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Monday, December 2, 2013

Step by Step Till Recovery

This is the sixth and final post documenting my experiences, living in Manhattan, after I missed one step on the way to the laundry room and broke a bone in my foot. First post was here: 
The Fractured Fifth - Manhattan Life with a Broken Foot

I took another walk out to the grocery store to grind coffee beans that we forgot to order pre-ground.  That was my successful mission for the day.  I still looked very awkward, and I was in pain, enough to invoke words of sympathy, "Get better!", from onlookers.  I started taking Motrin, and I think that helped the pain noticeably.

It was time for a shower.  I decided, as long as I kept the shower sleeve mostly to the side of the tub, my cast would stay dry enough if I just used ... binder clips!

They worked quite well.

I had one more day at home before needing to get back to work.  I decided to make it count, and I set a goal get a bagel, then walk to Battery Park, a ways away.  I noticed, on the way, that by not putting pressure on the cane, I was actually not doing much to support myself with it.  Bravely I tried taking a couple of steps without the cane.  It felt the same!  I had been practically walking without a cane for most of the time!  I learned that what I needed the cane for was traversing uneven terrain.  I got into the habit of stabbing the ground repeatedly with the cane, so it took the brunt of the shock of each step.  Doing this, it felt about the same as walking on even ground.

Every so often, I walked past an elderly person using a cane.  Each time, our eyes met, and better understood their plights.

It took over an hour, but, I finally made it.

There was Lady Liberty in the distance.  Liberty.  It had only been a day since I started walking, suddenly New York had returned to me.  The nightmare was coming to an end.

It was my first day back at work, and the pain was not getting any better.  I figured after a full night's rest, maybe it would, but I realized, although a long workout was a good thing, you have to also give your foot plenty of rest in between to heal.  I figured my workouts, from now on, would be just going to work, and going back.  That was it.

Progress was slow, but I found a station with an elevator near home which let me skip most of the stairs at least.  My commute to work was more than twice as long as it would have been otherwise.  I had no problem finding a seat, but the train wasn't overly crowded anyway.

At work, I found my desk and settled in.

A few people came by to say hello.  Most winced at my mention of pain.  I was mostly left alone.  It was a fairly peaceful first day back, but I largely felt like I didn't belong there.

Coming back, I didn't have the same luck finding an elevator.  Not just one, but both of the elevators I found at the station had these signs:

They couldn't just test one at a time?  I thought it weird that the handicap symbol was taped over, but I'm assuming they wanted people to be nice to not just those in wheelchairs.  Makes sense.  I also realize that the MTA (who manages NYC's subway system) is strapped for cash, always, so it's probably more economical for them to test/repair all elevators at once.  Slowly but surely I climbed three long flights of stairs.  I sure got in the way of others, but I had to assume priority.  I was suffering with each step.  I desperately experimented with my cane, and discovered that I minimized the pain, usually, by letting the cane swing naturally along with my leg, and making sure the cane hit the ground first each step.

I just couldn't wait until the weekend, where I would sleep in and just heal.  But for now, I had to go back to work.

I started to walk with more of a side to side motion.  It was either because my foot was getting better, or because I was adjusting better, but I felt a lot less pain each step.  Every so often, a misstep still sent a jolt of pain into me.  Getting onto the subway, I accidentally stabbed my cane into the gap between the subway and the platform, leaving my foot suddenly unsupported.  It hurt, but I certainly handled it.  Someone did offer me their seat, which was a relief as well.  Eventually I made it back to work and had a relatively pain morning.

People in New York are always in a rush.  They'll go out of the way to hold open doors for the crippled, but only if they see you.  Rushing out doors and around corners is very common, and when you're using crutches or a cane, they might very well plow right into you.  A couple times I had to stop short or turn fast to avoid someone, and each time, I stepped in a slightly bad way, sending throbbing pain shooting up my leg.

Another thing that caught me off-guard was in the restroom.  There was a small amount of water splashed onto the floor.  When the rubber of my angled cane touched it, I slipped.  I quickly recovered before falling, but I of course suffered more pain because of it.

I got an email from Cigna, and logged into their web site.  I hadn't looked there in a while and saw three additional claims listed since the bone stimulator.  I first looked at this:

According to that, I owe a crapload of money.  I'm eternally grateful on October 3rd, the day of my surgery, I did not log in to see this.  I may have preferred the morgue rather than the recovery room.  However, the latest item in the list was this:

Great, disaster averted, and good to know those doctors got paid.

