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Friday, September 13, 2013

The Fractured Fifth

I walk at New York speed.  I'm adept at weaving through crowds of tourists, smartphone users, panhandlers, and hand-holding couples in Times Square subway station, and getting to the front of the crowd, getting to where I need to go before anyone gets in my way.  I race up the stairs, skipping steps, reaching the sweet bliss of the sidewalk's freedom.

That was before the accident.  I know there are much nastier stories of nastier accidents, but this story is about such a tiny misstep that lead to one of the last hassles a New Yorker wants to deal with in life -- a loss of mobility.  What was my misstep?  Just that... I missed a step... on a staircase, on the way to the laundry room.  It hurt, but I was still able to walk.  I decided to mostly stay off the foot and get some sleep.  The next morning (Monday), my foot was rather swollen, and it was apparent I'd miss work, and I'd have to see a doctor.

I just started a new job 3 weeks ago, as a technical manager at an agency.  I had yet to use my new insurance, Cigna's "Network" plan, which requires referrals.  I did not see a primary care physician (PCP), who generally is responsible for issuing referrals.  I instead went to an urgent care medical office.  Urgent care medical offices serve as an immensely comfortable option in Manhattan, allowing for walk-in doctor appointments.  Cigna charges me $100 per urgent care visit, which I'll note is the worst of any insurance I've had with my previous jobs.  I put on shoes with good support, limped into a taxi, and went to "Medhattan", normally an 8 minute walk away from my small apartment, downtown in the Financial District.  Dr. Leslie Miller was very caring and attentive, and after looking at the X-rays, had a very sad look on her face...

This is a fracture of the fifth... the fifth metatarsal.  To me it was just a number.  But I learned what it really meant later.  For now, I got a referral for an orthopedist near my apartment.  I got an appointment at 8:15am the next day.  I was sold a $24 cane, for the time being, which I hoped my insurance would cover.  Cigna told me they only cover equipment sold through in-network providers.  I argued I needed some way to safely leave the office.  The Cigna rep told me to just file a claim and wish for the best.  What?  Really?

The cane gave me some meager means to protect my foot.  I did my best to learn to use it.  I found that I could hold the top to my hip for stability, and the closer the bottom was to the side of my foot, the more pressure it relieved.  I learned to slow my walk enough where I could use the cane most effectively.  Frustrating, given the pace I was used to.  My prized mobility, for however long, was long gone.

I showed up and eventually saw the orthopedic surgeon.  He looked at the X-rays and quickly presented two options... surgery, with 5-6 weeks healing, or no surgery, which would take over 3 months.  I quickly decided on the surgery, and he agreed.  Then I found out I'd be put under for the surgery.  This I was very uncomfortable with.  I always hated the notion of losing consciousness, entrusting your well-being to strangers, but I figured if it happened, I'd be in much worse shape, with a heart attack or stroke, and would be begging for relief.  This was far from that, and I felt my skin go cold, still nodding my head reluctantly.

My surgery was scheduled for the next morning, at 6.  I was shuttled off to an assistant who took more X-rays, and then another that quickly went through a lot of critical information that I needed to know in preparation for the surgery.  I stopped her often as I furiously took notes, trying to organize the simple steps of preparation in a short list.  On my way home, I stopped in a pharmacy for oxycodone, a powerful narcotic to alleviate the awful pain I'd have afterward.  While waiting for my prescription, an elderly lady asks me for my seat.  By habit, I got up, thinking I'd be okay balancing on my good foot, but quickly I realized I should impose on the girl in the one other seat.  She quickly reassured me and let me sit.  I knew I had to get used to leaning on the many samaritans of New York.

