Burning Sensation & the Scar - 21 Days after Surgery

Like a First Degree Burn!
As the OT predicted, the splint is driving me crazy! When will this frizzly, stinging sensation that runs from the incision up to the nail bed end? I feel it the most when the splint is on and the plastic is in contact with my thumb--- and the splint is supposed to be most of the time. The first-degree burn sensation is so annoying that I take the splint off whenever possible, taking care to not place the hand in any danger. Sitting on the couch reading. Typing (like now!). Even driving. I always put it back on before I move around, logic being that the worst thing that could happen is for me to fall and overextend the joint, damaging the repair.

Still, I know I'm supposed to have the splint on all the time, except for showering and doing the exercises. The skin covered by the sock feels oh so much better! I think I'll try attaching some moleskin to the inside of the splint and see if it helps at all. I'll have to report back about that.

The Scar - Well, see for yourself. The scar is the least of my worries. I think it looks pretty good!

Days 11-12: Ballroom Dancing & Hot Tubs

The Simple Pleasures of Life that I've been Missing...

Social Dancing
On Saturday night, day 11 following surgery, I attended a holiday social dance with friends from my ballroom dance team. I wondered how I'd do, my cold plastic arm resting on my partner's shoulder, using the fingers of my left hand, thumb protected by the splint. It felt fantastic! I needed some pure dancing joy: rumba, waltz, tango, foxtrot, east and west coast swing, cha-cha, samba, night club two-step. I danced each at least once and never felt that my surgical repair was in any danger. Bliss! I'm planning to return to my dance team in January, at the one month mark after surgery. Of course, I'll be wearing the splint, and I'll have to modify the holds for the fancy dips for awhile.

Soaking in the Hot Tub
Ah, another form of bliss on day 12... I've been worried about the hazard involved in getting in and out of the tub; the danger of slipping and destroying my repair looms large in my overactive imagination. I hit upon a solution. It's simple, actually. Settle into the tub before taking off the splint and sock, and then soak away. When ready to exit, dry off the hand and whole arm, and reapply the sock and splint before getting out of the tub. Voila!  Problem solved! How lovely that my postoperative instructions advise a daily soak or two in warm water prior to gently performing the exercises!

Day 11: Hypersensitivity

Frizzly Stinging!
I have been experiencing a frizzly, stinging sensation on the skin surface from the incision all the way up to the nail bed. On a scale of 1-10, it's between a 1 and 3, annoying, but tolerable. I experience this hypersensitivity the most when the splint is on and a good part of my thumb is in direct contact with the plastic splint. The sock that I wear must muffle the sensation at the incision site.

My postoperative rehabilitation instructions explain that the incision site is near a superficial sensory nerve which can sometimes result in hypersensitivity. If this occurs I am instructed to use a soft brush such as blush brush or a baby-soft fleecy cloth to gently sweep over the area for 2-3 minutes, presumably several times per day.  The fuzzy fleece belt of my bathrobe is working well.

I hope this hypersensitivity decreases over time!

Day 10 - Decreasing Stress on Thumb

How to Protect The Good Thumb

Recovery underway, I've been thinking about my other thumb. Similar processes are clearly at work, but my right has been far better than the left. I'm so glad that I remembered to ask the hand therapist the other day about how to protect my "good thumb." She had a whole page full of good advice. I've already ordered a new pair of scissors and the highly-recommended 5 in 1 tool. If only I had this information years ago. Take care of your good joints!

Day 8 - Couple of Cool X Rays

Now You See it, 
Now You Don't...

Go ahead: study those bones. Do you the differences? The
pre-surgical x-ray is on the left, the post-surgical (day 8) is on the right.

Need a hint?

Look at:
     Joint spaces
     Position of bones

Don't peek ahead yet...

A - That's my trapezium bone. Wikipedia explains, "The trapezium bone (greater multangular bone) is a carpal bone in the wrist."  Note the crunchy edges. Also compare the joint spaces in that area with elsewhere.  The cartilage has worn away, causing rubbing of bone on bone. And pain.

B - Where'd that trapezium go? Out with the bio-waste! My arm tendon, curled like a cinnamon roll, occupies that space, even though the x-ray doesn't show it. (How did I ignore the arrow when I added the B? Gonna let that one go...)

C - Another feature of this joint rebuild is that one end of the tendon gets threaded through a neighboring bone, thus pulling everything into proper alignment.  Or so we hope... Then it is critical for me to consistently wear a splint that locks the joint in a position that protects it and promotes maximal healing.

There are some great diagrams on the following site:

http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/hand/resection-excision-arthroplasty-of-the-thumb/

Day 8 - First Post Op

Splint off, Sutures out, Butterfly Closures on! What a rainbow of colors: red, yellow, blue, green, indigo... (Perhaps I should have warned you about that photo.) Whew, did it feel good to get that thing off! As a veteran of other surgeries, it actually looked about as I expected. The medical assistant, PA, and OT that I saw were both impressed with the degree of swelling still remaining. Slicing into that dressing had been a good idea. In retrospect, I could have unwrapped and rewrapped it, but at the time it had seemed like 1) too much trouble, and 2) I didn't want to compromise the stability of the dressing. I have learned that swelling of the hand and fingers can continue for up to eight weeks, so I'm actually doing okay. The puffiness is decreasing.

