Myke's 'blob.

To recap:
2009-08-21 - Injure left wrist while moving couch
2009-08-24 - Walk-In clinic doctor doesn't even look at it, offers drugs, fails to refer me to another doctor
2009-09-27 - See Dr. T for the first time, suspects Scapho-lunate Dissociation/Tear, TFCC injury, possible fracture
2009-09-28 - X-Rays, inconclusive for soft-tissue damage, no bone fractures observed
2009-10-05 - Hand doubles in size for no new reason
2009-10-08 - Start physiotherapy & Celebrex
2009-10-21 - Physiotherapist gives up, nothing is helping
2009-11-29 - MRI performed using a 3 Tesla machine at the Mont Fort hospital, finds a cyst, tendonitis, no soft-tissue damage
2009-12-17 - Not happy with the course of action, I revisit Dr. T and demand more
2010-01-06 - Bone scan, I light up too much, but nothing significant found beyond that
2010-01-12 - Consult with Occupational Therapist, is very concerned and tells me not to use my hand at all
2010-01-21 - Dr. T refers me to Dr. L, a plastics & hand surgeon (5th month of being injured today)
2010-02-25 - Initial consult Dr. L:

Through a well-timed stroke of luck, I managed to book an appointment with Dr. L in a matter of weeks rather than months. While he is a plastic surgeon who has a successful cosmetic practice, he's also a very well regarded/trained/experienced hand-surgeon.

He sat me down in his office, discussed the symptoms, and then we pored over my X-Ray & MRI films on my laptop. Well, he did; I just helped him navigate the software & images. After a few quiet minutes of flipping between various images, he says, "Do you see that?"
"No."
"That there."
"Okay, it's a triangular shape?" (Please stop poking my LCD with your pen!)
"Yes, that's where the bone has been avulsed by the ligament."
"What does that mean?"
"It ripped the corner off your lunate bone."

Welcome to the land of avulsion fracture. Somehow this was missed by both the X-Ray and MRI radiologists... and everyone else playing along. Dr. L is fairly convinced of this finding though because it could be seen in both the X-Rays and MRI, and the finding supported by a lot of fluid in the joint and many of the symptoms.

Apparently ligaments can be stronger than the bone, and despite my ligament problems (they're loose, they stretch and heal/grow very slowly) it doesn't mean they're not strong enough to tear a bone to bits. Who knew?

He goes on to perform a Watson's test, which I think Dr. T did the very first time she saw me... and he says I've completely failed it. (Despite not showing significant Terry-Thomas Sign) What does this mean?

"Your scapholunate ligament is torn, and it broke your lunate when it happened. So this is what needs to happen: your wrist needs to be scoped. We need to see what's going on inside of there and figure out what needs to happen next. This MRI reading is deficient and I'm going to get someone else to review it, since we have no idea what specialty the person who read this was, that needs to be rectified.
Unfortunately, I don't have the equipment to perform the scope, and while I have performed surgeries like this, there are other people who do this much more than me and have even more experience with this type of situation."

"So you're not comfortable to do this... I can understand that."

"Right, now, in 5-10 years if you develop arthritis from this, then you can come see me and I can help you with that. But for this I think you need to see Dr. v S, he practices in Toronto, but unfortunately has a one-year wait-list."

∗gulp∗

"Now, they might not even want to go in... or when they scope it, they might repair it right then... but understand these are complex and risky surgeries, and that you may have to face that they can do nothing for this..."

"... so what am I supposed to do?"

"Well you seem like an intellectual guy who's quite interested in this, so you should go research on the Internet, on PubMed, and look at what's involved here... get yourself informed so you can make the right decisions."

"And in the meantime? What can I do with my hand on daily basis?"

"The splint isn't protecting you from any more damage, and they're just going to make you get weaker... but I suspect you find you can't go for very long without it on, is that correct?"

"Quite."

"Right, so, go ahead and start using your hands for light tasks, you'll know your limits. Don't go building a house or anything like that."

"Yeah, though I tend to find out hours or days after the fact that I shouldn't have done something. Can I start playing guitar again?"

"You can try, but you probably won't be able to for very long." (Most textbooks state that casting/bracing is of limited value in Scaphoid/lunate/ligament injuries because the patient is self-limited by pain-feedback anyway.)

And that was it. He's ordering a re-read on the MRI films, referring me to the doctor in Toronto, and I get to wait a year for that consult.

Oh, and doing research on avulsion fractures and scapholunate repairs... I came across this summary in a study of 5 patients treated at one hospital:

"None of our patients enjoyed good pain relief with prolonged immobilization (three patients) or surgical debridement (two patients). All patients suffered persistent pain, and three suffered persistent instability after treatment. Further research is needed...."

