Final Fracture Clinic Appointment

Another five weeks have passed and since my memory isn't photographic, I'll just list a few highlights.

On Friday, April 26, nine weeks since surgery, I was scheduled in an all day meeting at the Citi Plaza close to the office. I decided to attend in person instead of by phone or Skype. I was able to hitch a ride and bring my scooter for mobility. Thanks Ann! I could hobble around in my air-cast already but was capable of only short distances. I kept the air-cast on all day and didn't have the leg elevated for most of the day. When I got home, the foot was quite swollen and sore. I was thoroughly exhausted and thankful for the weekend.

Full of game hen

Leafs vs. Bruins on Steve's iPhone

In my April 6 post, I mentioned working extra hours on an urgent project. Although that work is still ongoing, the lion's share has been completed successfully. I was invited to an appreciation dinner at the Airport Hilton, on Monday, May 6, along with many other employees involved. I was still unable to walk long distances so I was allowed to invite Krista to chauffeur me and my scooter there - I was the only one with a chaperone, as far as I know. I kept off my feet as much as I could, but still felt quite beat up by the end of the day.

My back started to spasm that week, and I had a deep massage on Friday evening to get 10 weeks of horrible posture working from bed worked out. I set up a table in the living room to work from after that.

We visited Krista's parents on Mother's Day weekend. It was great to see everybody and just to be out with family.

I kept making slow progress and decided to try going to work full time starting Wednesday, May 15, eleven and a half weeks after surgery. I'm very thankful for my carpooling buddy, as I am still not able to operate the clutch on my car. The three days that week were very successful. I immediately felt more alive and productive. And I had a long weekend to recover.

Mug  shot

Dr Stevens

Getting better

West Montrose

Today, Tuesday, May 28, I had my final fracture clinic appointment. No x-ray was scheduled. Dr Stevens just wanted one final inspection of the foot. He didn't even ask me to walk on the runway for him. He saw that I had come in without walking aids and was satisfied.

Self portrait with phone camera

We toured around a bit and I was reminded again that the healing process isn't complete. The surgeon warned me that full healing takes 10 to 12 months, so I need to be more patient. I will continue to pace myself through the spring and summer.



Incidentally, we just noticed today that it is exactly one year since my first consultation with Dr Stevens, on Monday, May 28, 2012. And what a year it has been. :-)

First steps

Happy birthday Mikayla

I had a few excursions over the last two weeks or so.

On Tuesday, April 9, my wife and I visited my parents' on their 46th anniversary. This was my first time out without the knee scooter. I didn't do a lot of walking but it was still a nice milestone. Stairs are quite awkward with the aircast, but I'm happy for the progress. We celebrated an evening out with dinner at Legends!

On Sunday, the 14th, we went to my niece's birthday party, again without the scooter. I had an awesome time with family. And my foot wasn't much worse for wear at the end of the day.

My replacement

Then on Monday, the 15th, we visited my workplace for an hour or so at the end of the day - this time with the scooter because more mobility was required. Krista carried the scooter up the stairs to get into the building (no, the building is still not handicap accessible). A few coworkers were not in but I was able to catch up a little with over a dozen of my peeps. Great times. A few of them took the scooter for a spin to compare it with the one I had rented for the previous recovery period. I prefer this one, but it has an annoying squeak at times.

Garrett, brake testing

James, cornering

Today, Tuesday, the 23rd, I had a fracture clinic appointment at Grand River Hospital again. I had expected this to be the final appointment, but it didn't turn out that way. Dr Stevens, the surgeon, wants to see me walk in street shoes before closing my file. No more x-rays are needed unless I have more pain, but I need to come back in five weeks. I expect to have been driving for a few weeks by that time. Since visits to the hospital in Kitchener take a fair amount of time, I am usually exhausted afterwards. This time was no exception, and my foot had swollen fairly extensively having been confined in the aircast for eight hours. I had it off only for the x-ray and examination.

