2,3,4 Weeks Forced Vacation

Writing entries on Percocet is incredibly difficult, so I have waited until I am not taking serious pain killers on a regular basis.

The original estimation of adequate recovery before returning to work was 2-3 weeks. Two weeks until the stitches came out and maybe an extra week to get back on my feet.

I had been told to try putting weight on my foot with the stitches still in, but that didn't work out so well. A real step down made my stitches feel like they were ripping out. while my foot ripped apart. Very. Painful. The best I could manage was a pathetic 'resting the outside of my foot on the floor', while keeping the ball of my foot and big toe off the ground. I tried wiggling my big toe but that was really intense. Everything was incredibly sensitive. Well of course, I had just had surgery I told myself.

Needless to say I was working with crutches for those two weeks. Very difficult, especially high on pain meds, but I

somehow managed. Again, I have to say, thankfully this is the injury of active people.

I had lots of visitors and helpers, very few repeats, which was fine by me because I did not want to put a burden on anyone, as a result I got to be more social than I had been possible in a while, got lots of conversation and my cat will now come out and greet visitors on her own.

Concentrating on pain meds was incredibly difficult for me, and when I tried to read I got distracted by something shiny or would read a word countless times or would have a short-term memory lapse and forget the subject of the passage....so I didn't do much reading.

I did upgrade my netflix subscription and streamed a lot of television. And games on Facebook. Who knew the internet could be so helpful?

I took my best friend Julie with me to get my stitches out on Monday February 1. This was not pleasant at all. First they cleaned the stitches and just the cotton swab brushing the sutures made me get the sweats and nearly pass out. When Dr. Ellis examined the foot...the first time it had been out of the bandage in two weeks, he said the swelling, color change and numbness was not uncommon and that I was experiencing some hyper-sensitivity, a mild form of Reflexive Sympathetic Dystrophy...a form of nerve trauma. Other than that, the surgery site seemed to be healing well and I was given a prescription to start physical therapy before the next follow-up. When I was up on my feet he wanted me to use the hard soled sandal or the cam boot. Physical Therapy 3 times a week would help to desensitize the nerves and I would need to relearn how to walk. he gave me a list of HSS approved sites if getting to the HSS was too inconvenient.

When the sutures were removed Julie gave me her hand to hold, which I nearly broke and I also nearly put a hole in the wall when the nurse started. I've had stitches before, and I had pins sticking out of my finger that were removed, so I had a frame of reference...my foot was being unreasonably sensitive. Damn it all. I called Kate on the way home and told her the news, she had been a case study for RSD, because she had developed a severe case of it as a teenager, which was very unusual according to her doctors at the time. Her blog about it is here.

I had Julie pick up some litter while I did some banking and she took my rent check to be mailed...for some reason I didn't have any stamps left...probably used them all on my holiday cards. As soon as I got home I took a nap. Then I notified the boss, the director, the family and the friends that healing was going well but my recovery would be slower than we had hoped.
Once I got home I decided it would be best to stop using the crutches and start the process of working through the pain. Every hour or so I would stand with my weight on my foot. I hobbled to the bathroom. I started working my big toe. Gradually I increased the amount of time I would stand. When my foot got too swollen and blue I would go sit down with my feet elevated. I would take aspirin or ibuprofen with my stronger pain pills, like Dr Ellis suggested. The first day I was able to bend my toe half-way, flexing it still impossible without extreme pain.

My boss was incredibly nice and accommodating and allowed me to stay home a fourth week because even on Monday, I could barely get to the bathroom without pain and severe swelling. Getting on the subway worried me, add the expected blizzard and severe cold the risk of injury was very high. I had also been hoping to return to rehearsals for Cradle Will Rock at Theater 1010 the weekend before preview on Feb 12, but reality superseded those wishes. However, I did get a bit a good news, the Director's Note/Program Opening I had written and David had edited made an appearance in Martin Denton's blog.

The continuous lesson of all of this seems to be giving myself the permission and time to do what is needed in the healing and recovery process. For someone with a lot of patience for most situations, I have the hardest time getting myself to slow down.

The Night Of

Waking up after sedation always weirds me out. I guess it's because I go out so quickly and wake up in an unfamiliar area, still really hazy. The haze prevents me from giving an accurate timeline, but I'll do my best, the time passed quickly for me, but I was also heavily medicated.

Apparently the surgery only took 30 minutes, but I was under for about 2 hours.

I woke up in 'my room' where I had started pre-surgery, Dr. Ellis was sitting next to me and Kate was there, but for the life of me I cannot remember if she was sitting or what side she was on. I remember Dr. Ellis sounding pleased at the success of the surgery, but he did say he saw something surprising. I forgot what he said shortly after and would need to remember to ask him later.

I slowly began to register that I was attached to a breathing tube. My foot was wrapped in a very thick bandage, a bulge over the incision site. Eventually a nurse came and unattached the IV bag, but left the IV injection in my hand, and the breathing tube and took me to the next exit station. There I was asked what kind of sandwich, turkey, ham or cheese...I chose cheese...It was plain, cheese, lettuce and wheat bread, and some cranberry juice, but I was very hungry. I was asked to move my toes, success!

