However, life also has a strange way of bringing things back into the spotlight, so maybe that's why I'm back here now and intend on sharing my story as it unfolds over the next several months and year. I'm being sent on a very, very unexpected journey and it's semi-frightening. It's going to be a very long road, an unknown road and right now I don't know if the start of this journey is like jumping off a cliff into...who knows...or, if it's a vindicated cushion. I'll try to back up. I'll try to start where it makes sense, even though none of it really makes sense.
...
2012 started off injured, got better, a few marathons and a half ironman happened, more injury followed, another half ironman and a few more marathons, and then more injury. And then the dark season. It was a strange wash cycle. The only thing of which I think any of this could attributed is my feet.
When I was a kid, I was diagnosed with flat feet and was prescribed orthodics following an incident involving Keds. I've been wearing fiberglass orthodics for years which have helped me to prevent bunions, but as a by-product, have created tailor's bunions that are not painful, but are definitely present. Right around October or so of 2012, approaching the dark season, my right foot started hurting, right on the tailor's bunion. I merely shrugged it off and figured it was due to running like a crazy lady and completing my 24th marathon. It was probably just shoe friction. The pain then continued to December and straight through the holidays and was accompanied by foot swelling. The foot swelling eventually gave way to an ulcer, smack dab in the middle. I went away on vacation to Puerto Rico and came home in excruciating pain, which drove me to see a podiatrist, figuring I would start 2013 off with being on top of my health. X-rays were taken, and I was told that the bones in my feet were just fine and that this was all due to fluid accumulation associated with the ulcer which was probably due to shoe friction, and that ulcers take a long time to heal and it would sort itself out. I kept it covered with bandages daily as instructed and kept on running as I was not given any restrictions. My foot didn't look normal to me though - the side of my foot where my pinkie toe resides had a giant bulge that was constantly leaking, sometimes healing over, but then reopening again. It had grown from a small, weird bump, to a big, gross bump.
March came, and with it, some personal changes which got rid of a horrific work commute. I was excited because this meant I could focus more time on training and finding a life balance and less time in the car driving to a stressful job that I hated. To decompress, we went on vacation to Barcelona for a week before starting my fantastic new job. On the second day there, we ran 4 miles and I was literally limping afterwards and could not get my sneaker off fast enough once returning to our rented apartment near Las Ramblas. Upon inspection, the ulcer had re-opened again (which was not unusual at this point) and with it, came screaming, white hot, hot, poker pain. Our trip continued and in a few more days, I started experiencing fever and chills. I think it was changing my daily bandage that morning and seeing yellow fluid come pouring out was what caused me to put two and two together. We bundled into a cab and drove directly to the ER. On vacation. In Spain. My medical Spanish sucks.
My foot before leaving for the ER:
When we arrived at the ER, I was treated so well by the attending and his residents. Broken English ensued, and it was a little scary and I had to wait around a lot. The residents asked if they could take a photo with their camera phones. I shrugged and let them snap away.
My foot in the ER, crusted over:
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Several hours passed, and I finally left with anti-inflammatories, antibiotics, a topical creme, x-rays, a culture for MRSA and several hours of personalized attention...all for $300. I'm not going to get into how I now feel about US health care. The rest of our trip was good.
Immediately upon returning home, I went directly to the US ER and did not pass go. I was able to follow-up with my podiatrist the next day. He looked at the x-rays and the reports from Spain and listened to my entire story about the Spanish ER. He said that the bones still looked fine to him and that he agreed with their antibiotic regimen, and that he wasn't going to add to it. My instructions were to stay on the 10 day regimen and to keep an eye on things.
April came and went, with the ulcer continuing to open and close, open and close, weeping different colors each time depending on the level of bandage I was using that week. I kept on running and biking and my usual training as best I could. There wasn't much pain though, but now in retrospect it was because I was keeping all shoe pressure off of the area by either wearing sandals or clogs and taking them off while working at my desk, or hanging around the house. Finally, I made another appointment with the podiatrist in May, partly because it didn't seem like much progress was being made as far as healing was concerned, but mostly because it had made a nastier friend - the joint directly under my big toe on the same foot started to throb and this was the point where running really took a nose dive. It simply hurt too much and I wanted to rule out a stress fracture.
