Alex’s Foot Surgery – Updates regarding Alex’s surgery in 2020

Brace Optional

Post author By Alexander Celeste
Post date 8 November 2020

Last Wednesday I had another follow-up with Dr. Koop. I know I ended this blog a few months back when I considered myself no longer recovering, so I’m mostly just posting about it here to put it as a record in the recovery timeline this blog illustrates for anyone interested in the future.

This appointment had what in effect was the last post-surgery X-rays, as apparently at my next follow-up, a full year from now, we won’t need to take X-rays. Everything looked just fine. Which, to be fair, I expected as I am in zero pain any longer. Usually, Koop said, if there was something awry on the imaging, it’d be more evident from daily pain or the like. That is, I’d expect to see something wrong.

The most surprising thing to come at this appointment was in regard to the AFO brace I wear on my right leg and foot when not at home, and have as long as I can remember. Dr. Koop said that at this point there is no medically-necessary requirement to wear the brace at any given point of time, length of time, or activity. When contemplating having the surgery over the past many years, he always said that the surgery would not remove the need for my AFO. So this was surprising news. But though it may not be necessary any longer, it also will not hurt. So for the moment I have no intention of changing my habit of wearing the brace whenever I go somewhere not at home (as getting rare come winter that is, thanks Covid…). But I am free to change that up when and as I see fit to do so. In effect, the brace is now optional.

At Home Recovery

A Semblance of Normalcy

It has been quite a while since I last wrote an update for you all, and as you will see, this may well be my last update. If this is destined to be my last update here, please feel free to check out my regular website, which includes my regular blog.

In the time since I last wrote I have progressed from the walking with a stick to not needing any assistive devices aside from the brace, and this includes no stick even when barefoot at home. Alongside that Dr. Koop had a few weeks ago said I should stop wearing the brace at night, and that we could make the brace more flexible (and since I have done those two things). Both of those have made the last few weeks far more “normal”. I found that I sleep better without the brace on, and am no longer half-tripping when standing up with the brace more flexible. All in all those two improvements transitioned my life to a more usual set of patterns.

This past week was even more significant in many ways. At my PT appointment (which are now just every other week) I was given the go-ahead to cease using a bench in the shower, along with the help in part of a nonslip mat. This has meant that the last few days my showering has gone back to completely independent, since all that was left I needed help with was the bench anyway. This has made my daily life get back very close to “normal” in many ways. Today, with the aid of a backpack-like laundry carrier, I did my own laundry, which frankly was the only other bit of regular life that had still been upended by recovery from surgery.

I also had a virtual visit with Dr. Koop earlier this week, at which he looked at x-rays that were taken the day before after PT. Those showed that the bone healing is moving along nicely, which is to be expected given my near entire lack of pain (only have minimal pain sometimes, and really that may just be stretching in the brace anyway). He was impressed with my near-daily walks that average around 2 miles each (though, for PT’s sake the walks can now be every other day, and as it gets warmer heat may be a weather permitting question as to if I go for a walk at all or not). He told me that from here on out wearing the brace is really a matter of stability and comfort, not as an aid to bone healing. As such, with his blessing, I’ve already begun the process of slowly diminishing how much I wear the brace while at home, since my pre-surgery normal was simply not wearing it around the house. For now, that means taking it off after dinner and leaving it off until just before breakfast the next morning, including using stairs in both directions barefoot. Eventually, with the advice also of my PT, I expect to go even more of the day without the brace. Dr. Koop said he’ll see me back in September, when the final post-operative x-rays would be taken.

But, now that I’m officially allowed to wear the brace less, and am walking very close to my pre-surgery normal with or without the brace (just have some gait issues with regard to even my steps out between feet to deal with), I functionally feel about 95% recovered. Yes there are still a number of exercises and stretches to do as PT each day, as well as those appointments themselves, and the bones will still be healing for the next few months, but other than that every part of my life is back to “normal”. You see, that is why this may be the last time I write here, and why I haven’t written here in so long, because I’m so close to feeling fully recovered that in many ways the recovery is far from the top of my mind or daily activity anymore.

