So… today was the visit with the orthopedic surgeon. He palpated my wrist and checked my range of motion. He took some X-rays. The good news is that I don’t have carpal tunnel.

The bad news is that I have something called Kienbock’s disease in both my wrists, but it’s worse in my left wrist. Rather than trying to summarize everything the doctor said, let me break it down this way - first, WebMD:

Kienbock Disease is an acquired bone disorder. Abnormalities of the lunate bone in the wrist develops following an injury or inflammation. Recurrent pain and stiffness occur in conjunction with thickening, swelling and tenderness in soft tissue overlying the lunate bone. The range of motion in the wrist may become limited.

The Kienbock Disease Information Center website has this to say:

Kienbock Disease (KD) is basically, where the blood supply to the Lunate bone in the wrist shuts off and the Lunate bone dies. There are different stages that depends on how much damage has been caused from the lack of blood supply. The bone dies and the body absorbs the dead tissue. This causes the other bones in the wrist to move out of place and rub against each other wrong. This creates a lot of pain.

Kienbock is considered “uncommon” instead of “rare”. All that means is about one in every 150,000 - 200,000 or so get it.

There is no single known cause of Kienbock Disease. Some think over-use causes the problem, but there are many who get it that do not overuse the wrist. There is no one single cause of it. There [do] seem to be many factors that contribute to KD: Overuse, Injury, Genetics, Long Radius, Long Ulna, to just name a few. Most people with KD have varying combinations of factors. This also creates a problem when trying to find a treatment. The treatment depends on the person and the contributing factors.

The American Academy of Orthopedic Surgeons OrthoInfo website has a bit more info…

Kienböck’s Disease

Bone is living tissue that requires a regular supply of blood for nourishment. If the blood supply to a bone stops, the bone can die, a condition known as osteonecrosis. That’s what happens in Kienböck’s disease, which affects the lunate, one of the small bones of the hand near the wrist.

Signs and symptoms

The cause of Kienböck’s disease is unknown. Many people with Kienböck’s disease think they have a sprained wrist at first. They may have experienced some form of trauma to the wrist, such as a fall. This type of trauma can disrupt the blood flow to the lunate. In most people, two vessels supply blood to the lunate, but in some people there is only one source. This puts them at greater risk for developing the disease. As the disease progresses, other signs and symptoms are noted, including:
•A painful and sometimes swollen wrist
•Limited range of motion in the affected wrist (stiffness)
•Decreased grip strength in the hand
•Tenderness directly over the bone (on the top of the hand at about the middle of the wrist)
•Pain or difficulty in turning the hand upward

Progression

Kienböck’s disease follows a specific progressive pattern through four stages.

•Stage 1: Symptoms are similar to those of a wrist sprain. X-rays may be normal or show a line indicating a possible fracture. Magnetic resonance imaging (MRI) may also be helpful in making the diagnosis in this early stage.
•Stage 2: The lunate bone begins to harden. On an X-ray, it may appear brighter or whiter than the surrounding bones. These changes indicate that the bone is dying. Either an MRI or a computed tomography (CT) scan may be used to assess the condition of the bone. Recurrent pain, swelling and wrist tenderness are common.
•Stage 3: The dead bone begins to collapse and break into pieces. The surrounding bones may begin to shift position. Patients experience increasing pain, weakness in gripping, and limited motion.
•Stage 4: The surfaces of adjoining bones are affected, resulting in arthritis of the wrist.

Diagnosis and treatment

In its early stages, Kienböck’s disease may be difficult to diagnose because the symptoms are so similar to those of a sprained wrist. Even X-rays of the wrist may appear normal. At this point, the goal of treatment is to relieve the pressure on the lunate and help restore blood flow within the bone. Your physician may splint or cast your wrist for two to three weeks. Anti-inflammatory medications such as aspirin or ibuprofen will help relieve any pain and reduce swelling. If the pain continues, your physician may refer you to an orthopaedic or hand surgeon for further evaluation.

Surgical options

Although there is no cure, there are several surgical options for treating the more advanced stages of Kienböck’s disease. The right procedure for you will depend on several factors, including disease progression, your personal activity levels and goals and your surgeon’s experience with various procedures. Do not hesitate to discuss these options with your orthopaedic or hand surgeon and to ask why he or she is recommending a particular procedure.

In some cases, returning the blood supply to the bone (revascularization) may be possible. This procedure uses a bone graft from the inner bone of the lower arm. It may be combined with an external fixator, a metal device that helps relieve pressure on the lunate and preserve the spacing between bones.

