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Wednesday, May 21, 2008

Sunday, May 18, 2008

Part Two: My Right Foot

The saga continues…

I was surprised that it was my foot – I had been truly convinced that I had just sprained my ankle. I was thinking that I would surely miss some days of work and probably need crutches for a week or so. I could wiggle all my toes (albeit with excruciating pain). Certainly my foot was not broken. The doctor ordered me to X-Ray.

I was whisked away and a painful series of pictures was taken of my foot, which now resembled a fat shiny balloon. A nurse rolled me back into ER and where, I called Jason and gave him directions to the hospital – nearly 50 minutes from home. Someone put an ice bag on my foot. I waited. I called my parents and a few friends to let them know the situation. I waited some more. I called the garage where my car was towed to so see where in the heck it was. Jason called to make sure he was going the right direction. I flagged down a nurse and frantically tried to verify where the hospital was – even though I work there, I’d not yet had cause to visit the ER. Eventually and I think somewhat miraculously Jason arrived, and very soon after the ER doc returned with a diagnosis.

I did, in fact, fracture my foot. The third metatarsal, to be precise. The ER doc, however, said this was really a minor issue – he suspected I might have a much bigger problem, called a lisfranc fracture. This is basically an injury, such as a facture or ligament tear, in the bones of the midfoot. This is what Wikipedia (http://en.wikipedia.org/wiki/Lisfranc_fracture) had to say about the origin of the name:

The fracture was first described by the French doctor and surgeon Jacques Lisfranc de St. Martin, who worked in Napoleon's army. This type of injury, which Lisfranc first described, occurred when a horseman fell while riding, having trapped his foot in the stirrup or fell into a drain. At present, such an injury happens typically when one steps into a hole and the foot twists heavily. Falling from a height of two or three stories can also cause this fracture. American football players occasionally get this injury, often when they have their foot pointing down and someone lands on their heel.

And here’s a scientific explanation from http://orthoinfo.aaos.org/main.cfm :

Lisfranc injuries occur at the midfoot, where a cluster of small bones forms an arch on top of the foot between the ankle and the toes. From this cluster, five long bones (metatarsals) extend to the toes. The second metatarsal also extends down into the row of small bones and acts as a stabilizing force. The bones are held in place by connective tissues (ligaments) that stretch both across and down the foot. However, there is no connective tissue holding the first metatarsal to the second metatarsal. A twisting fall can break or shift (dislocate) these bones out of place.

See, that part about no connective tissue? Those words are key. A metatarsal is the toe bone, with your first metatarsal being your big toe bone. So, basically, there is nothing but soft tissue connecting your big toe and second toe -- no muscle, no bones -- all the way up to where your foot joins your ankle. In my accident, my right foot pressed the brake all the way down to the floor, with all my weight behind it. During the collision, the brake was forced backward against my foot. If, as the doctor suspected, there was more damage than a broken toe, it would not show up on an X-Ray since X-Rays show bones and some muscles clearly and none of these connect the first and second toe. If these bones had been displaced in the accident, he suggested, I may need a CAT scan or MRI to assess the full damage.

I was a bit concerned, but the ER doc said that there was no certainty that I had this kind of injury, but I really should see a specialist like a orthopedic surgeon or even podiatrist to rule it out. For the time being, I received crutches, a prescription for pain meds, an ace bandage, and a little orthopedic boot. I was instructed to put no weight on my injury, to elevate it, and to ice it as much as possible. By this time it was nearly 8pm. My accident occurred, I think, at about 3:30.

Jason drove me back to Santa Cruz, where we filled my prescription and then went home where I actually fell asleep despite the pain and discomfort. I felt lucky to be alive, and really wasn’t processing the extent of my injury of what it would involve as far as work, where the semester still had five weeks to go before graduation and summer vacation. I didn’t know what was in store as far as recovery, or even the true extent of my injury. I would need to follow the labyrinthine instructions of my health insurance provider, and first go to my General Care provider so I could be referred to a specialist.

Tune in later to find out what the specialist says…

Saturday, May 17, 2008

Screech, Crash, Ouch

It’s usually a cliché to say so much has happened since my last post, but in this case I feel it’s actually true!

