14 Weeks Post-Op

Yay, so I'm not really good at keeping up with this blog thing!  But I thought I should at least do an update the progress Matthew has made in the  7 weeks since I last wrote.  Here we are 14 weeks post-op and things are looking great!!  Everything has gone so much better and faster then we had expected.

Rewind to the end of December ... Matthew had taken his first steps but was dealing with a stitch abscess.  We did warm compresses and added some pressure around the spot (as much as he could handle) for a few days and it pussed and oozed and one morning there was a bit of a hole in the area  and the pressure was gone and from there on it slowly healed up nicely.

Our follow-up appointment in Calgary was on January 6th. We had spoken to the clinic a few times but never to our own doctor and everyone wanted to error on the side of caution and told us to leave him in his walking boots until his appointment.  After 10 days in his walking boots we decided that we were going to go with the doctors first instructions that said when he was comfortable he could move try without the walking boots. 

Walking in the walking boots seemed like more work then walking in shoes as his feet had to drag around heavy items that seemed unnecessary and since he had two walking boots it did make it awkward to walk and seemed to be putting some strain on his knees.  He had quickly gotten comfortable in the boots and was having no pain, which made him want to get out and do "normal' things, so he would be biking around town and played goalie at the outdoor skating rink in his two boots.  We decided he was definitely comfortable and we wanted to give the shoes a try before we arrived at the clinic so we knew what kind of questions to ask if there were issues.

First time walking in shoes.  He found the biggest challenge was learning how to balance, as he had been leaning forward more when balancing in his walking boots.

For the first few days he just did a little bit of walking in his shoes with his orthotics and slowly he tried more. He found he could not stand or walk in bare feet.  That immediately gave a lot of pain, but as long as he wore his orthotics the pain was minimal if he didn't overdo it.  I made him continue to wear his walking boots when he went outside the house as often he would get more active and be less cautious then. By time we went to the clinic a week later the wheelchair was staying in the van and he was walking to his appointment.

Sunday morning he came out of his room and declared "I look normal again!"

On January 6th we seen the orthopedic surgeon.  He didn't even bat an eye that Matthew was in shoes and not his walking boots.  We reviewed what pain he was having, which was none in the actual surgery area, some in the heel and upper foot area if he walked for too long and some in his knees.  Upon finding out Matthew had been biking in his walking boots he got him in trouble and said this was likely where his knee pain was coming from.  He watched Matthew walk and then gave us a referral to physiotherapy telling Matthew he was to do no biking, to WALK ONLY and to follow physios instructions on how to SLOWLY return to activities.  For his entire life he has been walking incorrectly on his feet since the bones have messed up his structure, so he needs to be properly trained and have all muscles/tendons/ligaments working well before he returns to full activities.  Our biggest question was how to determine when he's done too much, as in, when is it okay-pain and when is it too-much pain. The doctor said that his feet should wake up refreshed each morning.  He should not start his day in pain, if he has pain then he did too much the day before.  It's a bit of hindsight, but he felt that was the best way to determine how much to do.   With that information Matthew was discharged from the clinic and only needs to go back if there are problems.

Before leaving the clinic I got pictures of his last x-rays before his surgery.  They never took x-rays after his surgery, but it would be interesting to see the difference.

X-ray of the left foot before surgery.  The Accessory Navicular is where the cursor is on the picture.  

Zoom in of the left foot.  The left AN came out in one piece.  You need to look closely at the x-ray to see the smaller, more faded piece where the cursor is pointing.

X-ray of the right foot before surgery.  This foot caused more pain then the left foot

Zoom in of the right foot.  The AN on this foot came out in two pieces.
On this foot the AN had completely attached/calcified to the Navicular bone. 
The part that is circled is the part that was extra and came out.

On January 12th Alberta returned to in-school learning and Matthew soon discovered that the school hallways are a lot longer and require a lot more walking then being at home.  His feet were sore by the end of the day but usually by morning were doing good again.  It would take his feet a bit to "wake up" in the morning as they would be stiff and he would walk awkwardly for the first little bit, but by time he headed out the door for school he was usually walking pretty normal.  

Matthew went for Physiotherapy for only three weeks, each week would start off painful but by the end of the week he was doing the exercises without much issue.  Most of the pain he was getting was on the top of his feet (especially the left) and sometimes in his heels, but nothing in the area of his surgery.  Because of his AN he also has Posterior Tibial Tendon Dysfunction (PTTD).   The posterior tibial tendon runs through the heel and attaches to the navicular, hence the reason his heel continues to give him pain.  An MRI of his feet last year showed that he has bursitis  (inflammation of the bursa - a fluid filled fibrous sac) in his heels.  It is our hope that as his feet strengthen this condition will also be alleviate as the AN was interfering with the Posterior Tibial Tendon and it needs time to recover.  Once it recovers it will hopefully function without pain.  After three weeks Matthew was doing so well that physiotherapy discharged him with some exercise to continue to do for a couple more weeks and told him he could slowly keep building up and doing more things as his feet tolerated.  He was extremely excited (to put it mildly) to be able to bike and play sports again, but for the next couple weeks these last physio exercises (involved jumping) seemed to cause a lot of pain on the top of his feet and caused him to have to back off on some of the activities he had been doing.  Eventually we checked back in with physiotherapy and they wanted him to have it checked out by a doctor and have some imaging done.  I didn't get around to booking anything right away and now these last few days this pain has gone away and he has been out skating and running and jumping and overall doing really well.  He still gets some heel pain if he does too much, but he's been making huge progress on what he's able to do!!