If the bones of the lower arm are uneven in length, a joint leveling procedure may be recommended. Bones can be made longer with bone grafts, or shortened by removing a section of the bone. This reduces the compressive forces on the lunate and seems to halt progression of the disease. If the lunate is severely collapsed or fragmented, it can be removed. The two bones on either side of it are also removed. This procedure is called a proximal row carpectomy and will relieve pain while maintaining partial wrist motion.

Another way to ease pressure on the bone is to fuse several of the small bones of the hand together. However, this will not improve range of motion. If the disease has progressed to severe arthritis of the wrist, fusing the bones will reduce pain and help maintain function, although motion is limited.

In your arm, you have two bones - for simplicity’s sake, I will refer to them thus - big bone and little bone. My little bone is MUCH shorter than the big bone… about 5mm shorter. Partially because of this shortness, the little bone is sort of pushing into the big bone which is then pushing into the little bones in the wrist, of which the lunate is the one that is being most compressed. Compression of that bone is the whole cause for Kienbock’s. Here’s a picture that sort of shows what my X-ray looked like:

Just that my little bone is a good deal lower than the little bone in that photo. It’s pretty pronounced - the doctor actually went, “Wow!” when he saw the X-ray.

Anyway, I made a call to another orthopedic surgeon for a second opinion and am waiting for his office to call me back about making an appointment. The recommendation from this first doctor is to get the surgery within the next 2-3 months because the longer I wait, the greater the chances of the bone (the lunate is the one near the arrow head) further deteriorating and the greater the chances of me developing some nasty-ass osteoarthritis and losing even more wrist function. As it stands, I won’t ever recover my full range of motion in this left wrist - but at least the pain will be gone and I’ll be able to do yoga and Pilates and stuff again.

Oy. Anyway, I’m glad I know. I can see doctor #2, schedule the surgery and then spend 4 weeks in a cast (since they basically cut a wedge-shaped slice out of my big bone to make it the same length as the short bone and take pressure off the lunate) because they’re creating a bone fracture. Four weeks in hard cast, two weeks in soft cast/splint, and then done. The sooner, the better - I guess.

We’ll see. Right now, I’ve got a hankering for some apple juice.

Yesterday, I got a bag of pre-cut red apple slices to eat at the trade show I was working. I had them refrigerated today and I’m snacking on them now - MAN, are they tasty! I might have to buy these regularly because they are SOOO convenient and so tasty. It’s worth the $$ in my opinion. I don’t have to core the apple or slice it or ANYTHING.

I wouldn’t spend the $5 for a pre-made salad, but pre-cut apple? Yessirree.

On the train ride home, we stopped at a station and I was observing some of the people sitting on the benches on the platform waiting for the next train. I was listening to the Gorillaz “19-2000″. That’s the one with the “get the cool shoe shine” chorus. At that moment, an old woman on the platform was tapping her foot exactly to the beat and then when the song moved into the next segment, her OTHER foot started dancing with that new rhythm. It only lasted about 15 seconds, but it was pretty cool and made me smile. Like when you find yourself walking in step with a friend, or when the blinker or windshield wipers are in sync with one another or the song on the radio…

Those little moments of synchronicity are pretty snazzy.

I am totally disconnected from my body. I feel no soreness - no pain - nothing. I’m just tired.

I emailed my professor since I logged onto the class chat and found I had nothing relevant or constructive or event somewhat intelligible to say in our discussion board postings (due at midnight tonight). I asked her if I could post something tomorrow when I’m thinking clearly again - thankfully, she said OK.

Three days of 10-12 hours days are no fun. I have $90 of parking and ferry tickets and food to put on an expense report tomorrow - my first one at this job! Yippee!

I just popped the first Harry Potter movie into the DVD player. I’ve seen it sooooo many times, it’s almost as perfect as background “music” as Pride and Prejudice.

It’s soo time to get the hell to sleep.

I’ve been on my feet - literally - since 9 a.m.

I got home from the expo/trade show at 8. In between, I stood and walked and stood and walked and didn’t eat a whole lot, but wasn’t really hungry. Thirsty, yes. Hungry not so much.

I am getting into bed RIGHT now and getting some rest before tomorrow’s “finale.” Then it’s back to work on Monday, and then a nice and well-deserved day off on Tuesday, on which I’ll be going to the orthopedist and perhaps having lunch with a friend or two. Then I can spend the rest of the day - I dunno - shopping for pants? Making Rice Krispie treats? Cleaning?

In any event, every part of my body is in that state of exhaustion that immediately precedes soreness and/or pain. I’m going to take some “Vitamin I” as a pre-emptive measure.