Foot ulcer in late May:
I was told by the podiatrist that I had turf toe in my big toe joint and to tape it for stabilization and to get new shoes; it was most likely due to a tendon strain. He took another set of films and said he saw no evidence of fracture. In terms of the ulcer, I got the same response from the podiatrist as previous. Meanwhile, in addition to telling him all about the ulcer and it's lack of healing progress, I also told him HOW I've been managing to continue running on it the entire time ever since Spain - by cutting a hole in my running shoes to offload the pressure. He seemed to think that this was a good idea because it was "Cheaper than going to a shoe cobbler in the Financial District to stretch [my] shoes."
My running shoes:
Through these months of ridiculous mutilating of shoes, I thought I was managing my pain well enough to write off the ulcer (hey, I was running!) and it was just how life would be until it healed. After all, ulcers are very slowly healing wounds and really can take months from all of the reading I had been doing. However, I think my final straw with the podiatrist was when I sent myself to urgent care in early June after thinking my foot was broken when I had to stop at mile 10 of a half marathon because of the "Turf toe" big toe pain. My gut told me to get a second opinion. There was something about "Turf toe" made me skeptical because it felt like more than just a tendon strain. My rationale for seeing the podiatrist was because he is part of the same practice where I have my OB/GYN and primary care doctor. My gut was telling me that I needed to up the ante.
Within that week, I managed to pull some strings to be able to see an Orthopedic doctor who is affiliated with a Fancy Orthopedic Hospital (FOH from here on out) that is crazy hard to get into anytime quickly as a new patient. He took one look at my foot, my various x-rays I had been collecting, the various reports over the past half a year, and ordered a MRI. A week later I returned, excited for a diagnosis to fix the "Turf toe" and I was told that he was referring me to a Foot and Ankle Orthopedic Surgeon who is also affiliated with FOH. Not much else was said.
My foot a week ago (not weight bearing):
Two days ago I had my appointment with the Foot and Ankle Orthopedic Surgeon. One can imagine why I was nervous going into this appointment - I had been blown off so many times that I was worried that I was going to be told that it was nothing again. But it wasn't nothing - I knew I didn't feel fine and at this point, my right foot ruled the roost. My big toe was in excruciating pain and I knew it wasn't a bunion because the bones were fine. I couldn't wear any of my favorite shoes, my running was so, so negatively affected, I couldn't even ride my bikes because neither pairs of my bike shoes fit, even after being stretched. Pushing off while walking on the big toe was becoming excruciating. The podiatrist had to be wrong!
I was greeted by a very young doctor with gentle green eyes and a nice smile, who introduced himself (I will call him Dr. J). He listened intently to me blathering on about how important running is to me and to my lifestyle. He listened to how frustrated I was with "Turf toe" and how I wanted to get a second opinion. He listened to how I had to bag races and cut mileage and tape up my big toe constantly. Then came the diagnosis. Dr. J calmly told me that it was not "Turf toe" and that I have a sesamoid stress fracture and I'll need to wear an orthopedic boot for 3-4 months. This meant no running or weight bearing activities, but I started to breathe a sigh of relief. I finally had an answer! Now I could get started with healing so I could start running like a wild animal again!
However, I quickly realized that Dr. J wasn't done yet. He then wanted to talk about the ulcer. The ulcer!? I was told by the podiatrist that it was just slow to heal! He asked a ton of questions and gave me a thorough foot exam and took a swab of the fluid coming out of the ulcer with a q-tip for a culture. Then he pulled up my scans. I think it was the immediate change in his voice that made me realize that this was just the tip of the iceberg. Either that, or "I'm very concerned".
He explained to me that my MRI scans revealed a very deep infection in the tissues underneath the ulcer, but what was concerning was that the infection appeared to go straight through to the bone and down my fifth metatarsal with a fistula that may be connecting to the adjacent joint. The next words to follow were "Emergency surgery" and "As soon as we can fit you in". That was the point where my rational, planning brain took over and somehow managed to plan all of the logistics, but right now I couldn't tell you how I did it because I don't remember much because my head was spinning. Due to FOH's busy schedule and Dr. J only operating on Fridays, my surgery date was set for the last Friday in June. But, we STILL were not finished yet. He wanted me to follow up with my primary care doctor and an infectious disease specialist the next day. We left it at that, but I left with an orthopedic boot.
Das boot!
