I haven't even logged into my blog since the day I posted my video almost a full month ago, and now that I'm here I'm struggling with what to say and how to say it.

It's been a long month, period. The entire process has been much more difficult than the first time around and the numbers can crush my spirits when I think about them...by the time I hopefully get off of these things again I'll have spent six of the past nine months on crutches, and that's the best case scenario. That fucking sucks. No matter how I attempt to spin it, it's just upsetting for me to think about. Given that I was on these things for three and a half months the first go around, and I am already four weeks in this time, I should ideally have less than six weeks to go, but as before it's one x-ray at a time right now, and again that's the best case scenario. I am currently refusing to process the worst case scenario.
(I'll specifically reference these xrays below)

Did I have surgery?

Why the hell not? Am I stupid?

I automatically assumed that once my foot faltered for a second time that surgery would be the best course of action. I think the majority of people believe the same thing. We're programmed to. As a general rule we are taught through many mediums to place surgery ahead of natural healing. To place modern medicine ahead of naturopathic/eastern medicine. We look to pills to solve everything in today's age and 'putting a pin in it' is not the instant solution everyone believes it to be.

I sat down with my surgeon for over an hour on Thursday May 19th, having already booked in for surgery the following morning. He had me slotted for a fifteen minute consultation, assuming I was simply signing the paperwork and going about my day. I had questions. Lots and lots of questions. I was not afraid to have the surgery, it's a fairly straight forward procedure, I just needed to know if the potential benefits of the surgery made sense. I wasn't about to have a screw put into my foot without knowing the facts, and here's where an additional frustration lies...

Everyone seems to think they know what's best for you without even having the slightest insight into the nature of the problem. A Jones Fracture is not 'just' a broken foot. It's one of the most complex single fracture lines you can sustain within your foot, and as such no matter what course of action is chosen recovery is quite difficult. If one more person tells me to take a calcium supplement I'm going to impale them with a crutch, upload their picture to every social networking site on the planet, tag them with their own name and many additional four letter descriptors, and threaten to eat their children a la Mikey Mike, Hall Of Fame, Tyson (I've had a bone scan and it's come back as 100% good)

I spoke to the surgeon for a solid hour and not a single answer provided to me was conclusive. Most were 'ifs' and 'maybes' and 'most likelys' but the words that were never uttered no matter how the questions were phrased were:

Surgery 'can be the better option for some people in some cases', but conversely that also means that 'non surgical healing can be the better option for some people in some cases'.

My thoughts when I broke my foot again in Hawaii was that I would obviously miss Western States on June 25th, but with surgery, six weeks sidelined, and a few months back on my feet I might just be able to make the starting line of UTMB in France on August 26th (yes in hindsight I now know how ridiculous this was). The estimated time line presented to me for recovery from surgery was 10-12 weeks. THREE MONTHS! That's what I just went through without surgery...why am I not hearing any benefits here??

Will the foot be conclusively stronger?
No guarantees

Is the recovery time significantly shorter?

Is it any less likely to refracture again?
No guarantees

I drove home (don't ask) and was completely uneasy about the whole thing. Surgery was now twelve hours away and nothing felt right about it. I did a bit more research and when I found a few specific studies around elite soccer players suffering from Jones Fractures my mind was effectively made up for me:

The return to play following a Jones fracture continues to be an enigma for the competitive soccer player. Caution and patience must be applied since re-injury to this area is common. Potential types of re-injury include a fracture with deformation of the screw, incomplete bone healing or non-union and compensatory injuries to the foot from the altered biomechanics. There are inherent risks with competitive sport and the athlete should understand that the Jones Fracture, even when repaired can create significant disability...

one must remember that this fracture site has a characteristically poor blood flow. Consequently, its healing rate may be slower than other types of fractures and the new bone may not reach peak strength until much later post-operatively...