I was told to make sure I drink a lot of water because the pain meds cause constipation...fantastic.

Kate told me she barely had time to get herself food during the surgery, it was so quick and Dr. Ellis and talked to her afterwards, excited with the successful excision. She was also lovely and called my mom and stepmom when I was I was out of surgery.

I was given vicodin for when the nerve block started to wear off...my foot was still very numb..discharge papers and wheeled to the next station. Kate discovered it was best to hail a yellow cab to get me home, since there was no local car service in Yorkville.

I watched the nurse get into a communication mess. The patient was from Massachusettes and had just come out of surgery. The nurse was speaking to the patients parents who were on the train to NYC, as the nurse got off the phone the patients friend came to pick her up, apparently the patient was planning to stay with her friend...the patients friend got her parents number...I hope it was resolved.

A nurse came to remove the IV injection from my hand and put on a bandage and in doing so had to remove a bunch of medical tape at my red skin she said, 'do you have sensitive skin?' 'Totally' I replied. She chuckled at my response. I thought I was told someone was going to help me change back into street clothes, but I was done. Kate closed the curtains for me and politely turned her back, I didn't really care at that point. Two ETW students and long time friends....plus I was really drugged. I managed to change myself, even remembered to put my naval ring back in, and removed two electrodes in the process.

Another nurse with a wheelchair arrived to take me out of the building, I think we chatted about the surgery. I remember him being very nice. Kate went and hailed a cab, and shortly after we were on the way home.

Kate helped me inside and helped to arrange me on my bed and called a pizza for me, and we chatted while she befriended my scaredy-cat hiding under the bed. She waited until I could not stay awake anymore, and as she was leaving she fed my cat.

While we were talking, I started scratching my chest, and noticed an electrode I had didn't realize I had forgotten to pull off...we had a laugh about that.
Unfortunately, the way my locks work I had to show Kate out so I could lock my door. The nerve block had started to wear off, and in combo with the drugs(I have been assured that this is normal) I started to faint while I was showing her out It got to the dizzy, light-headed intense sweating stage. Kate waited with me while I kept my head between my knees and waited for it to pass, and then we had to rush her out so I could get to bed before I started to faint again. One of the few downsides to living alone I guess.

I didn't sleep very well that night. Overall I was very warm and when the nerve block wore off completely the vicodin did very little to relieve the pain and allow me to sleep. The pain was so intense, it was like my foot was burning and ripping apart and the worst pain was concentrated where I knew the incision was and like a reverse 'L' shape, in the ball of my foot, which Dr. Ellis says makes sense...considering that's where the surgery was. And an intense throbbing when I had to lower my foot.

The next morning I talked to Dr. Ellis and we spoke about the fainting and the pain. If the pain was still awful we could try upgrading to percocet. I was lying down most of the day so a little nausea wouldn't be a big deal. Dr. Ellis told me what he found while he was removing the tibular sesamoid, there is a line of cartilage missing, very unusual. He told me the fibular sesamoid didn't appear damaged and we are still hoping this surgery takes care of the pain.

Two days after surgery I did 'upgrade' to percocet because the vicodin was not strong enough to let me sleep. My foot would wake me up every two or three hours...my best friend Julie was watching me the first two days, she got the grumpy drugged part...not very fun for her, but she was patient.

The Day of

The morning of Monday January 18, 2010. MLK day. A day off of work. A year ago on MLK day Jan 19, 2009 I found out my Grandmother had had a cardiac aneurysm that turned fatal. A lot has changed in the past year. Big changes, life-altering events seem to happen so quickly.

When I found out I would be having surgery, there was a massive, devastating earthquake in Haiti. My problems seemed trite and I felt guilty asking for help in comparison to such loss and destruction.

Never the less, I needed to ask for help, I didn't want to overburden one person, and I've never felt comfortable being cared for. However, there would be things I could not do for myself, and who knows the reaction to the pain medication, if one person was over for just part of the day during the period where I had to be off my feet...we could hang out, watch a movie, catch-up, play Scrabble. That might be ok. Some people had offered, but how many people did I trust in my home, in a compromised position, to see me vulnerable?

The morning of the surgery I woke up early to have my prescribed breakfast before 8am. The restrictions were no meat, dairy or fresh fruit. So I had oatmeal, with some sliced almonds and raisins, green tea and water. I went back to bed. Woke up and took care of some last minute cleaning. I put together my shower stool, which fell on my broken, bare foot mid-assembly and scraped it (thankfully the stool is plastic or the damage may have caused the surgery to be postponed). I drank gingerale, double-checked my meds and furniture placement. I had never been on crutches before, so I didn't know what was necessary and could only give my best guess.

I forgot to pick up Ibuprofen. efffff. I needed that for the first three days after surgery for swelling, and if I took the prescribed maximum amount I didn't have enough. I guess visitors could bring me some

I have made sure to wear loose pajama bottoms that will comfortable fit over a large wrap on my foot and have made sure not to use any lotions or perfumes. (I am allowed to wear deodorant, and take a shower, so I do)

I tried to arrange a pick-up time for a local car service to take me to the hospital, but because they were local and it was not an airport drop they wouldn't pre-schedule. I would need to call only a few minutes before I needed them. Ok.

