A Flick of the Wrist
Back when I was a young teen, I rode my bike A LOT. I also played the piano A LOT. Both activities put my wrists in an awkward position. Once, after a 25 mile bike ride (yes, I rode that much), I began to have pain in one of the wrists.
Years before Carpal Tunnel and Repetitive Stress Injuries were common phrases, I was in a world of hurt. Dad took me to our (nearly useless) family doctor, who sent us to the ER. Some Xrays were taken, and no fractures could be found. I was sent home with a script for anti inflammatories.
Six weeks later, the hospital sent an appointment card to come to a follow up clinic. Apparently, this is what they did with cases where they didn't arrive at a definitive diagnosis. I did something that shows a lot about me at 14 years old: I took the bus up to the hospital and went to that appointment by myself.
The doctor that saw me had tons of questions. What activities do you do? Where is the pain focused? Do you notice improvement when there's heat/cold? He was confused by the symptoms but concluded that immobilizing the wrist in a split was the best course of action. The high tech split was made by warming a piece of white plastic in hot water, molding it to my wrist and then cutting out a area for my thumb to move. It was then wrapped to my wrist with an ace bandage. I walked out with a script for some anti inflammatories and a suggestion to visit an orthopedist and possibly a rheumatologist.
I wish I could say that that was then end of the story, but it wasn't. I spent six years seeing eight doctors, six of whom could not find anything on xrays and declared there wasn't anything wrong. (One went so far as to call me a hypochondriac) The rheumatologist discovered arthritis (in my knees) and was a help in treating that. It was a stroke of luck that found doctor number eight. Giggles had sustained an injury and was referred to an orthopedist with a great bedside rapport.
My dad commented to the doctor that his other daughter (me) had been having trouble with wrist pain for years and no one had been able to treat it. Dr. K encouraged my dad to bring me in. The usual happened: I was xrayed, the current splint was inspected and I was questioned extensively. The thing that had confused each and every doctor is that the pain was in my non dominant hand. (I know now that I am truly ambidextrous for all but a couple of things, though)
Then I heard the magic words: "Just because I can't find it on an xray, doesn't mean there isn't something wrong." Dr. K got it. For the next six months, we followed some treatments I'd been through, then some I hadn't. A cast. Different anti-inflammatories. Cortisone shots (OWWW). One last try at a cast. That one was emblazoned with "It's Tendonitis" in black permanent marker in grafitti letters because I was so tired of six years of "what did you DO?!" Dr. K had a good laugh when he took THAT cast off.
Finally, he formed a conclusion after I'd had a contrast dye x ray. It was deQuervain's disease and the tendon sheath was the cause of all the trouble. He described in great detail what would happen. It was outpatient surgery, I'd get a Bier Block (a form of local) and the recovery would be pretty swift.
Other than trips to the ER, this was my first encounter with a hospital. Pre Op testing was easy. Surgery day came, and Dr. K worked his magic. I remember dozing in and out of consciousness in recovery. This first trip taught me that it SUCKS to be so fair skinned-they think you're too pale and keep you far too long.
That was 1987. I was almost 21 and once I dealt with the usual post surgery thing, I was golden. I learned how people with nearly normal wrists live, for the most part. In 1990, I got that first 'on paper' management job and as a condition of employment, they wanted a medical release from an orthopedist that I could lift sixty pounds.
I'd moved to Maryland a couple of years earlier, so I scoped out my medical provider directory and found an orthopedic practice within walking distance of my townhouse. It was serendipity-the doctor I saw was a wrist and hand specialist. He was very abrupt, but he looked at my x rays and said that Dr. K did a nice job. I'm glad I saw him, because it's a very pretty picture of my wrist.
About 9 months later, on April 16, 1991, I shattered the wrist at work. Cautionary tale is that you should never jump on boxes to flatten them for the recycling dumpster if your boss leaves with all the box cutters. I broke the radius and ulna and had scrambled all the small bones of the wrist. Oh, and I did it at 9pm but finished managing the restaurant that night. One of my employees drove me in my car over to to ER because I couldn't manage the stick shift.