So, this isn't really happy news at all, but I didn't expect anything else going into that consult... I'd hoped that he might order some more tests or imagery and then book for surgery, but clearly that's not going to happen any time soon. Very depressing.

But that's not the worst of it. I was already very depressed and down before that bombshell was delivered.

... Because a month ago, I lost someone very important to me; No, she didn't die (although that might've been easier to cope with), but Katheryne, the most wonderful person who'd ever come into my life, ended our relationship, our friendship... and the rest of a wonderful life I'd thought we could've shared.

Why? I don't know.

And she can't tell me.

In what tiny fragments of communication we've had... all she's said was "It just didn't work out. It was nobody's fault."

I guess that's a reason, one you could probably just leave standing with no other dialog ... if you were in the very early stages of a relationship.
We may have only been 'official' for ~8 months, but I sure didn't think that "us" was a new thing anymore.
But it's very clear, that whatever I feel, doesn't matter. (duh, she broke up with you.)

The problem is, I still feel. A lot.

I've been through breakups before, I've been rejected, and I've done some stupid things - and gotten the punishment I deserved. But I didn't see this coming. And I'm not okay. It's been 6 weeks, and not an hour goes by that I'm reminded of what's been lost. And the unending stream of emotions is unbearable. Guilt, loss, love, rejection, longing... the assault of realizing happy memories just aren't happy anymore... The dreams are the worst. Or maybe the self-doubt.

So here I am, struggling to find paying work that I can do with one hand... restructure my psyche to function without my (former) number one fan... cope with pain both physical and mental... and try to convince myself that I am not a horrible person who's going to be left alone for the rest of my one-handed life.

Now, there's a whole lot more to this story, most of which I don't want to talk about anymore. But I've been left scarred by this, wondering how I might ever handle a similar situation in the future; when the person you care about the most seems to be in trouble... and when you try to help them, they cut you out... leaving you to later realize that you might been the problem... well...
Was it that I cared too much? Or am I blind to what I did? I had so much to give...

Then again, from what I've heard, she's doing fine now. So I guess I'm just weak. Why else would I break apart so easily?

In the last chapter of my Busted Wrist, I wrote about how I was going to get a second opinion from another doctor. I was probably still upset/frustrated when I wrote that, and not at her.

Instead I decided to give her a 'second chance' and saw her on December 17th.

She was very professional (as always) when we met again and I explained I didn't think tendinitis was the primary problem, and that any therapy would likely worsen things. We talked about other things that could be done, went through the MRI & X-Ray imaging, discussed what aggravates my wrist... A bone-scan was ordered, and she maintained her recommendation to see a hand-therapist.

The bone-scan was booked for January 6th, but finding a Hand-Therapist (which is a specialization of Occupational Therapy) was proving rather difficult. I had a list of a dozen therapists, but it was from 2006 and most of practitioners on there had moved or changed fields... Then when I managed to get a hold of someone, they seemed to only accept two types of cases: Post MVA (Motor-Vehicle-Accident) Insured recovery, or workplace assessments. Confusing, and further frustrating!

Out of the blue, Danielle W., sent me a message saying there was an OT at the physio clinic I'd been to, and that I could call there to book an appointment. Done - January 12th.
(Danielle also recently injured her wrist, and she is Chris's housemate - Chris being my biz partner in Server North... so he's dealing with two one-armed people in his life!)

Christmas happened, New Years... K and I went to Upper Canada Village to check out their Alight At Night event... and I'd had a few good days, decided not to wear my splint/cast/brace-thing/"VacoHAND" while driving - and paid for that for several days. So much so, that when the 6th rolled around, my hand was quite angry and the lunate was visibly dislocated (Jesus-Hole!)

So what's a bone-scan all about? Well, unlike an X-Ray, where they beam X-Rays through you and an image is developed on a film, for a bone-scan you're injected with a radioisotope Technetium-99 - bound to a phosphate. You come back 3 hours later when any bone activity will have gobbled up the phosphates, and they point a Gamma-Camera at the parts of you they're interested in, and wait 5 minutes for you to irradiate the camera's sensors enough to generate an image of bone reformation.

It's actually a neat concept: Instead of blasting a source of radiation through you, they inject it into you and see where it builds up, and use you as the radiation source for the detector.

(Of note, kidneys filter phosphates... so I had radioactive pee after this test!)

And that's all fine and dandy, until a somewhat baffled radiologist walks into the suite and starts asking you questions about where you hurt, and your entire case history. It seems I lit up light a belated Christmas tree, and not just in my left wrist (they looked at both wrists/hands and elbows also), so he wanted to figure out what was going on... unfortunately I had no idea and couldn't tell him much. He pondered arthritis, asked if I had back pain or any other problems. He got me a little worried, especially since I've had a lot of medical imaging done to me over the years, and I've never even met a radiologist, so that was a pretty significant event alone.