Heading out for work, I noticed it was raining.  I had to think this through.  I was already holding a cane with one hand.  I had no room for an umbrella.  Fortunately, wool is very water resistant.  I had a leather coat on, but wool, with a wool hat, would keep me plenty dry.  I headed back up to my apartment.  On the way, given the angle I had to put my cane against the floor, it slipped, again.  Someone who was wearing clothes typical for a hospital saw me and asked if I was okay.  Aside from the mild pain, I was fine.  As we were in the elevator of my apartment building, he asked "They told you to hold the cane with your right hand?"  He explained that normally you hold the cane near the good leg, to distribute the weight.  My face went pale.  Over 3 days of using the cane for so long, the wrong way!  Why didn't anyone tell me?!

I continued on and saw the elevators were actually working.  A complete stranger saw me limping toward the elevator and excitedly shouted to me, "They're working!  The elevators are working!"  I smiled and we chitchatted in mutual exultation on the way down.

It was mostly business as usual, but the company Thanksgiving party was scheduled afterward.  I was not about to try to get food while dependent on a cane.  There was a crowd of people, some playing ping pong, some drinking and chatting.  The food would take a while to come out, and I had perfectly good food at home.  I didn't know if I'd ever be best friends with anyone there, but I certainly wasn't at the moment.

I just wanted to go home, so I did, slowly but surely.  Coming back, the elevators were already offline:

"Out of service".  That sounded worse than "Testing in progress".  Oh well.  It was good while it lasted for one morning.

I took my time on stairs.  I realized I didn't have to step on the same step with my good foot.  I could alternate pretty easily, and this allowed me to ascend the stairs at a decent pace.  Descending was still slow, but if I was careful and didn't waste time, that wasn't so bad either.

At home, I posted this silly Facebook update:

One of my friends asked "Same side like House?"

I replied "YES!! That is exactly why I was using the wrong hand. Watched too much House :(".

I watched practically every episode of House, so I thought his awkward, leaning walk was normal.  The people who decided how House should walk justified it as an acceptable way to use a cane.  Most done, but some do.  However, it seemed more dangerous.

With further experimentation the next day (Friday), I realized that there was a benefit to both.  It was definitely too risky to use the cane on the bad side when traction was questionable, but when the ground was dry, using the cane near the bad leg would better alleviate pressure.  I found while I was more stable using the cane near my good leg, every so often, I could switch to the other side for a break, especially when my foot was hurting too much.

On that Friday, my foot was hurting just as much as the past three days, but I realized I'd have a chance to rest my foot thoroughly that weekend, and hopefully it would have a chance to heal.  Although I didn't resort to taking out my knee walker, I did manage to mostly avoid using my foot much at all.  When I did move around, I used the cane on my bad leg, keeping most of the weight off it.  I hopped a bit, and sat down a lot.

Monday came around.  Elevators were again operational, and a mechanic at the station saw my cane and made sure to let me know this.  From work, I headed back to the doctor's.

Dr. La Puma's assistant first removed the cast, and then did what she could to scrape off some of the dead skin.  I couldn't wait until I could take a simple shower.  The doctor examined me, asked for me to do "figure-8" movements with my foot, and then delivered news I didn't expect.  I was being granted "freedom", in Dr. La Puma's words.  No more cast!  I'd now be able to wash my foot!  No more shower sleeve over my foot!  Finally!

He warned me not to let my foot stay in water for more than a couple minutes.  I figured it was to keep the scab on my surgical wound intact, which I had no intention of messing with.  He only put a bandage on me (which he was using for just the outer layer of my cast), and I was to replace it after each shower.  There was no hole for the bone stimulator on the bandage.  I could just take it off and put it back on each usage.  However, the cast just removed had a hole, so I had an area of skin swollen in that spot which was covered up.

He recommended an ACE bandage, which I've not used before but he instead gave me a cloth bandage I could use instead.  He admitted it wouldn't be as good, but good enough.  Free is better, right?

He suggested I could also try walking around home with a sneaker for 15 minutes a day, and if it was working out well, I'd be gradually shifted into a sneaker over the course of the next week.

It was a short week, due to the afore-celebrated Thanksgiving.  Just two and a half days.  I was happy I'd have more time to rest my foot.  Upon returning home that night, I tried on a sneaker for the first time in so long.  The sneaker for my good foot had been overused so much that it was breaking down, but the right sneaker was still in very good shape.

