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Finger/Thumb Right Thumb joint's LRTI coming up October 8!

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Grammyof2

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I'm terribly late to reply to your post--sorry! I don't know how old you are, but a new joint lasting 15-20 years would put me into my late 80s or early 90s. Good enough!

My 2nd surgery (dominant hand this time) went very well, and I expect to get the cast off in 8 or 9 days. Apparently some slightly different method's arisen between my 1st (late May) and the 2nd (early October)--my 1st thumb is lightly numb from scar to fingernail, but my surgeon recently told me that my 2nd thumb might not be numb at all!

Best wishes to you as you contemplate a surgical repair.

Been watching your recovery G-of-2 as it appears that I will have to have this procedure done too.
In fact both thumbs are bad.

This past April started to have stabbing pain in the right CMC joint and was told it was Arthritis.
Gradually gotten worse. In the middle of May had a cortisone injection which did little to nothing.

Have seen two ortho's now and will more than likely be having to have the LRTI in the very near future.
Somewhat worried as I have to type still for work.
Still wearing a thumb splint too but it's just so so.

"They" say "it'"s a 90-95% recovery and that "it" will last 15-20 years.
 
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Grammyof2

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Looks like I can keep walking every day until Maine's really cold weather + snow etc. settle in. My thumb doesn't seem to mind.

I can't really be sure, though, because I'm cheating: both hips and thighs ache incredibly every night, despite the oxycodone I was prescribed for the thumb. The thumb seems only mildly tired during the day and doesn't hurt at night... I'm betting that means I'm not overdoing it, but I couldn't be certain without stopping the oxycodone... which would leave my legs in agony.

I figure that if I don't do any more with thumb #2 at this stage than I did with thumb #1 at the same stage, I'm probably OK. (Thumbs crossed! :shrug:) I'm following the printed instructions and using every digit on the surgical hand within the confines of the cast. BTW, the cast comes off Oct. 20 and OT resumes (with a different person, if my request went through) the same day.

The legs: My PT is at a different hospital than that troublesome OT I had for Thumb #1, but she's even worse! She made several bewildering errors on my exercise printout last week and promptly went on vacation (as I discovered when I asked the secretary to tell her to *please* reply to my emailed queries). Only today did I get the corrected exercise plan, so I've gotten behind... and that might explain the extra pain.

The most difficult of this part of my surgical journey is how tired the meds make me. I take slightly over the maximum dose of methadone (in morphine equivalent terms) to tamp down my extremely severe Restless Legs [Restless Body!] Syndrome, the symptoms of which are indistinguishable from myoclonus. To that, as after every other surgery, my surgeon added oxycodone.

I could take 2 oxycodone pills every 6 to 8 hours if I wished, but 1) I'd sleep 24/7 and 2) they'd have run out by now. Instead, I take 2 pills per day, ~12 hours apart, spacing things out with Tylenol, gabapentin, and Celebrex. Despite the summer's (ongoing? hard to tell with the cast on) weight loss, I'm morbidly obese, so there's a lot of me to medicate; but I've somehow become elderly, so I process meds slower year by year.

Anyhow, I'm very tired most of every day. So I nap. But long naps mean little nighttime sleep. The rest I do get is good: my adaptive servo ventilator reports zero central apnea events despite the opioids. It's just, well, tiring to keep pushing up against fatigue to get anything done.

Well, off I go to do those PT exercises. With any luck, resuming them will reduce my leg pain (though they hurt like the dickens to do).

Do you suppose my legs ache because I keep twisting them around to kick myself in the rear so I'll be active instead of just lazing around?
 

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You aren't lazing around - you are recovering! And you are on some pretty heavy duty medication. No wonder you are tired. Take is easy and don't feel pushed. Your body is focusing all its energy on healing.
 
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Slept well, feeling so much happier! This morning I surprised myself. My husband was out shopping and couldn't help me, so when I needed to wear my apron I automatically tied a bow behind my back.

As one of my kids would proclaim when she was little, "I did it my own self!"
 