The wonderful hand therapist, Diane Newman-Branch, MS, OTR/L, CHT, at the Doctor's Clinic in Silverdale, instructed me in three gentle range-of-motion exercises that I will do three times a day for the next month or so. I could hardly even do the first one, gentle thumb rotation; my movement was minuscule, but she was encouraging and said it will improve. That was two days ago, and I already see dramatic improvement. The "thumb bend" was equally challenging, but the "wrist bend" was a walk in the park.

Custom-made Removable Splint
Diane crafted this lovely, form-fitting splint. It allows movement of my distal thumb joint, but protects the position of the thumb relative to the hand. I am not allowed to move the thumb far away from the hand or to pinch any object between thumb and finger. I am allowed to take it off to shower and do the exercises.  Hooray!!  Happy Dance!!!

Time for a Celebratory Manicure

6-7 Days After Surgery

Don't let the smile fool you. I am sick to death of wearing this splint. Showering with my arm double-bagged, rubber bands for tourniquets. Washing my hair with one hand. Wrestling clothes on and off. Trying to adequately wash my right hand with my right hand.  Go ahead, try it. It's a lot harder than you think. Maneuvering about the house without the usual check and balance of two hands. Accidentally slamming into things. Reading a book, a Kindle, a newspaper. One-hand typing. Shoes with laces: not possible. I'll need to plan ahead for a midday walk/jog on a beautiful, crisp northwest day so that my husband can tie my joggers on before he leaves for work.

Okay, rant over. I chose this. I can only hope optimal healing is proceeding under this fat bandage. Tomorrow is my post-op appointment. The splint comes off, but then what? I'm really hoping for a removable splint. I'll let you know.

A final word about drugs... I switched back to Naproxen yesterday, but I haven't taken one since yesterday morning. There is some pain, but tolerable: 1-4 on a scale of 1-10.

4-5 Days After Surgery: Puffiness, Aches, and Accidents

This is not pleasant. Puffy fingers and knuckles. Deep ache in thumb and forearm. I've eliminated the hydrocodone acetaminophen, because it just makes me uneasy to take an abusable medication for very long. So, except for one at night, if I need it, I'm relying on Ibuprofen to reduce inflammation and take the edge off the pain. That plus elevation and cold pack on inner elbow. Have to admit that I took my scissors to the bandage edge along the knuckles and cut two slits to relieve pressure of the bandage on the top of my hand. That made the dressing a bit more comfortable.

I'm glad to still have use of my dominant hand, but still, maneuvering through daily life is difficult. It's easy to do too much, because accidents sneak up on you when you least expect it. I violently jarred my bandaged hand a couple of times while attempting normal activities. Yesterday, finishing up in the bathroom--- doesn't get more ordinary than that--- having successfully wrestled my pants up, I was struggling to free my shirt hem while reaching for the door with the bandaged hand. This mishap occurred so quickly, I'm not even sure exactly what happened. Somehow, the bandage caught on the door while my body momentum was pulling the opposite way. The massive jerk elicited sharp pain in my thumb and arm... lots of swearing... ice.  Good thing the bandage is so secure. The second mishap, just this morning, involved laundry. In the process of a one-handed attempt to put a rayon top on a clothes hanger to dry, the hanger slipped. In that split second, my bandaged hand shot out to catch it, slamming into the bathroom towel bar in the process. The take-away?  Let someone else do your laundry!

2-3 Days After Surgery: Puffy Fingers

My hand is a marshmallow, puffing out over the edges of the bandage. It's not particularly comfortable, but I've read that this is normal. According to the post-surgical instructions, swelling tends to be worst on the second and third days after surgery.

I have kept my arm elevated the vast majority of the time. Usually, my upper arm is extended out somewhat level with my heart, and my forearm and hand are a bit higher yet, propped up on pillows. Perhaps I should have been more aggressively elevating well above heart level.  I don't know. I'll try that for the rest of the day.

2-3 Days After Surgery: Medication Changes

Ouch. By the second day, all residual pain relievers from the surgery, from local or anesthesia, were gone. Beginning 28 hours after the surgery, I upped my hydrocodone acetaminophen dose from one pill to two every four hours. This definitely helped get me through that second night. By morning I was able to switch back to the one pill dose.

I haven't been pleased with the 12 hour Naproxen regimen, so I planned to switch to a regimen that had worked well for me following a recent foot surgery. A post-surgical nurse who called to check up on me also confirmed that the switch would be fine. Basically, I would take the meds on an overlapping schedule, leap-frogging through the day: one hydrocodone at 7:00, 11:00, 3:00, 7:00, etc...; normal dose of Ibuprofen at 9:00, 1:00, 5:00, 9:00, etc...