You may have noticed that I’ve put “normal” in quotes where I did use it, and used other words to get to the same meaning as well. This gets us to the wording of the title of this post too. Maybe I am physically, as well as in most of my day to day life, getting back to my pre-surgery expectations and actions. But that is about where such “normal” ends. We’re still deep in the midst of the global Covid-19 coronavirus pandemic that went and upended all of our global human civilization in the midst of my recovery. So, not much beyond me nothing will be “normal” for a while, and maybe not ever (the “new normal” as some call it, but really, the world is just in a state of constant flux right now). Even I am experiencing this fully now, and believe that it is part of why I find it hard to think I am as recovered as I am, because so much of everything else is different around me.

But, closer to home, just about 6 miles from where I live, across the river, George Floyd was killed. So though few businesses directly near me were affected by the looting and property destruction (though the gas station across the street to our north was set on fire) I very much do live at the center out of which all the unrest across the nation, and protests worldwide, spread from. That completely overtook the pandemic for about 1.5 to 2 weeks in my ability to think about the world, and also made it hard to focus on what was going on as a result of George Floyd’s death in other places. News of the pandemic nearly disappeared from my awareness as the Blackhawk helicopters were flying overhead during our nightly curfews for so long. So that is very much another aspect of broader society were I am that has changed our course away from “normal”. I mean, I really do yearn for the time when my surgery was the most significant thing in 2020, but we are far from that time. At this point, the surgery will be a footnote even in my history of this year as we grapple with everything around us that is changing our lives forever.

However, even that isn’t all that makes my life right now have just a semblance of normalcy. With my recovery from surgery nearly complete (at least in the day to day of things), other forces take hold again, as do other medical needs (dental work on Monday morning, eye appointment hopefully in a few weeks). So as my physical health, with my right foot at least, begins to level off, other crap, including that which is around constantly, peeks out again. Though maybe those things are my regular too, making just the societal mayhem feed the machine of unknowns. But, as the recovery diminishes the unknowns and sense of living in a not-normal time will very much remain.

Anyhow, very much onward with the fine line I’m walking along right now between recovering from surgery, and feeling recovered from surgery, as well as between being present to those who want my presence and not feeling able to give that. All we can do for the moment is hang on to what we have, and hope for the best we want.

At Home Recovery

Outdoor Walks

Post author By Alexander Celeste
Post date 25 April 2020

The weather is getting more springy here in Saint Paul. Heck, it has reached 70 both yesterday and today. This is a welcome achievement for all of us, despite the continued stay-at-home order. We can have windows open, and also spend more time outside. Though we still should not interact with those beyond our households, this does mean we can see neighbors, and interact with them from a safe distance. Quite a change from just a few weeks back.

At my last PT appointment I was given the task of taking one longer walk a day, weather permitting, outside. So far I’ve done this twice, one to each of the corners of our block. Yesterday I used my walker, but found that much more difficult due to the way sidewalks are built (the breaks between the concrete segments meant that I could not really just go without constant stopping to get over obstacles). The walking itself seemed easier than needing to maneuver with the walker, honestly. After that walk we experimented with what it would be like with the walking stick my uncle Christopher gave us for Christmas a few years ago on my left side, and Eric helping support my right side. This was far more successful, and also enables things like going on the grass to maintain 6 feet of separation from others when needed.

This morning I did my second of these endurance exercise walks using the walking stick and Eric (who would join me on the walk even if I didn’t need him at all, to keep me company and get outdoors himself). I managed to achieve a very close to normal walking gait at times, when not really thinking but just walking and enjoying the nice Saturday weather. I think that this is the way that I will do these walks from here on out. This also showed me a clearer path onwards to eventual full recovery, because I was walking far more normally than I ever have with the walker. It forced me to put weight on my right foot in a way that I’d need to be intentional about not weight bearing through my right arm when using the walker. The ultimate goals with these walks will be to be able to do such walks without relying on Eric, eventually without even relying on the walking stick, and somewhere in there increase the distance first to around the whole block, and then beyond. When we approached the house, Mary took the below video to show off my progress (and document that we’re actually using the walking stick for once):

Follow-up Appointments

Walking and Stairs

Today I had a follow-up with Dr. Koop. Once we finally got x-rays, as that took far longer than it should have (even being one of just a handful of patients at the clinic, schedules have gotten all confused due to the pandemic, to the tune of an extra whole hour), we got to have a decent chat about my progress. The point I am at in bone healing is such that Dr. Koop has given me his blessing to begin walking on my right foot again. While this will take a lot of getting used to in the walker, which will be a lot of physical work on my part, between now and August when I next see him I may progress to not even using the walker the entire time when at home, we’ll see (that’ll be up in part to the PT over the next few months). Certainly, I expect to only get more confident in walking as time goes on. I have PT once every week or two until summer to help me with exercises and stretching that get me more used to walking on what in many ways is a brand new foot.