Kate, my friend taking me to/from surgery called for final arrangements. Because of traveling complications to Yorkville and because she lived closer to me she would come up to my apartment and we would take the car together. And yes she would pick up some Advil.

She arrives, I am nervous getting my jacket together, I have made sure to bring music and my camera, the admittance paperwork, my wallet with insurance info, my keys. We call the car, I take the aspirin Dr. Ellis told me to take to thin my blood. Kate offers me to stay at their place at least for the first few days, I decline, I've made arrangements, bought food, I say, for the next surgery I will gladly stay with them.

In the car I notice Kate is really beginning to show in her second trimester, and I worry and hope I don't fall on her when she takes me home.

We arrive twenty minutes early. Just enough time to fill out all the paperwork, including the proxy care, and learn how to use the crutches and practice on some stair steps they have set up. I do fine, but find myself wishing my hands were larger so I could comfortably hold both crutches going up and down stairs.

We both get name tags, and around 4/4:30 I am taken back to be prepped by the nurse. She is cute, whispers questions like 'do you have any allergic reactions to medicine?' 'do you need to ?' I have to pee in a cup. fantastic.

The gown they give me is paper lined in plastic and has special cutouts for easy access on the upper arm, the thigh, the belly. The blankets are heated and she puts my hand in a heated pad to prep for the IV. I hate IVs in the hand. The bruises are always so much worse, and the initial stick hurts more. Also the standard grey socks. Which are both constantly removed and put back on. Everything of mine goes into two drawstring plastic bags. Do I want to watch TV?...no, thank you.

Then a stream of doctors and nurses asking the same questions over and over. One Physicians Assistant from Chicago started talking to me. He asked me how the injury happened, if I was anxious to get back to dancing. I don't how well I'll be able to continue, but I have been considering going back to school for my Masters in performance, I could teach at the college level. What about accounting?...Oh, I worked hard and fell into it...He continues talking with me and the IV is entered. what's the matter?...I don't like hospitals...that's ok, neither do I, and I work in one...and the conversation ends with you know you have 'it' the thing that makes people want to talk to you... yeah, I know...I see a lot pf patients and some of them have it and I can't stop talking, you should be a psychiatrist. It would be great, you listen to someone, say 'time's up' and go teach dance. '....'

Dr Ellis comes in..more forms. He signs my foot. Kate comes in loaded down with my coat and her coat and crutches. I remember to ask Dr. Ellis about showering-saran wrap covered in a plastic bag... Crap. Kate, can you remember I need saran wrap? A nurse comes in washes the foot. There isn't an appropriate moment to take a picture of the signed foot. damn.

The head nurse in the OR comes in and wheels my bed to the OR. I pass a number of signs that say'please take off bloody booties'. oh boy. A big clock say 5:17. Seems to be running on time.

The OR is filled with lots of machinery, dark but shiny floors and a table in the center of the room. Someone's phone goes off, 'mom I'm about to go into surgery I'll call you back'...'how do you even get reception down here?'

They level the bed with the operating table, I scoot myself over and lay down, a nurse fixes my IV and starts the sedative. Dr. Ellis comes in. The anesthesiologist lays a napkin or cloth over my legs and starts putting down one, two, three large syringes for the nerve block/the local...thankfully I don't remember anything else.

Apparently the surgery was only 30 minutes long. I woke up maybe two hours later. Dr. Ellis and Kate sitting next to me.

Pre-op Prep

After arriving at work the morning of Friday, January 15, 2010, I immediately encountered a hiccup to a smooth relationship with my insurance carrier. Carlos, from Dr. Ellis' office called to inform me that the surgery had be approved, but as out-of-network because they had not received a referral from my primary care doctor. Ugh.

After several phone calls I managed to get it straightened out, all the while juggling my responsibilities with work and trying to set up as much as possible, my absence for 2-3 weeks...in a job where I have been unable to take a vacation for two years and reluctant to take sick leave because of my responsibilities and previous lack of cross-training in my department. An imposing task.

4:30 rolls around, and I have not heard my schedule time for surgery...another game of phone tag ensues, finally have the time, 5:30pm with a 3:30 check-in. I would be allowed to eat a light breakfast before 8am, and drink clear fluids until 3:30. I would need to take some aspirin around 3 to thin the blood.

I had to answer a bunch of in-depth medical questions on the phone in front of boss...he now knows more than he'd probably like to know. He had a sense of humor about it though.

I talked to both the director and producer of Cradle Will Rock, the show I am Assistant Director for, looks like the timing for me to be out will allow me to come back to rehearsals just before tech week. If that works out, it would allow be to have been there for the beginning and end of the rehearsal process. I am excited to see the growth achieved by the fantastical actors and musicians.

I picked up my prescriptions for post-surgery. While I was in line at the pharmacy I got into a conversation with a man who just found out he had lost the cartilage in his knee. He was in denial about it, didn't think old football and basketball injuries could do this, he was young, can't glucosamine grow it back? No, no it can't sir. Once it's been lost, it can't come back. I know there are different procedures for the knee, but the only thing they can do for my foot long-term is remove the bone.

