Seriously! Don't stick anything inside a cast

By Mary Kaye Ritz
Advertiser Staff Writer

Orthopedic technician Pete Makinney of Kaiser Permanente gives Brandon Ells of Mokuleia a new cast to protect his broken ring finger. Deborah Booker • The Honolulu Advertiser

This time, it was a flag football injury the last day of school.

"Flag football!" said his mother, sitting in the orthopedics waiting room at Moanalua's Kaiser Hospital, shaking her head. "Good thing it wasn't tackle."

Then she laughed: "We always have some stories. We're a colorful family."

The hard shell on his arm is the third cast for 13-year-old Brandon Ells of MokulÇ'ia. Ask him about the other two and he'll put on the most sheepish grin this side of the Farm Fair. Those injuries came from skateboarding and tripping over his mother's leg. Like most of the cast-confined, he'll have more queries from strangers ("Hey! What happened to your arm?") than usual this summer.

"It's not fun," he admitted.

Even though he lives on the beach, there won't be any swimming or surfing for a while. And his mother won't give him a break on chore duty.

"He still has to take out the trash," she said.

Pete Makinney has seen some pretty amazing things come out of a cast in his eight years as Kaiser Permanente's lead orthopedic technician.

He sounds a little like he's performing Cheech & Chong's "Up His Nose" skit when he lists them: "Toy cars, plastic spoons and knives, money."

Once, a man even required a skin graft because something got stuck in the cast and badly irritated the limb.

"It was nasty," he said.

Nasty, but not the worst thing he ever saw, an honor he bestows on the sailor in San Diego who returned from a trip where he, uh, made some new friends.

"They were in Tijuana, Mexico, having a good time," Makinney recalled. "He brought some hitchhikers back with him."

Hitchhikers as in "crabs" — and we're not talking the kind you find in beach sand.

"That didn't surprise me," Makinney said. "I was in the Navy."

Young Ells said he has been known to stick a chopstick in his cast to scratch, though straws and even a Connex toy have been called on in a pinch.

Here in Hawai'i, Makinney has seen sand come tumbling out of casts, despite explicit instructions to keep the casts warm and dry and AWAY from the beach, please. He has seen children who use their arm cast as an extra pocket.

"I always wanted a cast as a kid," he said. "Now, since I've been working here, I know I don't want one."

But he can relate to their itches and, in turn, the urges to scratch: He knows firsthand the frustrations of having a limb immobilized. He himself had a dislocated knee and had to wear a brace for a month.

Still, he never stops telling his orthopedic patients to refrain from sticking stuff inside their casts.

"It's not so much the object getting stuck," though that can cause skin irritation, he said: "If you keep scratching, that cotton (with which the cast is lined) will migrate and create pressure points."

Once the cast comes off, people who have rearranged the cotton layer between the fiberglass cast and their skin can find themselves with ripples in their arms.

There's also a chance the cotton will bunch up next to a bony prominence and irritate the skin.

The worst, however, is when something like a pen cap comes off when someone goes scratching, and becomes embedded in the skin. Then the cast has to come off, the damage must be repaired and a new cast built. Not fun.

Still, Makinney is able to joke about the phenomenon. He calls casts the "instant piggy bank" and jokes: "Don't worry, I only keep (bills) over 20s."

Be fashionable while cast away

Fiberglass is in. Plaster of Paris is out.

That's the dealio when it comes to cast fashions.

You can get a cast in a variety of colors, too: blue, black, green, neon green, orange, neon orange.

Want a print instead? Try camouflage, neon splash (imagine a splatter of paint) or a line of teddy bears.

There's even a waterproof cast.

If you prove yourself to be very responsible — though "not everybody is responsible," warns orthopedic technician Pete Makinney —the Kaiser Permanente orthopedics department will give patients the number for the representative who sells Gortex rolls.

You buy two or three rolls of the wrap from the representative at $15 a roll and take it in to your appointment. They'll use it as waterproof material between the skin and cast.

The cast itself is usually a fiberglass material that is water-activated. It takes 7-10 minutes to wrap and is completely cured in an hour. It's stronger and lighter than plaster of Paris, though the orthopedic surgeon will sometimes request a plaster cast when dealing with a fracture that's not stable. Fiberglass expands slightly when it dries; plaster doesn't.

The only bad part of having a fiberglass cast is that you don't have a nice, smooth surface for your friends to autograph, though white-out pens or a black Marsh pen will work.