Had my post-surgery checkup yesterday and am stuck in this same cast for another two weeks. However, the doctor had some X-rays done in the office and I’m healing very well - for just a week after surgery. The doctor actually thanked me for healing well; I don’t know if that’s just a thing he does or if he was thanking me for listening to his instructions and doing the exercises with my fingers and keeping my arm elevated, etc.

I’m getting a little better/faster at typing with one hand, but I don’t like it. One bit. It’s still slow and annoying.

I’ve added more of my library to LibraryThing.com; it’s easy to add ISBNs with one hand since I can just use the number portion of my keyboard. I’m up to almost 850 titles. I commemorated the event by posting something to the book portion of this blog - here.

Time to wash my hair. It’s a whole f***ing production. Since I can’t shower, I have to run a bath and tie my casted arm up in a plastic bag, then pull down the shower head (since I have one of those with a hand-held sprayer) so I can wet and rinse my hair without getting the plastic bag arm too wet.

My hand and wrist are hurting a good deal today. I haven’t taken any Motrin or anything today, so that might be it. I’d best do that soon, too. Ugh.

Typing with one hand is incredibly frustrating.

However, one of my homework assignments for Friday’s follow-up dr. visit is to flex and release the fingers on my left hand. Right now, my fingers hurt terribly since my wrist area and fingers are so swollen. It’s like having painful little Vienna sausages as fingers. My sister suggested that I consider it practice for waving like a princess; “but I’m not a princess,” I replied.

“Yes, you are. You’re Princess Vienna Sausage Fingers.” And then she kissed the icepack I have over my fingers.

Overall, I’m doing ok now. The surgery itself took longer than my surgeon expected (2 hours versus his original estimate of one hour) since they had to “finesse it a bit” and realign tendons and stuff so my wrist can heal nicely.

I also ended up staying in the hospital overnight since I had some pretty bad after-effects from the anesthesia (I couldn’t keep anything - water, Saltine, painkiller - down.) I got two intravenous anti-nausea meds, then an anti-nausea shot in my arm and another shot that had to be administered into a muscle (my gluteus maximus in this case) and an anti-nausea patch behind my ear. I got home at 1 in the afternoon Saturday and was finally able to eat and drink.

The pain in my wrist is pretty bad whenever I move that arm (I’m in a cast up to my elbow) but the Percocet helps a little with that. I’ve got more than enough pillows to support it and keep it above my heart, so that’s precisely what I’m trying to do. I’ve been sleeping a lot, and drinking lots of fluids since Percocet tends to dehydrate me.

I was also painfully dehydrated after anesthesia, but I couldn’t drink, so that sucked. I was intubated during the surgery, but didn’t get a sore throat.

Right now, I’m going to get into bed and read. I’ve been too dizzy and sleepy to do much of that, but I’ve decided to stop the Percocet and use Motrin instead since the pain isn’t quite as severe.

Theresa & Kofi came by yesterday to visit and we watched several episodes of “House” together, which was fun. They also brought me a feel better basket containing three types of tea, a vampire novel, a pincushion plant, a beanie-baby ghost named Ghoulianna and leaves from outside. My brother actually brought me a bouquet of flowers and my other brother and his girlfriend brought me lunch from Boston Market yesterday (because comfort foods rock.)

Now I’m feeling dizzy; time to lie down.

And trying to type with one hand. I’ll need to practice before I return to work. Actually, it’s not terribly bad if I type on a regular keyboard - so I might have to bring my regular non-ergonomic keyboard to work. We shall see.

Today, my co-worker/cubicle neighbor brought me a cannoli from the bakery in town, and then another co-worker brought me some Buffy episodes on DVD for me to watch while I convalesce. I went into my boss’s office to review a bunch of stuff that she would need to know about during the next week, and while we were sitting there, I was ambushed!

All of the people in my department, along with some of my buddies in other dept’s, gathered ’round my boss’s door and surprised me with a pretty grand send-off and two “get well soon” cards, signed by all my peeps. It was so nice and sweet and touching; I felt the love all around… which just made me think, “Wow - I really work with some great people!” Not that I don’t think it usually, but this made it all the more obvious.

(OK - I just typed those 3 paragraphs with one hand. It wasn’t tragic; just slow.)