Making progress

What a week! As of Tuesday, five and a half weeks since surgery, I am cast free again. Another big milestone passed.

Knee scooter on snow

I had to take the scooter to the neighbour's driveway and back to test the snow handling. The tires don't like the cold or snow because I skidded instead of turning. I didn't hurt myself though so it could have been worse. It seems, I have to remember to pace myself every time a milestone is passed. Krista put the camera down as I started to skid, so she wouldn't have gotten the action shot anyway.

I had survived two meals at the kitchen table over Easter weekend, with my leg only partially raised for an hour each time. Since that went well, I decided to ride in the front of the car to the hospital, instead of in the back with my leg sprawled on the seat on top of a pillow. 

 I'll leave out some of the mundane details, like how everybody oohs and aahs over the scooter. I guess I could mention that two people wanted my email address so they could contact me in case they wanted to buy it when I don't need it anymore.

Before surgery

After surgery

Anyway, to help explain what was done on the left foot, consider the before and after x-ray images.

When the small bones beneath the ankle gave out decades ago, I started pronating forcing the bones in the forefoot to roll over. This caused the bunion - it wasn't a growth. You can see how dramatic the bone shift was in the big toe. Note also the second toe stepping on the third toe.

You can see how normal the bone positions are after surgery.

Don't let the four pins freak you out too much, they have been removed.

The hardware that is staying in the foot is the same as it was for the right foot.

Before surgery

I didn't have before surgery x-ray photos last time, but the left foot had more dramatic or at least more visible work done, so I had to include them this time.

I don't know what to point out in the before image other than that the toes look a little weird.

You can actually see the swelling in the foot. It's not bad but kinda cool that you can see it in an x-ray.

After surgery

I didn't see the x-ray images until after the four pins were removed, so I was plenty nervous when the surgeon came at me with pliers and told me to expect some pain. It doesn't help that his personality is a little like a Batman villain.

The first pin to go was the one in the toe and I didn't feel any discomfort at all. I started to relax. The next two pins were more difficult and stung like a ... well they hurt and bled.

Count the pins - where's Waldo?

Three separate incisions on this side

The last pin had submerged under the skin so it had to be dug out before the surgeon could get the pliers on it. And it really hurt for a few minutes.

Dr Stevens told me that within 24 hours the holes would be completely filled in, and he seems to have been right.

A pin on the way out

Very clean incision

So, I'm supposed to gradually start to put weight on the heel and build up from there. I am using the same air cast boot as before. In the house I'm going barefoot and continuing to drive the scooter for at least another week. I pushed too hard last time.

One incision on the heel

Anyway, I'm doing quite well at this stage of the recovery. I'm much more comfortable at night and am resting a lot better. This chapter of my life is nearing a close. I'm looking forward to the next.

(It's hard making a post with this many photos flow well)





I had intended to write something earlier in the week but I've been burning the midnight oil for quite a few days getting some urgent work done.

First look at the surgeon's work

Some photos in this post may put some of you off your dinner, so beware if you have a weak stomach. Some have told me this warning should have given when the hospital gown photos were posted. :-)

Cutting the old cast is very ticklish

I can now get to the bathroom and back in more comfort. It's not a lot less awkward, but I've figured out where to perform the required five point turn in order to back in. Every little bit helps, and finding milestones in the little things creates an emotional boost.

I had my first follow-up appointment at the fracture clinic today. They removed the blue cast and extracted the staples. No x-ray yet. This visit was just to remove staples and get a first look at how the incisions are healing. The surgery was only eleven days ago, instead of three weeks like last time. The schedule had to be compressed because of the surgeon's availability. The next appointment is in four weeks.

Swollen but bunion-less

Four pins are visible

The left foot needed more work than the right did, and the incision artifacts bear that out. The inside incision is quite a bit longer than it was on the right foot, and there is another incision where the bunion used to be. After removing the staples and cleaning up some wound weeping, the technician called for Dr Stevens to have his review.

