising cream. If you have a surgical wound, do NOT scratch, however gentle you think you're being. Just don't do it. Likewise, if you have fragile skin, an injury that is very unstable, or any increased infection risk, please resist the urge to scratch. The short-lived relief that you might get is not worth the many potential risks - infection, wound breakdown, skin damage/ulceration, and possible injury to the joint.

So, back to our nice clean arm: give the skin a nice, gentle but thorough scrub with the flannel, spray with toner (the Liz Earle toner that I use is very light, and made mostly with natural ingredients) to moisten the skin, and scrub again with the flannel.

I don't need to tell you to be careful around any wounds, surgical or otherwise. Now is not the time to break open any wounds, or introduce infection. If nothing else, it'll itch even more as new scabs form!

Now moisturise well. Epaderm is my first choice. I first encountered it when I was at medschool, doing a dermatology placement. It was prescribed for patients with severe eczema, to use instead of soap, and as a moisturiser. In the UK it's available over the counter from pharmacies. This is not a light, readily-absorbed cream. It is thick and slimy; unscented and uncoloured. I know, I'm not really selling it. However, what Epaderm lacks in cosmetic appeal, it makes up for in moisturising power. This is the moisturiser for neglected feet and hands, left overnight under socks or gloves. Or, as in this case, under tubular bandages, padding and layers of fibreglass for a month!

Of course, my arm will still look puny, with wasted muscles and glow-in-the-dark skin, but I've done everything I can to avoid the weeks of itching inside the plaster, and the weeks of flaking skin afterwards!

You'll notice that my kit is made up of things that are natural, uncoloured, and unfragranced. I have numerous allergies, and am very sensitive to chemicals in general. Regardless of that, whatever you put on your skin at this point will be held there, in close contact with the skin, for not just hours or days, but weeks, so choose carefully! Now is not the time to try out a new moisturising cream, or to try to mask that 'plaster cast' smell. Keeping your skin healthy is the best way to combat that!

Only TWELVE more days until my arm is free!

Oh, and the surgeons were very pleased with their handiwork: the scar and the joint fusion underneath. Good news!

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