It's hard to believe that the original timeline for this surgery had him in Walking Boots until February 1st and instead here he was walking in shoes and discharged from physiotherapy by February 1st.  In recent weeks he has also been taking his shoes off in the house and going in socks at home without having extra pain, something he could not do during those first weeks of walking.  

A  mug shot of his "war wounds" 

Not only are his feet doing better but Matthew is also super excited that upon returning to walking he is now 5' 7 1/4" inches tall, which makes him not only taller then Marietta (who he surpassed during the summer) but also taller then Rebecca and his mom!  His next goal is to surpass his dad ... he has another 5 inches to go before he accomplishes that.

Time will tell whether surgery will alleviate ALL of Matthew's feet pain, but for now we are so very thankful for how the Lord has blessed this process in so many ways - with the timing of the surgery (COVID means he's not missing out on any sports), the straight forward procedure of the surgery with no surprises, the low pain levels he had after the surgery, his determination to be independent and do things on his own during recovery, the speed at which he recovered, that the infection he got did not become anything serious, that he had so little pain when he started walking again, how quickly he was able to build up his muscles and strengthen his feet once he began walking and how well he is currently doing.  Indeed, lots to be thankful for!  

I will give thanks to the Lord with my whole heart;

I will recount all of your wonderful deeds.

I will be glad and exult in you;

I will sing praise to your name, O Most High.

Psalm 9:1,2 

Walking ... and stitch abscess 🤔

Wow!! We're already past the six week mark!  The past six weeks have gone so well and have just sped by.  

On November 30th Grade 7-12 students in Alberta switched to online learning due to COVID.  Matthew was only back at school full-time for one week before the switch. So for the next three weeks of school this is pretty much what his classroom looked like:

Well, to be honest, he spent a decent amount of time at the kitchen table as well, but his preference place was his bed.  This meant for the last three weeks of school we did not have to carry him in and out of the house and he spent almost all of his time at home.  As far as the learning aspect of school goes he prefers online learning, and if it weren't for sports he'd be quite content to do all his schooling this way.  

This has also meant that he's had more free time and even though he couldn't walk he found lots of ways to keep himself busy.  For a couple weeks we had beautiful weather and he got pretty handy at coming and going on his own.  He would bum his way down the stairs and into our second wheelchair that was left in the garage for him.  (This wheelchair came from Red Cross, but did not have arms that lift on the sides for transferring in and out of the chair to the toilet, bed, etc.  Once he got better at moving around he was able to get in this one even though the sides do not lift).  Once in the other wheelchair he could be found in the garage working on his bikes or doing wheelies around the neighbourhood.  When he was done outside he would bum his way back up the stairs and was able to get himself back into his "inside" wheelchair all by himself thanks to being allowed to do heel pivots.  Overall he became pretty self-sufficient and independent when he so desired.

He learned to do wheelies on the Red Cross wheelchair since it overall lighter, but also did not have the heavy leg elevators on it.  But it wasn't long before he was able to do wheelies in both wheelchairs and it was seldom that we seen the wheelchairs with four wheels on the ground.

Occasionally we would see them would no wheels on the ground 😱  Or we would just hear the thunk and a yell for help.

When the weather isn't so great he likes to spend time putting together videos.  He's made a few video's about his surgery, which can be found here: M7Guy YouTube Channel 

At the four week mark he developed a small infection in the stitches on his right foot.  They suspected it was likely a stitch abscess.  We were told to apply polysporin several times a day and leave it uncovered and open to air as much as possible.  This was not hard to do considering he rarely leaves the house.  So for the next couple weeks he seldom wore the boots, only putting them on if he had to go out or wanted to go downstairs and Rob wasn't around to carry him so he needed his heels to bum down the stairs.  For a few days the infection seemed to spread along the stitch area, but by the end of a week it was looking pretty good again.  And now two weeks later it's decently improved.  

The infection didn't look bad, but considering there was no redness beforehand it's an indication that something was brewing

 On Monday evening was the big moment when he tried to walk again for the first time.  The doctor had told him he could start walking in his boots and then move to without the boots, but he did not give very specific instructions for this and so we are currently waiting for more guidance in this area.  At the time I did not ask much as I figured it would take a bit of time for the transition, but Matthew has gotten up on his feet and walked the last couple days and does not really have any pain in the Accessory Navicular area.  Once he got the hang of balancing he found that most of his discomfort is in the upper foot area and outside ankle area from having to lift the heavy boots, which he's not used to, especially since he hasn't worn them the last two weeks since he had the infection. His knees also have a bit of discomfort, probably a combination on being non-weight bearing for six weeks and walking awkwardly with having two boots and feeling like you're walking in ski boots. 