For the past two weeks, I’ve been laid up recovering from a car accident that occurred on April 30th. I was coming home from work, and exiting the freeway at a busy and dangerous off ramp. There was a semi parked in the right shoulder, and the driver was in the center divider looking to run across the road. Distracted by the truck and driver, I didn’t see cars stopping in front of me (probably someone was turning left – there’s a gas station entrance about 100 yards from the off ramp on the left). I slammed on the brakes, which was not enough to stop a collision but was probably enough to save me from more serious injury, because the impact tore up my right foot pretty badly but the rest of me is unharmed save for some bruises and soreness that disappeared a few days after the accident.

After the impact, I realized that I had been in an accident, and I guess I’ve seen too many TV movies or something because my first thoughts were: I’ve got to get out of the car before it explodes! and I’ve spilled hot coffee on myself! I’ve heard that strange things can go through your mind at times like these, but really! So I jumped out of the car and realized several things at once, including: something is really wrong with my right ankle because I can’t put any weight on it, the rest of me is fine, and I’ve left the car on and in drive and it’s still revving into the car in front of me. I jumped back into the car, put it in park, turned off the engine and grabbed my keys, and what I could find of my purse and its contents, which were scattered all over the front of my car. Then I hobbled out and around the back of the car, yelling for someone to help me.

The truck driver, who had distracted me earlier, turned out to be a stranger in the area who had been asked to stop by his trucking company who, oddly enough, wanted him to check another semi parked on the freeway because they “thought the driver might be dead.” In my state of shock this was really too much to take in (the other semi was vacant, by the way) and I asked to lie down. The trucker was very helpful and helped me lay down, and I propped my tender and extremely swollen right foot on the bumper of his semi truck, using my sweater for a cushion. From this strange position lying on an off-ramp next to my crashed car with my broken foot propped on the bumper of a semi, I called Jason to tell him I’d been in an accident, that I was mostly all right and that someone had called 911. He stayed calm and we agreed that I’d call him when I found out which hospital I was going to, since the accident had happened about 20 miles from work but 50 miles from home.

I was starting to shiver and was in shock but overall I knew that everything was OK. I talked to the truck driver and another semi driver who had stopped to help. They were very sweet and tried hard to make me feel comfortable about lying in the road, which was kind of freaky. I tried to assess the situation from this vantage point. I was pretty sure I’d hit a white van or SUV, but really wasn’t sure until I heard the police report. I couldn’t see it anywhere. My foot was huge, but I really thought it was my ankle that was broken and didn’t even consider that my foot might be messed up. I looked at my car, and saw parts of the engine lying on the ground under it. I figured it was totaled.

Soon firemen arrived, with EMTs not long after. They advised that it would be faster to return to the hospital in the town where I worked, even though it was much further from home. I called Jason and said I’d call again from the ER. I then had to be strapped to the backboard and my neck was put in a brace, which is really unnerving and uncomfortable. When they hoisted me up to go into the ambulance, I couldn’t move or turn my neck and could only see a square of blue sky above, and that’s when it all hit me and I started to cry. I’d been in an accident. I was going to the hospital. I was hurt enough to be going in an ambulance.

My first, and hopefully only, ambulance ride was not fun. It was painful and uncomfortable, and since I am scared of injections and getting blood drawn, I was terrified of getting having to get an IV. I have really small veins which make it hard to find a place to stick. Plus it makes me queasy. The EMT’s were very nice and I have to say that overall I felt safe and taken care of. After a couple of tries, the tech could tell I was freaking out about the IV and said forget it until the hospital.

I was wheeled in on a gurney and left in one of the ER “rooms” -- you know, that curtain on a rail that goes around the bed? Almost immediately, the ER doc came by and checked me so that they could remove the neck brace. He cleared me for neck and back injury, and moved down to my injured extremity. I told him my ankle was injured. He felt from my knee all the way down to my ankle… no pain. He lightly squeezed my foot. I screamed and pulled away in agony. “Oh,” he said, “it’s your foot.”

To be continued…