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Grammyof2

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Surgery was Thursday morning. This is Tuesday night. For three weeks I trained myself to do every possible thing with just my left hand, right forearm, and a fingertip or two. That skill made my first post-surgery days far less frustrating than they would have been.

A transition began today. In retrospect, the first sign was absentmindedly using both hands to tie a bow behind my back this morning. Since then, I've used my dominant hand's fingers more and more and more--and its thumb as well. Perhaps this cast is slightly shorter at the thumb than the other? I gently pinch, hold, and move many lightweight items.* No pain, all gain.

*Three fingers lift small laundry detergent with slightly bending wrist; thumb & forefinger pinch an oyster cracker or carry my new teabag to the counter.
 
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Frustration. A week or 10 days after my L hand surgery, an OT removed the cast in the morning and created a heavy plastic device (with a sock-like fabric under it) to protect the hand. Within minutes, I was in the surgeon's office, where he examined the surgery sites and pronounced everything good.

This time, no OT appt was made--just the surgeon appt. So yesterday I phoned to ask for one, only to be told it had already been made ("Didn't we send you the date in the mail?" "No, you didn't.") For the second time (first was right after the surgery), I made sure to specify that I did not want "Sue," my L hand's OT.

Today, a call from the OT scheduler: "Sue, your OT, will be on vacation that day."

"Sue??? I've explained twice that I want 'Ben,' instead!"

"Oh, we never heard about that. Just as well, I guess. I can get you in with Ben the next day."

"But that's backwards! How can the surgeon examine my hand with the cast still on? If he removes it, my hand will be unprotected for 24 hours!"

"Well, I don't know anything about that. You'd better call his office. We don't communicate with them directly. We use entirely different scheduling programs."

I call his office. Thirty rings, no answer. Call again 30 minutes later. Answerer: "I don't know anything about that. I'll leave a note and someone will get back to you."

Four hours later I call again. Reach a different woman. "I don't know anything about that, but I'm sure it will all work out fine."

"Fine in what way? Will my hand be unprotected for a full day?"

"Oh, I'm sure he'll wrap a splint or something around it."

"Have you heard this directly from him?"

(Annoyed) "Well, no. Look, he'll probably read your note sometime today and somebody'll probably get back to you tomorrow."

I am left pondering whether or not the removal of the cast might be delayed until whenever the surgeon's and "Ben's" stars align... days? A week? Never the twain shall meet?

I'd been patiently counting down to next Tuesday... I'm now left counting to next Wednesday. Thursday? Friday? Christmas?

I don't understand how the surgeon and his OT dept. can have such poor communication with each other and with me. It's a small building. Two surgeons. The hand surgeon uses the OT staff; the knee surgeon uses the PT staff.
 

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@Grammyof2 What a circus! Sounds like you need to speak directly to the surgeon. Everyone seems to be dismissing your needs. You might have to get a bit firm with these people. You know very well you can't have that hand unprotected for any length of time right now. Sorry you have to deal with this frustration!
 

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Sorry you are being frustrated by the surgeons support staff, though I imagine the use of support is stretching the truth right now.
Hope you find some answers from the surgeon.
 
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Grammyof2

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Thank you @pumpkin & @Jaycey! I needed caring words and you've both sent them my way.

There's no way to reach the surgeon except through his staff, of course. Tomorrow, if he doesn't call, I might try to reschedule both OT and surgeon's appts so they fall on the same day, OT before surgeon. But if that would make me stay in this cast several extra days, I'll be tempted to walk into his office, show him the cast, explain just how incompetent his office staff and the OT staff all are, and see what he says/does. :hairpulling:

I swear, if he sends me home with this thing still attached, I'll have my husband slice it off at home, keep the incisions clean, and wear one of those sturdy fabric braces (which I still have) until an OT appt. can happen. It's not a plaster cast, after all. Just a sticky Ace bandage over gauze. Only my palm and the surgical site are wearing a plastic or metal brace under that. By next Tuesday, the wound will surely be healed. If it looks "off," I could visit Urgent Care.

