Follow-up Appointments

Brace Optional

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.

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.

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:

  1. Walking independently
  2. Using stairs
  3. Walking long distances
  4. 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.

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.

Follow-up Appointments

Goodbye Robert Jones

This morning I went in to the hospital to get the Robert Jones Dressing from surgery removed and a cast put on. Dr. Koop helped with both and between the two examined my foot’s progress and answered many questions we had. Everything is looking as it should for a week out from surgery, the incisions are looking fine, swelling is as they expected, and my foot is much flatter than before surgery. I’ll have my cast changed in 3 weeks, when I will next check in with Koop.