Now that I can walk on it, I’m also allowed to use stairs more normally. That is, going sideways with the railing, but not on my butt. So not entirely normally again, and not independently, yet, but closer to normal. Also not a ton less energy-intensive, but I’ve only just begun, so my strength should build up at this over time, especially if I use stairs one to three times daily moving forward. The idea is to lead with my left foot when fighting gravity on the way up, and letting gravity help my right foot when going down. This will expand my universe during what is increasingly a coronavirus quarantine rather than surgery quarantine to 3 floors of our house rather than just the second floor, a 200% increase in territory at a time when most people are feeling stuck in their houses. This will be nicer for the 5 of us living here as we all effectively are stuck at home for the foreseeable future during this pandemic. My brother, Nate, who has moved back for now to not be alone, will get his room back in the next day or so. More of a normal lifecycle for us all in this house will emerge again in the coming days. I think a more normal daily life that uses more of the house may increase my happiness, as well as sense of purpose, and sense of normalcy as I get into this next phase of the hard work of recovery.

As a side note, we should all be in the mindset that there is no, and never was, a “normal”. So though more of my life will hopefully be getting better over the next few days and weeks as some things go back to what they were before surgery, nothing will go back entirely to how they were, in large part due to this pandemic. January 1st, 2020 will be nothing like December 31st, 2020. We all need to be thinking like that, because otherwise we will stay in a depressed mindset even after these stay-at-home orders end and the global economy gets back on track.

As I continue to walk normally, and use stairs in a way where my legs are the main weight bearers, this will itself aid in the further bone knitting over the next few months. You have to stay more sedentary by way of the bones for a while to help the healing, but then it flips and the work of using the limb more actually is necessary for proper healing. I’ve now reached that tipping point, and so even if pressure is something I feel, the more usual movement will be helping the healing. The PT has also, as will I think be a constant, added more repetitions of the exercises I’m doing, as well as a few more things to pay attention while walking and standing around in the walker.

Dr. Koop also advised that I can start wearing my brace a little less. While the definite time to wear it is any weight bearing, for the next few months, I can pull back a little, here and there, from the 20 hours a day “like a cast” wearing I’ve done this past month. That should help with the sweating problems I’ve seen in the brace too, though we also had that department look at the brace, adjust it, and give me more hints. Every now and then I could even go a night without it, should I wish. Come the next round of x-rays and talking with Dr. Koop (in August, when hopefully we’re all at least a lot better and more used to living in the pandemic, although I highly doubt we’ll be anywhere near through it by then) I may progress closer to the wearing it more outside the house only, though that will all also be a matter of what I feel like.

So, though perhaps this next few months will be hard work, it should also be good feelings to be in a more normal lifestyle. But again, with coronavirus normal has been murdered, so actually everything will still be a bit weird, just a different weird than being stuck on one floor.

At Home Recovery

Advice for Newcomers

So… I’ve been stuck at home recovering from surgery since January 16th, 2 months now. Across the world, but certainly as per CDC guidelines here in the United States, I’m sure many of you are now looking down the tunnel of similar isolation as you protect yourself, your family, and your community from COVID-19. I thought, since I have a bit of a leg up on this (although, it does mean in a few weeks this staying at home will flip from being related to surgery recovery to being related to COVID-19), that I should share some advice:

