Update on the Foot Saga

There are conflicting opinions about my foot. The doctor I’ve been seeing since February about it thinks it has not healed at all. Last Monday, in what can only be described as a bizarre and upsetting appointment, he told my husband and me that there is no evidence of healing and that surgery now is no longer an option. It was as if he was completely reneging on his prior assertions that surgery would be the only way to get it to heal, now he was saying because there was no healing, he was not going to do surgery. This paradox and contradiction completely confused both of us. Ben took the mature higher road and tried to ask very basic clarifying questions to ensure we understood his flip-flopped opinion. I sat there melting down with tears and sobs fretting that “I’ll be in a boot until I’m 40!” The surgeon completely ignored me and only shrugged at my husband’s questions. Ben, seeing that I was unraveling, said, “yeah so I mean if it doesn’t heal in another year or two you still wouldn’t do surgery to fix it?” He stopped shrugging, paused, then said, “maybe after another year.” Then he said he’d see us in another eight weeks and walked out. 

Like a barnacle on a sea rock, I clung to Ben and wailed about my frustrations and that the doctor didn’t want to help me. Although my response was emotionally over-dramatic, the stress of the appointment, diabolical nature of the doctor, and his unwillingness to answer our straightforward questions met at an overwhelming head. Even calm, cool, and virtually unperturbable Ben said, “this guy isn’t our doctor. He wouldn’t even explain anything.” Then like a mother duckling, he led me out of the office, trailing behind in residual sniffles and tears. 

I spent the rest of that afternoon trying again to find other viable specialist in the area. I made a couple of appointments and tried to table my anxiety and frustration for the rest of the day. Not easy. As usual, I could barely sleep.

I received a phone call from one of the offices I had contacted by Tuesday afternoon. She had a cancellation on Friday in Connecticut, a distance I felt reluctant (but able) to drive. Friday, I drove myself down and met with the new doctor. He had a vastly different opinion and equally different mannerisms. He took the time to explain things to me, actually evaluated my foot with clinical tests instead of solely relating on imaging reports, and a contrary treatment plan. “It’s basically healed,” he asserted. “There’s still some residual swelling in and around the bone but it’s essentially undetectable.” He encouraged me to start weaning out of the boot and resuming low level activities. He even said he thinks I could be back to running within a month, quite a contrast to the other surgeon’s prognosis which was, I wouldn’t be running again for a year or so, if at all. After all, he didn’t think running was a healthy activity for anyone. Armed with a more optimistic prognosis, I headed home in much better spirits. 

Unfortunately, that night while lying in bed, my foot had a more pronounced ache than normal. I had not even removed the boot for walking yet and it already seemed worse. As anxiety consumed my thoughts, we called the answering service (something I never do). To my pleasant surprise, the operator connected us with the doctor right away who assured me this is somewhat normal because he “really firmly manipulated it to assess the function and clinical symptoms.” He recommended icing it, taking anti-inflammatories, and keeping it in the boot the next three days and then resuming his purported plan. This made sense to me since we did do aggressive assessments after the conservative evaluation revealed nothing painful or abnormal. With the connective tissue disorder I have, it’s also normal to have tendon and ligament dysfunction coupled with extremely tight muscles, so he hypothesized that some of the calf raises and foot mobility against resistance had merely aggravated my muscles and tendons in the area.

I am optimistic about the treatment, care, and plan and delivered by the new doctor, but at the same time, my hesitation to remove the boat and start walking is rational. Not only has it taken so long to get to this precarious point of potentially healing, but the blatantly contradictory advice begs the question as to who is right and whom to trust. The answer lies within me. It is my responsibility and within my control to carry out whatever I deem best. It’s my foot and I’m the one who is experiencing the injury. More so than ever, I must listen to my body and pay close attention to my symptoms and needs. I plan to try carefully weaning out of the boot as instructed all while directly focused attention toward the area to monitor the physical response. I must strike an informed balance between heeding caution and restraining my anxiety so it doesn’t pollute my assessment. I pray that it has healed and can handle incrementally more sneaker time, but I am mentally prepared to dial it back if need be. This entire injury has been one of the most trying exercises of patience, maintaining faith and hope, and discipline. There have been more than many moments where I was ceded that I’d never walk again, let alone run. The future is still enshrouded in mystery, but the ominous gray cloud that used to conceal the bleak outlook portended, now looks lighter and brighter. My fears and worries are not gone, but they are better balanced by optimistic hopes for restored function, painless miles, and endless smiles.