I went home and waited.  Time passed, and I ruminated over my first surgery.  I went out for a "last walk" before surgery, in case I didn't wake up.  I know it was irrational and unlikely, but, it happens, doesn't it?  I like bagels.  I limped a couple blocks to the one good bagel place close by, Long Island Bagel, buying a cinnamon raisin bagel, with pumpkin cream cheese.  I like trying new things.  Never tried pumpkin cream cheese before.  It was like pumpkin cheesecake.  On the way back from my walk, I picked up flowers for my fiancee, Aliona.  I wanted something fresh and attention-grabbing.

I wondered what the real problem was.  One of my friends on Facebook suggested in jest that I film the surgery, with filmmaking as one of my hobbies.  I realized that if I was allowed to film the surgery (a quick google search told me this would be next to impossible), I would be a lot more comfortable with it.  Why was that?  Lack of trust.

Normally, if I choose a doctor, I'd check reviews online.  I'd learn something about him.  I hadn't.  I was entrusting my future mobility to this stranger.  I thought of how I was rushed through the paperwork.  I remembered an error in the X-ray form that the radiologist corrected.  I thought about how little was explained to me by the doctor, and how little I knew about him.

Aliona saw my obvious discomfort, and the tears I tried to hide, and looked up reviews for the doctor.  She said firmly, "Choose another doctor!  His reviews are awful!"  I looked at them and instantly I knew, "No way".  Instead of reporting in to the pre-op room, I cancelled the surgery.

I looked on for another foot doctor that my insurance supported, who seemed good.  I found one, Dr. Vito La Puma, with 10 great reviews.  His description on Zocdoc mentioned he was a chief resident, which I knew was an impressive thing, thanks to many episodes of Grey's Anatomy.  I figured I'd need to get some sort of referral or some exception from Cigna, since I didn't have a PCP yet, so I scheduled an appointment through Zocdoc at 4pm that day.

The next day was all about cracking the code.  Finding a loophole.  I talked to Dr. La Puma, who confirmed I indeed needed a referral before 4pm.  I tried three approaches.  I explained the situation to Cigna.  There was absolutely no flexibility.  No matter how long it took, I would need to see a PCP.  I realized an unmentioned possibility of shelling out another $100 for an urgent care doctor again, but I didn't feel I should be forced to do so, since I already saw one.  The second possibility was to find an available PCP.  I looked all over the Cigna list and Zocdoc, which lists open appointments.  But no one listed by Cigna appeared in Zocdoc.  Would I have to call each one?  The reviews I was finding on Cigna-listed doctors were rather bad.  I could temporarily choose a bad PCP, but would they even be available?  Probably not.  I did find one PCP with good reviews, also listed on Zocdoc.  I had to call a few offices to find out which office he still worked in.  Eventually I made an appointment for 5 days later, but I called his office to try to get a referral just for now, and I'd come in later.  They agreed at first, but refused quickly when they realized I wasn't a patient there yet.  I realized maybe I could try the urgent care doctor again.  Even though they usually only refer patients to their handful of lackluster options, I pressed and was granted a "blank referral".

I had no idea what a "blank referral" was.  Should I write something in it?  Should I just give them the blank form?  Later, I realized that they did write "orthopedist" and the purpose of the referral on it.  Just not exactly who it was for.  Dr. La Puma's office readily agreed it'd be fine.  But Medhattan's fax machine was flaky, so I had to limp over there to get the referral myself.  On the way, the NYPD blocked off the street right near Medhattan... some event for families of war veterans I thought.  I asked them to let me just cross that one street, trying to explain that I had a broken foot.  No exceptions.  So I had to limp a couple blocks extra.

Finally when I got to Medhattan, an apologetic lady told me it was closed, due to the event the NYPD were tending to.  I insisted that I was just there to pick up a referral, and she was nice enough to get it for me.  I limped around for a few more blocks until I found a taxi.  The taxi driver asked me "Why the stick?" referring to my cane.  I told him I missed a step.  He shook his head, saying he does that himself, and hurt himself missing 5 or 6 steps once.  I told him he needs an eye doctor more than a foot doctor, and he laughed.  I allowed myself to laugh a little at my own joke too.  I needed it.