For now he is not doing an excessive amount of walking, just walking from bed to table, table to washroom, etc instead of wheeling.  This is going well and once his feet get used to the boots or the doctors office gets back to us to tell us whether he can just wear his shoes with his orthotics, then he can start increasing the amount of walking he is doing each day.

He can't get over how tall he feels standing up again ... and then to have an extra inch and a half added from wearing the boots

As I was finishing off this post last night Matthew had just completed a shower and was getting ready for bed and tells me that his right stitches are flared up again and it hurts in that area.  I took a look at it and it definitely looked flared up again so I decided to wait until morning to post this and see what came of it.  This morning when he woke up it was bulging in the one area of the stitches that previously looked infected and there was puss coming from that area.  We sent pictures off to the clinic and they have since advised us that it looks like a stitch abscess, so in other words, we calmed the surface the last couple weeks, but the problem is below the surface and it needs to come out.  We were advised that it is like a pimple that will become more painful and eventually "pop" and push out the stitch that has not dissolved as it should have.  He is to put warm compresses on it to encourage it to continue to drain and continue to apply polysporin.  

The abscess stitch trying to make it's way out

His doctor was not in the clinic and the doctor who went over his file advised that he should continue to walk in the boots until his appointment on January 6 in order for his muscles and such to regain strength and not to walk without the boots.  This is not what our doctor had said, but with this abscess he won't be walking much anyways as he doesn't even want to put the boots on or walk since it rubs against the area. Seeing as we're mostly stuck at home and there isn't much going on, we'll just take it one day at a time and hopefully he'll be back on his feet again soon.  Regardless we are excited that he can walk if he feels comfortable doing so and that he did not have pain with walking as we had really expected more pain and discomfort when he first started walking.  In the meantime, we'll just have to be patient about getting this abscess out of the way!

And so since it's so close to Christmas I will end off with wishing you all a very Merry Christmas from our family

"I have told you these things, so that in me you may have peace. 
In this world you will have touble.  But take heart! 
I have overcome the world"  John 16:33

Good-bye Pink and Purple

It's hard to believe that it's been over two weeks since surgery.  The past two weeks have been busy and  have gone by very quickly.  I started a post a week after surgery, but time never allowed me to finish it ... so here's the update 17 days post op.

Matthew found sleep wasn't so great the first night in his own bed.  Keeping his feet on the elevation pillow was a bit of challenge and by morning he was complaining of a sore back from laying in bed all the time.

He received a visitor the day after he got back home who commented that his family had a "hospital" bed that they were not using.  Several hours later and ta-da, Matthew had a nice comfy hospital-type bed.  This has been such a blessing!!  His feet are much more comfortable because he's not focusing on keeping them on the elevation pillow but can move them around as he pleases and his back is much more comfortable with proper support.

Marietta and Matthew have been "sick-buddies" and like to play Among Us together

The first days he had to be mostly laying down with his feet up above his heart, but as the week went on he has been slowly able to sit up more with his feet reasonably elevated ... so more even with his heart instead of above his heart.  As soon as his feet were not elevated enough they would begin to hurt.  A trip to the bathroom was painful at first because he would have to put his feet down for this.

On Friday, four days post-op, there was an end of season Volleyball game (boys against girls) and pizza party and he was determined that he would go.  So his first outing was to this event, all said and done he was probably out of his bed for about two hours.  This was a good tests to see how the feet would do, would the pain increase to unbearable or stay the same and would the pain go away as soon as elevated?  This went well, the pain stayed at the same level and once he was back in his bed for a bit the pain went away again.  By Saturday he was off all pain medications.

On Sunday he went to church (one service) with his feet propped up on a chair.  While his feet hurt it was more the fact he ended up with an extremely sore back that he wasn't so eager to go out and about again soon ... maybe also because he hates school?!?  So we kept him home for a few more days to allow him some more recovery time.  This also gave a bit more time to make sure he was caught up in school work before getting back into the grove of things.

A special visitor

He returned to school 10 days post-op for a couple hours the first day and about four hours the second day.  After the first day I took him in to the wheelchair rental place to get a few things adjusted on his wheelchair as well as have leg elevators added.  I had not gotten them at first because they were ridiculously priced (almost 4x the amount of the actual wheelchair rental) and I had thought by time he went back to school he wouldn't need them.  Until we got them he could not raise his feet when in the wheelchair but needed to find a chair or something to rest them on and this was hindering him from leaving his bed for too long.  With the leg elevators he can adjust the feet and bring his legs up when needed and quickly put them back down for moving around.  This makes school easier because he is determined to be independent and doesn't want to have to ask someone to bring him a chair for his feet or move the chair out of the way of his wheelchair.  