I got a haircut/trim so that my hair is more manageable over the next few weeks and months. Now I have a crazy kickin’ headache and neckache and lower backache - stress, anyone? I might take a nice soak in a bubble bath with some Epsom salts. Though I don’t know if Epsom-salted water will respond to the surfactants in bubble bath and actually bubble. Hrm. That might be another experiment for tonight.

First, though, I have to eat something light and drink plenty of water since I’m not allowed to eat or drink after midnight tonight; I need to fast prior to the anesthesia. An apple. That would be nice. Maybe some pretzels. And then I need to get to sleep soon since I have to be at 5 or 5:30 to get ready and report to the hospital by 6:30.

OK. Water, fruit, bath, sleep. Sounds like a game plan.

I got to talk to my surgeon today and here’s the deal…

Surgery - Friday, October 27th, bright and early
He wants me off the job for 10 days afterwards… which means the entire following work week… so no typing for me (unless I use only my right hand) from the 27th all the way through to November… uh… 6th, when I’ll return to work to type with only one arm.

I talked to my boss tonight and she said we’ll work things out somehow. I might just be a slower typer for a while.

Additionally, the doctor confirmed that I’ll be in a cast between 4 and 12 weeks, depending on how I heal. Once I’m out of the cast, I’ll be in a soft brace indefinitely - but it will take up to a year to heal fully. I’m going to have to go for physical therapy 3x a week. That’s going to be fun to work around my work schedule, and to get my family to drive me to. I HOPE I can find someone who is either really close to home or really close to work and who can do early morning or late evening hours so I can make it work with my schedule. It’s not going to be easy. At all.

I’m still very much in a funk and I’m ready to go to bed already, though I only got home from work at 8pm. Just constantly drained. I won’t know my blood test results until Saturday… so no answers on the hypothyroidism question until then.

Between my physical and mental and emotional ailments, I’m really ready to exclaim, “Twenty-eight is really too young to be falling apart!” But I feel like I am. More often than I’d like. Gonna go to sleep now.

It’s called stress.

Between work (juggling three positions for this past week and the next two) and medical stuff and my usual worries, there is ample reason for me to be stressing.

How do I know that I am stressing? I wake up feeling nauseated and tired, even after 10 hours of sleep (like last night.) I have no appetite and no desire to do anything. I am SUPER-irritable and suffering from logorrhea, which is especially sucky at work.

The past five nights, dinner has been a bowl of Frosted Mini Wheats with 1% milk (all that we drink here at home - which is fine since I’m not a fan of milk) and breakfast has been… well, tea and picking at a muffin top from the cafe next door to work. I don’t have the urge or desire to eat anything else. Lunch has been a bit better, but even then it’s not like I’m devouring a ton of food. I just get to the point where I feel faint and physically need to eat, though I have no appetite. Yesterday and the day before, though, I just had a 12 oz. cup of soup each day. Today I had a little more than that. Thankfully.

Some of my stress was decreased by calling my insurance company and finding out what the hell was up with the claim from my first orthopedist. Turns out that his office not only filed the claim well after the accepted timeframe (February office visit - claim filed in September???) but that they used the wrong tax ID code for their office, making them come up as an out-of-network provider.

I got the correct info from my insurance company and tried calling the doctor to straighten it out. I tried calling for two hours straight; busy signal or no answer. I kept calling. Then it started going to the answering service. So - I wrote a letter and sent it via registered mail. Boom. Done. I instructed them to refile the claim using the proper tax ID # and informed them that they’d have to provide a letter of explanation to the insurance company outlining WHY the claim was so delinquent. And I tacked on that any further communication regarding this claim should be conducted with my insurance company, and thanked them for their prompt attention and for resolving this matter.

I’ll have to check the signature tracking at work tomorrow to make sure bitches got it.

I also made an appointment with a regular old primary care physician-type doctor, since I haven’t had a regular old checkup in… um… five years? I’ve seen specialists and mental health professionals, and I guess my gynecologist sort of qualifies, but she’s not one for the chatting and I need to chat. Because perhaps a lot of the things I’ve been experiencing lately are caused by one thing.

