Myke's 'blob.

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 I 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.

Write a comment...

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.

Almost 100 days of suck completed!

Just as I started planning a post-Christmas trip to Amsterdam to see Alia & Martin & Samara, and celebrate the new year, my knee MRI gets booked too closely to make going worth it (in terms of affordability and time-spent.)
I guess I need plan for the unexpected, what with more tests, doctor's & surgeon's appointments - and likely surgery itself, I'm not really sure that I can plan any real trips/vacation at all in the next year... And we were talking about a family trip in the winter too. And K and I wanted escape somewhere too.

This 'blog is approaching LiveJournal levels of emo

Wrist MRI is confirmed for this weekend though!