He was so excited about a couple Lego Technic gifts he received ... still loves his lego!! 
Always fun, but a little more challenging to keep little pieces from rolling off the tray and getting buried in the bed

Monday and Tuesday of this week he went to school full days and it has gone well.  His feet seldom hurt now and you can tell by how much more moving around he does.  He is determined to be independent.  In his room he will either have the wheeled commode or his wheelchair beside his bed.  The commode has worked great for getting in and out of the bathroom since its wheels maneuver more then a wheelchair.  It also was so much easier during those first days when he was in more pain to just transfer once from to the bed to the commode and then upon return from the commode back to the bed.  Using a wheelchair takes a bit more skill to get into the bathroom beside the toilet and then he has to transfer from the wheelchair to the toilet and back into the wheelchair.  That seemed like too much work when in pain, but now that he has pretty much no more pain he will usually use the wheelchair.

Right from day one he had a dislike for the commode because he could not do it himself as it required someone to actually push him since it has small maneuverable wheels.   But over the last days he has figured out how to push himself just right so he can make it from his room to our bathroom without getting stranded away from a wall. So now he pretty much doesn't need any help with the basics while at home.  

I caught the tail end of him returning from one of his bathroom trips.

Yesterday was the big day where we returned to the hospital to have his pink and purple casts removed and switch to walking boots ... but no actual walking.  He was sad to give up his casts.  He thinks they are more stylish then walking boots.  He also feels like the boots mean he should be able to walk and therefore feels more awkward being in a wheelchair.  He'll get over it and get used to it.  There are many people that have walking boots that are on crutches, we keep reminding him they are just a different form of a cast.

Casts off.  The stitches are dissolvable, so he can now bath and clean up his foot and wait for the stitches to disappear

For the next four weeks he will be in the boots and continue to be non-weightbearing.  These are the most important healing weeks, with no stress on the tendons so that they can properly reattach to the navicular bone.  He is allowed to take the boots off when sleeping or resting if he wants.  The boots mostly serve as a reminder that he can't use his feet and as a protector so he doesn't accidently damage them, as well as so others realize that he cannot use them.

After four weeks he is allowed to slowly start walking, first in his boots and then he can try without his boots.  This is different then what we were originally told, where we were told he would go six weeks in walking boots.  But we figure we'll just wait and see how it goes in his walking boots and make sure he's comfortable before we decide to go without them.  We'll cross that bridge when we get there.

So far he isn't too happy with the boots.  They are heavier and bulkier then the casts, but I'm sure with time he will get used to them.  He did not have a good first night with them.  He is allowed to take them off at night, but he's scared to do so, especially with his stiches not all the way healed yet.  So he went to bed with his boots and I suggested he try during the day to take the boot off for an hour or so here and there when he's in his bed and once he gets more comfortable he can take them off at night.  Well ... he had trouble sleeping with the boots, at first just couldn't get his feet comfortable and eventually they started to hurt and feel funny ... so finally after being awake for hours he gave in at 4 am and decided to take the boots off, he was asleep shortly after that.

Overall things have been going extremely well.  So much to be thankful for!!  The challenges we have encountered have been minor and the best part is that his pain has been so easily managed. The timing of all of this has also been great.  With all the COVID stuff going on, we are thankful the surgery took place at all!!  COVID has meant that Matthew is not missing out on sports and he won't be pushing himself to do more then he should in order to get back into sports.  And this week they announced that Grades 7-12 will move to online learning until January 8th.  While I'm not loving the school at home idea, my knees are definitely loving the fact that I won't have to carry Matthew into the house after school each day.  My knees have not been too happy about climbing stairs with that much weight, the one time I came close to going down with Matthew when my right knee gave out.  This was not something I had thought about when planning ahead for this.  

Matthew was shown how to bum up or down the stairs before he left the hospital and we may have to resort to this if necessary.  It brings it's own challenges because then he has to be lifted into his wheelchair from the ground, which is hard on the back.  The other factor is that it's winter ... the stairs are either snow covered or wet.  Normally we use the garage stairs, but with the rest of us using those and them being wooden it's hard to keep clean.  Guess he's just going to have to accept a wet or dirty butt 🤷  Yesterday when we got home from the hospital the outside stairs were actually clean and dry so he did give it a try.  With only 3 1/2 more weeks of non-weightbearing to go and him not needing to go out of the house every day anymore "We've Got This!" 😀

"And my God will supply every need of yours according to his riches in glory in Christ Jesus.  To our God and Father be glory forever and ever. Amen."  Philippians 4:19, 20

Home

Everything went really well last night and by 7:30 am we were going over the discharge information.  Matthew slept well last night.  Overnight the local anesthetic wore off and this morning he could again feel his toes and had some slight pain in the area of the incision/stitches, but the pain is mild.

I left Matthew to enjoy his breakfast while I headed back to the Ronald MacDonald House to help Rob pack up and clean the room and then we returned to pick him up.

He was pretty excited about the nice comfy wheelchair blanket we got him.