Over the weekend I tried to prep for post-op. Clean the apartment, make a big Fresh Direct order, frozen pizza, cereal, fruit, cheese, potatoes, oatmeal, things I thought would be easy to make standing on one foot and high on pain meds.

I cleaned my apartment as thoroughly as possible, knowing it might be a couple weeks before I could clean it again.

I got three weeks worth of litter and cat food, hoping I would still retain the ability to change my cat's litter immediately following surgery.

I found a shower stool so I could clean myself and not offend the kind people coming over and so I could feel somewhat human.

I started calling and texting friends with the goal of having at least one person with me for at least part of the day for the first week and most of the second week.
I decided getting a couch would have to wait...I wouldn't have time over the weekend to make the best decision, and I didn't have the cash yet. I had thought surgery wasn't going to happen until February or March.

I tried my best to mentally prepare myself. I predicted the hardest part past surgery was going to be the dependency and the possibility of getting a little stir-crazy.
I knew what the surgery was going to entail. The doctor had described it. I had seen the pictures.....HERE (they are not pretty) .... read the case studies HERE (with more not pretty pictures)....This would be a total scalpel job.

Whoops...Time to Freefall

With a surgery date of TBA sometime in March I continued with my business. Assistant Directing started. It felt good to be in the rehearsal room again and learning a play. I had a really hard time discussing my foot with the people I was meeting. I was pissed off about it actually. Most everyone has been exceptionally nice about it, but I can't help but wish I was in a different situation. I am grateful I have patient friends.

I got a copy of my MRI and X-Rays from the HSS on CD. It made me wince.

Work continued to pile up as systems conversions started and we were preparing for our annual audit. My VP had been on vacation for three weeks and we had been without a middle manager for nearly 6 months.

On the afternoon of Wednesday January 13, 2010 I got a phone call from Carlos, Dr. Ellis' office manager telling me that someone had canceled their surgery on Monday, Jan 18th, and he was wondering if I would take the slot. I said I would like to, but needed to talk to my boss first. I talked to my VP and my director and got the green light. My VP said I would need to available by phone to walk them through processes only I know how to do.

I gave the go-ahead to Carlos. He directed me to the pre and post-op directions and sent me a form to fill out and bring with me. I asked him about the cortisone shot, and if I should cancel, he said he would talk to Dr. Ellis. Dr. Ellis decided he wanted to see me again, for a pre-op eval and we scheduled that for 9am on Friday Jan 15.

I sent notice to as many of my support network as I could think of, but realized this was going to be a 'figure it out as we go' sort of situation.

On Friday morning I saw Dr. Ellis for one of the longest conversations I've ever had with a doctor. The appointment lasted over an hour. He re-examined my foot. The problem he was having is the MRI shows the most damage on the tibular sesamoid, but the most pain seems to happening around the fibular sesamoid. (there are two sesamoids per foot) The fibular sesamoid did show a severe loss of cartilage, but it was not bone on bone.

He fully examined my foot, flexion, pressure and compared it to my right foot. He was able to make it crunch in his examination...which is what happens now when I try to walk normally.

The problem here is that a double sesamoidectomy is not done because of the risk of creating a cocked up big toe. Which could mean another surgery.

But removing only one sesamoid might not take care of all the pain. He told me about a patient who had sesamoid issues and he removed one but she still had pain. He felt a great deal of regret about not being able to help her more.

We looked at my MRIs. Looked at the damaged sesamoid, and apparently I also have a small bone spur in the first metatarsal, but it was so small and not the big problem. I asked him about some things I saw in the MRI. What I did see as 'bubble', was in fact, a bubble of fluid from the arthritis.

The dark lines in the bone are normal.

There was some debate about the fibular sesamoid being necrotic...dying...we looked at a different patient's MRI and compared...nope...looked very healthy in comparison.

He told me he had talked to the senior surgeon about a double sesamoidectomy, the radiologist even asked if it was possible to remove both. The conclusion is that it's best to not remove both. The tibular may be affecting the fibular.

The other smaller issue is the tibular sesamoid is easier to remove and has a shorter healing time.

I told Dr. Ellis let's remove the one that's most damaged. If I am still experiencing pain in a few months we will cross that bridge when we get there. If we have to remove both, that's what we do. I would probably be more conservative about this surgery if I was 70, but I am 28 and can't walk.

Dr Ellis described the incision, and surgery. What the dressing would be like, a timeline for suture removal and physical work.

I asked him if I could get my prescriptions now, living by myself I would need to fill them now.

He was going to prescribe percoset, but went with vicodin when he learned I had to take anti-nausea medicine with my vicodin when I nearly tore off my finger.

I asked what I would need to clean myself...garbage bags and a shower stool, which I could get at any surgical supply store.

I went to Carlos and Angel, scheduled the suture removal. Found out I would get scheduled later that day and to call this number at a certain time if I don't find out my check-in time.

I hobbled to work.

A Decision

After discussing the news with my parents and my friends. I attempted to do research on something that hardly ever happens, let alone to someone my age and weight. The best I could come up with about loss of cartilage in the feet was osteoarthritis, or that the loss of cartilage in the feet happens after an injury and because of overuse. So, we haven't left the overuse and abuse scenario.

