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Archive for November, 2006

Pulling the trigger

Sunday, November 19th, 2006

On November 13, I went see my hand specialist, Dr. Post. He listened to my description of how the trigger thumb symptoms had returned, and then examined the thumb itself. Clearly, the corticosteroid injection on June 16 had not cured the problem. At this point, he explained, I had two options: a second injection or surgery. The second injection would provide short-term relief and might banish my symptoms for good — but statistically, it was less likely to effect a permanent cure than the first injection. Surgery was a more drastic approach, but it would definitely correct the problem. We agreed that I should go ahead and have the surgery.
So, on Thursday, November 16, I went under the knife. The surgery was a ten-minute procedure performed under local anaesthetic at Duke Raleigh Hospital (which I still think of as Raleigh.com Hospital). Of course I spent more than ten minutes at the hospital, but it was still a brief visit — I arrived at 1:00 and was on my way home by 3:00.
I was coming to the hospital from work, so I drove myself. But I had been told that I would have to be driven home by a family member, because I would be given a sedative. So I arranged for Ben to come to the hospital after school, pick me up, and drive me home. How and when to retrieve my car was something Marie and I would have to decide later.
After signing the requisite papers, I was ushered into the Day Surgery Center, where a prep nurse measured my blood pressure and temperature. She then informed me that Dr. Post’s team was ready for me and could start the procedure as soon as I joined them. Normally, day surgery patients are given a Valium as part of their preparation. But if I took Valium at this point, it wouldn’t take effect until the surgery was already over. I was clearly relaxed and in no need of sedation, so the nurse and I agreed that we could skip the Valium and get on with the main event. (Hospitals and medical personnel don’t make me nervous. I once lived in a hospital for six weeks, and that experience cured me of any anxiety I might have had about such places.)
The actual operation didn’t take long at all. I didn’t have to change into a hospital gown; the two surgical nurses had me lie down on the table and one of them cleaned and sterilized my right hand while the other put a blood pressure cuff and a pulse monitor on my left. They applied a tourniquet to my upper right arm and hung a drape so I wouldn’t see my hand being cut open. Shortly after that, Dr. Post arrived and got right to work. He injected an anaesthetic in the base of my thumb and, after the area was numb, began the procedure.
After making the incision, Dr. Post told me that he’d found something unexpected: there was a ganglion cyst at the base of my thumb, right in the area where the tendon was having trouble moving through its sheath. This cyst was almost certainly the cause of my trigger thumb. He excised it, enlarged the sheath as planned, and then closed the incision.
When the drape was removed, I saw that my hand was swathed in gauze and wrapped in an elastic bandage. My fingers were free, but my thumb was mostly immobilized (although I could wiggle the distal phalanx). Dr. Post told me that I could remove the dressing after three or four days and just cover the incision with an adhesive bandage.
I was escorted to Recovery, where a nurse gave me a Diet Coke and went over the sheet of post-operative instructions, which was all common-sense stuff: no strenuous activity with that hand, keep it elevated to reduce swelling, don’t get the area wet, and so forth. I was given prescriptions for an antibiotic (cephalexin) and a pain reliever (hydrocodone). After that, I was free to go, and since I hadn’t taken the Valium, I was even allowed to drive myself home. I called Ben and told him that his services weren’t required, then headed for the exit. They even let me walk out under my own power instead of having to take the traditional wheelchair ride.
I just want to pause at this point and say that in terms of the time, paperwork, and discomfort involved, this surgery was easier than donating blood. Isn’t that amazing?
I filled both prescriptions and began taking the antibiotic, but I set the hydrocodone aside. This is my fifth hand surgery, and my previous experiences have taught me two things: I typically have very little post-operative pain, and the pain medications that are prescribed on such occasions typically make me feel ill. If I need pain relief, I’m better off with over-the-counter ibuprofen or acetaminophen.
That evening, I felt well enough to go to Cinderella rehearsal, which was a music review and didn’t involve much physical activity. Ensemble players like me didn’t have another rehearsal until Monday, and Friday was a work-from-home day for me, so I was able to rest my hand (no driving required) and generally take it easy for the next three days. It’s now Sunday night and I have removed the dressing, replacing it with a big water-resistant Band-Aid. My hand doesn’t hurt and I can now type again (which is why I’m finally posting this account, three days after the surgery). I’m still being careful not to exert the thumb unnecessarily, but I’m back to functioning more or less normally.
I have an appointment for a follow-up visit to Dr. Post on December 1. He’ll remove the sutures and examine my hand to make sure it’s recovering properly. If all goes well, that will be the end of my trigger thumb story. I’ll have a scar to add to my collection, but that’s a small price to pay for a working thumb.
I mentioned previously that my father had experienced trigger finger in both hands. It turns out that in his case, a second corticosteroid injection cured the problem. He’s been symptom-free for a couple of years. I’m glad that worked for him, but I now know that a second injection wouldn’t have helped me — not with a cyst pressing on the tendon. Surgery was definitely the best option.

Thumbs down

Saturday, November 11th, 2006

The last time I posted about my trigger thumb, I was careful to say that it was “in remission” rather than “cured”. It turns out that I was right. Starting on October 26, the symptoms began to reappear, and now it’s a daily occurrence again. I am back to using the heating pad every morning to restore my thumb to usability.
So the steroid injection provided only temporary relief. I have scheduled an appointment with my hand specialist for next Monday so that he can examine the thumb again and recommend what to do next.