Getting Greg Back in the Game

It was like a scene from a movie when high school basketball player Greg Smalley returned to the court after surgery to repair his broken fifth metatarsal. Fans were on their feet, excitedly cheering when they realized the 6 foot 8 center was entering the game. In moments, Greg quickly stole the ball, sprinted up the court and dunked the basket against the opposing team’s defenders – valiantly marking his return.

“Greg hadn’t told anyone he was going to be playing that night – he kept it a secret,” said mom Janine Smalley. “Everyone was so happy to see him back, so they all started cheering when he stepped onto the court. When he dunked it, the crowd went wild. The place erupted.”

Greg wasn’t sure that he would ever be able to return to the sport he loved. The previous year, he had broken the fifth metatarsal, commonly known as a Jones Fracture, and missed his entire junior year of basketball with his nine-month recovery. When he broke the bone again early into his senior year, Greg knew he wanted to seek out alternative treatment options so that he could finish his high school basketball career.

When I saw Dr. Canales for the first time, I knew immediately he understood how badly I wanted to play again. He assured me he would do all he could to get me back as fast as he could.
— Greg Smalley

Jones fractures are common among basketball players because of the stress the sport places on the lower extremities through side-to-side cutting, stopping and sudden acceleration. Because of poor blood supply to the area and soft tissue that is attached, Jones fractures are notorious for not healing well. They are often career ending.

With the second fracture to the same foot, Greg turned to St. Vincent Charity foot and ankle surgeon Dr. Michael Canales for treatment options that would allow him to rejoin his Parma High School teammates before the end of the season.

“I knew I wanted to get back to the game as fast as I could,” Greg said. “When I saw Dr. Canales for the first time, I knew immediately he understood how badly I wanted to play. He assured me he would do all he could to get me back as fast as he could.”

Knowing it was likely the first fracture did not heal well through previous nonsurgical treatment, Dr. Canales performed a minimally invasive operation to place a screw down the metatarsal bone. He also used intraoperative x-ray to strategically inject platelet-rich plasma into the fracture site.

“When you are an athlete, you are counting the minutes you are on the sidelines,” Dr. Canales said. “I felt that this minimally invasive surgery, combined with the platelet injection, would give him the best chance to get back on the court safely and efficiently.”

Miraculously, this time, Greg was able to heal and rehab after surgery in less than 3 months. He was able to play the last three games of the season, including that cinematic moment in his first game back when he ignited the crowd with his heroic leap and slam dunk for 2. Greg’s team went on to compete in the state high school playoffs that year.

“This surgery and such a quick recovery time were kind of unchartered territory. Everything had to go exactly as planned to make Greg’s dream of getting back in the game a reality,” Canales said. “I am just glad he got to have his fairy tale ending.”

Celeste's 10-year journey with pain ended with doctors who listened

Celeste Cocca knows how quickly life can change.

Her day in March 2001 started just like any routine morning for her as a single parent - she rushed to get her kids up and off to school, prepare herself for work and beat the traffic downtown to make it on time for her job at a local bank. However, her life was turned upside down in an instant on that winter, Cleveland morning as she stepped out of her car onto black ice, and fell to the ground. 

That split second marked the beginning of a 13-year ordeal of pain, multiple surgeries and her quest to get her life back.

As Celeste sat stunned in the street on the ice, trying to figure out what had just happened, she looked down and saw her foot and leg going in opposite directions. Instantly, she knew the ankle was broken. She was in shock and felt no pain, but was unable to stand to get out of the way of oncoming traffic. She thanks God that a co-worker was just behind her and helped move her to a nearby emergency room.

The next day, she had the first of what became 10 surgeries over 10 years to install rods and screws and fuse bones in an attempt to repair the destroyed ankle. None of the surgeries worked. Celeste lived in constant pain and found little understanding from her physicians of the nightmare she was living. It was as though they did not believe the constant pain she felt, like a knife sticking out of her ankle and stabbing her with even the slightest movement.

At one point, Celeste was told there was nothing more that could be done. She would just have to live with the pain the rest of her life. 

“I just sat in the doctor’s office and cried,” Celeste said. “It was horrible. Just like that, my life became about the pain.”

However, as a single parent, Celeste said “failure was not an option. I had to take care of my kids.” 

So, for 10 years she managed to work around the pain and find creative solutions, like sitting on a stool to cook dinner, to take care of her family. She struggled to get out of bed in the morning and, if she did any extra activity, she couldn’t move the next day. Celeste lived her life coming home from work every night to ice her swollen ankle and praying just to get through next 24 hours. Somehow her determination carried her through what needed to be done, miraculously never calling in a single sick day throughout those 10 years.