Healing?

Good news! My body may be finally stepping in and trying to heal my foot. We are going to postpone the surgery until May 11th, to give it a few more weeks. I’m happy about this for two reasons: there’s the relief that the surgery isn’t tomorrow morning (which makes it feel less real because it is less imminent and there’s a chance I won’t need it at all) and it makes me feel like my body, even though weakened in many regards, may have some inherent healing ability hidden within it after all. I also started to be overcome with nervousness about the general anesthesia required for the procedure.  I had no idea that it meant I was not going to be breathing on my own and would have tubes down my throat. In the past 24 hours, I’ve done enough research to convince myself that logically, this is safe and would be uneventful, but emotionally, it still triggers fear.

So, here’s to hoping that my body decides to heal this thing up on its own. While that’s certainly far and above what I’d prefer, I will face whatever outcome we reach on the 11th with as much stoicism and positivity as I can muster.

Prognosis

I’m crutching all around the hospital today. For some reason, they’ve designed it so that the orthopedist is in the basement in a small office that’s only reachable by snaking through several very long hallways. The radiology department—where he sends nearly every patient to get an X-ray after first seeing him—is upstairs at the opposite end of the building, in an entirely different wing, down another set of long, zig-zagging hallways. Thank goodness that I’ve been doing my strength training and have these triceps in gear!

After crutching for what feels like 30 minutes, I’m sitting back in his office waiting: waiting for him to come back in, waiting to hear why my foot is not getting better, waiting for an action plan. I start working myself up into an anxious state, flirting with a full-blown panic attack. I have my huge headphones on to drown out the rattling of the heating unit that seems to be situated in the wall behind his office rooms. I wear my noise-blocking headphones without exception when I go on most errands, unless I’m certain the place is very quiet or I’m accompanied by someone (in which case, it would be rude). I’ve also been wearing my winter beanie basically as part of my daily get-up since November (at least I have three!). It not only keeps me warm, but it tamps down my little flyaway curls that otherwise blow as I move—a guaranteed fast-track to throwing me into sensory overdrive.

The thick hat and the enormous headphones are quickly sending me into overheated territory. Thermoregulation and body temperature awareness are significant challenges for me with SPD. I seem to have to no idea if I’m trending towards becoming too hot or too cold until I’m beyond the point of easily reversing the situation and re-establishing comfort. This is one of those moments. It seems I am still dressing for January and it’s in the 60s outside. I begin to sweat. Anxiety is indubitably contributing to this heat flush, but my down coat isn’t helping. This doctor makes me nervous and so does this injury. I have a premonition it’s not going to be a favorable prognosis. My foot throbs as if to remind me, yes, I’m here and I really hurt. I don’t need the reminder but the throb won’t be silenced.

For some reason, once I’ve identified that I am, indeed, too hot, I do nothing to remedy it. I keep waiting.

I wish Ben was with me. He’s at work so I send him a text telling him I’m bored. I’m sure he knows to substitute in the word scared or lonely. I do multiplication problems in my head while I wait; over the years, I have found this to have a mild relaxant effect. 243×77

Finally, my doctor enters after reviewing my x-ray. Even though I struggle to interpret facial expressions appropriately, his is a clear tell.

It’s not good news.

I need surgery. He will insert an intermedullary screw, which is essentially a screw that gets drilled longitudinally into the metatarsal bone marrow. It will help my fracture heal.

The word surgery doesn’t jive well with runner or anxiety-riddled—both of which are equally understated adjectives to describe me.

So that’s where I am today: just wrapping my head around this next hurdle and working on convincing myself that I’ll be fine and this will ultimately be the best treatment. I will and it is.

I’m sure that I’ll have a lot of thinking and writing to help me digest this but I’m actually feeling like the depression might be lifting a little bit. Even though this is a scary proposition, it will ultimately help me heal. April 25th sounds like a good day to have surgery anyway, right?

 

Face-Planting

I face-planted today. I was at physical therapy trying to walk with an iWalk, and I literally toppled prone onto the floor like a stiff board. (I probably should have been in the parallel bars while testing it, right?)