Today was day one of the three day working weekend at a trade show. I have to be in NYC by 10 a.m. tomorrow, so I’m going off to bed. It’s odd to feel that I have a “bedtime” on weekend night. Strange.

I think I’ll have to take my sleeping pills to make sure I actually sleep THROUGH the night. The beginnings of a frightening dependence? I hope not. Two nights do not a habit make. I don’t think so, anyway. Maybe that’s how it starts.

Carpal tunnel is hurting more than usual since I didn’t wear the brace today (for fashion and practicality purposes) but I’m going to have to bring it tomorrow since moving things around without it today just aggravated it a lot.

Last night was a bad bad night in terms of sleep. I fell asleep at midnight or so and then woke up at 2:30 and couldn’t fall asleep again until almost 5, then I was up to get ready for work at 7. So tired all day… and my tummy has been rather unsettled all day as well.

Right now, I’m FREEZING. Totally. I’m sitting here wearing flannel pajama pants and a long sleeved t-shirt, knee high cotton socks, and my winter coat because I am shivering. I turned up the heating and still, I shiver. I know that sleep deprivation can prompt these symptoms, so I’m not getting too nervous. However, last weekend my little brother’s girlfriend experienced similar symptoms (with the addition of a 102 degree fever), a few people at work have been out all week with these symptoms, and my friend LJ has been down since Sunday with the same - chills, fever, achiness, exhaustion. Sounds like the flu to me… but I just feel chills and exhaustion, which are also the body’s responses to sleep deprivation. We’ll see. If I start feeling totally horrible over the weekend, that would suck…

Anyway, I don’t have class tonight since our paper is due today - we just have to post asynchronously sometime over the next week. I don’t have to be at work until noon tomorrow, and even then, I have to go to the Javits Convention Center in New York for work. So I can sleep a little later than usual.

I have to do laundry and do my nails and some other things. I can do laundry in the morning, really, but I’ll do it tonight so I don’t have to worry about it in the a.m.

Tonight’s Netflix bedtime story will be “The Third Man” starring Orson Welles.

Chilly!!! Time for some hot tea and laundry.

this week is really hectic.

I have an appointment with the orthopedic surgeon next Tuesday. I can hardly wait. This is painful painful painful.

Anyway, since I am in pain, I shan’t be writing much this evening. Here’s something I just heard from Vincent D’Onofrio, as Detective Robert Goren, on Law & Order:CI:

“I need to use my most important investigative tool - my library card.”

That’s the best Law & Order line EVER. Only he could deliver that line without coming off as a total public service announcement cheeseball.

It was just President’s Day weekend. But still - I have a strange compulsion to make “the most” of these three day weekends and not just do my ordinary weekend things.

Unfortunately, this weekend I did just that. Except that I wrote my first grad school paper, finished my group project, did the rest of the readings for the week, watched a couple of movies, hung out with my sister and with my brother and my friend Vin (all separately), and cleaned the bathroom. I also watched lots of “Law and Order” since it was on ALL day today while I was trying to get other work around the house done.

There was some slight family drama. My father threw the old, “As long as you live under my roof you live under my rules” shit at me (because I didn’t “hop to” and do the dishes the moment my mother asked me to). Which is funny, because until this weekend, I’ve been the only child who ever LEFT the home and lived on her own… for a year, but that’s longer than anyone else did. Never fear… as mentioned last week, I’ve begun scoping out apartments along my various public transportation options. The next few months will show me the way financially.

Otherwise, I had my mother throwing my mental state at me in a disparaging tone, indeed. I was helping my sister move furniture in the living room so she could have some space to set up her easel and canvas to work on her paintings for her senior portfolio. My mother said something really inappropriate and bitchy to the both of us, and I joked, “do you want my psychiatrist’s business card?” To which she snapped, “He doesn’t seem to be a very good psychiatrist because I don’t see any change in you. If you have to keep seeing him, he’s not very effective.”

I was clenching my teeth when I told her, “I don’t want to kill myself anymore. I think that’s a pretty good change. Unless you disagree and think that’s not very important, mom.” Of course, she said, “No - that’s good, but you still have a lot of attitude.”

She doesn’t understand the purpose of therapy, apparently. I’m being treated for clinical depression, NOT for some strange attitude problem. A psychiatrist doesn’t perform attitude adjustments. Especially with a mental illness that’s been plaguing me my WHOLE LIFE but which was only diagnosed when I was having majorly self-destructive impulses, the complete treatment isn’t going to consist of 30 cumulative hours of talking and some pills. It’s a little more involved than that.

