Diagnosing (Ashleigh) in Dominica

The last few weeks I've finished each of my posts worried that I wouldn't have anything "new" to write about for the next weekly installment of my blog. I mean how many times can I write about "embracing the environment I'm in," taking advantage of everything this opportunity has to offer, how my classes are going, what my friends are like, and the things I miss about home? Granted, all of those things are extremely important aspects of why I wanted to start this blog, but they can only be discussed so many times before they become repetitive. Up until this week, I'd reach my weekly "day to write," and somehow something just came to mind for me to write about. Whether it was a thought or revelation that I had, or a unique experience that had occurred, I had something. Yesterday arrived; however, and I honestly had nothing. Not that nothing had happened, but the majority of my time since last Thursday had been spent on campus in a space called the Large Learning Lab (LLL) with a few other classmates reviewing lectures, discussing questions we had come across, and really just focusing on our studies to ensure we continue to progress through the semester as well as we would like. I took a few breaks to watch a couple episodes of Grey's Anatomy and NY Med, exercise, and walk along the ocean, but for the most part it was a fairly uneventful span of days. Definitely nothing to write home about. I knew I wouldn't necessarily stick to a strict "every Monday" writing rule, but I was afraid that my not writing yesterday would turn into not writing for another week, which would turn into two weeks, three weeks, etc. I'm sure you catch my drift. Well, I think somebody, somewhere sensed this onset of fear, and decided to give me something to write about. Whether you want to look at it as fortunate or unfortunate is completely up to you, but I'm choosing to view it as both (as well as a bit ironic).

Last night I was in my "usual spot" in the LLL with one of my friends going over the Anatomy of the Anterior Abdomen lecture we had been given earlier in the day. We had just gotten back from a brief trip next door to the Pic 'n Go coffee shop, where they now know me by name, and greet me with "Hello, my dear," every time I enter, for our last jolt of java before they closed. As I moved my chair out to sit down and get back to work, I noticed that my right foot and ankle were significantly larger than my left due to what appeared to be inflammation. Now, at this point, let me just say, being "doctors in training," studying lecture material for the rest of the night was not going to happen. We had entered full-blown investigation mode.

Between the two of us, we began palpating different aspects of my foot to determine what the problem was. Ruling out possible infection due to a lack of heat radiating from either my foot or ankle, we moved on to investigating possible sprains, fractures, and other soft tissue or skeletal related problems. She went through the standard patient interview protocol that we learned a few weeks ago, and I recalled that throughout the 6-7 weeks we've been in class, my foot has been a little sore on both the bottom and top surfaces, but nothing that had caused significant discomfort or excess fluid build-up. I assumed it was a result of poor footwear, a weak plantar aponeuorosis (a fibrous tissue overlaying the bottom of my foot), and weak arches. I've always had minor problems with sore feet when I don't wear the right shoes. I didn't think anything else of it this time. As I continued to think back throughout the last 8 weeks of being "on island;" however, I remembered that the weekend before classes started I stepped in a muddy patch along the road leading to my apartment and fell. Since my foot was literally stuck in the mud, I ended up twisting slightly as I fell. Now we were on to something! She and I both continued searching for possible causes of "localized pain and tenderness along the dorsal (top) surface of my foot and oriented more laterally." Consulting WebMD as a "symptom checker," we ruled out several things, and finally reached something that aligned pretty well with my presentation. Lisfranc Fracture Dislocation. (The Lisfranc joint is another name for the junction between your tarsal and metatarsal bones, or the border between your midfoot and forefoot.) We were sure of it! Well, actually, knowing that we don't really know anything, we accepted the high probability that we were completely wrong. That being said, I continued to research it, and prepared myself to be in a non-weight bearing cast for 6 weeks followed by a supportive boot for an additional 6 weeks. I went to bed last night with my foot elevated and an ice pack wrapped around my foot/ ankle.

As soon as I could this morning, I went to the clinic on campus (although I still just wanted to "wait until I got home" to see my regular physician), and consulted the Dominican physician on staff. Based on my presentation and history, he wasn't exactly sure what it might be, and wanted to get further confirmation from x-ray. He placed a phone call to the Portsmouth Hospital to see if their x-ray machine was "up and running" today, filled out an order for the x-ray, I hopped into one of the Campus Security trucks, and arrived at the hospital about 10 minutes later. Knowing I would not be walking into the kind of hospital I am used to, I wasn't exactly sure what to expect. Honestly, I would equate it to a large clinic in the United States. One floor, each respective department pretty much running itself, and 30-40 patients sitting on benches just waiting. Signs encouraging early detection of HIV and diabetes lined the wall, and posters urging children and families to begin healthy teeth-brushing habits early were impossible to miss. We found the Radiology department (luckily I had the security guard with me) and knocked on the office door for the technician. He took the imaging order from my doctor and led me into the radiology room. 2 different views of my foot were taken. Ten minutes later both films were developed, I was assured "it's okay," and was on my way back to campus to follow up with the physician. He deemed it a soft-tissue injury, gave me medication for the fluid build-up and pain (basically a stronger version of Tylenol), encouraged me to wear sandals or "non-limiting" shoes so as not to place additional pressure on my foot with the fluid accumulation, and sent me on my way. Extremely different than the United States in terms of the details of my medical encounter; however, at the end of the day, incredibly similar.

Am I happy my foot isn't broken? Absolutely. On the other hand, I still really have no idea what's wrong, and the not knowing is driving me crazy. Guess I'll have to wait it out for eight more weeks, and follow-up with my MD at home. Who knows, maybe I'll never find out what the actual problem is/ was.

At the end of the day, our diagnosis was wrong, but it was a "real-life" opportunity for us to apply what we're learning in class, and we loved it.

Moral of the story: NEVER doubt that there will be something to write about.

Now, for your viewing pleasure, the bones of my right foot.