How is someone even supposed to know they're losing their cartilage in the ball of their foot?!

The next morning, Wednesday Jan 6, 2010, I called Dr. Ellis' office and set up the appointment for the coritsone shot. The next available appointment was on Monday, Jan 18th, I chose 4pm.

I also told Dr. Ellis' office manager, Carlos, to let Dr. Ellis know I would do surgery. Carlos said, 'Ok, the next available time for surgery is March.' I said, 'Put me down for March, the earlier the better.'

I called off the bone stimulator application.

Told my original doctor the results and plan...he tried to sell me on his orthotics.

I ordered a copy of my MRI and X-rays.

Now is the winter of our discontent....

Ok, so March would be the surgery. I had time to plan, prepare, buy a couch for post-op lounging and recovery.

I would be able to go to the Cradle Will Rock rehearsals which started on Jan 10. There would be an end to this blasted boot and cane. Maybe life is forcing me onto a different path, but at least I will be able to walk and probably run it pain free.

The 12 Week Marker and the Results

I hit 12 week anniversary of going to the ER on Tuesday, Jan 5, 2010. 12 weeks of hobbling, walking like I am 60-70 years older than I am, battling New Yorkers during rush hour, hauling myself up stairs. 12 weeks of trying to keep my spirits up and figuring out the best way and finding the best doctors to help me figure out exactly what was happening and help me heal.

A few weeks earlier, my legs had started to cramp and twinge with the combination of the sudden lack of motion, and the added strain and muscular push needed to hobble and climb stairs...not to mention the added strain on my hips and knees. I began to work at home modifying floor barre, pilates and basic stretches for a short time every few days. The stretches and bit of exercise made a tremendous difference in how my legs and hips felt.

I was already doing chin-ups before my foot started complaining and have continued to do them. My chin up bar is not far from the ground, so I don't drop. I can let myself down my putting the right foot on the ground first. Being able to keep up some fitness has helped my emotional outlook as well. In order to sustain a sesamoid injury, one is usually very active. These usually occur to athletes and dancers, (plumbers also tend to get them as well) so to suddenly stop being active is a big blow. I myself am also incredibly independent and like being useful, and suddenly switching to a level of dependency is disheartening.

Anyhow, to the results. I spoke to Dr. Ellis on the phone. He told me he had to consult with the radioligist because what they saw was so unusual and unexpected. They were expecting to see a fractured fibular sesamoid. Instead what they saw was a complete lack of cartilage-bone on bone arthritis-between the tibular sesamoid and the metatarsal joint.

Cartilage can not be re-grown or replaced.

The only long-term solution that would allow me to walk unaided is the sesamoidectomy. The very surgery I had been hoping to avoid.

Well the tables have turned, now it isn't about me getting back to normal, doing the things I used to be able to do, being able to dance again. Now it is about whether I will be able to walk at all.

I did start crying, but managed to hold back the waterworks on the phone.

The only non-surgical option is to control the pain with a cortisone shot. They would use a sonogram to make sure the cortisone was delivered exactly where it was needed. We could try that first and see if it helps. He told me to call his office in an hour and set up an appointment.

I called my family and friends in my support network.

I missed calling his office in time for closing that day to set up the appointment.

I decided to leave work early.

Happy New Year...You're Getting an MRI!!

Dec 31, 2009. I have my MRI. My insurance company has sent my a letter notifying me the procedure has been approved, but I still had to be covered at the time of the procedure and the necessity would determine the billing. So, I am even more nervous. I am nervous about the procedure, as a child I had to spend ten days in a hospital and have had a fair amount of procedures done to warrant a dislike of hospitals and complicated diagnostic tests. I also don't enjoy enclosed spaces. And now, I am nervous about the financial implications.

I check in and am nervous about the bright pink financial aid information sheet in my form. I am nervous when I check off the box saying I've been a welder/metal worker, but thankfully it was wood that had to come out of my eye.

The office assistant shows me into the men's changing room, at first he does not realize the mistake and thankfully there is no one undressed. But I get to the women's locker room. I have to change into a gown and special socks, make sure I am not wearing any metal and remember to take my locker key with me. My locker? I didn't even think about that storing my belongings part. I had to sit in a chair and wait for my MRI guy. While I was waiting a woman came back from her MRI...she seemed near the end of a nervous breakdown or in a lot pain....probably both. I didn't know what to do, but smiled at her attempt to make a joke, and tried to not be too intrusive.

Oops, forgot to remove the naval ring. He came with a wheelchair. I was not wearing my glasses and could not see, but he seemed very concerned about my comfort and well-being.

He put me on the table and put my feet and legs the way he needed them for the picture and strapped my legs in position. This MRI was going to be at least 40 minutes, my legs were going to get tired. He put a blanket on my upper torso, explained that only my legs were going to be in the big coffin-like structure and asked me if I would like to listen to music with the (mostly) noise cancelling head-phones, gave me some choices... I chose the Beatles....it was their early hits.