The next day I saw my knee doc for my MRI results (ligaments still intact, as useless as they are, lots of minor secondary damage, some minor arthritic changes, an unknown mass between my tibia and fibula, but nothing really exciting) and mentioned the surprising experience with the scan the previous day... so they (my knee doc and I guess a student) pulled up the images on the computer and were quite surprised by the brightness too. So the bloodwork was ordered, but I didn't get it taken right away since I'd had both of my flu shots right after the bone scan, and I theorized that since they're checking for autoimmune response, getting a sample less than 24 hours after getting 2 shots, one adjuvanted (H1N1), probably wouldn't be the most useful course of action.

Fast forward a week to the appointment with the OT. She's actually a certified hand-therapist, so, pardon the pun, I was in good hands. Could this be the beginning of the end of this saga? Back to having 2 useful hands? Could it?

No.

Damnit.

She was very concerned about the stability of my wrist, surprised I hadn't yet had a surgical consult and very strongly felt I should be doing nothing to load my wrist. Keep wearing the big hardware and protect & immobilize the arm-wrist-hand. Could I do basic things like squeezing a foam ball or something to keep up my strength? NO!

Sigh. Fail.

Then she started talking about how she thought I've got a 'positive ulnar variance' and how they might want to actually break the bone, shorten it, then screw it back together. (my knee doc had actually mused about the same thing when she saw the big ulnar hook on the X-Rays.) The OT was also concerned about Keinbocks, where the lunate bone dies from the damaged ligaments... Oh happy times! She offered to make me a smaller, custom thermoplastic splint that I could use if I wanted to wear gloves, or a winter jacket... so I took her up on that, but she said to keep wearing the big badass hardware too; this little one was just for practicality and reprieve.

She wrote up about a page of notes for me, recommended I go back to my doctor and request a surgical consult, possibly do some physio, but cautioned it might not actually help.
On the upside, she was actually a favourite hand-therapist for one of the local rock-star wrist surgeons, and suggested that when the request for consult was called in, to drop her name... maybe that'd help get me further up the priority list. No follow up, because there was nothing to do.

Got my blood sample taken a couple days ago. And I'll mention here, because I haven't anywhere above, there's been zero improvement. Nothing is any better. Nothing has changed.

Which brings us to today. Met with my wrist doc again, a fairly short & sweet discussion: I reported back what the OT said, discussed the Bone-scan report (rather vague, not really conclusive of anything other than "wow! That's bright.") told her about the blood-tests in progress, and then we talked about next steps...

Or rather, the only step: Surgical Consult.

Referral being sent within the next 48 hours. Hopefully with all the testing and therapists I'll get prioritized a bit closer to the top.

Just before I left, she says to me, quite candidly, "You know, when I saw you on the schedule today, I was really hoping you were coming in to tell me that you were getting better. :(" - I swear she almost verbalized the sad face.

Oh, and by the way, it's been 5 months to the day that I sustained the original injury.

An item to add to the Things I must do before I die: Build & Use This:

_(via)

While I don't actually have Windows 7, other than the (now expired) free Beta... and while this doesn't quite count as getting published... I just thought it funny that Mark @ M2 Magazine actually quoted my snark about the Windows 7 Launch Party Pack - in his opening editorial!

52 Ways to Deal with Windows

The (only?) other magazine I love to read is the venerable Wired, and just a few days before Christmas, a copy showed up in the mail with my name on it... for days I was mystified as to who had subscribed me...

w00t!

... turns out Alia thought I'd like reading it; little did she know is how I battle with Dad every month for his copy. Now I've got my own coming!

Localizer

COR 3D MEDIC WE

For the next gripping chapter in my busted wrist, let's explore other things I should consider:

1.0 Engage in witty dialogue:
Joe Random: Wow! I hope you're right handed...?
Myke: Does it look like I have any choice‽

1.1. Continue with witty dialogue:
Costco Cashier: Oh geeze, what happened to your arm?
Myke: My brother bought a couch here, and it broke my wrist.
Costco Cashier: Hahah, right.
Myke: I am not making this up.
Costco Cashier: ∗agog∗

2. Alternatives to fixing:

_{Thanks to @WTL for this suggestion}

3. Augmentation:

But will it improve my Quake II score?

4. Give up Used-Car-Salesman Aspirations:

Seriously - who would buy anything from someone who can't throw "The Guns"?
_{Or was screwing up my wrist just a deity trying tell me something?}

5. Be a stunt-double for Mark Hamill in a live performance of The Empire Strikes Back.
(This will require that Option #2 be taken afterward.)