It took a little bit for him to get comfortable in the van. His feet will begin to hurt if they are not elevated above his heart, so sitting up for a longer period of time was not the best for them.  But after an early lunch he zonked out for the majority of the ride home.

He's happy to be home and back in his own bed.  He joined us at the table for supper, but by the end was asking to go back to bed as his feet began to hurt again ... so for the next few days he'll be vegging in his bed, keeping those feet up so they don't swell and they don't hurt.

His sisters put the money for his pink and purple casts in the balloons above his bed, so he's going to have to pop the balloon to see if they paid him correctly. 🤯

It is such a blessing to see Matthew cheerful and energetic, wanting to do as much as he can on his own, but also realizing his limits and using caution.   We are so thankful that everything has gone so smoothly thus far and pray that things continue in this manner. 

Pink and Purple

It's been a good day!  We are grateful that surgery took place, went well and so far recuperation is going well also.  

We arrived at the hospital at 6:45am since Matthew was scheduled for first surgery of the day.  He was off to the OR shortly before 8am.  The surgeon advised it would be about 3 hours, so after an hour of so of sitting around Rob and I decided to go stretch our legs ... we were only gone a short time when we heard our name being paged over the PA system to return to the Unit.  Thankful it was good news.  They were done the surgery, it had gone faster then expected but everything went as planned.  The ANs were removed and they were able to suture the tendons back in place without needing any pins or hardware.

Matthew was not able to see/keep the bones as they are sent off to the lab, but the surgeon did take pictures of them so Matthew could see what was removed.  The large piece on the left is from his left foot.  The one from his right foot came out in two pieces, which are pictured in the center and on the right.

Apparently it was a busy day in the OR/Recovery Room today and there were lots of babies screaming/crying when Matthew woke up.  So his stay in Recovery was short and they brought him back to the Unit as soon as they could.  He was still pretty zonked out and slept for the next hour and a half, before slowly waking up.

Physio came around in the afternoon once his nausea began to settle to teach him how to get in and out of his chair.  They provided him with cast shoes to give his feet some grip, since casts are really slippery, so that he can do heel pivots.  He is allowed to put some weight on his heels in order to balance himself when transferring in and out of his wheelchair.  This is the only time he's allowed to put weight on his feet and most of the weight should still be in his hands or through someone assisting him.

Yes those are pink and purple casts. I guess he was desperate enough for $10. 

At this time he is being given stronger pain killers (I believe Ketorolac) and his feet are still numb/"frozen" from the local freezing they gave. So he is feeling good with almost no pain.  He feels like he could go home, but that can't happen until the local anesthetic wears off and we know how his pain actually is. Feeling well has given him a chance to try to be independent, and he is determined to do everything himself.  At this time bathroom breaks are his only time out of bed as he has to focus on keeping his feet elevated above the heart to prevent swelling. 

Overnight the local anesthetic will wear off and by morning we should have a better indication of how he is truly doing pain wise.  If all is well then we will be able to head home tomorrow. 

Thank you to all who sent their well wishes and prayers, they are muchly appreciated. It's a little bit of a different feeling to be in the hospital with something that is not so complicated or chronic or serious or life-threatening.  It's a different province,  different hospital, but still so many of the same things that bring back lots of memories of past events in our lives.  Adding the Ronald MacDonald into the mix also brings up extra memories of where we were 13 years ago at this time, which also makes us think of where we were 17 years ago at this time.  Life has certainly had it's challenges and this seems like a simple journey in comparison, but it is still a journey that Matthew has to go through and will need strength and patience for during the process.  We give thanks that the Lord has cared for him this day, that he could be healthy and able to have his operation, that all went well with the operation, with no surprises or extra challenges and that so far recovery is going well.

Oh give thanks to the Lord, for he is good

for his steadfast love endures forever!

Psalm 107: 1

Accessory Navicular

 Accessory Navicular?  What is that you may ask?

Google tells me that “an accessory navicular is an extra bone that is on the inner center arch of the foot. Up to 2.5 percent of individuals are born with the accessory navicular. Throughout early childhood, this condition is not noticed. However, in adolescence, when the accessory navicular begins to calcify, the bump on the inner aspect of the arch becomes noticed … Accessory navicular is a fairly uncommon condition which is rarely symptomatic”

An Accessory Navicular (AN) is something you are born with.  It is an extra piece of cartilage located in the inner side of the foot just above the arch.  As children grow this cartilage develops into bone.  For most people this AN is not a problem.  The above quote says 2.5% of the population have an AN, but various websites give different numbers anywhere from 2% to 21%, 4% being the most common.  The reality is that they don’t really know how many people actually have an AN because if your foot is not giving you pain you’re not going to be having an x-ray done to indicate it is there.  What they do know is that of those who do have an AN it is rare or uncommon for them to be symptomatic, if it is symptomatic often non-surgical treatment can help, such as custom orthotics, in a small number of cases surgical intervention is required.