On Tuesday I woke up with a knot in my stomach. I had my two appointments and was filled with all sorts of questions and feelings that still remained unlabeled. My first appointment was with my primary care doctor, who actually was on vacation, so I saw her partner instead who told me that she was surprised by this diagnosis because it's unusual in the general population; typically people who have these types of infections are either elderly diabetics or competitive athletes. I explained my running and pursuits to her and she said that it makes sense then. She gave me a physical exam, took medical history and cleared me for surgery. Then, quickly into the car and off to FOH to see the infectious disease specialist.
I was greeted by a short, older man with smooth skin and snow white hair who stared at me over the top of his glasses, just long enough to make me second guess myself, even when stating obvious facts like my birth date. He was very direct and no-nonsense. His name is Dr. M. He asked me about my lifestyle, family history, personal history and explained that Dr. J had called him the day before to tell him all about me. He asked me even more questions than Dr. J had asked the day before. Then he started explaining what the next steps were and stopped abruptly. He stood and walked out into the waiting room, and brought my partner in to hear all of the news as well, while barely missing a beat or giving me time to say anything at all. Gulp.
Apparently, the culture of fluid that Dr. J took with a q-tip that was coming out of the ulcer the day prior had revealed that the fluid contained staphylococcus gram-negative. This in addition to a deep bone infection that appeared on the MRI lead Dr. M to believe that the bacteria that is within my bones is necrotic and essentially eating through the bone.
And -then- the bomb dropped.
Immediately after surgery I would have to stay in the hospital for five days. The day after surgery while still in the hospital, they would be installing a picc line in my upper arm, which will need to be cleaned and re-dressed daily. The picc line would be direct access into the deep veins in my upper arm; its tubing threaded up my artery and over to my heart for twice daily IV antibiotics which I would have to administer at home with the help of my partner. I would need to do this for the next six weeks at least. Depending on what Dr. J finds during the surgery, it may warrant longer, or even more aggressive treatment which might require me to constantly carry a pack to hold the tubes and an IV machine so I can do normal things like go to work and not be plugged into a wall. I am not allowed to sweat or be in the sun. They will be sending a home nurse to help us in the first few days at home, and I will need to come back every two weeks for a follow-up visit with Dr. M to review progress. We would reevaluate then. I was given no other choices because there aren't any other choices.
...
Dr. M peered at me over the top of his glasses, he shifted in his chair and his voice softened. "Are you going to cry?" he asked.
"NO!" I said. But I blinked and took a shaky breath anyway. I took a few more breaths and then repeated Dr. J's words from the day prior "It's just one step backward to make a few steps forward." I was surprised to hear them out loud.
...
We then asked all sorts of questions - what about our pets? What about worrying about bacteria and further infection at home? What happens after the picc line is out? When I can get in a pool again? What about air travel? What kind of restrictions do I have? After answering everything, Dr. M then gave me a deep nostril swab for MRSA (ouch) which was sent off to the laboratory, and then I was sent off to the laboratory for blood work. Finally, we went home.
On the way home was where I first felt angry. WHY hadn't the podiatrist taken a simple swab of the ulcer? Why did he keep telling me it wasn't a huge deal? What could have happened if I didn't get a second opinion?! And...FIVE DAYS!? When women give birth they are out of the hospital afterwards in 24 hours!
That evening was a bizarre swirl of phone calls. I spoke with the hospital who gave me information on what I needed to be doing over the next several days to prepare. I talked to my Mom for awhile. I talked to my neighbor who I consider family who offered to take the pets and to help at home. I talked to my boss who was supportive and understanding and amazing. Of course I talked to my partner and I talked to my dog and my cat. I fell asleep in the crook of his chest, my salty tears being mopped up by soft hairs, arms wrapped around me, until I fell asleep.
...
Things are still unfolding and will continue to do so. Perhaps this unexpected journey is the next turn that I'm going to take and who knows where things will go. I've been wanting to start writing on here again, so I'm going to do just that. What you may find however may not be the poetic heartbeats I felt on the harbor or the wonderment of my sneaker treads and where they are going to lead. What you will find is this unknown story and wherever it decides to turn. I don't even know myself what is going to happen, but it makes sense to write about it. Making sense of anything right now feels good.
Hopefully it has a happy ending, or at least ends with me running off into the sunset, eyes wild with love and excitement and joy, happy and healthy and on to the next challenge.
Buckle in.
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