The sneaker felt different, but surprisingly comfortable to stand in.  With my first steps in the sneaker, I immediately noticed the shock absorbency.  It was a major problem I was having with the cam boot.  I was desperately trying to use the cane to avoid that initial shock with each step.  This seemed like a solution.  I texted Dr. La Puma about this, not wanting to use the cam boot with its awful hard bottom and velcro straps.  The sneaker was more comfortable!

The doctor replied with strong reservations, saying how it was very early.  He suggested I'd have to be very careful.  He mentioned the possibility of a "surgical shoe" I could wear, providing a middle-ground.  For now, I was going to try the sneaker.

In bed, I noticed my foot was a bit more sore than I'd have liked.  I worried that I did something to my foot while wearing the sneaker.  I then remembered about the puffy area of skin being pushed down by the bandage.  I remembered this being more severe the night before my surgery.  However, this time, despite my foot feeling sore, the bandage was thin enough where the discomfort wasn't that bad.  If it woke me up, I could just loosen or even remove the bandage.  It didn't.

The next day, I woke up early to take my first shower with my foot fully exposed.  I first took off my bandage to use the bone stimulator.  More dead skin fell from my foot.

I then carefully entered the shower, still using the stool, and not stepping on my bare foot.  I rinsed my foot and applied a layer of soap, then easily rinsed the soap off.  Then I scraped my foot with my fingernails, trying to remove most of the dead skin.  I washed between the toes multiple times.  No longer did I have to live with the idea of having a foot that hadn't been cleaned well since the surgery.

Still not perfect, but it was looking more human.

I wrapped the foot in a bandage and wore the sneaker.  I was very careful with it on my way to work.  I would only take small steps, restricted by the still throbbing pain in my foot.  I made sure to only step on even ground.  With the sneaker, I was able to move with more ease, because the top edge of the cam boot was no longer there to dig into my leg each stride.

By the end of the first day in a sneaker, my foot was still in significant pain.  I figured I was exercising more muscles and tendons, and breaking up new scar tissue.  Even if it was alleviating the pain I had before, there would no doubt be more pain with the additional freedom of movement.

I finished the short work week and then I was home.  I was able to just relax, finally, for four full days.  Each night, I was able to sleep in, and each morning, my foot felt better.  I walked more naturally.  I noticed a tendon around my ankle felt strange, but I eased up on it and the next day, it felt fine.

I actually had the confidence to try stepping on my bare foot.  I took three steps as a test.  It felt a bit less comfortable than with the sneaker, but it mostly felt fine.  I tried walking around, very carefully, with bare feet, but as my bad foot got sore, I switched back to the sneaker.  I decided there wasn't much reason to rush, as walking around with a sneaker, not even with the laces tied, was at worst a minor inconvenience.  I did notice though, when my foot touched the cold floor, that my foot was incredibly sensitive to temperature compared with my good foot.  The dry bathroom tile floor actually felt as if it was wet with cold water.  Just like a painful tooth becomes less sensitive as nerve endings recede from the surface, so would my foot.  It actually felt refreshing.

I was able to stand on both feet in the shower, however, and it not only felt fine, but it was much safer than carefully balancing myself when I needed to stand.

It was difficult to apply the bandage evenly over my foot, probably because it was slightly too short in length.  When taking off the bandage for a shower, I noticed how my foot retained the imprints of the bandage, looking irritated.  It wouldn't stay on when I put my foot into the sneaker anyway.  The bandage would slide off the heel, riding up onto the ankle.  I decided, after a shower, to try just a sock, if for nothing else than to protect the scab on the wound.  I didn't think the slight support a thin bandage would offer was worth worrying about anymore, especially since I was indoors for the next couple of days and being very careful.  It turned out not to be an issue and protected the scab just fine.

On the third day, I didn't even need the cane anymore.  I couldn't walk around for too long without a cane, but using the cane would only be necessary outdoors.  I was able to carry things with two hands again.  I was able to take out the trash.  I was able to hold my affectionate cat with two hands.  I began to feel liberated.  I noticed the skin on my knees was chaffed, from all the crawling on hands and knees.  Those days were over.

My last shower for the weekend resulted in part of my scab falling off.