Perhaps this thing is hypothyroidism. My mother was recently diagnosed with Hashimoto’s thyroiditis and I was tested for hypothyroidism six years ago and the results were negative. Things can change, though. Check it - symptoms of hypothyroidism:

Fatigue - yup
Weakness - yup
Weight gain or increased difficulty losing weight - YUP
Coarse, dry hair - nah
Dry, rough pale skin - dry and pale, not rough
Hair loss - yup
Cold intolerance (can’t tolerate the cold like those around you)- yup
Muscle cramps and frequent muscle aches - yup
Constipation - nope
Depression - YUP
Irritability - yup
Memory loss - yup
Abnormal menstrual cycles - N/A since I regulate that medically
Decreased libido - N/A since I ain’t got no man

The doctor might send me off to an endocrinologist, but seeing a PCP is a good first step, I gather. I’d rather do this than just pick an endocrinologist off of my insurance website and start from there. A diagnosis would be a good start - self-diagnosis can only take a person so far. The appointment is next Friday. Three weeks later (Oct. 27), I have my wrist surgery. Chances are that I will be a less active web person during the recovery.

In the land of “things I’m looking forward to” - there is tomorrow, which is Friday and an indication that I made it through one week already. There is Saturday when I will be seeing “The Science of Sleep” with Kofi and Theresa. I am quite excited about that. I’m getting a sort of darker “Amelie” vibe about it (that’s probably the Michel Gondry effect)… and then there’s the stunning fact of Gael García Bernal. Adorable. My age, so I don’t have to feel weird. And pretty damn sharp.

I saw an interview with him when “The Motorcycle Diaries” was first released (I don’t remember if it was Charlie Rose or what) and he was extremely well-spoken - more so than most of his acting kin for whom English was a FIRST language - and politically informed and just… I dunno. Dreamy. And, apparently, “when he was 14 he taught literacy to indigenous peoples in Mexico, most often with the Huichol Indians.” That’s just lovely.

Anyway, I’m feeling exhausted. I’m going to finish this mug of green tea (Harney and Sons Bangkok blend - green tea with coconut, lemongrass and ginger… delightful) and collapse on my bed. I’m not even washing off my eye makeup. Splashing any water on my face at this point would wake me up too much.

While I was on the train home, the doctor called. We chatted for a bit and he’s going to give me a call the week after next when he is able to schedule my surgery for sometime after October 16th.

I’m going to be having a proximal row carpectomy. “What,” you may say, “is a proximal row carpectomy??” Allow me to explain. Rather, let me paste in what an orthopedic journal online had to say, including information on the post-op treatment, recovery time, etc., and then write up my layperson’s view.

Proximal row carpectomy(PRC)- The surgeon’s purpose in removing the bones in the proximal row is in attempt to eliminate pain but maintain ROM that wouldn’t be present with a wrist fusion. A PRC is indicated for diagnoses such as scaphoid non-union, radioscaphoid arthritis, scapholunate instability, and AVN of the lunate or scaphoid.

The primary therapy goals are to eliminate pain, maximize function and prepare for productive activity at home and work. It is likely there will be eventual decreases in ROM and strength (approx. 30%) compared to the uninjured hand.

Weeks 1- 4: The patient is immobilized in a thermoplastic splint which is removed only during therapy. Edema and pain control are achieved with appropriate techniques such as edema massage, TENS, NMES, fluidotherapy, or cryotherapy. Full active thumb and digital ROM is initiated on the first post-op visit. Digital flexion may be limited because of the decrease in carpal height and the altered length-tension relationship of the flexors post-op. The exercises should be performed 3-5 times a day within the splint.

Week 4: Gentle AROM of the wrist is initiated. ROM should progress slowly and according to pain tolerance. Throughout the rehab process, some minor increase in ROM might need to be sacrificed for a less painful, more stable wrist. The wrist splint is normally continued for protection, but may be removed for bathing and exercise. The patient will likely spend approximately 8 weeks in a protective splint before discontinuation.

Week 6: As AROM begins to plateau and reach functional levels, gentle isometric strengthening exercises are initiated as well as light functional activities at home.

Week 8: Progressive resistive exercises using weights to strenghten the wrist and forearm can be initiated if the expected ROM has been attained and the patient is without pain. Grip strengthening can begin using theraputty with progression to a spring gripper as tolerated.