Then, fate stepped in around 2011, when a friend referred her to St. Vincent Charity’s Dr. Lou Keppler for a knee replacement she needed most likely caused by the body adjustments she was making to cope with her ankle pain. Seeing Dr. Keppler was the first time, Celeste says, that a doctor looked at her entire situation and acknowledged her pain.

“Finally, here was someone who saw my pain was real and not just imagined.” After knee replacement, Dr. Keppler believed there was something that could be done to help her ankle and referred her to Dr. Michael Canales for treatment.

Dr. Canales and Dr. Keppler literally gave me my life back.

“Dr. Canales was a God send,” she said. “He was the first doctor to look at my X-rays and understand what was causing my pain. He was the first to ever say out loud that my ankle was in trauma. He came up with a two-year treatment plan and gave me hope.”

As part of his treatment plan, Dr. Canales developed a short-term and a long term plan to bring Celeste relief. “I wasn’t going to eat the elephant in one bite. Both previous fusions had failed and every time a patient has an operation, the likelihood of success goes down.”

As a believer in communication as the cornerstone for the doctor-patient relationship, Dr. Canales quickly picked up on Celeste’s nonverbal cues regarding additional bone fusion surgery. Dr. Canales could see from Celeste’s body language that there was no way she was going down the fusion path a third time. So, he worked with her on a two-year plan, including removing hardware and prescribing a brace that Celeste said made her “look like a football player” to strengthen the ankle, and move her closer to a successful total ankle replacement surgery.

As her December ankle replacement drew nearer, Celeste prepared herself and her kids for the long recovery after such a major surgery. She warned her kids not to expect the family’s Christmas traditions – the homemade cookies and candies she made each year – following her replacement. She did not anticipate feeling well enough to do the things she had always done to make the holidays special for the kids. She expected the pain after her ankle replacement would be temporarily worse than the pain she had lived with since her fall.

After living all those years in daily pain, it was amazing. I could move again and I didn’t need any pain medications.

However, Celeste’s Christmas surprise came in what seemed like an instant, quickly changing her life again. Almost immediately after surgery, she was pain free.

“I felt so great- it was unbelievable. After living all those years in daily pain, it was amazing. I could move again and I didn’t need any pain medications. I was actually able to make all the cookies and candy and do it all. It was an amazing Christmas.” She was also able to take back up riding her bike, a hobby she loved before the ankle injury, and then lose 30 pounds as a result.

Celeste credits St. Vincent Charity and Doctors Canales and Keppler for helping her end her 13-year ordeal. They treated her as an individual patient, looking at her specific situation and believing that they needed to find and COULD find a solution for her chronic pain.

“Dr. Canales and Dr. Keppler literally gave me my life back.”

Dementia Care Week


Dementia is the 6th leading cause of death in the United States with over 5,000,000 people diagnosed. So what exactly is dementia? Dementia is a disturbance in a group of mental processes that include:

  • Memory
  • Attention
  • Reasoning
  • Language
  • Planning
  • Learning
  • Perception
  • Behavior

Some common signs of dementia include misplacing things, blank stares, trouble recalling words, difficulty solving daily life problems, troubled learning, social and work withdrawal, judgment problems, memory difficulties, confusion and change in personality.

Risk factors of dementia include advancing age, family history, hypertension, diabetes mellitus, head trauma, strokes and late life depression.

At St. Vincent Charity Medical Center, we take a unique approach to caring for those suffering from dementia. Our dedicated geriatric psychiatry unit provides a safe level of care for those ages 55 and over suffering from dementia and other behavioral health issues. With a focus on restoring patients to good emotional and physical health, our comprehensive program addresses co-existing medical illnesses, medications, family concerns, and social and environmental issues.

“At St. Vincent Charity, we treat these patients differently and we know exactly how to approach them,” said Janine Smalley, MSN, RN-BC, ECT Program Coordinator. “It’s important to always remember that those suffering from dementia are not giving you a hard time, they just simply are going through a hard time.”

Treatment is goal-directed and encourages patient participation. The geriatric team understands the patient’s particular healthcare needs, as well as their family situations, and strives to provide the help needed to restore good emotional health in the least restrictive environment. Additionally, St. Vincent Charity provides these patients with music and art therapy sessions that allow them to explore and express their feelings in a new, creative way.


It is important for people to know that severe memory loss is not a natural part of aging
— Janine Smalley, MSN, RN-BC, ECT Program Coordinator


There are many myths about dementia and it is important to educate people on the facts for proper treatment. Here are some common myths about dementia:

  • Dementia is a disease
  • Alzheimer’s disease is not fatal
  • Only old people can get dementia
  • Artificial sweeteners like aspartame can cause dementia
  • Aluminum intake can cause Alzheimer’s dementia
  • Alzheimer's is the same as dementia

Dementia is an umbrella term