Wednesday, April 27, 2011

A picture is worth a thousand words...


Ok, well maybe these pictures aren't worth a thousand words, but they do help tell my story! And, if you are reading this blog then you are probably curious about what type of trauma my poor foot went through. As someone jokingly said, "It looks like your foot is pissed." That, my friends, is a fact.

I received my preop, intraop, and postop x-rays this morning from Dr. Kwon. I decided that tonight's post needed to showcase these beauts and some other pictures that I've taken over the past three months. Enjoy...


1/30/2011
The first image of my swollen foot (understatement of the year) taken on 1/30/2011 on the busride home from NYC:
The next two pictures are taken 1/30/2011 before going to bed:

Yikes!


















January 31, 2011
Took some ibuprofen, iced it and went to bed. Woke up the next day hardly able to walk, went to work anyways, walked from the T to my office and then took this picture on the morning of 1/31/2011:

Some additional pictures of the bruising and swelling over the next few days. As a note, I stopped putting weight on my foot on February 2nd, the bruising and swelling stuck around for at least two months.
Bruising along the outside of my foot

My toes turned completely black and blue.


Bruising on the heel

After a lot of internet searches, the large, disturbing bruise on the bottom of my foot had a name: plantar ecchymosis...this bruise just started to fade a few weeks ago (8-9 weeks after the injury was sustained).
This is the worst picture, from my perspective. My foot looks so deformed:


Preop X-rays
Now for the legitimate images that I received from the doctor today. In order to diagnose a lisfranc injury properly, the x-rays need to be load bearing. This means that even though it is extremely uncomfortable, you have to balance on your injured foot. Not fun! This is the x-ray that was taken on 2/3/2011: 

   
There is a nondisplaced 4th metatarsal base fracture and a lisfranc fracture dislocation of the 1st and 2nd tarsometatarsal joints. Got all that? Ok, it only took me three months to figure out what the actual name of the injury is.


The smaller red circle highlights the faint line at the base of the 4th metatarsal (the bone in the midfoot region that looks like it is being crushed by the other bones). Yes, this explanation is obviously very technical. The lisfranc fracture dislocation is easier to see and is highlighted with a larger red circle. That separation shouldn't exactly be there.




Postop x-rays
(2 weeks after surgery, non weight bearing image):


Two screws is better than three screws!


The screws will be removed ~6 months after the original surgery.

























So, what do you think of that? I know what I think, there will be no more dance battles anytime soon. 

Tuesday, April 26, 2011

The surgical experience...

Until this bizarre foot injury, the most invasive procedure I’d experienced in my life was having all four of my wisdom teeth removed. I know that surgeries are performed every day, but there is something very eerie about having medicine injected into you, passing out, having some cut your foot open to insert a few screws, and waking up 2 hours later with no memory of it.

The surgery was scheduled for Tuesday, February 8th, midmorning. It was snowing out on this particular day, which should come as no surprise to my fellow New Englanders reading this entry. This winter was out of control and potentially the worst winter EVER to of had to be on crutches. Not sure if I was more observant because of my own situation, but I noticed so many people trudging through the snow this year on crutches. My sympathy goes out to these people on crutches during the 2010-2011 Winter, it sucked. There is no other way to describe it. At any rate, the snow on February 8th caused traffic delays which morphed my quiet, internalized panic to something a bit more noticeable to those around me - I morphed into a raging B. My poor parents – Patrish and Bri have been wonderful, I will write another post in the future about how important it is to have a support system through this type of injury.

We safely arrived at the surgical center and I got myself checked in. Waiting and anticipating was the worst part for me. I hate not knowing what is coming next – fear of the unknown. Luckily, I only had to sit in the waiting room for a few minutes before they took me in so I could get changed into the lovely johnny.  It took a while to get changed, because I was still new to the balancing on one leg act – this gets easier with time. They did give me a fun slipper sock (yes, singular) so that I wouldn’t slip on the tile floor…that was fun! I was weighed and asked a lot of questions before they had me lay down in the bed. The anesthesiologist came over and started my IV – I’m sorry to admit I have forgotten his name; he was so cheery and perfect for his role. I’m very afraid of needles so he didn’t have the easiest patient in me, but the anticipation of the IV was worse than the actual thing. They started to feed me the ‘magic juice’ so I would stop shaking like a leaf. It worked for a little while.

