Today was visit #3 to the orthopedic hand specialist’s office.
About 2 weeks ago, I opened a jar of spaghetti sauce while Jim was at work — and even though the jar was not stuck or a terrifically difficult twist-off, it was the first jar I’ve opened since sometime last August. The result was immediate pain — you know that pain chart? Well, this hand has hurt up into the 8-9 range — and for the last 2 weeks, it’s been hovering between 4 and 6. I always leave 10 open, because I am certain severe burns, accidental mutilation and such must hurt far worse than a nerve being crushed between 2 bones.
(in the pic above, it’s the carpometacarpal joint.)
So I went in today fully expecting that they would recommend another injection of cortisone to cool off the inflammation. But when I described my bad reaction to the first round of cortisone (Oct) — the resident said he wouldn’t recommend it. And once again, he outlined for me the 3 possible treatments for this problem:
- long-term/continuous splint/cast
- cortisone injections
These residents are on a 4 month rotation, so this is the 3rd one I’ve seen — and each one has described a different surgical procedure, and each one has quoted different success rates. The middle guy said surgery hardly works at all, and really wanted me to do the injection again. The first guy wanted to skip splints and injections all together, and was pretty unhappy that I didn’t just jump straight into surgery. Today, the resident described exactly the surgery I’d read about in online descriptions from the Mayo Clinic website, but wanted to keep it as a last resort, and suggested I give the splint a chance to relieve this latest round of swelling and pain.
So I let him know about the discrepancies between his recommendations and the other 2 guys. It probably didn’t help that I referred to him and his 2 predecessors as “Resident Elves” — but he asked if I wanted to talk to the “real” overseer doctor. The one whose name is on the appointments and the referral.
Evidently, according to Dr. Real, there are several dozen possible ways to do surgery on this joint. So all 3 residents were just describing the procedures they had seen. One or two methods are the most common. The bottom line is that they remove the trapezium bone, and either leave the space blank to fill with blood or scar tissue, fill the space with fat or some other tissue from somewhere else in the body, or fill the space with some artificial material.
But contrary to the 2nd resident and most of the internet, Dr. Real says there is only about a 5% fail rate. He says almost all surgeries in this joint are successful because the joint is so fluid and flexible. This is the opposable joint. This is the joint that separates us from the rest of animal life on earth. (those are my words — not the doctor’s.)
And removing the bone that makes up part of that opposable equation makes me a little nervous.
And neither Dr. Real nor Resident Elf #3 like that I’d given up knitting and so much cooking, driving, daily tasks etc. because I can’t grip the spoon to stir a pot or pick up a Kleenex. Right now, I can’t even shake the salt shaker or hold a pen to write. But both also said the surgery should be the move of last resort.
So I’m home again, in splints, typing one key at a time. There’s nothing to take — pain killers don’t work on this. Anti-inflamatants may help a little — but not much. I’m alternating between ice packs to reduce swelling, and heating pads to relax the muscles — at least that seems like we’re doing something — though a cup of tea seems to make just as much difference.
Dr. Real also seemed to think this kind of mechanical failure in this particular joint is usually hereditary, and usually passed through women — even though it was only ever my dad who had joint problems of this kind — and most of his were injury-related and caused by abuse of the joints. Real said it was probably not over-use or abuse that caused this damage for me– it was probably inevitable.
Ultimately, it doesn’t make much difference how my hand/s got to this point. Now that I’m here, I’m going to have to figure out how to live with it, or if I can’t — how to think about the surgery options.