The ER visit was quite interesting. Try pulling down your pants to pee with one hand! The X Ray tech came out with films in hand shaking his head vigorously. No one on the medical staff would even consider doing more than putting a splint and an ace on it with orders to call my orthopedist as soon as the office opened. Thankfully, I'd called Ken and he drove over from Hagerstown and drove my car home while one of his roommates drove his. I got home at 6am.
(My ex husband heard a mumbled "It's broken, I'm calling Dr. M in a couple of hours" in my Demerol haze) when he woke up at 7.
At 8:30, I was on the phone. The office didn't want to set up an appointment until Monday morning, since Dr. M was out of town. I explained that the ER sent me home with a splint for what must have been a bad fracture. They relented and set me up with Dr. C at 9:45. Not enough time to go back to sleep.
Dr. C took more films and decided to manipulate the wrist with some Novacaine. I got another X ray, and a clamshell cast. I plead sleep deprivation in that the alarm bells did not go off when he looked at them and said "I think that will be okay." Dr. C sent me over to Washington County hospital for a Tomagram. Somewhere in there, I contacted my usual car rental place to rent an automatic, as I would not be driving stick for a little while. He met me at the hospital and I dropped him back at the car rental place an then DROVE TO WORK. I know, I am stupid!
I did not miss a day of work with that wrist. After the swelling went down, I got a lovely long arm cast that I wore until May 27th. I remember the removal day because it was my anniversary. Soon after came the physical therapy, and it was torture. The therapist I normally saw was trying to get my wrist to a nice 90 degree angle and showed me how my left wrist did it, see? Well, what I didn't know at the time is that my left wrist had the same 10 degree downward turn that all of us have. My right wrist, the mangled one? It was set 22 degrees UP-a difference of 32 degrees!
Months of PT caused a lot of pain and tears. I would leave those sessions, walk home and go to bed crying at the pain. Finally, Steve (the therapist) decided I had endured enough of his torture and decreed that it was as good as it was gonna get.
Thanks to the trauma the right wrist was undergoing, my left hand had to do double work. Soon, I was experiencing some very familiar pain in it. At least this time, I didn't have to wait six years and see eight doctors to get a diagnosis. I made an appointment with Dr. C, since he'd been the one treating me already. He followed the same protocol that Dr. K in NY had: splint, anti inflammatories, cortisone shots and skipped the cast with good reason. Once he realized that I was in that tiny percentage of deQuervain's sufferers that gets surgery on both wrists, I was passed back to Dr. M.
Some facts about deQuervains for you. It is usually considered a 'new mommy' disease, that picking up and caring for a baby puts stress on the tendon sheath in such a way that many moms develop symptoms. The majority of patients get better with splinting or anti inflammatories. Surgery is the last resort and only occurs in 2% of cases (my first 2% that I know of), but then only 1% of those who have surgery go on to have the surgery on the other hand.
I was back in the care of the wrist specialist and he did a tendon release in late April, 1992. As he knew I was a lefty and remembered a frantic phone call from me when I was at work with the cast on, he wrapped a ball of gauze the size of a grapefruit, put it in my hand and then wrapped me post surgery. He wanted to make sure I didn't do anything to damage his handiwork. (At this point, I think he thought I was a problem patient.)
In one of the post op visits, I made an off hand comment about the right wrist being perfect and then I screwed it up. He stopped, looked at me and asked several questions, then put my films on the light box. The calm, cool and collected Dr. M then showed a hint of his temper. He whipped around at the chart, saying "Who the hell set this mess?" He saw Dr. C's notes and made some sort of comment that I don't remember. (This was a turning point in his bedside manner). He realized that I wasn't a whiner-the wrist was really screwed up bad.
He spent about a half hour going over what had to happen. He had to reconstruct the wrist, take a graft from my hip and put some pins in it to anchor the grafts. I would be in a long arm cast for 8 to 12 weeks and go through another round of physical therapy. As I'd spent the previous April and May in a cast in the humid Maryland weather, I asked if the surgery could wait until fall. Once I gave my rationale, he agreed and promptly wrote a script for some anti inflammatories that were the most effective of any I'd ever taken.