It was really difficult to not move. The position became very uncomfortable, there were loud noises and I felt trapped. As awesome as the Beatles are...even they couldn't keep my mind off the muscular and emotional discomfort. Eventually it was over, I asked him how they looked, and he said the quality was very good but I wouldn't hear the results until next week. he wheeled me back into the room and I saw a posting of who to call to get copies. I took the number down.

I bought some champagne on the way home, and rung in the New Year quietly while my cat slept.

Acupuncutre and Bone Stimulator

But first the Chinese medicine/acupuncture Dr. Ting. The idea of going to him was not so he could fix my fracture. The idea was to see if he could alleviate some of the secondary pain in the soft tissue/muscles caused by this pea-sized problems otherwise known as the sesamoid bone.

I saw him the 28th. We discussed what I had done with Western medicine, and how long it had been, and that I would be getting an MRI. He was understandably hesitant to do too much to my foot. But he did try to pin point the pain and tried to get the circulation to improve. He said that I should stop doing cold and use a heating pad to help with the circulation. I said I had actually stopped using ice packs because the cold made my feet hurt so much worse (at this point with NYC winters I had been wearing 5 pairs of socks, which only works a short while when you keep pace with the hobbling elderly). He said based on the pain he didn't think the bones were smashed, but something was wrong with them...perhaps a hairline fracture, and that he would like to see the MRI. He is the one I credit for encouraging me to get copies of my X-Rays and the MRI. Once we knew exactly what was wrong he might be able to help more.

My foot did feel different, it went numb for a bit, which it was supposed to do, and something was going on down there, whether it was increased blood flow or something else, for the first time in months my foot felt something different than pain.

Also at this point in the timeline, I had been contacted by a person representing a bone stimulator manufacturer, who would be applying for approval. One of the reasons it takes a fractured sesamoid so long to heal is the lack of blood flow in the foot, and loss of blood can cause necrosis, make the bone die. The bone stimulator, depending on manufacturer, sends either electromagnetic or ultrasonic waves to help stimulate blood flow and encourage growth in fractured bones....the studies have shown it to be effective to varying degrees. This is the one Hilary worked for.

She needed medical records from St. Luke's and we decided to wait until we had the MRI because that would show something definite.

Personally I was having a really difficult time. Socializing became harder. I wanted to take all possible measures to avoid the surgery and have my bones heal. I would wait a year if I needed to do, keep pace with the hobbling elderly, maybe write a blog, find as many theatre opportunities that would be willing to deal with the disability...Shakespeare's Richard III and Laura Wingfield (Glass Menagerie) are written disabled, but surely there are roles that a gimp could make work?

I wanted to be able to dance again and get my energy back, and I would do whatever it took.

Because of the holiday timeline I started carrying my camera with me and took some pictures of the season. In holiday seasons past, I used to walk all over the city, see the trees and the decorations, one of my favorites being the giant snowflake hanging over the intersection at 57th and 5th Ave. During this time I realized my day-to-day perspective was changing. Perhaps it was because I had to move slower and was able to notice more.

In the beginning....part 4

By the 22nd I had an approval for an MRI and requested referrals for second opinions.

On the morning of the 23rd I went to the Foot Center. I did not fully realize what a teaching hospital entailed until I went here. Perhaps this is the exception and not the rule, it was during the holidays, but the administrative staff was disorganized the students were...students...and the actual doctors seemed overwhelmed.

They did do a very thorough examination and history, noting the discoloration took X-rays and I waited to be seen by the actual doctor. They came back and said the X-rays didn't show anything and that they would recommend and MRI and these types of injuries could take a long time to heal. For me it was basically an extra backing to wait on the surgery proposed by my original Doctor, but to stay with him. One of the student attendants talked with me for a bit because she was writing her thesis paper on ballerinas with sesamoiditis. Interesting, but no new information to be gleaned.

I got to the HSS a half hour earlier than recommended and worked on my paperwork. The waiting room staff had noted they had received my referral. I was ushered into X-rays before seeing the doctor and then to a waiting room. By the time the doctor came to see me he had already examined the x-rays.

But the first thing he said was that the discoloration was consistent with a sesamoid injury. He checked my alignment and determined the reason for the injury was not structural (meaning I didn't have a high arch and the reason for the injury was overuse/trauma). Upon examination of the X-rays he noticed the beginnings of a bunion forming (probably because the hobbling), some odd coloring in my big toe, and two oddities in the sesamoids themselves. 1) the fibular sesamoid seemed to be slighty smaller and ever so slightly out of alignment 2) the fibular sesamoid was darker than the tibular. We discussed the consequences of a sesamoidectomy (he noted that I had done my research) and that he liked to wait up to year with conservative treatments. He encouraged me to get my MRI at the HSS, if just for the superior technologies. I was able to switch my MRI to the HSS, but first I had to talk to Dr. Werter, who thought the pain might have something to do with the TB I had when I was little...reaching far and wide.

Yes, it is true that sometimes TB can show up in bones and the stomach, but I had it as a little girl a long time ago and it was a primary infection in my lungs. If it was going to show up anywhere it would have already done so. The only time I really have to worry about it is when I get pnuemonia, which is why I get allergy shots, or if I need to be tested....but that's another story.