I opted to receive a nerve block. I’d recommend getting this done for any type of surgery. The actual process of receiving the block was not very fun for me, but it definitely minimized the pain after surgery. They had me roll onto my stomach so they could find the sciatic nerve on the back of my calf – they used a sonogram machine and found it no problem, I didn’t feel a thing. After that injection was done, I rolled onto my back again so they could do another injection on the side of my lower left thigh. They located the nerve, but the actual injection brought me to tears. The pain was really, really bad and although they injected me with more of the magic juice to help with the pain, it was still an unpleasant moment before surgery. With the nerve block complete, I was all set and ready for surgery. The magic juice had worked and sent me into care free mode, although I was still shaking like a leaf, not from fear at this point but because I was freezing (weird side effect I guess?). I was wrapped in blankets by the very friendly nurse.  My parents came in to sit with me while I waited for my time. My care free feeling from the meds had me sitting there pretending to read a book – kind of funny. Dr. Kwon came out to say hello and let us know that the surgery should take two hours and during that time my parents could pick up my pain meds and that there was a cafĂ© for them to grab some food. We said our goodbyes and I was wheeled down the hall to surgery while they gave me more meds through my IV. It took only a minute or so for the meds to set in. I remember being wheeled down the hall into the operating room and being put on the table, but after that I’m blank.

I woke up in recovery to another friendly nurse and Dr. Kwon who was letting me know that everything went great. He told me he only had to put in two screws as opposed to the original 3-4 with some pins. One thought had been weighing on my mind for the last week was the Celtics/Lakers tickets I had purchased 9 months earlier. The game was two days away and it was my goal to be at the game. In my medically induced stupor, I had to ask the doctor if I could go – he delivered the bad news that it wouldn’t be possible.  I started crying and the nurse said emotions usually run high when you are coming off of the anesthesia…well that might be the case for some, but I would have cried regardless of the drugs I was on! Oh well, maybe I’ll get to see them play when the Lakers come to town next season. Though, I won’t get to see Ray Allen break the 3-point field goal record next season, damn it. I guess my post op anesthesia story isn’t as embarrassing as some others that I’ve heard.

I had some ginger ale and graham crackers while I was waking up. The numb sensation and warm/hot feeling in my foot was very weird and I was also feeling a bit nauseous at this time. I got dressed and was brought to the car in a wheel chair. I was feeling OK at this point and requested a Friendly’s Chocolate Fribble as a post surgery treat. My Dad stopped and got me the chocolate Fribble and we went home and that is about all I remember from that day.

Actually, the next few days of recovery are a bit of a blur as I was in and out of sleep and on the pain meds. Dave came up from Philadelphia the day after my surgery because both of my parents had to work – he stayed for two days and helped take care of me – bringing me food, drinks, and making sure I stayed on schedule with the medication. I highly recommend staying right on schedule with the pain meds – my post op pain was minimal because I didn’t miss a dose. The drugs keep you in a weird, dazed state but it is better than the other option. The nerve block stayed active for right around 24 hours – I remember I absolutely hated the feeling of it, but if I ever need another surgery I’m getting it again – this definitely kept the pain minimal, too.

Overall, the surgery ended up being very successful and although anxiety is normal, it was a much easier process than I anticipated. The pain of walking around NYC and Boston on my injured foot was much worse than the post op pain for me – maybe I have a high tolerance, who knows. I think the moral of this blog entry is to have a great support system, a great surgeon, and make sure you keep up with your medication to stay ahead of the pain.
I think my next post will talk about the day to day living with a long term non weight bearing injury...how to use crutches, how to shower, how to do anything for that matter....

Monday, April 25, 2011

Let me get you up to speed...

As a 23 (now 24) year old female, I live a pretty normal life and have been very fortunate thus far to have never sustained a serious injury (broken arm when I was 10 doesn't count) or undergo a surgery for something other than my wisdom teeth. When I heard the doctor tell me that I needed surgery on my left foot and would be non weight bearing for about three months, I lost it.


Here is a first hand account of how I suffered the dreaded "lisfranc injury".....