So why the foot anatomy lesson?  Well ... doesn’t something like this pretty much fit with our “One Percent Family”? 🤷

Over the past 5 years Matthew has had feet pain.  He was originally diagnosed with planter fasciitis, which I knew was incorrect at the time based on where his pain was, but since orthotics seemed to take the edge off the pain we just stuck to making sure all his shoes had orthotics.  Summer of 2019 rolls around and he's hobbling pretty bad, along with having some knee issues.  Now that we have a benefits plan I figured we might as well invest in some custom orthotics to help settle this issue.  

An x-ray from the podiatrist showed us that Matthew has Accessory Naviculars.  Over the next 6 months we work with a podiatrist, custom orthotics, knee braces (is the knee pain from how he's walking, is he walking this way because of the knees or the feet?), physiotherapy for the knees and the feet, several bouts of complete rest, icing and oral and topical anti-inflammatories, and shockwave therapy.  The knee pain was likely Osgood Schlatter and between time, braces and physiotherapy this pain has mostly subsided.  Custom orthotics took a bit of the edge off of the pain in his heels for basic walking, but it returns as soon as he is more active.  Unfortunately nothing has helped the pain in the AN area, except for sitting on his butt and doing absolutely nothing, which COVID proved when all sports came to a stop and he was able to truly rest, but as soon as he got back out to do sports or a long walk the pain was back.    

The podiatrist we seen was hesitant to do surgery, feeling it was better to wait until Matthew had finished growing.  As I did some research and read what I could find about AN Syndrome, I found that the surgery was often done around age 10-12 and many adults who had the surgery had suffered with pain throughout the years and wished they had had it done at a younger age.   And so we decided to get a second opinion from someone who normally deals with children, which meant heading to Calgary to the Children's Hospital to see an Pediatric Orthopedic Surgeon.

Our first visit to Alberta's Children's Hospital (ACH) was a bit of a waste of time.  I'm not sure why, but we didn't actually see a surgeon, I think the guy we saw was just a pediatrician (from what I can tell from google).  Maybe it's a bit of a triage process, but what he suggested was nothing we hadn't tried already.  The only difference was that he wanted Matthew to talk Aleve consistently for one month and wear his orthotics/shoes at all times, except when sleeping 😆  After one month we called to say it had made no difference and we were placed on the list to see a surgeon ... except by this time COVID had hit and it wasn't until the end of September that we seen the Orthopedic Surgeon.

We are able to see the Orthopedic Surgeon on September 29 and he presented Matthew with three options: 

#1 - Do nothing - it may go away in a year, or 5 years, or 20.   With this option is the choice to live with the pain or adjust his lifestyle to reduce the pain.
#2 - Have surgery done to remove the AN and reattach the tendons properly.  Do one foot, wait 6 months until recovered and then do the other foot. 

#3 - Have surgery done on both feet at the same time.

Matthew had no trouble ruling out #1.  He wasn't for surgery during the first months of constant pain, but by this point he just wants to be done with the pain.  The pain is pretty much constant and increases as soon as he does almost any activity (except biking, which he loves to do and is very thankful for).  During the winter when he played both basketball and hockey there were days where he pretty much crawled once he got home because it was so painful to walk.  Ice and pain medicines did nothing to reduce the pain.  But he loves his sports and so he would get up and go out and do them again the next day.  At first I would often think it couldn't be that bad if he would go back and do more sports, but eventually you could see that it was just the stubbornness of not giving in and trying to enjoy himself without having to sit on the sidelines all the time.  And some days no matter how hard he tried to keep going and ignore the pain he would still be hobbling.  So #1 was not an option in his mind.

The decision was between #2 and #3.  He knew he wanted #3 but we had to help him realize some of the logistics of this so we knew he had made a decision knowing what he was getting into.  For a period he felt guilting for wanting #3 since it would be more work for us, but we also helped him to realize that we were okay with that, and in the end doing it once with more work would probably be less then doing it twice and all the extra driving back and forth to Calgary and physio etc.  And so the decision was made to move forward with option #3.

We had thought this would mean a surgery wait of about a year, giving us many more months to be confident in this decision and that he wasn't outgrowing the pain.  But we were surprised to find out that they expected to be able to do the surgery at the end of November/beginning of December.  And even more surprised a few weeks later when we actually got a surgery date of November 9th. 

As far as surgery goes, the surgery itself is not that complicated.  They will make a small incision by the navicular bone and take out the extra part of the bone.  They will then reattach the tendons to the navicular bone.  It is assumed that this is why he has so much pain.  The tendons are messed up and being interfered with by the bone and so this will have to be reconstructed based on what they find.  Depending on what they find they will either attach the tendons with sutures or it will be screwed into place.

It is the recover period that is the difficult part.  In order for the tendon to properly reattach he will have to be non-weightbearing for 6 weeks.  This means six weeks of no use of his feet.  And this is why the decision to do both feet comes with a lot of extra work.  He will be wheelchair bound for six weeks, will have to learn how to transfer himself from bed to chair to toilet, etc without using his feet.  We of course can help, but with time hopefully he can become somewhat independent.  Getting him in and out of the house means carrying him up and down nine steps, but once in the house everything he needs is on the main floor.  We moved him into the spare bedroom, so he is on the main floor.  Elevating his legs will be really important for the first days, so we are expecting he will be in bed with his feet up for the first 5-7 days.  After that we will see how he's doing and how independent he is able to be and then figure out the whole return to school process. 