November rolled around and I had the surgery the day before Thanksgiving. Dr. M came in and talked to me and the ex like we were shooting the breeze around the kitchen table. It'd be a four to six hour surgery if all went well. He apologized that I had to go under a general for this one (a first for me) and warned that I may have to spend a night in the hospital. I sent the ex off to work-I just couldn't see the point in sitting around the hospital all day.
Dr. M came to me in post op and talked to me for what seemed to be a long time. I could see his lips moving and instead focused on the ceiling tiles behind his head. I remember going tacacardic and puking sometime after he left. The next time I woke up, I was in a hospital room, Ken at my side. I vividly remember that conversation, his dad had died that morning. A nurse came in, gave me some ginger ale and told me I could use the phone if I wanted.
I called the ex to say I was in my room and that I'd probably be staying overnight. He then laughed and told he had spoken to Dr. M an hour earlier and that I was going home. Apparently, I did better than expected and he thought home was better. The ex was wrapping up the work stuff since I wouldn't be okayed to go for another couple of hours. (Darn fair skin again!)
This time, I was off from work for the recovery. I should have been the first time, but I felt that darn obligation to work! I had to jump through some hoops to get Worker's Comp from the old employer to pay for everything, but they did. So, I spent 8 weeks on top of a mountain in my newly purchased farmhouse. We were so far out of town that the only channels we got were the holy roller, Maryland Public Television and an NBC affiliate. Can you say 'stir crazy'? Dr. M's plan was to keep me out of work for 16 weeks. I wore him down at 8 when he saw the paint flecks on the cast.
The day came that the long cast came off, and four weeks after that, the short arm was removed and the pins taken out. Therapy went far better this time, though Dr. M told me that the wrist would never be normal. It wasn't "if you get arthritis", but "when you get arthritis." I appreciated his honesty.
A few years later, I started having more pain in the wrist, caused by some bone spurs on the site where the two pins had been. I had to get the case reopened, only once it was, I was pregnant with Gameboy. No elective surgery for me. I spent half the year (every year) in pain, splints and on medication.
Finally, the day came and I got the bone spur surgery. However, in the interim I developed a common problem-Carpal Tunnel Syndrome. Surgery would be on both sides of the wrist. Dr. M greeted me like an old friend when I came in for appointments. The first time I'd seen him as a single woman, he did a double take, now I had a different husband with me!
Remembering my difficulties with the general anesthesia, he offered me the option of having the surgery done under local or twilight, which I jumped on. We discussed how long I'd be out of work. He replied "The average patient? Six weeks. You? Three." We laughed. Once again, he worked some magic and three weeks later, I was back at work and in physical therapy. This time, I got an angel and it was so much easier to get the wrist functioning.
Five years later, you have to really examine my wrists to find the scars. The only noticeable one is the first scar from Dr. K's traditional stitches. Dr. M is fond of a 'wire' closure that he sews underneath the skin. So, when the coworker walked in with a splint a few weeks ago and we started talking, she had no idea that my wrists had been through war.
The benefit of all of the war is that I could share what the protocols were. She went to a doctor who gave her three cortisone shots and wanted to schedule surgery. The digital age means she didn't have a doctor telling her she was a hypochondriac and she was informed about other options. Now she had someone who'd had deQuervain's and could share what happens, though I was quick to point out that I am in that tiny percentage that had to have the surgery.
Today, I talked to her some more. She got a second opinion and this doctor wants to follow the conservative protocol that Dr. K had put me through twenty years ago. Apparently, there isn't some step that has been added or makes all the steps unnecessary since then. She laughed at my offhand "I'm a freak of nature" comment and you know what? I can now say that there are only a handful of days in a year where the wrists give me trouble. They went through all that trauma and adapted.
I hope someday I can be in the same place with my leg.