Also, the traditional guideline of letting pain direct activity progression is not infallible because the athlete may be pain free or there may be only very minimal pain prior to re-injury. There are also many adjacent joints and bones that may generate a pain response due to disrupted mechanics or contact from the screw head

And Another Report
          - out of 15 people who had surgery there were six treatment failures: four refractures and two symptomatic non-unions
          - there was a higher proportion of elite athletes (division I or professional level) among the failure group (83%) compared with those without complications (11%)
 - return to full activity, especially among elite athletes, before complete radiographic union was predictive of failure

And this was WITH SURGERY!!!

I called off the surgery immediately. My summer was over anyways. My racing season was a wash. There was no rush. I needed a few days to come to terms with it all.

Hadn't I been counselled with 'pain as my limiting factor'? Wasn't I told that I should be good to go? Could all of this have been prevented? Would I have even listened at the time and really slowed down anyways?

There was a lot weighing on my mind, and none of it was made any easier by feeling like I was repeating my story to people every five minutes. I know the questions were coming from a place of genuine concern and caring, but I just did not want to talk about it. How could I when I was still so uncertain on so many aspects of it myself?

By the end of that first weekend I was confident I'd made the right decision. Knowing what I'd gone through the first time round had given me slight insights into what might and might not work. Back in late December early January I had an immediate healing response once I introduced regular acupuncture and ultrasound. As mentioned in a report above, lack of blood flow to the area is the number one complication in the healing process. I immediately referenced my friend Kim Graham at Thrive Total Fitness and began getting acupuncture 2-3 times a week. I unfortunately had no luck in attempting to land an at home ultrasound device this time around.

I had viewed enough x-rays of my own foot by now that I was certain what I'd seen in Hawaii was not quite as severe as what I'd seen way back in September, and then on my follow up xray in December. On top of all this, my foot itself looked completely different. The first time around the swelling continued right into my HURT trip, ten weeks out. This time however there was very little swelling initially and virtually none within the completion of the first few weeks. I requested a follow up x-ray here in BC on May 31st.

The x-ray on the left was taken two weeks post fracture in Hawaii. The x-ray on the right, SIX weeks post fracture in Oregon (travel insurance is your friend)

You don't have to be a Doctor to clearly see that although I definitively re-fractured the exact same line of my foot, it is not as severe as the initial break was. There is still some integrity to the initial healing process.

A few things can be taken from this, as reiterated by my own Doctor/Surgeon (and I should clarify that he's been great throughout this entire process). Given that the x-ray on the right was taken six full weeks after my initial injury and had yet to even begin to adhere to itself at all, there was serious question as to if I would in fact be able to naturally heal the bone. It's actually quite common for people to not gain union of this fracture through natural avenues and THEN surgery becomes the only real option. Some people still do not gain union of this bone even after surgery. It's a shitty situation no matter how you slice it. 

So What Does It All Mean?

-Because I have recovered from a more severe version of this already there is no reason to believe that I won't be able to do so again. I WAS on the right path to a full recovery if I'd only been counselled slightly differently from the start
-PAIN is NOT the limiting factor in a full recovery from a Jones Fracture, TIME is
-Once I do get back onto my feet running will be seriously limited for an extended period of time. Vive le bicyclette, but Lance is going down
-The world is a nicer place when you're on crutches, people actually care, but I'd still toss em tomorrow if I could
-If The Canucks lose in game seven at home I'll join the looting just for the hell of it. Put in your pre-orders now but keep in mind it will need to fit into an average size backpack
-I think they should cancel Western States this year because of all the snow and roll over all 2011 entrants into 2012
-UTMB should be postponed until at least December so as to avoid a possible mudslide like last year, PLUS covering the course in the winter would be way cooler...and I only mean that literally
-WHAT the hell is Jersey Shore and WHY the fuck are they on TV? Seriously? I just got cable for the first time in over two years
-There are no shortcuts in life and Lebron James epitomizes what's wrong with our way of thinking in North American society. No professional athlete wants to take the time to build a franchise into a winner anymore, everybody wants weight loss and happiness in a magic pill or potion, and the majority think that surgery is an easy fix. It is not.

It's one day at a time right now, one foot in front of the...err...one foot in front of, uhh, itself I guess? Over and over and over again...

PS Here's the song you should definitely have in your head on your next run. You're welcome