Got the MRI scheduled for Dec 31.
Then I met with an orthotics specialist for a new pad for my boot. The pad already in place was an improvised J pad, in an attempt to even out the pressure placed on the first MPJ (first metatarsal joint). He had also give me an arch support which I had removed because it was not relieving the ache in my arch and was also causing me some heel problems.
This orthotics specialist (I think her name was D. Sauer) became slightly irate on my behalf for the improvised pad. She removed it, checked my alignment, marked where this new off-loading pad would go (it resembles a raised bump) and explained that this pad would lift and isolate the first MPJ. Whether the bone was bruised, broken or if it was all soft-tissue. Immediately I felt a difference in the right direction. It felt like the way I had to gimp without the boot.
She also told me (when I had mentioned my previous doctor only saw one of these types of injuries a year) that they saw 15-20 a week.

With a renewed sense of hope I returned to work.

In the beginning....part 3

December 18. A day my foot decided to express itself.

Dr's follow-up to continued Cam walker. My foot was not better at all.

Looking back with 20/20 hindsight I can see my Dr being flustered. This had gone beyond his experience, a good doctor, but not much experience with this specific problem. He said surgery was definitely on the table for discussion, but he wanted to try using a bone stimulator for a month or so and he

wanted to give me a cortisone shot. Because I had been researching this as extensively as Google will allow a novice...I brought up that I thought cortisone shots weren't given to people with fractures. He said it might hinder the healing slightly, but he was hoping it would help with the swelling and reset the healing process.

The shot was one of the longest I have in memory. He put it through the top of my foot, because he said the top was a less sensitive area than the bottom,

and it hurt. From the beginning to the end it hurt like nothing else. There was also Novocaine in the shot, which would buy me a few hours of numbness but I was not to expect my foot to feel better until the 21st.

While we were waiting for the Novocaine to numb my foot I asked the doctor why my toes on the affected foot were purple. This discoloration was something I had just begun to notice. He was baffled and unable to give me a good explanation.

When the numbness wore off the pain was incredibly intense, my hobbling slowed down to quarter speed and I had to take serious pain killers that night and the next day. On the 21st my foot started off with a dull ache but progressed into a sharp pain. I called the doctor and he ordered an MRI.

Over the course of those few days I had been speaking to my friends and one of them told me about the Hospital for Special Surgery. I looked first at the podiatrists and saw that one of them had written a case-study or a non-union sesamoid fracture. He had treated a professional ballerina and used a bone-stimulator for a year, but she was able to go back to her professional dance career.

This, plus everything else I had been reading started sending off bells in my head. We were talking about surgery incredibly early in the progression of this injury. And I became more and more aware that this surgery and injuries to the sesamoids and sesamoidectomies were not to be taken lightly, were rare and needed to be treated with as great care as possible.
I decided to try a set up an appointment with a doctor at this hospital. This proved difficult at first. The referral line found an orthopedic surgeon (my request was that I wanted a second opinion on a non-union sesamoid fracture) who took insurance (hurdle 1). Hurdle 2 was that this Dr. Ellis was booked until May.

Luckily for me I have a friend who was able to get me an appointment on the afternoon of Dec 23 between surgeries.

In my desperation to avoid surgery I also scheduled an appointment at the Foot Center of NY first thing in the morning of Dec 23 and with an acupuncturist/Chinese Medicine doctor my dancer friend recommended, Dr. Ting on Dec 28th.

A quick note to the 'why?'

There are some important truths that should be laid out.

-This injury/condition and subsequent removal of the fibular sesamoid is not like removing an appendix. The sesamoid and metatarsal joint are vital the the mechanics of a healthy and normal foot.

-As a dancer/mover/athlete, this surgery will forever alter my performance capabilities.

-But without the surgery I can't walk.

-This has changed how I feel about/view my body and will change how I define myself as a performer.

These are the truths I have the hardest time accepting.

In the beginning....part 2

During all of this I had to deal with doing everything slower. Walking time turned into hobble time. I kept pace with the elderly, about half-time compared to my normal walking speed. My gait also changed because I had to use a cane I could only carry things with one hand. I started ordering my groceries with Fresh Direct and using a backpack instead of a shoulder bag for balance. I am conscious of my speed especially during rush hour and have started avoiding crowded areas and stores as much as it is possible in NYC because my bulk with the backpack and cane and the awkwardness and lack of reflex makes navigating those spaces difficult... I just end up knocking something over, grow bright red with embarrassment and try to fix it, but make the situation worse.

Traveling in NYC's public transportation is a job in itself for the disabled, temporary or not. I figured out a hop/hobble for going downstairs and a haul-up for going upstairs. In the beginning I was really sensitive to the looks I got when people realized I had a cane and boot couldn't walk. On crowded subways I would hold a pole next to the designated handicap seats, but most folks consciously ignore each other in those seats. On one crowded bus a fellow rider told me I should have given up my seat, I had to tell her my foot was broken, but she still looked at me with disgust. Keeping balance while standing on the subway is much easier than the jerkiness of the bus, but the bus is easier to get on and more convenient for short distance traveling.