Still hoping for a more normal resolution of this problem, of course.
 
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Grammyof2

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Finally sorted this mess out.

My surgeon's secretary never really listens. This afternoon I realized she'd had me pegged as an annoyance who whimsically changed an OT appt then expected *her* to make the appt. with the surgeon work the way it should.

I almost heard her jaw hit her desk when I sternly said, “I did not change that appointment," and re-explained that the original OT had cancelled it. The secretary (perhaps actually a nurse or an OT?) then
informed me that she herself will remove the cast and create a splint to protect my hand until my OT appointment the following day.

Surgery makes people feel quite vulnerable, I think. At least it does me. I finally feel a bit reassured about what will happen Tuesday. But when I get my feedback form, I'll have some things to say about the workings of this nutty medical practice.
 

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Glad you got your appointment sorted! These "gate keeper" staff actually make more work for themselves. All that nurse had to do was tell you what was planned in the first place.
Surgery makes people feel quite vulnerable, I think.
I think many underestimate this. In fact, many of our members report symptoms of PTSD post op.

Do let us know how it goes on Tuesday.
 
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Will do. First, though, a surprise.

I spent much of yesterday in the emergency room. Turns out that when preoccupied (SO much going on in my family and the world, plus dealing with surgery & this ^@#%$ cast) plus taking pain medications, I can fail to pay sufficient attention to other pangs. I'm always in pain from one thing or another, so I tend to ignore it and focus on other things.

Well.

What I'd assumed was a minor reaction to laxatives and various foods had me moaning for an hour or so a couple of mornings. No big deal. Then yesterday I realized moans were turning into screams. My belly really hurt! Tender, swollen, it was agony to bend over.

Managed to get dressed. Woke my husband. Off to Express Care, which promptly sent us to the ER. Kind clinicians, two eventual ultrasounds with contrast, and, hours later, a diagnosis: a UTI. They gave me some kind of morphine-related painkiller & a prescription.

Oh, for crying out loud. Hadn't had one of those in over 20 years. I'd ignored the usual symptoms until it got really bad. Caught it before it could damage my kidneys, though now I suspect why I had some iffy blood test results just before the iron infusion. My hematologist had immediately gone on maternity leave and I couldn't persuade anyone, even my PCP, to respond to the numbers.

The good news is that the kindly and thoughtful ER doc was interested in my history of penicillin allergy. It consists of having had a pale rash on one leg while taking penicillin for pneumonia 40 years ago. She's trying me on a nearly-penicillin antibiotic (I think she said "three generations removed") that's 1) unlikely to give me an allergic reaction and 2) will encourage my PCP to get me a test that could prove I'm not allergic after all... opening up a world of antibiotics I've had to avoid all these years.

Feeling better already!
 

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@Grammyof2 Right - I think it's time for you to get a break here! Gosh - you just have so much on your plate at the moment! I do hope the medication sorts that UTI. These infections can indeed be nasty.

Take care!
 

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Frustration. A week or 10 days after my L hand surgery, an OT removed the cast in the morning and created a heavy plastic device (with a sock-like fabric under it) to protect the hand. Within minutes, I was in the surgeon's office, where he examined the surgery sites and pronounced everything good.

This time, no OT appt was made--just the surgeon appt. So yesterday I phoned to ask for one, only to be told it had already been made ("Didn't we send you the date in the mail?" "No, you didn't.") For the second time (first was right after the surgery), I made sure to specify that I did not want "Sue," my L hand's OT.

Today, a call from the OT scheduler: "Sue, your OT, will be on vacation that day."

"Sue??? I've explained twice that I want 'Ben,' instead!"

"Oh, we never heard about that. Just as well, I guess. I can get you in with Ben the next day."

"But that's backwards! How can the surgeon examine my hand with the cast still on? If he removes it, my hand will be unprotected for 24 hours!"

"Well, I don't know anything about that. You'd better call his office. We don't communicate with them directly. We use entirely different scheduling programs."