OK. So, in your wrist there are eight little bones. Those are the carpals. They each have a special name; there’s hamate, capitate, pisiform, triquetral, lunate, scaphoid, trapezoid and trapezium. They’re divided into two rows in your wrist - the distal row and the proximal row. The distal row is the row of bones that’s attached to your finger bones; there are five bones in the distal row. Below the distal row, connected to your ulna and radius, is the proximal row. The proximal row is composed of the scaphoid, lunate and triquetral bones. The disease/condition I am suffering from is Kienbock’s disease, which is otherwise known as avascular necrosis of the lunate. My lunate - the middle bone in the proximal row - is dead, fracture, and turning to mush. This causes great pain, arthritis, loss of strength and loss of range of motion (the ROM referred to above).

Since my lunate bone is essentially mush, there are limited procedures that can be done. It is what my doctor called, “a salvage mission.” We want to decrease my pain and get back my range of motion. Thus, what my surgeon is going to do is a proximal row (the entire row of three bones including the lunate) carpectomy.

Now it’s time for some Fun With Roots!

-ectomy: a combining form meaning “excision” of the part specified by the initial element, used in the formation of compound words

Carpals = carpectomy.
Appendix = appendectomy.
Tonsils = tonsillectomy.
Hystera = hysterectomy. (hystéra means womb or uterus in Greek)

So… he’s going to remove or excise that second row of bones closest to my ulna and radius. Rather than becoming bionic and having metal implanted in my wrist, my body will now have only 203 bones compared to the 206 in normal, healthy adults.

I’m sort of OK with this. Less chance of infection since they’re not putting anything IN, just taking bones out. I’ll need physical therapy , but that’s OK, too.

Ah. My mother is home. I haven’t had the chance to talk to her since she got back yesterday, so I’m going to go do that now. Perhaps I’ll write more later.

I spoke with the doctor today… and there’s still no definitive answer on when and how my surgery will take place. But that’s OK. I got some piece of mind just talking to him and seeing that we’re on the same page… with him a little ahead of me, fortunately.

However, we discussed several things. He’s been reading and researching, and talking with other orthopedists and hand specialists (including a hand dude who has operated on many Kienbock’s patients and with whom my doctor would team up for the surgery) and my MRIs and CAT scans are currently with this second doctor. Basically, his main concern is picking the right surgery for me so that I have as much use of my hand as possible afterwards… that is, the smallest possible decrease in range of motion (ROM) and grip strength.

I spent about 5 minutes on the phone with him discussing what I’d found on the Kienbock’s disease website I’ve been visiting and I asked him if one of the things he was considering for me was a titanium lunate implant. He said that option came up several times and is certainly one of the things he’s considering. He just told me that he didn’t want to make a recommendation until he’d explored ALL possibilities for me… since the complications are that I’m in such an advanced stage of the disease (3b of 4 stages) and because I’m still so young and have so many years of use left in this wrist. Rather than making it easier, my youth makes it harder because, in his words, “It’s not like a broken bone where we stick a pin in it and let your healthy young bones heal together.” This is something degenerative and it’s not a matter of just setting things right and letting them go. He asked me about the case studies/personal accounts I’d read and I told him that most of the people who were posting up their experiences were older than I am, with a few exceptions.

As we’d discussed during my last office visit, I reiterated that my biggest concern was regaining some range of motion and decreasing the pain. The doctor asked me if the personal accounts I’d read online gave any indication of the difference in pain and ROM, etc. pre-op versus post-op. I told him that most of them were pleased with their surgery results because the pain was virtually gone (unless they overdid it and tried to perform headstands or something) but that there was some residual loss in ROM or strength, but less so in the case of the titanium implant - which is why, I said, I was asking him about that specifically.

He also mentioned that he was considering a new type of external fixation, but I just looked that up (at least the current or “old” version) and it’s got a minimum healing time of 6-8 weeks, which I’d spend with a large metal device mounted to the outside of my arm with pins sticking into my bones at the wrist and forearm, and which I’d have to clean vigorously to prevent my skin from grafting to the metal pins.

That, to me, seems like it would greatly decrease my usefulness in the real world. Unlike the woman who posted her experience with an external fixator on the Kienbock’s website, I don’t have a wonderful fiance who’d make it easy for me and take care of things… or give me a sponge bath… or comb my hair.