Forget about the weather report. I mean, seriously, why bother. You aren’t going anywhere anyways. The most it can affect you is if severe storms risk power outages, so pay attention to NWS warnings, but the daily forecast really isn’t important.
Give up on activity tracking like that which the Apple Watch does for the time being. This was definitely a thing for me stuck at home not even walking much, but for everyone who is at home all the time you won’t likely meet your goals. That is just fine. Your health is important and being protected largely by staying home for the time being. If you don’t meet your movement or exercise goals that is fine. Your stand goal should still be met, though. You may even want to disable the activity notifications your device has for the time being.
Stay in touch with friends and family using the internet. Social media is one way. But so to is the use of tools like iMessage, FaceTime, Zoom, Google Hangouts, and many more. Oh, and also phone calls. Regularly check in with your people.
When shopping is necessary, consider going at low-volume times like right when stores open or right before they close. Also go to local shops for the necessities as much as possible. But hey, I just read that as I haven’t been anywhere except doctor’s appointments recently.
When working from home, which remember is my norm anyhow, find a hobby or other fun activity to do, be it on the internet or entirely offline, to break things up. Also it is best to have a given place in your house in which to do your professional work.
Perhaps, just maybe, try to stick to a regular basic schedule of when to sleep, when to eat, and so forth. That will be healthier than sleeping more, eating more, and such.
Netflix and other streaming services are your sanity’s friends. So are games you play on your devices.
Having reputable news sources to read online is a good idea. This will help keep you informed, and sane.
Whatever you do, do not panic. Seriously, that will make things much worse (see toilet paper hoarding, for example).

Of course, the CDC plus my advice is not the end of the line. If you have more, feel free to share. Together we will get through the next few weeks to months of this COVID-19 more or less shutdown of good swaths of society.

Also posted on my regular blog.

Follow-up Appointments

Stage Three

The first stage of surgery recovery was the hospital stay. That lasted about 2 days. That is also when this blog really begun to document the process of my recovery. One could say this stage lasted the first whole week, until the Robert Jones bandage came off and I was settled in my long term recovery routine.

The second stage of surgery recovery was casting. It, like stage one, is a fully non weight bearing stage of recovery. This is the stage that has been the last 8 weeks, and also is probably the longest, in reality, not just in the patient’s head. This stage ended at around 11 am today.

After the last cast came off I got a second round of x-rays, and then it was all hurry up and wait for Dr. Koop. But hey, I don’t really mind that wait, because it comes from the amount of time he spends with each individual patient. He takes the time that is needed rather than getting in and out quickly. In many ways that is part of what makes him such a good surgeon, and part of why I got around to this surgery before his eventual retirement. Also, he is a Johnnie (I wonder if he dislikes the purple clinic rooms and prefers the red ones, as they’re color coded at the hospital, I saw him in a purple room today ? ).

When we saw him, it was, as may be expected, all fantastic news. He saw ample evidence of continued bone healing, and was able to answer all of my lengthy list of questions. I am now, officially, done with the non weight bearing recovery, hence stage three begins. While I won’t be given the green light to walk on my right foot until my April follow-up with Dr. Koop, I am now allowed to, and encouraged to, set my foot down on the floor when sitting, or even when standing using my walker. Up until now I’ve been keeping my foot up on stools when siting. Really all I cannot do is walk on the foot. Super news, and a solid step forward!

After meeting with Dr. Koop I went and got my new AFO fitted. It is far different from the old one, but already feels better than the old one did at the end, though that is likely mostly my foot having been literally rebuilt at the skeletal and muscular levels in the time since I last wore my old AFO. Though for the next chunk of time at least I’m to wear my AFO as if it were a cast (about 22 out of 24 hours) it is not, indeed, actually a cast. There is no top, so my foot gets lots of good air, also I can take the AFO off. While usually this will likely be in the evenings after dinner before going to bed, the nicer side-effect of this is that I can take baths, and wash my right leg and foot even in my regular showers again (although I should still use a shower bench and get help). Later tonight I’ll probably soak in the bathtub to wash off all the grime on my right leg and foot (and the rest of my body, but it has been getting showers about every other day all along during recovery). Further, this means that the three incisions will be able to regularly breathe openly, instead of being stuck under padding in a cast, which should help the skin healing.

My last stop was at Physical Therapy to get an evaluation and overview of what that process will be, which stretches out until early June. As I cannot walk yet, this was basically getting an idea of what PT will be, and laying out my goals, which in order are:

Walking independently
Using stairs
Walking long distances
If time left, get an idea of what exercises I should do long term to not just help my foot, but my weight and health in general, seeing as my professional work is all at the desk I’m sitting at writing this right now

I was also given a few exercises I should be doing twice a day, to simply keep my muscle strength up as I continue to not be walking at all on my right foot. Those I’ll probably do in bed before going to sleep and after waking up each day, as they’re to be done lying down.

