Monthly Archives: June 2014

The Pre-Surgey Appointemt

Appointment #1

Doc J (the podiatrist): “So about running…”
Me: “Is my marathon career one and done?”
Doc J: “Yeah. I would be happy if you would stick to 5Ks. Actually, I’d be really happy if you would stick to swimming.”
Me “…*disgusted face*”
Doc J: “I would be fine if you never played soccer again.”
Me: “…I wouldn’t be.”

This was the moment I realized that there wasn’t going to be a simple, easy fix for my foot. I’ve never had a doctor tell me I shouldn’t do something for the rest of my life. Sure, running another marathon isn’t at the top of my Let’s Do That Again! list, but I had been toying with the idea to join my friend Jen for the Honolulu Marathon in December because if I’m going to run another 26.2 I want to be able to cross the finish line and then head straight to the beach to recover while sipping a Mai Tai. Having someone say I can’t do it sort of makes me want to try. Yeah, I’m that kind of person.

Joey drinking a Mai Tai in Hawaii...it's loosely related to this story...
Joey drinking a Mai Tai in Hawaii…it’s loosely related to this story…

After x-ray confirmation of the injury, Doc J gave me two options:

1- treat it conservatively with rest, ice, supportive shoes, and a blast of NSAIDs

2- surgically insert a screw across the joint to hold it in place

Option 1 was basically what I had been doing for the past year, minus the blast of NSAIDs, which would be an attempt to get it to calm down after I had angered it by trying to play soccer. There was a small discussion about corticosteroids to reduce the inflammation if the NSAIDs didn’t work, but I’ve been on those bastards many a time for terrible colds and pneumonia and I try to stay as far away as possible from them. Option 1 would also never be a solution to the problem since it wouldn’t fix the ligament, it would just try to make living with the pain more manageable.

Choosing to have surgery when death isn’t imminent is not an easy choice to make, but after a year of constant pain and not being able to participate in the activities that bring me joy, I had a feeling it would have to happen. And let us not forget that I am currently studying for a profession that routinely involves 12 shifts on one’s feet while caring for others. One of my goals in nursing is to work in critical care, I can’t be limping around while my patient is coding.

Doc J: “You’re in nursing school? Then I’m going to treat you like a nurse.”
Me: “Does that mean you think I’m stubborn?”
Doc J: “Exactly.”

But I was still a bit hesitant, I hadn’t gotten my mind wrapped around it all. One of the things I like about Doc J is that he’s straight forward and won’t sugar coat anything (but in a nice way, not a rude asshole way), and he put it something like this, “if you spent all day at a desk and the rest of the time on the couch, you could probably deal with option 1, but you’re young (he says this a lot, I’m not sure he fully realizes that I’m almost 30) and if you want to lead the active lifestyle that makes you happy, you’re going to need this surgery”.

Picture of my active lifestlye- running Hood to Coast
Picture of my active lifestyle, aka running Hood to Coast

Next came the logistics. The schedule in an accelerated nursing program doesn’t have a lot of downtime when you can be on crutches. The only feasible time in the next 9 months would be in May during the one week break between spring and summer semesters.  The plan in the mean time was for me to try option 1 to see if I could at least get the foot to calm down a little and discuss with the school if surgery between semesters would even be a possibility.

There’s something relieving about just having a plan, even if that plan involves having a piece of hardware inserted into your bone. It was nice to at least have an answer to why my foot was still hurting and to have a doctor who 1- believed me when I said I was in pain and 2- wanted to do something to fix the problem. When he was walking out of the exam room one of the nurses was walking in. As he rounded the corner he yelled to her, “treat her like a nurse!”.

It’s nice having a doctor who gets you.

Life, The Universe, Lisfranc, and Everything

Once upon a time, this was a running blog and one very hot day in October of 2012 I ran a marathon.

zombie

As someone who hated any running that didn’t happen in a soccer game for most of their life, this was a pretty big accomplishment. The marathon itself didn’t really go as planned (see knee pain starting at mile 6 and throwing up at the finish line in the last post) but thanks to some super awesome people (friends, family, and Team in Training teammates) I thoroughly enjoyed myself.