Traffic was miserable and I accidentally gave him the address of the PCP, which was also on 45th street, but on the east side.  Oops.  So I caned my way humiliatingly crosstown, through a rush of midtown foot traffic, like a rock a river flows around.

Dr. La Puma's office was in "Foot Care of New York".  I was greeted by an ultra-perky assistant who smiled and gave me minimal paperwork.  Zocdoc was also great, by the way, letting me fill out most of my paperwork electronically.  Learning to appreciate them a lot.  I just had to sign 2-3 things, including a privacy notice, but they got my thorough notes on my medical history from what I submitted to them online.

I was led in, to sit in a chair, and the assistant told me she was preparing a medicated, cold "whirlpool bath", to help with the swelling.  The chair had my feet raised, and I got a good look at my ailing foot.

I remembered my soccer games from when I was little.  I was never very good, but man, did my foot know how to kick that ball hard.  I remembered how I ran around Central Park on a whim, and wherever else I wanted throughout my life, just exploring.  I was quite a runner.  How much miles I covered during my college days, walking across large fields of grass, rushing to exams as I pursued my engineering degree.  And what did I do for my loyal foot?  I carelessly rushed down a flight of stairs, and left it to the mercy of a broken healthcare system and an unforgiving urban environment.  But things are finally getting better.  My poor, suffering foot, that the world seemed against, was actually going to be pampered.  I felt my eyes tear up again, but unlike the night before, these were happy tears.

This bath felt so good.  The cool water swirled around my foot.  Afterward, she gently toweled my foot dry, and led me over for a third set of X-rays.  Every doctor seems to have their own type of X-rays that they're comfortable with.

Dr. La Puma walks in, and we discuss my foot.  He says some good things and some bad things.  The bone has minimal displacement, which helps it heal without surgery.  However, the fifth metatarsal, he explains, is the worst possible metatarsal you can break in your foot.  It's attached to a bone in the leg that pulls on it, every step.  But it's not like I got to choose.  Also, it's a mid-shaft fracture, which is less stable, and with less blood flow.  But, more good news... he could provide me with a "bone stimulator", which is a little device that sends imperceptible current into the area, promoting bone healing.  "Steroids for bones", he calls it.  Also a surprise.  He tells me, if the leg does heal non-surgically, it would likely take around the same time with surgery.  It's just less guaranteed.

After a quick confirmation by him, I state that I'm fine passing on the surgery, at least for now.  I felt no pain, as long as I was meticulous and careful.  I had received email from my employer that they were accepting of me working from home.  I figured, I had as good a chance as anyone, now that I finally had the medical care I needed, for my foot to heal naturally.  The doctor wants to see me every week to monitor progress, and if effective healing wasn't happening, we'd go to the surgery option.

He admitted that while he was a resident, he would have jumped at the surgical option, but since then, he's learned to be more understanding and humane.  This reminded me of the ultra-competitive surgeon-residents depicted in Grey's Anatomy.  I asked him about his "chief residency", and he quickly admitted he was quite proud of it.  One time opportunity and it was quite competitive.  He explained he was an "attending" now, and I joked about him having "dreamy eyes", like the attending physician in Grey's Anatomy nicknamed "McDreamy".  We shared a laugh as he finished up my "soft cast" and his assistant returned with a "cam boot".  I was warned, that when I showered, to do whatever it took to keep the soft cast dry, such as a plastic bag and tape.  Otherwise I'd have to come in to get it replaced.

Finally my foot had some protection.  I felt the healing process was finally starting.  The security guard at the door commented on my exposed toe, warning me about people stepping on it in the subway.  I just wanted to fall into a taxi and be taken home where I can finally relax and play with my cat.  But, it was rush hour.  No taxis to be found.  "Bike taxis" kept offering their service, but I didn't trust them, and heard they charge a lot.  I opted for the subway, knowing New York is pretty good with offering seats to the disabled.