Once done, I was at the hospital for 5 hours. A long time. But not as long as I was there right after the surgery.

Alas, this ultimately means anther month or so of this upstairs-only (except for doctor’s appointments, though this time there’ll be some not related to the surgery, if all goes as scheduled) routine, and not really going anywhere else. But, given all the Covid-19 messiness in society all of a sudden, and all that is being cancelled or ought to be cancelled, and everything likely to get much worse before it gets any better, I really don’t mind. Hey, due to the surgery recovery I’ve effectively been self-quarantining myself for the last 8 weeks. Another 4 or so minimum ain’t bad. I mean, honestly, I don’t really want to go anywhere for the next few weeks anyway now. Thanks Covid-19. But in all seriousness, we should all be keeping track of everywhere we go these days, just in case. To that end, if you have an iPhone, it is doing this for you. This data can be seen on all your Apple devices, but is locked with encryption only you can decrypt. Really, Apple needs to give everyone a quick way of sharing this to health authorities now. Your device has the data, for public health they should let you share it.

The good news is that with having casting behind me, and a sense of the PT routine (plus the therapist’s contact info) we can probably make it through any shutdowns of normal society, normal medical appointments, or even if we get sick, without much harm to the overall surgery recovery process. This is not something I could have said yesterday while still in a cast. We’ll see. But truly, it is now onward not just with stage three of surgery recovery, but the total uncertainty of how society will move forward as this Covid-19 pandemic continues to unfold.

Achievement unlocked: Casting done, AFO begins

Follow-up Appointments

Last Cast

This morning I had my third follow up appointment with Dr. Koop. This time I got the first post-surgery X-rays, which showed that the bones are healing and fusing at a better pace than expected for someone my age. It has only been 6.5 weeks since surgery, but the bones are already showing clear signs of fusing together as expected.

The swelling was down enough that we were able to make a mold for my new AFO. This brace will be a solid piece, without any hinge, though once the rehabilitation and PT are far enough along Dr. Koop may decide to modify it to allow for ankle movement.

I got my next cast put on (this one light green), which Dr. Koop says is bound to be the last. This cast, like the one before it, should be on for exactly two weeks (barring any complicating factors if Coronavirus spreads across the Twin Cities before then making the hospital appointments change in some way), and then it’ll be time for another round of X-rays, and in all likelihood fitting my new AFO. So, this is the last cast as far as we know right now.

Further, Dr. Koop said that at least some degree of weight bearing will start following that next appointment if all goes as it seems it should based on today’s visit. We’ll see what that means in two weeks, but my guess is mainly that I shouldn’t put 100% weight on it (so, take stairs like I have been right now or just using my left foot weight bearing on stairs), and may want to have the walker nearby if needed. Certainly, more semblance of normal may pick up over time starting then, including the ability to bathe and shower more normally, perhaps. But we’ll see. It’ll all be according to Dr. Koop’s medical orders two weeks from now. Onward.

Achievement unlocked: AFO molded.

At Home Recovery

Silly Eric

So, you know that part of my non weight bearing recovery where I was going to stay on the second floor except for follow-up doctors appointments? Bit late for that, all thanks to Eric. Story time:

Over the last few weeks Mary has been complaining that our fancy (but at least a decade and half or so old) front door lock that lets you use codes to unlock it has not been working for her. It has been working just fine for Eric and I.

Anyway, a little bit ago she came home and, again, could not unlock it. But this time, Eric insisted he show her it worked. So, he went outside, with no coat, just a T-shirt and pants in sub 20 degree weather, locked the front door, and proceeded to watch her try and unlock it. She failed. Again. And again. Then he failed. Again. And again. The lock has a normal key too, but neither of them had it. Cadi enjoyed watching this unfold from the front hall. I, less so, hearing it from upstairs wondering if they would need help.

Then they call me. First Mary insisted that Eric ask me for my code (which I’ve used since we got the lock, and that originated from my student ID number at Crosswinds). I tell it to him. They try it. Again. And again. The lock doesn’t unlock. Nuts.