Let me back up. I recently broke my foot and I’m to be non-weight bearing for 8 weeks while it heals. I’m on day 3. As an avid runner and someone whose coping mechanisms involve movement, this is not a brief nor welcome prognosis. I’m already falling off the rails a bit. Because of physical issues, I get injured a lot, but this is different because the world becomes much more limiting on crutches. So, the doctor suggested an iWalk. As I mentioned, I clam up and become nonverbal in appointments, so I was unable to ask any questions about this device. While I can certainly see how it would be a useful ambulation aid for most healthy adults who are able to balance, it could not be a more mismatched tool for my safe mobility. The Amber-iWalk incompatibility stems from three six crucial issues (all of which could have been addressed had I advocated for my needs and asked questions at my appointment!):

  1. Balance: you have to have normal to good balance to use this thing. Essentially, it’s like a prosthetic lower leg that sits on a small foot with a platform for the injured foot to remain perpendicular to the ground. Since the base of support is smaller than one’s normal foot, it’s hard to control. As I mentioned, one of the primary issues with sensory processing disorder (SPD) is significant difficulty with balance.
  2. Size: it’s meant for adults 4’10”-6’5″. While I do fall within this range, albeit close to the minimum, it’s still too big for me. We were unable to tighten the straps sufficiently around my leg without maxing out their available adjustments. The therapist tried sticking a towel in there to bulk up my dimensions, but the thing still kept rotating around my leg. That doesn’t work when you’re trying to control an artificial leg. Take it from me: I spent two years earning my MS in prosthetics & orthotics, a degree that I don’t use for my vocation, so I might as well apply it to my own life situations! Prostheses need to have as intimate of a fit as possibly for control and comfort. This loose fit resulted in a device that was neither comfortable nor well-controllable!
  3. Body control, kinesthetic awareness, and coordination: sensory processing disorder issues manifest in poor coordination, and proprioception, body control. I’m somewhere between a pinball and a snowball rolling down a big hill. The laws of inertia do not necessarily seem to apply to my movements. I tend to go faster and faster with unintentional reckless abandon once I get moving and I can’t seem to control the movement of my limbs or coordinate limbs and trunk. The one exception is running. Running seems to iron out my kinks and turn me into a relatively graceful, well-oiled, unified machine. It’s always been my magic.
  4. Lack of interoception: (so, I guess there’s another reason; this is now #6). I mentioned in my first post that I have difficulty with detecting and processing internal body signals like hunger, temperature regulation, and when I have to use the bathroom. Females, or anyone wanting to sit when using the bathroom, can’t really have the iWalk on. It doesn’t allow you to comfortably flex your knee and hip appropriately to squat down. It’s also not that easy or quick to remove. Therein lies the problem. The operating window of time that I usually have between realizing I need to use the bathroom and when I will start peeing hovers around 90 seconds to 2-minutes. This works well for someone who is home and can ambulated normally, but strap on a device that’s stubborn to remove, a broken foot, and a big open physical therapy gym with a long walk to the bathroom and you’ve got yourself a free two-minute slapstick comedy show. While everyone watched the panicked and desperate struggle of two PTAs and a tech careen my awkward gait like a baby giraffe, all the patients at their respective tables or exercise stations stopped and watched. Once inside the stall I yelled, “I made it!” Ah…why do I exacerbate mortifying situations? I hate when I get anxious and blurt stuff out.

After I face-planted trying to walk with the iWalk, I lay silently on the ground thinking to myself: Wow, can this be any harder?! I have all these challenges and pains and now my foot kills, I can’t run, I can’t even walk, and more and more is taken away from me like I’m on some sort of slippery slope to doom. Thankfully, the pity party of one lasted less than two seconds. I rolled onto my side and got up using my arms and my good leg in a strong single-leg squat before the PT was even able to catch up with me.

“I was going to help you up!” She exclaimed.

“I know, thanks. But when I fall, I get back up.”

And I do, and I will.

The iWalk is getting returned. Some tools are just not suited for a particular job. You wouldn’t use a staple gun to saw a board! It turns out my insurance immediately agreed that a knee scooter was medically necessary, given my risk factors with using the other standard devices and my injury. I’m sure that’ll be another adventure, but I’m up for it.

Just like the strong callus that forms over the fracture line of a healed broken bone, strengthening the new bone beyond that of the original bone, I become stronger where I was weakest. I fall and I rise up braver, tougher, wiser, and more determined. Sometimes it takes just a second or two; other times it has taken a couple of years, but I commit to myself that whatever is thrown at me, I will face, I will fight, and I will overcome.