07 February 2008

Your Christmas Wish: A Long-Winded Medical Account, Right?

Because you care (and by "you" I mean me), I have de Quervain's Tenosynovitis, aka Something I Can't Pronounce and Assumed Was a Made-up Name But Hurts Like Heck. This is a condition where the tendons leading from your thumb to your wrist become damaged, swollen, and painful. This syndrome, sometimes called New Mother's Wrist, they believe is caused by the unusual position in which you are forced to stretch tendons previously unstretched in order to do things like pick up a baby under his armpits. Apparently the scooping motion combined with forcing the thumbs outward causes the problem.

I had this in my right wrist for several months after Peawhistle was born. My doctor at the Army Hospital (we'll call him Dr. Combat; few things amuse me more in this world than seeing my physician eternally dressed in BDUs and combat boots) injected the tendon with a cortisteroid mixture and all was well without any further pain. That is, until Peanut was born. For nearly four months I have had the same thing in now both wrists, the left being the worse culprit this time around.

I have a new doctor through Johns Hopkins. She's a lovely individual who is kind, patient, humble and welcomes criticism. In the negative column, I don't think she typically knows what she's doing. However, I think she knows this, and thus when something comes up that is unfamiliar to her she is more than willing to admit it and if necessary send you off in the direction of any number of specialists who hopefully have a better understanding than she. This is why I like her. She's basically me, but with the legitimacy of a doctor and access to prescription and referral forms aplenty. Thus, I'll call her Dr. Referral. Going in to her about the recurrance of the wrist pain I had an inkling that she would be at a loss, particularly with how to treat it, so I brought along Dr. Combat's medical notes he made at the time. As I started to describe my symptoms to her and the confusion began to spread across her face, I whipped out Dr. Combat's notes and she was simply delighted. She had to look it up in her online medical dictionary (always the willing learner, that one), noted the remaining treatment (injection), declared she couldn't do it and wrote me a referral for an orthopedic hand specialist. She attempted the test for deQuervain's, called Finkelstein's Test (pictured below), which is supposed to result in consideral pain, confirming the diagnosis. "Does that hurt?" "No." She did not administer it correctly. Nevertheless, she sent me to the specialist with her blessing.

I came home and did some research of my own, given that Dr. Combat never told me what the condition was even called (I think he felt such communication was unnecessary and pointless). He had written it in the notes, but I couldn't even read it until Dr. Referral looked it up with me. I realize that it is a cliche that doctors' handwriting is unreadable, but I seriously contemplated sending my medical record to NSA, convinced they would immediately offer Dr. Combat a job designing the country's newest unbreakable code. But back to my point, I found Finkelstein's Test and decided to administer it myself. My result was something like this: "AHHHHHHHHHHH!!! SON OF A .... AAHHHHHHHHHHHHHH!!!! AAAAAAHHHHHHHHHHHHHHHHH!!!!!!!!!!!" I administered the test correctly.

The next day I went to the specialist and his nurse-practicioner, who both poked and prodded me individually and then together. First, the nurse (aka Nurse Excruciating) took notes, did the test, ("AHHHHHH!!"), and then called in the doctor (aka Dr. Pain). He did his own exam, intentionally inflicting pain and then asking if it hurt. Fortunately he asked before doing the Test again: "You've already done the test, yes?" "Yes. And we're not going to do it anymore." "Fair enough." I elected to have both wrists injected in the same visit as I am not one for making unneccessary trips. I didn't understand at the time why they then gave each other "a look." I certainly understood afterwards.

To give you a better understanding of my willingness to have both done, let me explain how Dr. Combat treated me and my conditon. First, the diagnosis went like this:
Manipulating my hand as little as possible, he asks "Does this hurt?"
"Depends. Are you even touching me?"
(exasperated sigh, which his conversations were well peppered with when it came to me) "Fine. You do it."
"OK, it hurts when I do THIS."
*scribble, scribble*
He leaves to go get the medications for the injection. I wait 10 minutes while he chats up every person in the hallway (the man talked more than a 13-year-old girl), strongly tempting me to get up and yell out the door, "Hey Oprah, could you cut the interview short? I'm in pain here!" until I recall that he could very well inflict great pain upon me "accidentally" so I keep my trap shut and patiently wait for him to make his jr. high locker rounds.
He finally returns having got the talking all out of his system enough to continue his habit of exchanging as few words with me as humanly possible. He holds my wrist in a very comfortable position, gently and slowly injects the cortisteroid, massages and works it into the tendon, and then checks on my pain level. The pain has disappeared utterly and completely. He laboriously scribbles some more, hands me my chart, and shoves me out the door with his fondest fairwell. Overall, a satisfying and pain-free experience.

Nurse Excruciating and Doctor Pain do things differently. After deciding that it would be better to send me into complete shock, they choose to do both injections at the exact same moment. Forcing my wrists and thumbs into the most painful position available to them, they jab each tendon with the needle and dispense the medication as quickly as possible. They seem perfectly oblivious to the neverending trauma they are inflicting. To ebb the now-steady flow of blood from both injection sites, they apply large bandages to each wrist, which, to the unknowing observer, now strongly resemble a botched suicide attempt on my part. I am instructed to obtain specialized braces for each wrist, which incidentally my insurance does not cover through their office, forcing me to travel into my arch nemisis, Annapolis, to obtain them. I made it out by the very skin of my teeth, particularly given that I cannot move my wrists or thumbs in the new braces. Apparently, those are important in operating a vehicle, reducing my ability to steer to that of your average, large household pet. I am to go back to the specialist in a few weeks so I can tell them that their hack job didn't do the trick, leaving surgery as the final available option. They strike me as the sort who would do it without anesthetics, too, possibly on a dare.

It was not until this week that I became fully appreciative of the level of competence displayed by Dr. Combat, the medical one-stop-shop. Not only did he immediately know what was wrong with me, including that horrendous name for it, but also how to treat it, how to administer it himself, and with as little pain as possible. He did the work of three people, only better. Incredible.

Stay tuned later for the Complete Adventures of Dr. Combat, where not a single encounter ever resulted in anything less than complete amusement and entertainment on my part (on his part: an ulcer)!


Misty D. said...

Oh, Abby. I'm so sorry! If you need to have surgery, I am more than willing to take time off of work to come out there until you heal.

Think of all the crazy fun we can have!

judiroso said...

ROFL, I almost peed my pants that was so funny. I think I had that same thing once but I didn't have to go thru the agony you did. Three Cheers for Dr. Combat, it is so rare we find someone competent.

Abby said...

No joke, Di. He's the only doctor I've ever complimented by telling him he was a good doctor (can't have them getting big heads now, right?). He said "Thanks" in a way that really said, "I know it." A lack of confidence was never an issue he had to deal with. I'm glad the Army has him 'cause they surely need him.

And Miss Misty, that's terribly kind of you to offer. My mom's on tap should it come to that; however, nothing's stopping you from visiting me anyway.

Audra said...

Well written article.

Abby said...

Thank you very much. Glad you enjoyed it.