Was I disabled?  I'm used to my former New Jersey life.  You had to do a lot to get a handicap license plate.  But on a subway, yes, anyone with an injured foot certainly qualifies.  So I had no problem sitting down.  It took me a while to get to Grand Central.  On the way, another cane-wielder limped by, at a faster pace, telling me "There ought-a be a CANE LANE!"  Already him, the security guard, and the taxi driver are trying to cheer me up.  New York can be unforgiving in many ways, but everyone's in it together.  That's New York.

This is me with my cam boot and cane, in my apartment.  I spend some time figuring out how to order crutches through my insurance.  I'm also, at some point, supposed to be visited by a man with the "bone stimulator".  I call up Foot Care of NY, asking when it supposed to arrive.  She said she'd check on it, and I joke that my bone really needs to be stimul... err... I cut myself off and realize how horrible that joke was sounding.  She was very understanding.  Oops.

I spent some time thinking about how to modify the apartment to better accommodate me.  I could use my office chair to roll around if openings were wider.  I shifted things about, but the problem was, Luna the cat kept jumping in my chair at every opportunity...

The next morning, it was time for my first shower with the cast.  I took out the packing tape and a trash bag.  I hoped, if the tape was tight enough, I wouldn't have to make my hairy leg suffer.

Getting in the tub was difficult, but I realized I could push the rubber foot of the cane safely into the bottom of the tub then jump in.  There has to be a safer way, however.  While in the shower, Luna took her time investigating my cam boot.  "Get outta ma friggin' boot, cat!"  She didn't listen.

 I don't think the doctor required me to wear the boot around the apartment, and it's rather heavy on my foot, but I want all the protection I can get.  I spent more time online investigating other things that might help.  Quickly I ordered:

Something better than a bag and tape, to cover my cast with:

A stool to sit on when in the shower:

A "knee walker", that will be so much better than crutches, usable outdoors, and unlike the chair, can roll over the bathroom and kitchen thresholds (useful, no?):

I don't know if I can get insurance to cover any of it, but I ordered all of it.  I don't know if I'd be too embarrassed to zip around on a scooter-thing on the streets.  But I remember once when I saw a girl on crutches try to enter a frozen yogurt shop.  There was a very slight downward slope leading into the store.  She tried to go down the slope on crutches and just didn't feel comfortable.  Do I want to deal with that?  Or could I survive just hiding in my apartment building for 2-3 months, only coming out when I need to jump in a taxi?  Just one missed step, and now this!

But first thing's first.  Fortunately, we had a good supply of frozen meals in the kitchen to hold me over while getting life sorted.  I had time to sync up with work too, and they're so far very reasonable with accommodating me.  They delivered my laptop home, so I should be able to work on some projects.  Maybe not the time-sensitive ones, but I'm planning on doing quality work still.  Now to deal with my most pressing matter.  I need to heal, and that requires rest.  But I can't rest until Luna is dealt with.

Totally not a real strangle, don't worry.  We love Luna.  I feel bad that I'm the one who plays with Luna, throwing little toys around for her to chase, and I can't really do that much right now.  Maybe with the knee walker.  Luna's a trooper though.

My crutches were supposed to be delivered at 6am.  I checked with the medical equipment store to make sure the crutches would be delivered to my door, and not just to my building's doorman.  I pass the time reading up on instructions for how to use crutches.  I realize most cane users don't use the cane to bear their full weight like I was.  Or so I assume, because it's quite painful on the hand, eventually, and awkward.  I realize that most likely, after using a cane to do so much -- even hopping in the shower stall -- crutches would be much easier.

6am passes, and I happen to review my email.  I see an email saying that my crutches were delivered to the doorman.  The doorman was fortunately willing and able to bring them to my door for me.

After I got my crutches, I try to sit back down to see how they work.  Luna is of course in my chair.  I shoo her away with my new crutches.