So the doctor shows me into the exam room, before I've even turned to sit down in the chair she announces, "Well I've got your MRI results... it's nothing surgical."

...

"What?"

Radiologist's Report

"You have tendinitis."

That's it?

So welcome to my hypermobile life: My ligaments stretch, never contract, and heal on a scale that's 10X longer than the average human. (And in an average person it's very slow going anyway.) It's the same root-cause to the problem I have with my knees and ankles. And hip. And shoulder. And TMJ. And now my wrist. And bad enough that life sucks, but not bad enough that they'll (be able to) do anything. Surgeons won't operate a) because nothing's actually "wrong" and b) my ligaments are so loose that anything they do would be rendered moot after a semi-negligible amount of time anyway.

What's got me angry/frustrated/annoyed/sad is that when I finally thought real progress was about to happen, my doctor takes the position that there's some tendinitis and with some PT/OT, everything will be fine.

Except I disagree.

Remember this?

X-Rays showing scapholunate-ligament dysfunction

Yeah - that shows the scapholunate ligament ain't doin' it's job. The ECU tendinitis that the MRI shows has nothing to do with that. (ECU runs from the base of your pinky almost up to your armpit.) While it partially explains the constant pain, the apparent TFCC pain, and some of the gripping problems and flexion/dorsiflexion (scooping motion), it doesn't come close to being the reason for the clunking, the hypermobile lunate, the wicked spasms that inhibited my PT from doing anything. It also means that if I start working my wrist, there's a really good risk of developing some awesome arthritis due to the very poor structure within. I think my doctor completely missed this. Or forgot that the X-Rays show this.

Admittedly it took me a few hours afterwards to realize there's a logic problem here too, but I think this is a very big issue that is unaddressed. Her advice was to taper using the splint/cast-thing "since we're not protecting anything anymore, you might as well get things moving." I think this would be premature, since my wrist still feels extremely unstable. She agreed and said that we should defer to the hand-OT to start that progression.

Oh - And from a casual Googling - sometimes a cyst in the scaphoid is an indicator of a latent fracture, or cartilage damage. She didn't mention this at all. Maybe it's moot, maybe it's relevant. Maybe it's the elephant in the room.

... I'm going to get a second opinion.

Tomorrow I call my other sports-doc, (the one that's been seeing me since I was 9, who's looking at my knees again) to look at this, she's the one that I'd been referred to originally. (Reason it took so long to get an appointment? The referring physician never indicated any priority on the referral, so I was at the very bottom of the pile.)

I'll also order a copy of my MRI films.

I'd really like to talk to an orthopedic surgeon too... see what other options there are. (Pin the ligaments?) (Prolotherapy?) (Temporary/External Fusion?) (Rubber bands?)

This isn't the end of this story. Not a chance.

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I was the official photographer of TEDxOttawa this past weekend, TED Talks are a pretty amazing conference/notion, and to have a 'baby' TED here in Ottawa was definitely something I needed to be a part of.

Here's how the event looked from my perspective, from the final planning 'party', to the setup and the main event.


_{Please ask for my permission before you take/use any of these photos. I'm very reasonable about it. Just ask.}

MRI Tech: Can you put your arm over your head?
Myke: Uh, yes...?
MRI Tech: Can you lay on your stomach?
Myke: err... Yes?
MRI Tech: Put your hand in here.
Myke: ∗puts∗
MRI Tech: ∗clamps the damn vice down on it∗
MRI Tech: How's that?
Myke: ∗Wince∗ It's... sucky, but I'll live
MRI Tech: Okay - try not to move.
MRI: ∗bwong bwong bwong∗
Myke: ∗trying to not move while breathing on stomach in a Village People dance pose∗
(Towards the end, I could feel twitches and spasms in my arm & fingers, I was quite concerned that might screw things up.)
MRI: ∗stops∗
MRI Tech: All done! ∗unclamps my hand∗
Myke: That is one angry wrist.
MRI Tech: Oh yeah... err... probably eh? But that coil really helps the imaging.
Myke: So it was good?
MRI Tech: Yes, great images.
Myke: Good, I was worried, I felt my arm & hand move during the scan, I was worried that it screwed things up. (This is likely a 3.0 Telsa machine)
MRI Tech: Oh no no, we actually stimulate the nerves, very strong signals. But very good images. Don't worry.
Myke: Cool - Can I see them?
MRI Tech: Sure!
(I had no idea what I was seeing, nothing really obvious, sorry) (tho they did look damn cool)

2-3 Weeks for Radiologist's report. I'll be requesting the 'films' from that too. Stay tuned.