Afterwards I took a few weeks off to evaluate the knee situation and decide what I wanted to do next. After a few weeks away from the team I realized how much I missed spending my Saturday mornings with them and, though a little apprehensive about my physical health, I signed up for the 2013 Eugene Marathon with the Team.

goteam

My knee was still cranky and my body wasn’t loving running as the weather started to get colder, but my heart was happy being surrounded by the amazing people who are part of TnT. There’s something magical about being involved with the Team, though it’s hard to explain to those who haven’t gotten the chance to experience it. My second to last run with the Team before getting injured (foreshadowing) was 3 days after my grandmother, the woman I owe all of my athletic ability, mental toughness, nursing skills, and stubbornness to, passed away. I don’t remember a lot from that evening, mostly just running around the Duniway track in that dark with tears streaming down my face while captain Mike silently ran next to me, but it’s a memory that I hold in my heart to this day. It seems like a small thing when describing it, but thinking about it still brings me to tears.

Four days later this happened.

bumfoot1

I was playing soccer, like I did most weekend, with my beer team that had a soccer problem. I had the ball and went to take on a another player when we got tangled up. At some point the ref blew his whistle to call a foul on the the guy, at which point I tried to stop playing, but they guy didn’t right away. Somewhere in that mess the guy stepped on the mid-foot section of my left foot as I was pushing off of it. It hurt immediately, but being the stubborn lady that I am, I tried to take a few steps to walk it off, because seriously, who gets hurt by getting stepped on during a soccer game? Getting stepped on happens about every 30 seconds every game. After taking a few steps  the pain got worse, so I hobbled off the field while my teammates gave me a puzzled look and I just shrugged my shoulders.

I think at this point it would be fun to mention that at one point in my soccer career in Portland I was playing on 5 teams at one time. When I first started playing, my friends and family would come watch my games all the time. But when you’re playing 5 games a week, the number of games that people come to dwindles quickly. This game, however, was the one game I convinced my mom, her boyfriend Kraig, her roommate Pam, and my friend Kelley to come spectate. They got to see me play for all of about 8 minutes. My bad.

Back to the game. I got to the bench, took my shoe and sock off, didn’t see any visible injury, so I decided I was being a wimp about it and could just run it off. I waited until halftime to go back into the game. I lasted, at most, 30 seconds. It hurt fairly bad when running, but then I tried to pivot on it, and then it was game over. With the help of my mom, Kraig, and Pam I hobbled home, hoping that it would magically fix itself over night.

Spoiler alert, it didn’t.

Then started the most frustrating experience with the medical field that I have ever had.

I had a few hydrocodone pills left over from the time I got my appendix out, so I took one that night to help me sleep. It did nothing. I (gingerly) tossed and turned all night because of the pain, waiting until a reasonable hour to call my mom to have her take my to urgent care. At this point, I couldn’t put any weight on my foot. However, when I’m in a lot of pain, I don’t act like I’m in a lot of pain. The first time I broke my collarbone (yeah that happened playing soccer too…) and it was making a nice a-frame shape because it was in multiple pieces, I had stopped crying by the time I had walked off the field, which was maybe 2 minutes after it happened. I then sat in the ER making every person who walked in the room hit the button on the signing bass that was mounted on the wall. I am easily entertained. The nurses told my mom that when they had big tough guys come in with the same injury they would spend the whole time screaming. The second time I broke my collarbone (same side, same place while carrying a rowing boat down to the water my freshman year of college), it took me 2 months to go see a doctor, during which I ran, rowed, lifted weights, did push ups, and most painful of all, did bear crawls, because the athletic trainer said it was just a bruise, and who sees a doctor about a bruise? Not this stubborn girl.

So my mom and I go to urgent care, where I proceed to crack a lot of (slightly inappropriate) jokes. It becomes pretty obvious that the PA does not believe that I’m in a lot of pain. She orders an x-ray, which comes back negative, then says I can walk on it and wants to send me on my way, with an offhand, “you might want to follow up with an orthopedist, but I don’t think it’s broken”. I had to point out to her that, as I said before, it was too painful to walk on. She finally got me some crutches.

I didn’t have insurance at that point so I hobbled around on crutches and then in a walking boot hoping that if I rested it for a bit, it would heal. The boot, which I affectionately named Das Boot, came on many an adventure with me.

He went to pilates

bumfoot2

To Hawaii

bumfoot3

To the top of Mauna Kea at 13,796 ft

bumfoot4

To Curling for a Cure

bumfoot5

To a TnT aid station

bumfoot6

And many other not pictured places. After a few months of denial, I finally scheduled an appointment at a highly recommended orthopedic office in Portland. The first PA that I saw thought it was a Lisfranc ligament tear and ordered non-weight bearing x-rays and a MRI. The x-ray, not surprisingly, came back negative. The PA was so sure that the MRI would show a Lisfranc tear that he wouldn’t even discuss any other possibilities when I asked about them. Turns out, a MRI is not the gold standard when diagnosing a Lisfranc tear, especially 3 months after the initial injury. So when the MRI came back negative, the PA just sort of shrugged his shoulders and sent me to see a different doctor in the office.