Tomorrow is Thursday already and I think I have an appointment with my other doctor tomorrow night… but I have to call and make sure since I didn’t get a confirmation phone call tonight, but I think they’re closed on Wednesdays. It certainly won’t hurt to call tomorrow afternoon… and if the appointment is for Friday, I’ll be OK too. I just need to see the doctor since today was also less than pleasant… but I won’t go into that. There was drama; I was treated like 13-year old; I cried in the bookstore.

But I talked to Theresa and she gave me some good advice and reminded me that I am an OK person and made me feel warm and happy. I was telling her that while the natural “unnatural” inclination during a depressive episode is to withdraw and recede from the world, it’s really not the best thing to do and that spending time with a good friend is as good as, if not better than, taking an anti-depressant since it naturally stimulates those happy neurochemicals and generates that sort of “contact high” from being around someone who cares about you… even when you don’t exactly care about yourself too much at the moment. So, she told me to call her even if I don’t feel like it… because it will be good for me.

And I discovered my new favorite kind of tea at Barnes and Noble - Harney and Sons “Bangkok Blend” green tea. It’s green tea flavored with coconut and ginger. I had it with a bit of honey and it was divine. I’ll have to ask my sister to get me a few tins on her next employee appreciation day, which should be coming up in October or November.

Well, I took my sleeping pills at about 10:30, so they’re going to be kicking in sooner rather than later and I need to try and get up early tomorrow since I’ve been oversleeping these past three days. Not good. There might also be an argument awaiting me in the morning, so I’d best be prepared for that, too. Happy happy, joy joy.

Here’s one view of the CAT scan of my left wrist. Until I get the CAT scan of my right wrist tomorrow, this image means very little to anyone who’s not an orthopedist. I just think it’s cool-looking. I actually made a wallpaper from it. I’m not going to share that with the world at large just yet - or ever.

I’m just not having a good day today. I missed out on the relaxing weekend I was hoping for and the return to work was not smooth. I just couldn’t find my groove and found myself wanting to go hide in the bathroom stall and cry for no reason. Just because I don’t feel like myself right now. It certainly doesn’t help that my next paycheck is entirely gone before I get it to pay the second portion of that big school loan… and that means I have no more income until September 15th. That really blows. Horribly. Truly. I think that, more than anything, is responsible for the funk I’m in right now.

However, it’s not the only factor. I am feeling lonely (after having been surrounded by couples at the BBQ yesterday) and feeling unattractive and gross in a variety of ways. By the time I got home tonight, I felt like I was going to throw up, so I did not get on the treadmill. If I go to sleep soon - say, 9ish? - perhaps I can get up at 6 or 6:30 and start my day with a run and find myself in a better mood all day as a result. Maybe? It might work. It might not.

I’m watching “Dark City” again. There’s just something about that Rufus Sewell. He’s captivating. Kiefer Sutherland = not so much. He’s got this wacky stilted stutter thing going in this film. I don’t know whether to be amused or annoyed by it.

My wrist hurts. My head hurts. My stomach hurts. My eyes itch (ragweed season ahoy!) and I need to get to sleep. I’m not sleepy, but perhaps this is a night to break out the sleeping pills.

Today was visit #2 to doctor #3. We went over the results (rather, lack thereof) of the NSAIDs I was taking for my wrist.

Before discussing the nitty gritty of surgery, the doctor asked me if any of my prior doctors had sent me for a CAT scan. I said no, and he said that he wanted to send me for one before determining what kind of surgery he’d recommend. According to him, the pathology can present one thing, but what is actually wrong can be quite different, so it’s best to do every possible pre-test and pre-diagnostic and examination before slicing anyone open.

I strongly agree with this mode of thinking.

So… he wrote me a “prescription” for a thin-slice CAT scan (+ 3D of my left wrist - I’ll be asking for those films!), and called the insurance company to get the pre-certification/authorization. Tomorrow morning, I am calling one of the two radiology/imaging centers in the area and seeing who can get me in for the CAT scan sooner. One of them is on my way to work and starts scheduling people at 7 am. The other has Saturday hours. Hopefully, they can get me in way early on Thursday or Friday at the one place, or fit me in on Saturday at the other. I’ll find out in the morning.