The last time I had my height measured at a doctor's office, I was measured at 5 feet, 11.96 inches.  I argued they mistaken, and surely were adjusting something wrong.  I've been over 6'1" throughout my life.  Could it be at the age of 36, I shrank?  I thought that happened later in life.  I figured it was inaccurate, but whatever my height was, I needed to figure it out to adjust the crutches, which had "pin holes" labeled by height.

I read enough warnings to know the things at the top are not supposed to touch your arm pits.  My initial tests went well and I was able to hop around the room.  I was thinking that maybe I should cancel the knee walker.  This didn't seem so bad, and I was less self-conscious of crutches.  But then I realized the feet of the crutches were supposed to rest six inches in front of me, and the height should be adjusted for that, which accommodated longer strides.

I readjusted and tested a bit in my small apartment.  I did feel I was able to move a lot farther each stride.  I had a bunch of wobbly moments.  Turning was very awkward.  I suppose I could have adjusted the height for indoor and outdoor use, but then I'd worry about being used to the shorter stride, which could be dangerous.  I decided then to not cancel the knee walker.

It was time to go back to sleep.  I believe in the importance of sleep, for healing, and thought that if I'm going to have any chance at healing without surgery, I needed to have plenty of sleep.

I slept very well, and at 11am I received a call from the supplier that was supposed to deliver the bone stimulator.  He seemed unaware of details, and said he might have to check X-rays, but I told him my doctor had cut a hole in my cast exactly where the bone stimulator should be applied, so he didn't have to worry about that, but then proceeded to explain that I'd need to come in to pick up the equipment.  No house call?  I thought about trying to use the crutches to go somewhere else random, or trying to direct a taxi there.  I told him I barely knew how to use my crutches and how I wasn't expecting to have to leave my home.  Silence, then... "Okay, where do you live?"  Phew... he's supposed to stop by on Monday.  Time is often measured with obstacles.  I hadn't taken a shower yet today, so that's 4 showers from now.

My boss called and we're going to figure out everything I'll be working on in the upcoming months.  They're rather supportive.  All I need to do is heal.  Will post a sequel when I get more material.  Long road ahead.


  1. Scott,

    I broke my fifth metatarsal last August. I had a similiar situation with one Doctor telling me to have surgery, so I went for a second opinion and she told me not to. I'm so glad I listened to her! It did take mine almost 10 months to heal, but once I finally got a bone stimulator it helped speed up the process! I'm very active and have always exercised daily so it was extremely hard and depressing for the first few months. I pushed things as far as weight bearing too soon which I know prolonged my progess. My advice would be to stay off of it for at least 6 weeks. Sounds like you are doing everything right though! Hang in there, life will get back to normal!:)


    1. How is your foot? Are you healed?


    2. Yes, thanks for following up. Very kind of you! I posted 5 more blog entries since, with a happy ending... I had to get surgery along the way, and have a scar, but the foot feels great, and I'll probably try going for a run once the weather gets a little warmer. I tried to publicize my 6 long blog posts so that others suffering from a foot injury can know what to expect, but web site moderators don't like you posting URLs to other sites, even if it's for a good cause :/

    3. Oh, I didn't see your other blog entries?! Anyway, great to hear you are all healed up! :)

    4. Thanks so much :) Yes, glad it's behind me, and I have much more sympathy for the disabled I pass by during my city commute. I also am a lot more careful on the stairs.

  2. Hi, I was googling about 5th MT bone fractures and I came across your blog post. & omg the process of how you got injured + your xray was so similar to mine! hahaha i was heading for the washroom at 4.30am and i missed the last step of the stairs and OUCH there goes. this is my xray result, similar isnt it! Hahaha.

    I only got injured like.. last week? my doctor told me i'll need at least 3-4 months for full recovery but then i'm seeing a specialist next week so i'll see what he/she says. omg i hope i don't have to undergo surgery..... T_T i'm only 19 this year and i'm v afraid for what's gonna happen in my school life and normal life etc (omg i hate the crutches zzz) hahahaha.

