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Thursday, January 16, 2014

After the Boot

I fractured my fifth metatarsal of my right foot about 6 1/2 weeks ago.  I wore an orthopedic boot for nearly six weeks, and now I am back in two shoes.

I thought a lot about what I would do for six weeks in the boot.  And I feel like I was successful -- I stayed active within my limits, remained fit, and did not gain weight.  In fact, I dropped a couple of pounds.

For some reason, I thought the boot would come off, my fracture would be magically healed, and after a couple days of walking, I would be back to running.  Such is not the case. 
My foot in all its x-rayed glory.  And proof that a car window can indeed serve as an x-ray light box.

Unfortunately, the fracture hasn't fully healed.  It's definitely better, but the two pieces of my fifth metatarsal bone have not completely fused.  My orthopedist has told me that there is no running permitted for the next four weeks, at which point we will perform another x-ray to evaluate.  In response to my shock, he responded that running prematurely could lead to nonunion of the fracture, which would then require surgery.

I hadn't truly thought out the consequences of my foot being immobilized in a boot for six weeks either.  My calf muscle and the muscles at the ball of my foot are all tight from not being used, and in fact there's probably some muscle atrophy as well.  I have been walking this week with quite an interesting limp.

This is what happens when one leg is immobilized in an orthopedic boot for six weeks.  The muscle atrophy on the right is pretty apparent.

With all my difficulty walking, it is ironic that the only place where I have felt like a normal person is on a spin bike or in a pool, because the mechanics of stationary cycling and swimming are not much affected by the condition of my foot.

I had a physical therapy session yesterday, where a few things were pointed out to me.  My hip strength is off, and in fact my right hip is weaker than the left.  And, since the muscles at the bottom of my foot are tight and atrophied, I am taking a much smaller step with the left foot than with the right.

I have some exercises from physical therapy, and with a bit of stretching and attention to my gait, particularly making sure to take a larger step forward with my left foot, I am feeling a bit better today.  In fact, on my lunch break, I went for a thirty minute walk.  In my athletic life prior to this fracture, I would roll my eyes at even considering that to be a workout.  The toes of my right foot ached with each step, but I know I need to build and stretch those muscles so I kept going.

This weekend, I look forward to my first outdoor bike ride since my fracture.  And I look forward to developing stronger hip flexors, and walking like a normal person.
 
I thought I would be recovered by now, but I'm not quite there.  In due time, I will be.

Monday, January 13, 2014

Motivation for Change

I talk about lifestyle change with my patients daily.

One of those conversations occurred last weekend.  A previously healthy woman had a major health scare -- chest pain, followed by a cardiac arrest.  She was resuscitated and I performed an emergency angioplasty on her in the middle of the night to open a completely occluded left anterior descending coronary artery. 

Luckily, she recovered quite well in the hospital, and I had a conversation with her and her husband about diet and lifestyle.  She was hesitant about changing her diet, saying that she felt that this would be very hard for her.

Her husband said, "Honey, you almost died.  You have to do this.  Or you will have another heart attack."

Fear is a big motivator.  But it doesn't do well to lead to permanent changes.  Fear eases as the acute event becomes more distant.  Positive reinforcement is a better motivator to make change.

I love how Dean Ornish says it: "...re-framing the reason for changing from fear of dying to joy of living."

Because, living a healthy lifestyle makes you FEEL good.  Eating clean and exercising gives you more energy, more vitality, better mood.

Lifestyle change is hard.  But, in the long run, when you live cleaner, you live happier.  And that's how I want to frame the conversation with my patients -- good habits aren't punishment, they are changes that will lead to a happier, healthier, and longer life.