I trusted this guy a little bit more than the PA, not because of the educational difference, but because this doc had read the MRI results to me without having read my file and asked me if I was a runner or a soccer player. He nailed that one. He thought he saw some arthritis in the area where I was having pain, assumed that I had chipped a piece of bone off when I first injured it, gave me a steroid shot to help with the inflammation, told me to wear supportive shoes, and that the pain should go away in a little while. While the pain did get better, it never fully went away. After a few more frustrating appointment, I decided it wasn’t worth my money to cry after every time I went to that office. But as long as I didn’t do anything too crazy, my foot was ok and that was what I could deal with at that time.

I then packed up my stuff and spent the summer in San Francisco taking care of my fabulous little niece.

littleA

The night before I left for SF, I played soccer for the first time since the injury. I had started running again and had made it up to a mile, which was the point at which the ortho said I could try soccer again. I lasted into the second half (which was a miracle just given my lack of fitness, but we had no subs) when, for some unknown and very stupid reason, I tried to cut to my left with the ball and push off of my left foot. HUGE MISTAKE. I knew immediately I was done and just walked off the field. Then my team scored 3 goals while playing a man down and won 4-0, so clearly they didn’t need me in the first place.

The foot got pretty swollen after the game, and then even more swollen the next day after flying down to California, but I was quite busy with the little munchkin, so I just tried to rest it and ice it as much could so it would calm down. I spent the summer taking the babe on walks through SF, up and down all of the hills, and though it hurt, I was used to it hurting at this point, and didn’t think too much of it.

SFview

At the end of the summer I went back to Portland for a few days, and then headed out to Nebraska to start nursing school. (Holy shit, big life change) Not just any nursing program, but an accelerated BSN program that is crazier and busier than I could have ever imagined. We started clinical a month into the program, and though my foot hurt even with wearing my Danskos, I didn’t have the time or energy to do much about it. And I could still function, which was the most important part.

nursingschool

On a Friday afternoon at beginning of spring semester some classmates got together to kick a soccer ball around at the gym. I was pumped to run around with them even though my foot hurt the moment I started running. I ignored the pain and had a blast with my classmates (seriously, I have the best and most amusing classmates ever). Afterwards it was pretty sore, so I went home to ice it, and then it proceeded to swell up. By Saturday morning I couldn’t put much weight on it and contemplated going to urgent care but figured they would just refer me to an orthopedist anyway so I might as well just wait until the student health center opened on Monday. On Sunday the foot was feeling a bit better thanks to some ice and probably more ibuprofen than my kidneys appreciated. Student health referred me to a podiatrist, whom I chose solely based off of location. Turns out, that was the best decision I ever made.

When I explained the story (in a much shorter version than this) to the podiatrist, he immediately went to a Lisfranc injury. We discussed the previous MRI, how it was a waste of time and money, and he ordered a weight bearing x-ray, which is what the ortho PA should have done in the first place. He came up with this:

IMG_4124

The pen is pointing to separation of the joint that shouldn’t happen but did when I put weight on my foot. Besides icing, NSAIDs, and supportive shoes, there’s not much that can be done for a Lisfranc injury besides surgery. So 4 months later (I had a tight schedule with nursing school and clinical), I had this done:

IMG_4389

That was 30 days ago. Summer semester started 20 days ago. To say it has been a long 20 days would be a slight understatement. I’m exhausted. My first week back at school I did 2 12 hour clinical days in the ICU on crutches. I think I was more tired after the second day than after I ran that marathon. Luckily my school has some very understanding faculty and my podiatrist is the best doctor I have ever had, so somehow this crazy plan has worked.

So that’s where I’m at now. I’m not really sure what sparked me to write out this (incredibly long, sorry about that) story, but I want to share my Lisfranc journey so that others going through it know they aren’t alone. I’ve just started the process of weaning out of the walking boot and can already tell that it’s going to be a frustrating endeavor. I probably won’t be running any time soon, so this really isn’t a running blog anymore, but maybe you’ll learn something about Lisfranc if you stick around. (Side note- the joint is named for Jacques Lisfranc de St. Martin, who was a surgeon in Napoleon’s army. See you learned something already!)