There was still some metal poking out so I asked about it. Apparently those are the pins holding the bones straight so they can heal sans bunion. I hadn't pictured the pins as longer staples - I guess I had thought it would be similar to the big bolt in the heel. I was wrong. Anyway, the pins stay in for another four weeks - unless there is an infection. (touch wood)

Outside incision

Preparing for the new cast

The big toe is bandaged to help hold it straight while the healing continues. It doesn't feel like it's pulling as much as it did with the first cast.

The rest of the experience was similar to last time. I still got a lot of attention with the knee scooter. I really think there is a business opportunity for someone. I guess we didn't take any photos of it this time.

Red this time

We got home just after five and I was exhausted. A two hour nap made me feel better and so here I am pretending I've got something to say. Perhaps that's my cue to stop.

Challenges

The defrosting was well and truly complete by the wee hours of Sunday morning. I had been starting to hope that I might have an easier time recovering this time. Denied. I slept very poorly, and had a lot of discomfort. I tried to let Krista rest but she could hear me downstairs. Her maternal instincts / spidey senses wouldn't let her rest either. That night I skipped my pill installment because I felt so poorly and I felt Krista should get at least one night off. Probably a mistake, in retrospect, because I had a low grade fever at 6am when I couldn't cope any longer.

Even relatively comfortable positions were next to impossible to find. I started taking the Percocet more regularly, and that left me groggy and feeling ill. Next trick, up the water intake. Over a couple of days of tweaking, I eventually found something close to a balance. I'm using my cell alarm to remind me every four hours to top up both water and pills - even during the night.

So much for having learned from the first experience.

By Tuesday, my fever was under control and I felt well enough for my parents to visit. We spent an hour or so, updating them on my status and experience in the hospital.

My appetite was getting better by this point too, and I hit another milestone: I actually went TO the bathroom. I had been "making water" in a plastic urinal we got from the hospital, but I hadn't yet beat the constipation inducing drugs in my system.

The journey to the bathroom was difficult, because although I had started finding pseudo-comfortable positions in bed, my knee's range of motion had been decreased significantly and was painful to move. I couldn't put the knee on the scooter, let alone put any weight on it, without a lot of pain. So there was a lot of hobbling and wailing as I made my way to the bathroom.

The next hurdle: this time it's the right leg doing the work, which means I am on the right side of the scooter while in motion. So everything is backwards now. I couldn't drive into the bathroom, because I couldn't perform a dismount from the other side of the scooter. So, get out, turn around, back in. Argh. The scooter had felt very natural while performing for the physio nurse, but now it is almost impossible to use. Not useless - because I can still get around, but nothing is easy. Hopefully, that changes when I'm to the point of being out and about.

The range and pain in the knee is quite a bit better now, but I still dread having to get around in the house.

My goal for this week is to get acclimatized enough to be able to actually work from home productively next week. Of course, since the surgeon wants to see me in the fracture clinic on Tuesday, I'll only have one work day before another off day and possibly a tough recovery from being out. Sigh.

In the mean time, other business continues as usual. We're still struggling to get the stove we paid for on Jan 23. On Wednesday, the delivery boys came by with the wrong stove. We have had little luck getting The Brick to take responsibility for it. That is, they say "sorry", and "we'll look into it" and like that but haven't produced results yet.

Today, Thursday, is my birthday. We're trying not to let anything get us down when we should be celebrating. And I had another milestone: I got my hair washed for the first time since 4am on Friday morning. What a relief. I've been feeling so oily and dirty. Thanks for the hose down in the kitchen sink, Krista. I also had a nice Thai dinner and some TV catch up time. Krista joined me on the bed for that.

Next? Tax time.

Doing it all again

At the hotel on Thursday night

The surgery has come and gone and I am back at home. Dr. Stevens said the surgery went beautifully. He was very proud of his work on the bunion. Apparently, when the small bones in the mid foot let go, the forefoot shifted and turned out. Now when the pin was established mid-foot, he was able to turn the forefoot back to it's correct position and pin it there. So no "ectomy" was required! Pretty cool.