I  really hope readers will forgive the ugliness, but I want people going through the same thing to know what to expect.  Anyway, compared to before, I don't think this is ugly at all.  I can see the uncovered section at the top healing almost perfectly.  There's a small remnant of the scab hanging on to show you where the scab stretched to previously.  To think, someone sliced very deeply into my foot, and the wound could heal this well, just two months after.

I was itching to go for a walk on Sunday, and Aliona and I went to a restaurant in Tribeca, Sarabeth's, a mile away.  Usually, because of Aliona's high heels she wears, she is the slower walker, but this time it was me.  I felt mostly comfortable, but I still had an obvious limp, and needed my cane each step.  Occasionally I walked without the cane, but only for short stretches on an even surface.  The food was exquisite:

In the picture is a giant shrimp, lobster sausage, two scallops, and this sweet bubbly sauce that I can't identify.  There was a type of pasta (herb garganelli) and a "tomato ragu" as well.  Such a normal experience.  I did have to ask for a chair to prop my foot up on.  I noticed, while walking for a bit, my foot was understandably sore, and it wasn't feeling better while sitting on the ground.  If I rested my leg on a chair and suspended my foot, the soreness would fade away, just like when I used the stool at work.  I didn't know how long it would take before this soreness would stop, but I was improving by leaps and bounds (figuratively) and I certainly was happy with my progress.

On the next day, my foot felt great.  I definitely still did not need the cane walking around my apartment.  After my shower, I decided to take a bit of the cloth bandage and cover my wound with it, just so the doctor would not fuss too much about me just using a sock.  I also didn't mind a little protection for my scab, so it wouldn't be rubbed at unnecessarily.

I certainly took the cane on my way out, but after two weeks of returning to my feet, I was walking much more comfortably, and faster.  I was still offered a subway seat, but people weren't very concerned to move out of my way.  It seemed like New York knew I'd be just fine, and they were gently reverting accordingly.  When I got back to work, my foot was still a bit sore, however.  I propped it up once again on my stool.

It was time to go back to Dr. La Puma.  I do acknowledge he would have never wanted me to go so quick to using the sneaker so much, and certainly not stepping on my bare foot for a while.  However, I was using even a slightly sharp pain, or significant soreness as a guide for what not to do.  I had to live.  It's been almost three months of dealing with this injury, and I was certainly out of the woods, even almost done with it.

I walked over to Foot Care of NY with much more ease than just a week ago.  Although I was using the cane, I felt it was mostly getting in the way.  You can't just use a cane while maintaining a natural stride.  The motion to put weight on the cane breaks the natural movement.  I every so often walked without using the cane, still limping a bit, but it felt weird to not use the cane that I was holding.  Eventually I started to walk as if I was using the cane, but I was putting no weight on it, so the effect it had on my stride was negligible.  It was good to have the cane in position for safety, although I was conscious of the possibility that the cane might get stuck on something and indirectly cause me to trip.  Now, because stairs were responsible for my initial injury, I've been very careful navigating them, but I made a point of moving a step up and down each step.  I realized it was certainly easier to use the stairs just with the handrail, without the cane.  It was a little awkward descending steps, feeling the stretch on my heel, but by angling my feet 45 degrees, it wasn't too bad.

When I entered the doctor's office, I soon had X-rays taken.  Dr. La Puma came in, saw that my bone was still perfectly straight, then he asked how I was doing.  I told him the whole truth, and nothing but the truth.  He acknowledged there was no need for a surgical shoe, and that I was way ahead of schedule.  I told him about the restaurant I went to a mile from my home.  He exclaimed, "You walked a mile?"  I nodded.  In retrospect, I realized I actually walked back as well, so that was two miles.  He sprayed some Biofreeze on my foot:

It basically just made my foot feel cold, supposedly relieving pain.  My foot was elevated, so there wasn't much soreness, but it's the thought that counts.  He suggested I continue to use my bone stimulator for another two weeks, and then looked at the scar on my foot.  He suggested in the future, he would have me massage "vitamin-E gel" into the scar, which should "break it up".  He added, however, that it was mostly the massage that mattered.

He took the further liberty to wrap some bandage over just the front part of my foot with the wound.  He added that he was comfortable not seeing me again for a month.  I figure the next day, I wouldn't even use my cane.

Ladies and gentleman.  It's been three months since the injury, two months since the surgery, and two weeks since I started walking again.  I consider this story over.