So far, so good. Actually, last night (third night) I took the last hydrocodone at 8:30 PM and then only one Ibuprofen during the night, plus one Benadryl to knock me out. I resumed the leapfrogging med schedule this morning, but I am really hoping that this will be the last day for controlled substances. They have their place, but they make me nervous!

I wish that I could apply cold directly to the surgical sites, but I'm so thickly bandaged that it's just not possible. I continue to apply cold packs to the inner elbow around the clock. It's hard to tell if it's helping or not.

The Day After

Day 2 Swelling

Surgery may be easy (at least for this patient), but the day after was not. I've continued to ice and elevate my hand and forearm, but it's clear that the hospital meds have worn off. Yesterday I got by easily with one hydrocodone-acetominaphen every four hours. Today's pain swelled over the morning. By the time of my 1:30 PM dose, I knew I needed to increase to two pills. Even that did not fully remove the pain. Beyond that, there's not much else to do but tough it out.

The second prescribed medication is Naproxen, a long-acting anti-inflammatory. I'm not crazy about that one since I've felt a bit nauseous after taking it each time. Tomorrow I plan on switching to Ibuprofen on a leap-frogging schedule with the hydrocodone. That worked well for me during last year's foot surgery. I expect that I'll be able to reduce the hydrocodone to one pill---my goal being to eliminate the heavy drugs as soon as possible!

Surgery...

... is the easy part. I arrived at the hospital at a relaxed 7:15 AM, thankful to have not been assigned an earlier time. After checking in with the front desk, I was escorted to a pre-surgical room for required preparations: verification of health history, checking vital signs, disrobing and re-robing in a new-fangled hospital gown that can be inflated with heated air, installation of IV, and then a long wait. At some point, my husband, Craig, left to run a few errands in town.

Surgery was scheduled for 9:15, but I wasn't wheeled into the operating room until around 9:30. After brief introduction to the OR staff, it was lights out. I awoke to a splinted, bandaged hand and the good news that the surgery had been uneventful and was over. Ice chips never taste more delicious than after surgery!

By noon we had conferred with the surgeon, dressed, received discharge instructions, and I was on my way home. I knew from personal experience with past surgeries how important it is to have that second pair of ears carefully listening to discharge instructions. Even though I felt alert, pain-free, and "with it," there was a good chance that my memory of these conversations would be fuzzy. Written post-op instructions are valuable, too.

Craig drove me home and I lounged about for the rest of the day, feeling pretty good while the heavy duty pain meds were still coursing through my system. I also finished some laundry and household tasks and, more importantly, wrote down a schedule for taking the pain and anti-inflammatory medications and a stool softener. It's very important to stay on top of the pain meds, and its easy to mix things up, especially when you're hurting. From past experience, I knew that the next few days were likely to be among the hardest. My velcro ice packs worked marvelously. A discharge nurse had explained how to apply a cold pack to the inside of the elbow, since there is too much padding around the thumb for cold to penetrate directly.

We decided that I would sleep in our guest bedroom for a couple of nights. I planned to set my alarm for 1:30 AM for the nighttime dose of hydrocodone. Also, I wanted to flop about out in bed, my arm elevated on a pillow in either direction, without fear of bumping or being bumped. With these preparations, I had a very good sleep and so did my husband!

The Road to Surgery

I finally did it: surgically repaired the joint that has been plaguing me for years.  (One hand typing is a real treat, let me tell you!) Underneath that swollen area at the base of my left thumb lay diseased bone and cartilage.

I first experienced pain at the base of both thumbs when my first child was an infant. I attributed the sharp, stabbing pain I felt at the base of my thumbs to overuse. After all, I was overusing them---hoisting my "one ton son" in and out of high chairs, car seats, walkers---multiple times each day. And then came one ton sons two and three. It's no wonder I never took the time to investigate the intermittent sharp pain. It would get better eventually, I thought. Years passed, and the boys hoisted their own bodies where they needed or wanted to go. My thumb pain subsided for awhile. Then I became a teacher and spent twelve years overusing my left hand in a different way: flipping pages, toting heavy manuals, and shuffling through mountains of paper.

Eventually, the pain in my left thumb became a daily haunt. Pain avoidance was a daily challenge. First, I bought a splint for nighttime, figuring that immobilization at night would give my poor thumb a much needed rest. This did not help a whole lot. Finally, a few years later I visited a doctor and received the verdict: osteoarthritis of my carpometacarpal joint. We discussed options. I decided to try wearing a better splint while at work to try to avoid overtaxing the joint. But the damage had already been done.  Here's a description by the Mayo Clinic:

"Thumb arthritis is common with aging, and occurs when cartilage wears away from the ends of the bones that form your thumb joint — also known as the carpometacarpal (CMC) joint.

Thumb arthritis can cause severe pain, swelling, and decreased strength and range of motion, making it difficult to do simple tasks, such as turning doorknobs and opening jars. Treatment generally involves a combination of medication and splints. Severe thumb arthritis might require surgery."   (Mayo Clinic Staff, 2016)

So, here I am, one day after surgery. I'll tell you about my journey to full recovery in upcoming posts.