The short version...If Ryan is going to learn to stand or walk, he is going to need something to stand on, so priority #1 is getting those feet and legs straightened out. Ryan starts the first casting on Wednesday and then continues to get a new cast every week for a while. From what I understand, yes, it's a regular little plaster cast just like when Mom and Dad were kids. (I think that it's just feet/ankles to start, so the casts will probably be to his knees -- Derek)
The long version...Kiersten, Derek, Aunt Jen and Ryan met Dr. Lawrence Rinsky on Wednesday, May 14. He is the pediatric orthopedic surgeon who is in charge of straightening out most of Ryan's crooked parts. Stanford being a teaching hospital and all, a young doctor named Arthur Lee came in first and started with something like this:
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"...so Ryan has some stiffness in his joints....hmm....can you describe, what you mean by that...?"
(Aunt Jen -who is holding Ryan- turns him so that young Dr. Lee can see his legs neatly folded together)
"Oh...Okay then."
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Dr. Rinsky came in shortly and told us that commonly in cases like Ryan's, not all of the nerve pathways develop, meaning that some of the muscles can't contract. Hence -- his arms are straight because his triceps, which work, pull them straight, but his biceps aren't doing their part to bend them. Dr. Rinsky also stretched and bended Ryan and was generally positive about the range of motion that Ryan did have in both his legs and his arms. Down the road, there may be tests and muscle biopsies to try to ascertain what we can hope to get out of those little arms, but we have not confirmed what the condition of those muscles or nerves are.
The above concepts apply to his legs too, but I don't know the names of all those muscles, and I'm sure you can all follow the concept without me having to look it up!
That's pretty much where things stand for now. Treatment starts right away, and there is not really any way to know exactly how much "normal" motion Ryan is going to have down the road. We'll just stay hopeful and continue to stretch him until he hates us or the physical therapist tells us to stop.
If anyone has more questions (I know -- how could you after such clear, concise, intelligent updates?), you can email them to Ryan's gmail.com account at ryanjmcauley and Derek will check it every so often. (We're avoiding typing the actual email address to avoid automated spammers, but it's ryanjmcauley and then @ and then gmail.com)
Today Grandpa joined Ryan and me as the first casts came off and we saw the progress of Ryan's little feet. As an added bonus from the casts, his legs loosened up a bit, as you can see from the pictures (which we will try to get in focus for you next time). Dr Rinsky was pleased with how Ryan's feet looked today and also liked the range of motion Ryan had after just one week of casting. We are planning on 6 weeks total of casting, then Ryan will have his first tendon release surgery. After that, Ryan will have casts on for 3 weeks straight and then the doctor will assess where we are at - either we will continue with more casting or we will move to braces for his legs.
After our trip to NJ in June, Ryan will meet up with his new physical therapist (PT) and his new occupational therapist (OT). Once we meet them, Ryan will be fitted with arm splints to help straighten his wrists.
Ryan is eating like a champ. Devin and Lily are enjoying the newest addition to the family and they both shower Ryan with lots of hugs and kisses, sometimes a little too enthusiastically! Derek and I are looking forward to spending time back east and introducing everyone to the little guy.