Getting prepped

Also, I do have the same fiberglass cast like last time. The staff at the pre-surgery clinic had told me that they wouldn't be able to use a cast because the forefoot must be allowed to swell. I asked Dr. Stevens about that and he said the pre-surgery people don't know what goes on in surgery and they didn't ask him what to tell me. Interesting to experience staff dynamics as a third person.

In my room, feeling no pain

All the staff I interacted with were very good - pre-surgery, day surgery nurses, operating room, recovery room, floor nurses and physio. Even after I scared the day surgery nurse by telling her that for my first surgery, three nurses had tried to set up my IV and all failed after much stabbing and prodding. I wanted the anesthetist to do it because that had gone very well in July. She eventually relented and had an IV nurse give it a first try - and by golly, it worked.

It's easy to believe the bunion is gone

Another fun event was that they woke me up before surgery was complete. Apparently my breathing had become erratic. The spinal and nerve blocks were still in place so I felt nothing. It seemed as if they must be working on somebody else. When the cast was on, Dr. Stevens lifted my leg so I could admire his handiwork, and it still didn't fell like it was my leg he was holding.

Shepherd's pie

Some of the renovations in the hospital had been completed by now, so Dr. Stevens was able to find Krista to give her a status report immediately after surgery. After a couple of hours of "defrosting" I asked a nurse in the recovery room to give Krista another update. I felt better knowing she was informed.

Scooting for the physio nurse

They waited a bit longer before bringing me to my room because a bed wasn't immediately available. When they did bring me up, it was to a four person room. Having a semi-private insurance upgrade doesn't help when a room isn't available. My roommates were decent enough fellows though, and all was well. I even got a window corner.

Even so, my goal was still to go home at the earliest opportunity. The nerve block hadn't worn off all the way the following day by the time the physio nurse came to see how I would get around at home. We had brought my knee scooter, so I had to reschedule until Krista could bring it in. Anyway, I was fairly pain free and impressed the physio nurse that I would be fine at home. We made it home by 3pm on Saturday.

Round 2

I've been mute in this forum for four months. That doesn't mean that nothing happened in all that time. My right foot has been healing and strengthening steadily. Whenever I overexert my feet these days, the operated foot recovers more quickly than the flesh-and-broken-bone foot. That's a good sign. I still find myself walking on my heels, even on the fixed foot - I will have to work on strengthening the muscles in the forefoot.

Besides mending, I have been trying to schedule my second surgery. My left foot needs the same triple arthrodesis surgery, but it also needs a bunionectomy. So the surgery may take longer and the healing will be different. I'm told my foot will swell significantly, so I won't be able to have the same type of cast as before because it would be too confining. Anyway, back to the scheduling process. My surgeon's staff haven't been as available as I'd like and I spent over three months attempting to get a surgery date. His office moved over the holidays, and apparently their systems were down for three weeks, but in my mind that doesn't explain three+ months of inaccessibility. When the date did finally get communicated, I had a mere two weeks to prepare. I had seven weeks last time. Oh well, that's in the past and the surgery is TOMORROW.

We've got my home "hospital room" set up in the living room again. We're doing final preparations and packing now. Today is a work-from-home day for me so I'm checking my laptop at least every half hour to make sure I'm not leaving anybody waiting on me. And, apparently, I'm writing a blog post.

We're leaving for Kitchener this afternoon. The surgery is at 8am and I have to be at the hospital by 6am. Three hours earlier than last time. I'm still hoping to stay in the hospital for only one night and come home on Saturday.

Another difference this time around is that I was taken off my pain medication for five days before surgery. That has taken and is still taking its toll. I've also been diagnosed with high blood pressure. Too bad sodium tastes so good. More medication and diet changes in my life.

All in all, I think it's manageable. Again, I think it will be harder on Krista than on me. Somebody should give that lady a medal. Oh, I think that somebody is me. Thank you for your perseverance, my love.