Unstable Lisfranc Fracture/Surgery/Recovery

Hello To all.  On 9/6/2011, I slipped in sandals on the edge of a road, and my left foot went down into a ditch, as i fell, it wrapped up underneath me, and my entire body weight came down on my left foot.  I laughed at first--then as i started to get up, I realized my foot wasn't working--thought i had cut it... looking at my foot, i about went into hysterical shock--it was severely disfigured!  My business partner (and best-friend), right beside me, kept me calm.  In the Emergency Room, the nurses immediately gave me morphine for the pain, and asked for my ID later.  The attending ER doctor immediately called-in the services of THE BEST ORTHAPEDIC SURGEON who just happened to be less than 500 yards away from the ER.  The Ortho Dr. diagnosed my injury as an unstable lisfranc fracture (laterally) of all 5 metatarsals.  I was put in a quick-splint to imobilize the foot, and sent home with pain medication and instructions to keep ice on/off every 1/2 hour.  I was to see the Ortho Dr at his office the very next day.  A very creative Xray technician took many Xrays of my left foot using items such as pillows, tissue boxes, and duct tape to elevate my foot just right for the xray image. 

The initial visit to the Ortho Dr on 9/7/2011 was met by the office secretary asking for a ton of money up front--way more than i could come up with--and i had a full-blown nervous breakdown in front of this woman, invoking the name of Jesus multiple times between blowing my nose.  She went to talk to the Dr. on my behalf, and he agreed to work with me on this situation--since by company's survival was hinged on my returning to work; to do so i needed both feet!  He scheduled surgery for me on 9/15/2011; again i was sent home in a custom formed splint. The pain medication was percocet 7.5/500 every four hours, and many times i had to take every 3 hours.... KEEP AHEAD OF THE PAIN - KEEP THE PAIN MEDS ON-TIME - USE DOCUSATE CALCIUM STOOL SOFTENER because after a few days, going to the bathroom gets a whole lot harder (no pun intended). 

On 9/15/2011, I went to the hospital, and was admitted, prepped, and undewent an ORIF of the 1st and 2nd metatarsal, where the reduction was closed with two (2) 3.5 titanium screws.  I also received Kwires on the 4th and 5th metattarsals.  The one thing I remembered about this surgery was laughing at the OR nurse who said to me as she's holding a mask over my face... "take a deep breath--this is Oxygen..."  Yeah Right, Oxygen :).

Coming out of the surgery was scary, i immediately burst into tears, and called for my best friend--who has been an absolute angel --standing beside me through this whole ordeal.  My Ortho Dr. came bedside, and i asked if i could go home.  He told me that once the anesthesia wore off i would be in an extremely painful condition.  I told him that i could handle the pain, and I was released.  From the 15th to the 20th of September, I was at home, bandaged, ice packs, STRICT ELEVATION, and Percocet every 4 hours (except three times where I had to take 2 at a time in a 4 hour period).  The pain was not as bad as you would think, only trying to focus on something other than this foot was the hard part.  I was unable to function in my part of the business for many days due to the effects of the narcotics--however, again, my best friend stood beside me regardless.

On 9/20/2011, when I went for my first post-op visit with the Ortho Dr., he removed the wrapping, the splint, the gauze wrap, and immediately called for his assistant--call the OR immediate admittance for Mr. Parr.  He then calmly told me that my foot was extremely infected, and i looked down at a ton of stuff oozing out of it.  I didn't know whether to throw up or pass out.  I was so very scared.  Within 10 minutes, I was admitted, and within 10 more minutes, I was being anesthetized in the OR.  An emergency IND was performed (the incision was opened again, irrigated, and packed open).  Coming out of anesthesia, I was moved to a room.  I had to spend from the 20th to the 27th of September in the hospital.  The Kwires on the 4th and 5th metatarsal had been rejected by my body, and had to be removed.  Fortunately, my foot was swolen enough that those bones were not going to move! 

 Each day, the Ortho Dr. would come first thing in the morning and unwrap my foot, yank out the packing, squeeze around on the flesh around it to monitor the drainage, and then pack the wound again.  He said that if the swelling didn't go down, i would have to have this packed open for about 30 days while it healed from the inside out...  The pain associated with this dressing change--there are no words to express--and the Nurses were on standby with the morphine to titrate into my IV immediately before and after the change. I had three types of bacteria in my bloodstream--and i was extremely ill.  I was given IV Vancomycin every 12 hours, until the pathology came back identifying the bacteria... i was then switched to Ciprofloxacin ("Cipro") which was also available in pill form--meaning I can go home??? 

On the 26th, the incision was closed, because I did exactly with my Ortho Dr. asked... keeping this foot ELEVATED and focusing on positive things...   On the 27th, I was able to finally go home.  Believe me, you gain a whole new concept of time when you have to stay in the hospital for a solid week, away from your life and loved ones.  But my best friend was with me each day, and his visits are about the only thing that kept me sane.