So here we are the night day before surgery.  It was a busy couple weeks before hand getting in some last minute appointments and prep before surgery as well as the challenge of getting his medical equipment for post-surgery organized - you would think that there would just be a simple system for out-of-town children seeing as it's a Children's Hospital that serves more then just Calgary, but alas, nothing in the medical system ever seems simple or straightforward.  Regardless, by Friday morning we finally had all the correct equipment.  And by Friday evening we were on the road headed to Calgary due to a blizzard that was suppose to hit southern Alberta.  We did not want to get stuck in Coaldale unable to make it to Calgary, so we headed up before the storm came. The storm arrived later then expected (we could have waited until Saturday morning to leave), but it did arrive and we are thankful to be in Calgary, at the Ronald MacDonald, right across the road from the hospital.  The weather will not prevent us from getting to his surgery, now it's just a little over twelve more hours of him staying healthy with no sniffles before we arrive at the hospital at 6:45 am

September 2020

I had to look for a while to find a picture where he wasn't wearing a hat.  They are pretty much a permanent fixture on his head.  But prior to surgery I wanted his hair short so I did not have to concern myself with keeping his greasy hair clean (that's enough of a battle when he has two feet and can shower himself 😨).  So just so you all know 😁... he HATES his new haircut!!!  He didn't think I meant "that short" when I said short.  My preference would have been a buzz cut, then he could just sponge bath that part of his body too.  For now he gets short fuzzy hair, with no product in it, so it doesn't get greasy as fast.

Haircut done!  Ready for a Swim!
Friday night we stayed in a hotel and on Saturday afternoon we got a call that the Ronald MacDonald House had a room available for us, so we moved there Saturday afternoon - but not before Rob and Matthew got a swim in.

Oh ... and his sisters dared him to get pink and purple casts.  I don't think it's worth the $10's they'll give him, but we'll see what he decides 😲  I'm sure if someone offered him more money he'd have an easier time deciding 😆 or maybe he just wants those colours because he knows how much his mom and dad don't want them 🤷

It is our heartfelt prayer that all goes well with surgery tomorrow, that the Lord may bless the surgeon's hand as he does his work.  In a world where less invasive medical procedures are a daily event we often just assume that all will go as planned, but we know that all will go as GOD plans and so we lay this before Him knowing that He will be watching over Matthew.  We pray that the outcome may be relief of pain, but we also know that whatever the outcome may be God will strengthen and carry us, just as He has done in the past.

This is the confidence we have in approaching God: that if we ask anything according to his will, he hears us. And if we know that he hears us—whatever we ask—we know that we have what we asked of him.  ~1 John 5: 14,15

She Did It!!

Marietta has graduated from High School ... it took an extra year and a few tears, but she made it!

If you look at Marietta's report card you would never know that she accomplished about a third of her high school time while having a brain injury.  Her marks remained superb throughout all her years, but the effort and energy and pain it took to accomplish those marks changed drastically.  Brain injuries are hard to understand, but one thing we are reminded of from her experience is that a brain injury does not mean a person has suddenly become a dunce and cannot think, it does mean that at times it takes them longer then normal to think or they simply cannot process what is being said, but when the brain kicks in it is quite capable of doing amazing things.  

Marietta could have chosen to just go with the flow of her injured brain and let her school work reflect the fact that many days she could not process what was going on, but instead she chose to make sure that her work and her marks reflected the ability that she is capable of.  Last year was a hard year for Marietta as she returned to school and slowly worked her brain up to being able to do an afternoon of courses; this year proved to be an even harder year, not necessarily because of the school work, but because of the disappointments she had to work through.  She had expected after a decent summer that she would slowly be able to work her brain up to being able to take a regular course load, but this was not to be, and this fact was hard to take.  Each semester this year Marietta took 2.5 courses (Bible being a "half-course").  The plan had been to add another course in, but as the school year wore on she was still struggling to manage the courses she was taking and had to come to terms with the fact that her brain simply could not do more.  The dream of becoming a teacher slowly closed for the time being, talk of dropping out of school happened at various intervals, tears of frustration were shed from time to time, many days were missed due to the brains inability or simply too much pain, but in the end she made it and we couldn't be more proud of her.

It has almost been two and a half years since Marietta's accident and sometimes we feel like she is not making progress, but at those times we have to take a step back and look at the big picture.  Instead of looking back days or weeks, we need to look back months or even years.

Just over a year ago Marietta could not make it through a full "normal" day without rest.  She slept in and took a long time to get out of bed, it was a slow process for her to wake up and get through breakfast and get ready for school. She attended 2.5 hours of school, driven by car because the bus caused motion sickness and had way too much noise, and came home exhausted and needing to rest.  Life outside of school was pretty much non-existent as school drained all her energy.  