January 29, 2011
Jackie, Samantha, and I took a trip to NYC from Boston to celebrate David's 25th birthday in style. We had a classy hotel room, fancy outfits, and were ready to paint the town. After a night filled with dancing and drinks, the party relocated back to the hotel room for some late night snacks and an epic dance battle. The song choice of night was "Teach Me How to Dougie" and for those of you who are not fortunate enough to know the song/dance moves that go along with it, I would equate it to a 'modern day Electric Slide.' See the YouTube video for a visual aid: Teach Me How to Dougie


January 30, 2011
David and I were "dougie-ing" and I guess he needs to take lessons, because he fell, hard, with all of his weight, flat on my foot. The pain was instantaneous, I felt something pop, it swelled up and started turning blue/purple, and I couldn't put any weight on it. My best friend Jackie, the sprained ankle guru, wanted me to keep it elevated, but I opted to just douse it in cold water from the highend bathtub.


The next morning was a painful one, with both a hangover and a foot swollen beyond belief. After ice and ibuprofen, the pain hadn't subsided but I put on a poker face (or so I'd like to think) and trekked the five blocks on foot from the hotel to Port Authority to hop on a bus back to Boston. With a lot of time to think about the pain on the busride home and work pending the next morning, I started to wonder how I could possibly take the red line train from Braintree to Charles/MGH and then walk to my office at MGH (yes, luckily I work at a hospital!). I figured if I iced it, took some ibuprofren, and slept it off the pain would subside enough to get to work.




January 31, 2011
Ha. Fail. The pain did not subside, it got worse. I went to work anyways and showed my dance battle wounds to some colleagues. The bruising and swelling were enough for them to persuade me to go to the Urgent Care Clinic at the hospital. My friend, Charlotte, escorted me over to the building and the nurse at the UCC checked my foot by pressing on certain areas - since the pain wasn't too bad, I was given a small shoe/boot to walk in and went down to have x-rays taken just to be sure nothing was broken.


The nurse followed up with me later that afternoon and told me I had a non-displaced fracture of the fourth metatarsal and another fracture in some other part of my foot. They wanted to send me to a specialist to ensure I didn't have this really rare injury she referred to as a lisfranc fracture, but no more detail was shared at the time. So, I continued to laugh off the injury and make jokes about it. I mean honestly, what are the chances that someone is having a dance battle (why was a dance battle even necessary?), the other person lands on their foot (can't dance well/needs to learn how to Dougie better?), and they end up with a fracture (bad luck...)? It's such a freak accident ---- it's funny. Don't forget to play "Teach me How to Dougie" while you're reading this, it definitely adds to the humor.


February 1, 2011
My first appointment with ortho......


Dr. Kwon had me take weight bearing x-rays (ouch) since that is the only definitive way to get an answer as to whether it is/is not a lisfranc injury. I had been laughing about the injury for a few days now and started to tell the story to Dr. Kwon while he pulled up the x-rays on the computer. His first statement after looking at the images was "this is serious" and his second was "it is a lisfranc injury and you will need surgery". Well, that about did it for me - I went from joking around about a small fracture to crying in the exam room because I needed surgery (anxiety, fear of the unknown...). I also felt like a jerk for laughing about something that was obviously so serious - hopefully I didn't offend the doctor :)


Dr. Kwon sent in one of his assistants who talked to me for a few minutes to calm me down. When I stopped crying, he came back in and explained what the injury actually is - he started talking about the history of the injury and this was in fact one of the only things I remembered after my appointment. Useless, yet interesting information. The injury is named after a  field surgeon, Jacques Lisfranc de Saint-Martin, in Napoleon's army. It was a common injury for cavalry when they fell off their horse and their foot would get caught in the stirrup causing a twisting motion, thus injuring the joint now more commonly known as the lisfranc joint. I digress, but the takeaways from this interaction were that 1. I needed surgery where screws and pins would be inserted in my foot to put it back together and 2. I would be non weight bearing for an extended period of time (close to three months). Ahhhhhhhhh......


In shock, I left the office with my packet of preop instructions and was instructed to wait for a phone call to schedule surgery. This funny freak accident just wasn't so funny anymore.




In future postings, I plan to talk about my experience with an extended non weight bearing injury and how I manage to get around. I found that with this injury, there was very little out there for information and a lot of blogs that talked about how horrible other people's experiences have been while recovering from this. Hopefully someone else who suffers from this injury can find something useful in this blog.