Nevermind the fact that I’ve been seeing the doctor for almost 3 years, which is not a long time considering the severity of my condition initially. I was seeing him weekly for almost 6 months. Then it was down to once every two weeks. Now it’s just once a month. I still cry in session sometimes - less than I did, but I still do.

Nevermind the fact that ONE thing the doctor and I can both agree upon is that I won’t be able to deal with/handle/”cure” my depression until I no longer live in this environment with my family and parents. It’s nothing but corrosive [my words] and toxic [his words] - just a constant barrage of negative stimuli. Am I responsible for some of it? Yes. But it’s not really possible to stay totally afloat and 100% happy when the people who are supposed to love me and support me unconditionally (my family) instead focus on keeping me “grounded” - which is their phrase for berating, insulting, and generally making me feel like a loser.

They think it’s in my best interests and that it’s going to fill me with the fighting spirit… but that’s what the rest of the world is for… for treating a person like crap and teaching us all how to fight for ourselves. Home and your family are supposed to be the place you go to relax and be yourself. Friends are an extension of that family idea… but they are not obliged to provide unconditional support at all times. They have their own families.

(Shaking it all out. Done.)

Oh, crap. For some reason, I can’t login to my grad school’s library via proxy server and can’t access the database I need to as a result. I’m going to email my professor and let her know this is the case, and also email the IT group. I have all week to complete this assignment, but this is annoying.

The last few nights, I’ve had some exceedingly weird dreams. Thursday night, I dreamt I had a nosebleed that would not stop. I was walking around with a towel to my nose and remember feeling the heat of the blood in my nose and on my face. I totally expected to wake up and find my pillow drenched. But no. No blood, thank goodness.

There was something on Friday night, too, but I didn’t write it down or otherwise commit it to memory. Oh, well. I know I woke up feeling equally disconcerted.

This morning, I woke up after dreaming that I had an assignment in grad school that required me to hold two different kinds of large poisonous spiders. I know where they came from in real life: my friend asked me if I’d ever done a Google image search on a camel spider and I had, but I did it again just because - well - gross things are kind of fun to look at from a distance. Also, when I was writing my paper, a really gross but small black spider was crawling up my wall. I didn’t kill him and didn’t freak (though I am rather scared of spiders, really - I just don’t exhibit paralytic fear of anything. I can’t watch spider movies. I won’t HOLD a tarantula. NO touchie).

Still, last night I dreamt I was assigned a final exam that required me to hold two different varieties of rather large, hairy spiders and that the instructions indicated we were to hold the first spider until he bit us and then promptly release him. The second spider just came with a warning that he was highly toxic and that while we’re holding him, we should pay attention to what look like an extra set of legs on his rear because those are actually false legs that are really the pincers he uses to inject poison. I just remember that in the dream, I was begging the professor for an alternative method of earning my grade because I could NOT hold the spiders.

Yeah. So I woke up feeling a little shivery and grossed out. I had also drooled on my pillow (highly unusual) so perhaps I was talking in my sleep and protesting. I dunno.

I’m done with my paper, for all intents and purposes. I am now reviewing with my APA guide in hand to make sure my citation, quotation and other elements are in line with APA standards. I also need to go through and do my usual check for repetitious verbs (”as stated in”, etc.) and change those up. I’m glad to find out that my mental check list for writing academic papers is still intact. When I’m in that mode, there is no such thing as a verb tense change. Nope.

Great. My father just came in here to tell me that he wants to change the household PSE&G billing into my name. I already pay for half of it, so I don’t want the bill coming in my name as well. He also lectured me on spending money. I have most of my shoes lined up along my entertainment center/bookshelf. He pointed to my shoes as evidence that I spend too much money. I replied by pointing out that my shoe size hasn’t changed in 15 years and that the silver Doc Martens he was pointing to were a birthday gift in 1996, the pink and black Saucony Jazz sneakers were purchased 2 or 3 years ago, and the newest shoes were the $40 pointy toe heels I bought at Marshall’s. I just wear them for a long long long time.

Of course, iPod guilt came flooding back in. After NOT having purchased anything in MILLENIA, I get an iPod (which arrives Tues or Wed) and now I’m going to feel incredible guilt about it. Probably only until I delve into this paper again and forget about it.

I hope I’m going out today. I have tentative plans to go into Manhattan with LJ and Aaron today, but I haven’t heard a peep from them. It’s probably going to be later in the day, though. Sigh. I’ll have to wait. I think I’ll go downstairs and have some breakfast, since that’s a good thing to do every day.

Note: Did you know that Sunsweet Prunes have their own testimonial website?? I mean, I love prunes as much as the next girl… but “amazing testimonials”?