I have had weekly office visits to check the progress on 10/4, and 10/11.  On 10/11, the stitches were removed, ans sterri-strips were applied across the incision.  The drainage output on the gauze pads had gone from 2" wide dispersion, to quarter, to nickel, to dime, to size of rice, to dots... and yesterday--nothing.  Today I was able to apply a gauze pad around the incision--and put a sock on, and then the splint, and the ace bandages for support.  My leg from the calf down is approximatley 60% of its normal size... my muscle mass is gone, and there is a lot of loose skin.  I am unable to exercise anything from the knee down... with explicit instructions not to try and flex my ankle at all.

On 10/11's visit, my Ortho Dr broke the news to me that due to the seriousness of the injury (all 5 metatarsals were dislocated, and ligaments stretched) my NWB (non-weight-bearing) time in this splint would be 90 days (12 weeks). 

I am hopefully going to be changed out into a "walking boot" right before Christmas, and start PT. 

In the interim, I want to pass along these tips for anyone going through this ordeal:

1. DO EXACTLY WHAT THE DOCTOR TELLS YOU-- no deviation!  If he says keep your foot up - for GOD's sake -- keep your foot up.  The swelling can cause edema, can cause infection.  If the infection becomes too severe, your body may reject the hardware--required to stabilize the ankle enough to walk again--if rejection of the hardware, only option is to fuse the bones or AMPUTATE the foot.  So, with that in mind, again KEEP YOUR FOOT ELEVATED, AND FOLLOW THE PAIN MEDS AND ICE-PACK SCHEDULES.

2. Take stool softeners with your pain meds... if you're Dr didn't prescribe them, ask.  Life takes a whole new turn dealing with the pain, when your entire process stops for 11 days!!!  When I finally was able to go, the sound in the toilet was "CLANK".  Take the stool softeners and drink a LOT of water.

3. You will experience some sadness, and depression... to be expected with this continual use of the narcotic.  Vivid Dreams go both ways, some saddening, some exciting!  Make sure that you have your cell-phone beside you at ALL TIMES, and have company over as much as possible.

4.  For the beginning stages of this, consider renting a wheel chair.  Narcotics make you dizzy, and trying to motivate on crutches while dizzy is not condusive to NOT FALLING ON YOUR ASS AND BREAKING YOUR OTHER LEG!!!  So rent a wheelchair for about a month.  IF you're at all like me (not graceful) consider a WALKER, it was so much easier doing the one-legged-hop, than trying to manuver on those damn crutches!!!

5.  The single most important thing is FAITH.  And I have three very important men in my life - Jesus, my best friend Charley, and My Orthopedic Doctor.  Keep your thoughts positive.  Try with all your might to focus on positive.  Time is percieved.  We are the only creatures on this Earth that measure time.  IT can be damaging when the recovery sets in and feels like it's going too slow.  At the same time, TIME can be thrilling because you now have so much of it to try out new things - like crocheting, crafts.

6.  In the mean time, while you're healing... EAT THE RAINBOW!  I was 430 pounds about a year to the date before this injury (circa September 2010).  I decided to eat healthier, and paid attention to what my body was doing i.e. when i ate mcdonalds and felt sleepy, i didn't want mcdonalds... but when i ate certain green foods and felt energy, i gravitated to more of thos green foods!  I didn't sit still at all, the day before my injury (9/5/2011) I had weighed and had lost 116 lbs.  !!!!!  EAT THE RAINBOW means to have as much salad and brightly colored fruits and vegetables as you can possibly stand!!!! they taste sooo good, and help to keep your body moving (See #2 above). 

7. Do not,  DO NOT look at your recovery period as a huge amount of time that you have to digest and process and conquer all at once.  YOU MUST REALIZE EARLY ON that you need to take this daily, and set goals for yourself each day - keep focused in the day. I HAVE had to take it hour by hour sometimes. 

8.  You will become edgy, irritated, and feel so very sad and sorry for yourself.  You will probably vow never to wear sandals again.  In any event, FORGIVE YOURSELF, and realize that we are all entitled to an accident in our seemingly perfect lives.  The best advise I have received was from a Nurse Assistant...  "climb the wall baby.... don't hold it in... climb the wall --everyone else does!"   I didn't understand what she meant at first.  As I got home, and started going through the process of dealing with the time-frame of recovery, and the things i couldn't do from my regular life... i felt anger, rage, sadness... and I then understood that the nurse assistant was telling me DO NOT BE AFRAID OF LOOSING IT!   So now, I've upgraded her advise to "climb the wall baby... don't hold it in... climb the wall, and when you get to the ceiling, dig those claws in and hang upside down!!!"  

9. REMEMBER to laugh as much as you possibly can.  Laugh at anything, at spuratic random things... laugh at yourself.

In closing, I will be visiting this post again with updates as they occur in my healing.  My next visit with my Ortho Dr. is 11/1/11.  That should be lucky... all one's.  I am praying for a miracle.  I am asking that the Holy Spirit heals my foot in such a way as the prescribed/expected timeframe of 12 weeks is blown off the charts... that the sheer speed of it will astonish the doctors as to their only scientific explanation of the event--it's a miracle--it's God.  Praise you Jesus!

I pray that reading this post gives you strength, courage, and made you laugh a little too.