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Archive for June, 2006

Thumbs up

Wednesday, June 28th, 2006

On the morning of June 23 (a week after the steroid injection), my trigger thumb symptoms were so mild that I decided to skip using the heating pad and see what happened. Half an hour later, the symptoms had cleared up on their own. The following morning, I awoke symptom-free. So the steroid seems to have worked. My trigger thumb is cured — or perhaps I should say “in remission”, since my father’s experience shows that the symptoms can return eventually.
Today I visited my ophthalmologist for a routine semiannual examination, and my glaucoma is also still in remission. The medication (Xalatan at first, and now Travatan) has kept my intraocular pressure under control for two and a half years.
Modern medicine is miraculous. No other word adequately describes it. A disease that could have blinded me is neutralized by putting drops in my eyes once a day. Another ailment that threatened to cripple my hand is banished by a simple injection. I’m also grateful for the dental restoration techniques (crowns and onlays) that have made my brittle middle-aged teeth better than new. And the orthopedic treatment that, twenty-six years ago, restored my ability to walk. Miracles, all of them.
Historical note: Movable Type tells me that this is my 300th blog post. That’s not a terribly impressive number for a blog that has been in operation for 57 months. Some bloggers post multiple times per day, while I’ve only averaged a little more that five posts per month. But at least I’m still blogging after almost five years.

The cursive menace

Friday, June 23rd, 2006

Three years ago, I joined Bob in criticizing the practice of teaching cursive writing in schools. At the time, I condemned cursive for being illegible, but it didn’t occur to me that it can actually kill people. However, in one particular context — the handwriting of doctors — sloppy handwriting can cause prescriptions to be filled incorrectly. The result could be harmful or even fatal. Recently, the state of Washington addressed this issue by passing a law that forbids physicians from using cursive writing in prescriptions. On prescription slips in the state of Washington, cursive is now illegal.
Some people are already making fun of the new law. On the blog of the libertarian Cato Institute, Michael Cannon calls it “really, really dumb.” Blogger Pejman Yousefzadeh asks, “Doesn’t government have more important things to worry about than this?” But despite my normally libertarian leanings, I approve of this law. In fact, I say it doesn’t go far enough.
Medical mistakes can kill people. If doctors’ sloppy handwriting leads to such mistakes, it’s inexcusable for them to continue writing that way. The medical profession should have solved this problem on its own, but if doctors are not willing to do so, it’s reasonable for governments to step in. In an ideal free-market economy, this would not be necessary, but health care is heavily regulated in our society and thus largely insulated from market forces. If our governments are going to regulate doctors, requiring them to write clearly is a valid part of that. Besides, governments created this problem in the first place by teaching cursive writing in public schools. It’s only fitting that they should have to solve it.
So Washington’s new law is a good idea. But why does it only apply to prescriptions? The harm caused by doctors’ sloppy handwriting is not limited to prescription slips. It also occurs when their treatment instructions are illegible, leading to medical mistakes that can be a deadly as an incorrect prescription. This law should have prohibited doctors from using cursive for any written instructions, not just prescriptions.
Medical schools should be teaching a handwriting class — one that concentrates on clear, legible printing. If doctors write illegible instructions that lead to harmful treatment mistakes, that should be grounds for a malpractice suit.
Now, can we get the public schools to drop cursive writing from their curriculum and use the class time to teach something useful?

Trigger thumb

Monday, June 19th, 2006

Several weeks ago, I started noticing that my right thumb was behaving oddly. When I first woke up in the morning, I found it difficult to straighten or bend the thumb. It would flex normally for part of its range of motion, but at about the midpoint I would encounter resistance. If I made a greater effort, the thumb would flex past the point of resistance with an unpleasant (and occasionally audible) pop. Sometimes this would actually hurt. The problem would clear up after I had been awake for an hour or so, but it always came back the next morning.
Eventually, I noticed a couple of additional things. First, the problem did not disappear until after my morning shower. It was responding to heat, as an experiment with a heating pad quickly confirmed. Second, the problem was a little worse each day — flexing my thumb was more difficult and painful until it was heat-treated. I made an appointment with my primary physician for Monday, June 12. I also did a Web search on the terms “thumb”, “bend”, “straighten”, and “pop”, and found numerous pages documenting a disorder called “trigger finger” (or, if a thumb is involved, “trigger thumb”) that sounded exactly like what I was experiencing.
My doctor’s diagnosis was, indeed, that I have trigger thumb. He referred me to the Raleigh Hand Center. The earliest appointment I could obtain was for Friday, June 16. The early-morning impairment continued to get a little worse each day, and — more ominously — the problem started to flare up during the afternoon. I don’t have a heating pad at work, so I would have to get a cup of hot water from the break room, put it on my desk, and dunk my thumb in it for a few minutes.
On Friday, I went to Raleigh Hand Center and was examined by Dr. Post. He confirmed the diagnosis of trigger thumb, and explained that the first thing we should try was a corticosteroid injection into the joint at the base of the thumb, which often cures the problem. (If that didn’t work, an outpatient surgical procedure would be the next step.) I agreed, and he gave me the injection after administering a local anaesthetic. Dr. Post said that improvement might take as long as four weeks to appear, but that most patients noticed the benefits of the injection after one or two weeks.
The thumb was sore for a couple of days after the injection, but now feels fine. I phoned my father yesterday to wish him a happy Father’s Day, and in the course of the conversation we traded stories about our recent medical developments. Dad astonished me by revealing that he has trigger finger in the middle fingers of both hands. His doctor gave him steroid injections, which cured them problem for a while. But it gradually returned. The doctor decided to repeat the injections, and Dad is symptom-free again. If the cure isn’t permanent this time, Dad will undergo the surgery.
It’s interesting that we both developed the same problem at about the same time. I suppose there might be an inherited predisposition, but the causes of trigger finger are poorly understood and may be environmental. Dad and I both use computers a lot. (Dr. Post speculated that my thumb seizes up during the night because I’m not moving it. If that’s how it works, the afternoon flareups at work probably happened because my right hand was holding a mouse, which involves very little thumb motion.) In any case, we now have something new to talk about. The next time our extended family gathers around a dinner table, Dad and I can bore everyone else by comparing notes on our trigger finger experiences. And of course I can bore the readers of this blog (if any still exist) by writing about my thumb here.