I call his office. Thirty rings, no answer. Call again 30 minutes later. Answerer: "I don't know anything about that. I'll leave a note and someone will get back to you."

Four hours later I call again. Reach a different woman. "I don't know anything about that, but I'm sure it will all work out fine."

"Fine in what way? Will my hand be unprotected for a full day?"

"Oh, I'm sure he'll wrap a splint or something around it."

"Have you heard this directly from him?"

(Annoyed) "Well, no. Look, he'll probably read your note sometime today and somebody'll probably get back to you tomorrow."

I am left pondering whether or not the removal of the cast might be delayed until whenever the surgeon's and "Ben's" stars align... days? A week? Never the twain shall meet?

I'd been patiently counting down to next Tuesday... I'm now left counting to next Wednesday. Thursday? Friday? Christmas?

I don't understand how the surgeon and his OT dept. can have such poor communication with each other and with me. It's a small building. Two surgeons. The hand surgeon uses the OT staff; the knee surgeon uses the PT staff.
I went through something very similar with my surgeon's office. My surgeon is in a group of other Drs with one set of people answering the phone and a separate text message system. My phone calls and texts went unanswered for weeks. When I finally saw the Dr I told him what was going on and also said "I like you as a Dr and need my other thumb done, but if your office is going to treat me like this I will find a new Dr" I was given an extension directly to the Dr's aide and they now call me back very quickly. My OT is fine once the appointments were figured out. I hope all goes better with you.
 
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Grammyof2

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Thank you, @Grammy57 ! Good advice. Today I saw my surgeon for the first post-op appt., and pretty much told him what you suggested. I don't have a direct line to the aide, but I'm expecting reasonably clear sailing from now on--just OT appts. (hoping I like my new OT!).
 
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Grammyof2

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Cast off, hand great! Already, I can touch my thumb to the base of my little finger.

At today's post-op appt., my surgeon drafted someone to slice off that dratted cast, tape some gauze around my hand, and fit a Spica cast.

It's size extra-small, but I'd never seen such a huge one! It cost $100 and I'll need it just for one day... I hope/expect my insurance will pay. I was in passive, obedient, "patient" mode with her, so it didn't occur to me to ask for the smaller version I'm used to. I could use a new one, since they all have a fatal flaw--the Velcro on both of my Little Spica pairs wore out after just a few weeks.

Got home, laughed at myself, ripped that monster off, put on one of my old ones, and held the narrow strap on with a rubber band. (My surgeon had actually suggested that I wear no protection at all for a day because my hand's already so strong, but when I said I was concerned that I might damage it while rolling over in bed he agreed that I needed something. So I feel no worry about using this slightly different protection device.)

I'll wear the giant version tomorrow to my first OT appt., hoping eventually to be given a replacement of the small kind. Looking forward to him molding a Real Deal black plastic protector. I've got some rugged yard work to do this week.

My surgeon was amazed that my hand's gained so much flexibility already. He spoke of an emerging trend toward shortening the official recovery process, perhaps with casts like mine that let the thumb move a bit more, and removing the cast sooner to start OT exercises.

The wound's still pretty fresh and slightly swollen and the hand got wrapped so fast that I don't yet know whether or not that thumb's numb, too.

I'm a happy camper tonight, though my appt. got delayed an hour in a large waiting room with a whole lot of other masked & socially distancing patients. I overheard someone say there'd been a local accident, with multiple surgeons called into the hospital. Perhaps there'll be a story in tomorrow's paper.

Isn't it grand that so many talented clinicians can do so much to help heal people who've been hurt or whose bodies are slowly crumbling!
2020 Oct 20 S's huge 1-day thumb brace.jpg
2020 Oct 20 S's smaller old thumb brace.jpg
 
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1st OT visit with "Ben" went fine. He molded a nice black plastic brace to the shape of my hand and assigned one simple exercise (glides).

He said to be sure to come in ASAP if there are any irritations, so I'll call ahead and duck in tomorrow--a bit of the brace is rubbing my thumbnail. He'll either mold a new one or trim this one.