Since my method of dealing with something strange/new/unfamiliar/potentially scary is to research the F**K out of it, I’ve done a lot of reading in the past 30 minutes on thin slice CAT scans and computed tomography in general. I shan’t bore you with details, but here’s a rather informative site for the layperson.

Once I get the CAT scan results, I already have an appointment to see the orthopedist next Thursday to review the results and discuss our next steps. It’s good to have these discussions; they keep me from feeling totally frightened since he tells me exactly what is going on, why he is sending me for tests or what-have-you, and uses the actual medical terminology unless I look confused or otherwise indicate that I have no idea what he’s talking about. Even though I hadn’t heard the term “avascular necrosis of the lunate” until a few months ago, I was able to figure it out… though I still regret not having been able to take Latin in high school. But I manage.

“Avascular”: prefix “a-” denotes absence of, as in “amoral” = lacking morals. “Vascular” = having to do with the veins and circulatory system, as in “cardiovascular” (heart and circulatory) as opposed to “cardiopulmonary” (heart and lungs). Thus, “absence of circulation/blood/vascularization.”

“Necrosis”: prefix “necr-” implies “having to do with death”, as in “necrophilia” (love of the dead) or “necromancy” (summoning of the dead). So necrosis = death.

“Lunate”: well, this one wouldn’t have been clear without knowledge of my wrist’s anatomy, but it makes sense in general. The lunate bone is supposed to be shaped like a crescent moon when viewed from the side - “luna” = moon. Done.

All told, death of the moon-bone due to lack of blood. Yay, roots! Yay, language!

Ok. It’s now 10:30 and I excused myself from watching “Spiderman” with my mom and my cousin since I want to get to bed at a decent hour and get up early to go to the bank (in addition to shaving my legs and the other morningtime fun I have planned.) Last night, I finished off a really good read - and an entirely OK memoir - called “The Glass Castle” by Jeannette Walls. It’s not going to win a Nobel Prize for Literature, but if you want a book to make you think, “Hey, my childhood was pretty OK, though not nearly as memoir-worthy”, this is a good fit. Unlike some of the memoirs I’ve read (”The Liars Club” by Mary Karr comes to mind) this one doesn’t play (as heavily, anyway) upon the manipulation of the reader’s emotions in trying to elicit a response. Instead of belaboring the, “Oh, wasn’t it tough!” point or “…and I didn’t realize until I was an adult that [insert odd childhood detail] wasn’t normal…”, this particular memoir just told the story - and you don’t feel sorry for anyone, really. You identify with the author’s sense of shame, and her desire to make things better… but you don’t ever feel your eyes welling up with tears or find yourself wanting to donate money to a charity.

Then again, someone might read it and think it’s the saddest thing they’ve ever read since, admittedly, it’s not easy to make me cry, especially through contrived methods like movies, fiction, etc. I’m quite skeptical on that front, but not entirely cold and without feeling. I just recognize when bullshit is being thrown at me and when someone is trying to manipulate me through emotions instead of speaking to logic or morals or my innate sense of justice. THAT is more effective than the emotional nonsense.

I had a big spinach salad for dinner at an authentic New Jersey diner - where we took my cousin for the experience. I didn’t finish the salad because it was HUGE, so it’s my lunch tomorrow. My cousin had a Caesar chicken wrap and enjoyed it very much… so that was cool. My sister’s boyfriend drew us a storyboard/panels for a cartoon on the backside of his placemat and we all had to take turns writing dialogue for the characters he drew. I made the strange popcorn-looking fellow state that he was appalled at the beaver-looking critter’s sense of patriarchal dictatorship and proclaimed that he/she was a feminist vegetarian supporter of Jesus. My mother wrote in an apology on behalf of the beaver, and my sister wrote in the popcorn’s response, “You type of people make me want to put up my fists!” and then the popcorn was eaten by a shark that appeared from nowhere and I wrote in the dialogue for the beaver who was laughing at the shark-devoured popcorn. The beaver said, “You’re going DOWN, beyotch! Aw, yeah - JAWS STYLE. (Watch Shark Week on the Discovery Channel!)” And that was it.

And now it grows even later. It’s 10:56. I am going to get to bed and continue reading for a little while, but not until 2 in the morning like I did yesterday since I was so intent on finishing “The Glass Castle.” Silly me.