So they ask if I can go downstairs to unlock the door manually, as, you know, you can do from the inside. Mind you, I hadn’t done that while in non weight bearing recovery on my own before. Good news, I figured out how to do it. They got in. Eric could begin to defrost.

He tries the lock with no pressure of the door being closed. It doesn’t unlock. Well, he thinks, should have tried that first. Guess we need a new lock for our front door. But by this time I’m downstairs. So we all eat lunch in the dining room and Eric researches new door locks. I now know I can get downstairs on my own, and have already pretty much been getting back upstairs with no help anyway. Well, in both cases, I still need someone to bring the walker up and down. But still, I get myself on the stairs well enough.

As I write this I’m back upstairs and Eric is off purchasing a new lock. Since technology, as, well, technology, constantly changes and it has been over a decade, we at least get to try some of the benefits of that time. The new lock he plans to buy will still have a way to enter codes to unlock the door, but also work with the Home app on our devices so our phones and watches can lock and unlock the door as well, even with proximity. Apparently this also means we would be able to remotely unlock the door if, say, an aunt or cousin needs to get in and we aren’t around. Maybe we’ll use the codes way less, and also all share one within our family, and still possibly have one for my cousins who are in colleges nearby.

Achievement unlocked: I can get down, not just up, the stairs on my own.

Lesson learned: Try unlocking the door before you lock yourself out.

Follow-up Appointments

Cast Change

Today, amidst the frigid windchills in the Twin Cities, I had my first cast off, a check-in with Dr. Koop, and a new cast put on. The most important questions I had for Dr. Koop were how he thought my recovery was going, and what the timeline looked like. Everything is going as expected from his view, and the casting people were also pleased with how well the cast held up and how my foot was doing in it. There were no signs of infection by the three incisions, and the foot was more or less the same color as the rest of my leg. So, just keep doing as I’ve been doing was the basic advice. This is a great relief to me, because I’ve been worried that maybe parts of what I’m doing weren’t as good, or that things weren’t quite right, but it turns out that it is all good.

This new cast will be on for a few hours less than 2 weeks, which is nearly half the time the last one was on for. At that time the plan is to get X-rays and based on those and the progress of swelling diminishing determine if it is time to mold an AFO, and what the timeline to weight bearing is. The pre-surgery information regarding non weight bearing was really 8-12 weeks for an adult, but 6-12 is the full window. This next appointment will be the 6 week mark. There will be at least a third cast while the AFO is made.

We’ll see how it goes. I’m taking my recovery day by day, and mostly with no pain (just stretching that I’m feeling) my days are both a normal pattern, and a good way along back to doing normal activities (that is, spending time at my desk doing the consulting work I do). I’m still just on the second floor, but life is getting along towards normal. As such, there simply isn’t much to report here in between follow up appointments. But I will still report following appointments, if something comes up, and if I have advice for others in similar recovery processes. Feel free to reach out to me as desired.

Adapting Daily Life At Home Recovery

Showering

Everyone needs to stay clean, even if they don’t go anywhere often (like me most of the time during this recovery process). But casts cannot get wet. Hence, there is a bit of a dilemma, isn’t there? Well, at first, and still half the time, we’re doing this by just giving me sponge baths. This gets most of my skin clean, but not all of it, and notably doesn’t clean my hair at all. So we do that about every other day.

On the opposite days, though as of now this has only been going for about 2 cycles, I take an actual shower. Firstly, since I cannot stand on both feet for the moment we use a shower bench that we put into the shower so I can sit down. But what we use to keep my cast completely dry is a product that a member of the Gillette Children’s casting staff recommended, DryPro. This is a latex sleeve we put over the cast leg that has a pump to create a vacuum seal around the cast by pumping out all the air. Then I can even place my right leg directly in the shower, and yet the cast will not get wet in the slightest. As such, I can shower (or even take a bath if I want) to get the entirety of my body with the exception of the parts in the cast completely clean, just like before (and after) this whole recovery process.

Of course, I need help getting myself clean like this, unlike when not in this recovery, but at least I can have a way to get quite clean regularly. That definitely helps a bit with regard to feeling better even amidst the (physical and otherwise) pains of this lengthy recovery process.