Seems like progress on my right hand is at least three weeks ahead of where the left was at the 1st OT appt. That thumb can touch every other finger and slide to the base of the pinkie. I can shower with no brace, gently holding onto the grab bars as I turn around; washing, drying, and putting away dishes is no problem. I just avoid all sudden hand movements, make very gingerly trials of any potentially heavy lifting, and stay alert to possible hazards to the thumb.

:SUNsmile:
 
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I had my last post-surgery appt. with the surgeon this week. It went very, very well! He said my recovery is six weeks ahead of what's expected, so no need to return at Week 12! He's thinking of changing his rules for Occupational Therapists, so people who heal quickly can speed things up a bit.

I'll still see Ben for a few more OT sessions, building strength and flexibility. Despite my determination, I tend to backslide on exercises when there's no one measuring my progress.

Yesterday he showed me a printout of the surgeon's timetable, and now I understand why Sue was so hard on me--she was valiantly sticking to those instructions. "You opened a teabag?! You shouldn't be pinching anything for weeks!" With her, I always felt guilty about making progress. But Ben's more flexible. He tested my hand's progress multiple ways at every session with various tools and by moving and squeezing flesh and bone, and went by that plus the fact that I had no pain.

He took a risk on me, I think. But as I told him immediately after seeing the surgeon, "If Dr. Thaller had told me my hand was a mess, I was all set to say, 'Oh, dear. Ben's been telling me not to do that, but I went ahead and did it anyway!'"

And I also said to Ben, "If I were in the market for a son, I'd encourage you to apply." Such a wise and caring man. He's actually the same age as my elder daughter, 45.

Off-topic a bit: My first lumbar spine injection (Lidocaine) was Nov. 12. I hobbled into the hospital on my cane and strolled out carrying it like a baton. I'm in PT now for the bursitis in my left hip--with Amy, who got me through both TKRs. The awful physical therapist half an hour south, whom I endured for 3 or 4 sessions, is history. Amy's reduced my daily walk from 4 miles to 1/2 mile, since long walks are what prompted bursitis in the first place. My first three walks post-injection were heaven!

Then the Lidocaine started wearing off. Pain's up to "4" or "5" now, when I stand or walk any distance, but I'm still out there. I was worried that my lumbar spine pain signals that I'm damaging my spine. In a way, it does, she said, but I'm not having any leg weakness, tingling, or incontinence; eventually, that sort of thing might start happening, and that would mean it was getting to be time for back surgery.

I'm obviously not going to just lie around, hoping to fend off the need for surgery. All that walking plus dieting helped me lose about 33 pounds! I've got 40-60 pounds to go, depending on how ambitious I keep feeling. I haven't lost any weight since I stopped walking (just the normal little ups and downs), but I'm determined to keep moving.

Bursitis is so frustrating. If I sit more than 5 minutes, the first few steps are agony. But I can't walk around and around this little house all day, so I sit again... Then I stand again, and that left hip says, "Why do you keep doing this to me?!"

On Nov. 25 I'll have the 2nd lumbar spine injection, which includes cortisone. On Dec. 7, that doc's assistant will examine me and (I hope) we'll set a date for the injection that will discourage certain nerve fibers from carrying pain to my brain.

On Jan. 12, he'll inject something (cortisone?) into that pesky bursa to reduce the pain, if the PT hasn't eased it enough by then (no progress after 3 sessions,; looks like a long road ahead). Last night I slept quite poorly, thanks to being too ambitious--I'd done a bunch of extra repetitions of my PT routines, forgetting that my problem isn't muscles that need extra exercise, but arthritis thorns that scrape my spine! My back's not going to heal itself like my friendly thumbs.

That's about it for my thumb surgery adventure, BoneSmart friends. My husband and I are still in self-quarantine apart from medical appts. and grocery shopping (which he does--no use exposing us both to the maskless wonders). I hope you are all well, and will remain so. Things are looking hopeful, vaccine-wise. Perhaps a year from now we'll all be out from under pandemic restrictions. I can wait patiently--my life's at stake!
 

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