    I jus wanna say that reading your post kinda prepare me for what i'm gonna face so HAHA i hope you're recovering well yep! :)

    1. Hi kwonyulyul!

      I recovered well! You should look at the next 5 blog posts! There's a lot more good information in there that you'd appreciate. But I'm sorry to hear about this happening to you. It's so easy to do, isn't it? I'm pretty religious about using handrails now.

      I'm sure the specialist is going to confirm things, but it looks a little messier than mine, with two breaks... but at least yours isn't mid-shaft, so it has better bloodflow. Honestly, based on my personal coordination and situation, I'd probably go for the surgery sooner rather than later. It'd probably be mostly behind you in 2 months if you took that route. But if you have a very good support system (parents?) and the flexibility to use a kneewalker (still not completely safe, having missed the kneepad), you might be able to heal naturally. It was so discouraging when I slipped on crutches and reinjured my foot, forcing me to get surgery.

      I hope whichever route you take works out, but for now, read the rest of my posts on this! I can't say the surgical scar is very pretty, but it's not a big deal being on my foot, and I could probably get it cleaned up down the road if it ever really bugged me.

      Good luck! Post back here with how things work out.

  3. Hi Scott just found your blog about your broken foot am going through the same thing at the moment :( 6 weeks so far with a big boot on and not much weight bearing. Doctors said it's healing but little slower than expected (this was after 2 weeks) so mentioned surgery but I opted for more time to heal so will be 8 weeks by time I get re xrayed now to see what's going on. Don't really want surgery if can help it but guess will see in a few more weeks. Getting little frustrated with being mostly house bound I keep boot on most of the time even sleeping with it just to be safe. I can walk with the boot without my crutches with no pain but I don't know if I should be doing this? Before I started moving a little more my leg was stiff an sore just repositioning it (like dead weight) so think it's better to keep mobile a little..... Anywho I would love to read your other posts about how your healing went an why you had to have surgery in the end but I can't find them? Any chance you can post a link to them on here???

    Many thanks

    1. Hey Stuart! Sorry this happened to you. I hope you luck out and manage to avoid surgery and, also importantly, get back to walking. I think you should be able to see the other articles in the blog archive. They're organized by date at the top right of the first article you read:

  4. Hi Scott thanks I did find the other posts about how you got on... I have a quick question for you I know everyone is different but how was your swelling post surgery? I can't seem to keep mine down using ice packs and keeping foot raised but the swelling doesn't seem to shift. I don't know if this is a problem as I'm not in any pain and was even able to put little weight on my sore foot last night with no boot on and still no pain.

    Hope I don't have to have surgery as been 5weeks off work now without pay and got 3 more weeks to go till I see a doctor again.....


    1. Sorry, I didn't see the followup comment. There was certainly plenty of swelling, but I remember too much compression, which was the doc's main strategy, was extremely uncomfortable for me, so it was mostly time that fixed it. I hope everything worked out for you by now, and you've managed, like me, to avoid breaking anything else since then.

  5. It’s fine I got an email about this other day when someone new commented and was strange reading it all back.... erm yes I have avoided breaking anything else but my swelling was still a massive problem and ended up going to doctors about it as my leg looked like I have been bitten off a spider/snake!!! Anywho he took blood and ended up ringing me later on the same day and told me to get to hospital ASAP as all signs pointed to a blood clot (DVT)

    Long story short ended up on medication for 3months to thin my blood the clot has since gone but to this day I still suffer from swelling in the bad leg and foot! Been back and forth to many many doctors/vascular specialist and been told this could be for life and to wear compression stockings long term and see if it helps.......... all this from a tiny break is unbelievable

  6. Hello! I fell 6 days ago. My foot looks like the picture! And I just gained a new bruise under one of my toes today. I still don't know if it's just a sprain or if it's actually fractured. I can walk/limp only without putting pressure on that area. How did you know when to go get it checked out?

    Also love your storytelling.