This is the biggest aspect of change we have seen.  She gets up each day with the others, goes to school at normal time, attends her classes and when not in class works on homework at school.  At the beginning of the year when we lived in Taber she took the bus to and from school, now that we are in Coaldale she walks home (about 20 minute walk) when she is done at school.  This helps to keep her on schedule with her daily exercise that the Concussion Clinic wants to see.  Once home she does usually have some "down" time, which for her means texting/chatting with friends or doing some non-homework things.  She works on homework in the evenings again and tries hard to get to bed on time (around 10 pm) as she needs a good amount of sleep to get through her days.

As far as symptoms goes, unfortunately we haven't seen as much change as we would like in this area.  Symptoms continue to be up and down with no real rhyme or reason.  They are not the same all the time but can vary from head nausea to head pain, vision disturbances, noise sensitivity and sometimes still light sensitivity (she has special tinted glasses that seem to help a lot with this issue, which she would really like to wean out of, but just hasn't been able to so far).  During these times she will be exhausted and have no energy, these symptoms will also effect her ability to process what is going on around her, her balance and sometime her ability to speak.  Some times she can simply feel that the brain is not really processing as it should and knows that she needs to keep it low key and stay home, other times she can start off doing okay and suddenly tumble into pain.  When things are good she enjoys it and does what she can because there is no storing energy for another day. Just use what you got when you have it. 

These challenges mean that Marietta very seldom drives and if she does it's only a very short distance as she has to be sure that nothing will change from the time she leaves until she comes home that would change her ability to return home.  A couple months ago Marietta's brain entrainment equipment broke and she decided to try without it.  This means she no longer has to be woken up at 5:45 am to turn on the equipment (she could go back to sleep while it ran).  She would also run it when she went to bed to help her get to sleep - the first few days without it were harder for her to sleep, but with time she has adjusted and seems to be doing okay without the equipment.

In January Marietta started at the Concussion Clinic at the University of Lethbridge.  Through their assessments they have determined that Marietta's brain can work and she can have energy at times, but if you try to get the brain to work while doing something that takes energy (walking on a treadmill) then it isn't able to function very well anymore.  We have always known that she is struggling with energy ... is it the brain that is draining the energy or is use of energy draining the brain?  The clinic has her working towards increasing her ability to do these separately and then they want her to work on putting the two together.   Previously the clinic had her doing physio therapy, which ended up causing a ton of symptoms and a lot of missed school.  So since Marietta has already been struggling a lot, especially the past couple month, just to get to school we decided not to throw any further loops into the situation and have put the clinic on hold until school is done.  

With school done Marietta has decided to take some time off to simply work on letting her brain recuperate.  Holding a job at this time would be a challenge as she is unpredictable on when she is well enough to work and returning to school in the fall has absolutely no appeal to her since it is so hard on her brain.  She simply wants to give her head some time and see where it leads her.  This time will likely also involve trying a few different therapy options which we just didn't want to attempt while she was in school as it seems all the previous options we tried didn't help or caused more symptoms

In October Marietta developed a bad head cold that really wiped her out.  Since her concussion she has been struggling with major sinus pressure and has tried various home remedies to help alleviate this, but it never seemed to help.  After this cold the pain got extreme enough that we ended up taking her to Emerge (since we did not yet have a family doctor) so we could try some antibiotics to see if this would help.  She tried the antibiotics for several days but when her symptoms did not improve and she started having some other weird issues we realized the medication was the problem and so we returned to Emerge where she was given pain medication and told to stop the antibiotics.  With no real answers we decided to implement our other suspicion - removing egg from her diet. This suspicion has been confirmed as the pressure is about 90% gone now and mostly just appears on her really bad days.  

On February 3rd Marietta made Profession of her Faith.
After 18 months of not being able to attend church Marietta was finally able to join church for the sermon section (without the noise of the organ/piano and singing) a year ago.  Throughout the past year she has had ups and downs in her attendance, sometimes attending just the sermon, sometimes being able to stay a bit longer, sometimes listening livestream at home and sometimes not being able to listen or process anything.  But even with these challenges she speaks of how these difficult times have helped her to grow in her love for God.

Marietta will tell us that it's her classmates that got her through this school year.  At times when she just wanted to quit she couldn't give up the idea of missing out on the social aspect of school and the friends she has made.  But while she quickly felt at home here, she still has her best friends in Ontario that she misses and was so excited that Elianna could come visit during the Christmas Holidays and Kendra came for a surprise visit during the Spring Break.

And a few pictures from her graduations.  The class had an official photoshoot (in the rain), but those photos won't be ready for a bit, so here's a few snapshots that were taken throughout the day.

Marietta had really hoped to no longer need her tinted glasses by time graduation came around, but she just isn't ready to give up the tint yet (they are always like that, it's not just because she's outside) , so she did some of her pictures without her glass so at least we can see her lovely eyes 

Their grad text:

"Fear God and keep his commandments, for this is the whole duty of man"  Ecc 12:13b