Of mending hearts and hands Sun, Mar 7. 2010
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?
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?
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#2 - Gordon David Bonnar said:
2010-03-08 03:51 - (Reply)
So sorry to hear about the wrist news. I really thought this surgeon would be the guy.
You are one of the stronger people I know. You are by no means someone I would define as weak. Sensitive, sure. Caring, of course. But not weak.
Every break-up is different, and even more so for different people, so I won't tell you I know what it feels like, as I don't know what it feels like /for/ you. I will tell you that it will only get easier. Time actually does make things a little easier to swallow. It will make it a little easier to sleep without thinking of her, it will make it easier to do things you used to do together without being emotionally stabbed. All told, just hang in there.
Also, you should become a wrist specialist. I bet you know AT LEAST as much as the frontline doctors who first saw you and mis-diagnosed the hell out of you. You could specialise in scapholunate ligament avulsion fractures.
Comment (1)
#2.1 - Mike Geiger 2010-03-08 15:55 - (Reply)
Thanks for the encouraging words. I need them.
Comment (1)
#2.2 - James (Nessalc) 2010-03-18 03:03 - (Reply)
I went through a similar breakup--no explanation, just "I never want to see or hear from you again". Last I heard, she moved to Afghanistan (go figure). As Gordon said, time makes it easier, but I can't say that the pain goes away, even 2+ years later. But as I said, it will get easier.
Comment (1)
Myke's 'blob. on : Single-Handed Combat
Myke's 'blob. on : It's Safe To Say It's Over