I was crossing a street in the Lower East Side, it was my light, a cop car with no lights flashing was in the middle of making a right turn but had paused for the pedestrians ahead of me, so I continued across. It obviously took me a little longer than normal, but when I got across one of the cops got on the speaker horn and said"Go ahead, take your time...it's not like we're the POLICE or anything" and sped away. I shook my cane at them and several pedestrians around me were very indignant, but the car was long gone.

As far as theatre was concerned, auditioning in general was out of the question. The one audition I did go to was for Working Man's Clothes, She Like Girls, because I really wanted to be a part of it and it was during the first phase, so I was sure I would be back to walking normal by rehearsal time. Thankfully I was not cast, but not because I was broken at the time. I was helping to workshop some new writing with Jody Christopherson, and was able to attend some shows. At one of them, actors did inadvertantly run over my foot going through the aisles...I have been extra careful about where I sit, but have had some close calls. At Theater TenTen's production of Arms and the Man I was offered a position as Assistant Director for Cradle Will Rock in January and February which I accepted. I also was able to help out at the concession stand for Flux's Lesser Seductions of History.

During the fall the weather was extremely unpredictable. I kept extra socks in case of rain. The boot is water-proof, plastic and neoprene, but does keep my foot from getting wet. I would wear two socks on my boot foot to try and keep my toes warm. For Thanksgiving and the week after I got very sick. A friend had to come over and put me in a cab so we could go to a walk-in clinic.

The four weeks leading up to my Dr's visit on December 18, feel like they went faster than the previous four weeks, but they include Thanksgiving week and a week of being sick. Thankfully Flux started their Flux Sundays and was able to incorporate me into the readings. I had something fun to look forward too. This time I kept a cautious outlook. I refused to say it was getting better or worse because I had been fooled before.

Since October I had been doing my research on sesamoids, sesamoid fractures and the treatment, and found basic information, but knew that if my foot was not healing and still fractured there was a possibility of a sesamoidectomy. The Dr. had also mentioned this, but he viewed it as prescription for bunions.

The week leading up to what would be my final visit with Dr. Werter, I could tell my foot was in fact not getting better, and my foot was trying to communicate that with me as much as possible.

In the beginning....part 1

I am performer, and my injury/condition is as a direct result of performing. The tipping point happened June 2009 I was performing as Ariel in an outdoor production of The Tempest. See the You Tube Video here. We rehearsed in this space as well. Needless to say my feet hurt, and they continued to hurt. With rest and care the deep ache dissolved to a barely present mild discomfort.

In July of 2009 I was performing in this same space again, and rehearsing another show. I would notice the sharp pain in the front of my foot coming back after a long walk or workout, but it always faded. I also noticed that my left foot would cramp on cold floors. I kept it in mind, but thought my feet were on the way to healing.

Going into September a sharp pain creeped into my walking until I was no longer able to walk without severe pain Columbus Day weekend. I was able to isolate the origin to the ball of the foot and had to visit the ER at St. Luke's on Tuesday October 13. X-Rays were taken and a break was not seen, but there was noticeable inflammation around the sesamoids and I was told I had sesamoiditis, at least, and needed to see another doctor. I was given an anti-inflammatory, codeine and a cane for support.

I was able to get an appointment Thursday October 15 with their podiatrist Dr. Werter who took me on as a patient. He said it was definitely sesamoiditis on the fibular sesamoid, and he saw maybe one case a year. I was to see him again in a week and we would see if it was feeling better after taking a different anti-inflammatory, icing it twice a day, keeping it wrapped with special pad and staying off it as much as possible.

Needless to say, walking supported only by cane was incredibly difficult and disheartening. I stayed as positive as possible. Thankfully I have a desk job (with insurance) when I am not performing, but the discomfort, fatigue and loss of energy presented new challenges.

The next week I went back to Dr. Werter and asked him about getting a walking boot because my foot was just not getting any better and I could barely hobble half a block supported by cane. For an active, social individual I needed to be mobile.

I got the boot, but I had to pay out of pocket for it, because the insurance approval process was long and had already been delayed and the co-pay would have been about the same.

I would need to wear this boot for three weeks, and then I could take it off and walk with a cane and special pad in my shoe for a week. Emotionally I was doing my best to not be deterred, stay as social as possible, tend to my new apartment and cat and started my Assistant Director duties. I missed being able to go for a run and walk around the city but I was able to be mobile and enjoy my Halloween, still see shows and go to birthday parties. I visited the Dr. once before the boot came off and after the week sans boot.

My foot felt like it was getting better. I now know it was just adapting to the new footwear. The first few days without the boot my foot felt weird, like the big toe was asleep, or the tendons were stretching. An injured sesamoid can affect a large arch muscle, so I was not sure if the pain and strangeness I was feeling was related to the foot being isolated for so long, or if it was just not healing. The Dr was suspicious and did an ultrasound on my foot and discovered what appeared to be a patch of fluid and fracture. Back to the boot for four weeks!

I was discouraged. Once I was back in the boot the pain came back full force, it eventually dulled away, but it was excruciating! And my good foot was also hurting! What was a gimp to do? Well, then we hit Thanksgiving.