oldtimer has modern problem

Owney · Jan 4, 2004

Oramar,

DO NOT TRIFLE WITH THAT FINGER! As a nurse your hands may be your only meal ticket.

Were you seen at Employee Health in your hospital? If not, you must report to them immediately, especially to get it on record that you developed a job related disability. Your next stop should be to get a second-third et al opinion. See a hand doctor; orthopod, plastics, and an arthrologist ASAP You also might get in touch with your attorney, since you can be sure the hospital will contact risk-management as soon as they know you have a problem.

I do not know how old you are but I am 57 and have developed several strange lesions on my right hand after 25 years as a nurse. I would guess that the damn thing is nothing, but I worked in plant medical at a factory where I saw many cases of repetitive stress injury of people in their twentys, who were on semi-permanent disability. Most of these were carpal-tunnel, which sounds nothing like what we're dealing with.

I don't mean to frighten you but indulge me for a moment with a painfully detailed personal story about hand problems. I was on vacation up North and was cutting firewood one night and the next morning I developed a swelling near the base of my left thumb metacarpal. For a few days the area had swelling and pain, sure signs of infection but I could find no sign of an entry wound. A couple of days later, sure enough the skin ruptured and out poured some pus and a small sliver of some very nasty wood. So, I did hot soaks and dressings for a few days. The wound was closed, and so was the case. NOT!!

A few days after that it started swelling again. So one midnight shift I was working with an OR nurse in a little dinkey ER. I did an OR scrub with Phisohex/Iodoform and assembled the instruments for an I&D. I woke up Dr Ivanovich, a Russian, who was only marginally licenced and asked him to do a I&D. I'll never forget the moment! The guy rubbed his eyes like he'd just stepped off the red eye from Vladivostok, (like he always did) a quick visual hand exam an said, "Oh, NO, that is your HAND, you really need to see a HAND surgeon. This guy was a real Quack! My first shift in this ER I saw him destroy an old lady's incisors with a #2 Mackintosh blade in a futile attempt at intubation. Probably didn't matter much, she was pretty ripe when we got her, but I know her untertaker was p*ssed! That basic procedure is the FIRST thing they teach in every ACLS course. I thought he was dodging work in refusing to do my hand, which is something he did very well. My first inclination was to just do the d*mned I&D myself with Letty's assistance. But I made an appointment with a hand surgeon anyway. Dr. Bhat saw me in his office and told me that this thing was dangerously close to the superficial radial nerve, which could be transected during exploration. If the nerve was severed, Dr. Bhat would have to reconstruct it with under his microscope so he made arrangements for me at same-day-surgery. He performed the procedure under a Bier block (pretty neat regional anesthesia trick, I assisted an Orthopod on a radial reduction in a 9-year old male a year or so before who used it) They exsanguinate the hand and forearm with a rubber bandage, put on a b/p cuff to keep it exsanguitated and then put in big dose of lidocaine. Not only does it perfectly anesthetize everything from the elbow down, it also provides a nearly blood-free field. The human forearm and hand can only survive 30 minutes without a blood supply so I had to keep time on the case that I assisted with and deflated the cuff in stages. We had to help the kid's heart from a massive infusion of lidocaine. When I had mine, the B/P cuff was part of a neat machine that had a count-down timer and automatic staged deflation.

Dr. Bhat is a true artist. My suture scar of his surgical entry is the neatest tiny 5-0 or 6-0 Ethilon artwork I have ever seen.

After my babbling, you can see that I took that Russian Quack's advice to the bank. If you have trouble with your hand, you need a hand specialist. The question is what kind of hand specialist. In some major hospitals they juggle this specialty between several services, general surgeons who happen to do hands and are on-call today, orthopedics or plastics. Occupational health specialsts may be the place to start, that's another good reason for you to check with OHS in your hospital.

I have had three bizzare lumps in my right hand. The first BB sized thing was on the palmar surace of my left thumb. I showed it to one of the docs and he felt it, to see if it wasn't simply a calciified outgrowth of the flexor tendon, and suggested that I get an x-ray, which I did, (all off the record, you'd think I'd have known better.) I hurt my back in a GM plant when I was a teenager and never reported it to plant medical. Ten years later I found out that I had a compression fracture of T5 and a partial lateral crush of my T4-5 disc and a pinched nerve. It hurts me nearly every day. That lump eventually did just go away, just like my incomplete RBBB--I never cease to be amazed by the body's abilities to heal itself.

The second lump developed in my right palm way down at the base of my "hawaiian salute" finger. I finally asked an "arthropod" resident about it. He told me that it is a Depuytreyman's Contracture, a swelling of the fascia over a joint, and that I could have somebody hack it out if it bothered me. It doesn't, so I just try to limit the stress on it and it seems to be slowly shrinking.

The newest thing is about the size of a navy bean. It is the back of my hand near the base of my right thumb, firm, painless, not very mobile and seems to move minimally with the joint. This last point leads me to believe that is most likely not an outgrowth of that joint. I haven't been working for the last few months so my lack of medical insurance accounts for the fact that I haven't sought out the best doctor I can find to figure this thing out. After all we are talking about my hand. If I get an early retirement from nursing with a hand problem, I can't even enjoy my rocking chair money at home. My main hobby is instrumental music. My house is filled with stringed, keyboard and percussion instruments. The minute I get back to work and have medical insurance again I'm gonna track this thing down to make sure it isn't cancer.

I would postulate that if your problem is anything like most of mine, it is anything but new, but is older than human kind.

Do you have a history of arthritis? Did either of your parents? Both of mine did, so no wonder I have to go on max dose NSAIDs now and then to deal with my joints.

Your pencil sounds like a reasonable prosthetic finger. Have you ever thought about one of those finger protectors? It's a little plastic cage-like finger extender that you tape over your finger tip. If one of these things works, you should get several lengths so that you can tape them in various places. The worst thing you can do is to keep tape on your body for any more than 12 hours. When you tape it on, make sure you do not tournequet your finger.

Have you thought about using your knuckles to push buttons? I count 14 on each hand. If knuckles work, you could alternate use among these 28 to share the load.

How about using one of its neighbors while you let it heal? Have you thought that if you used your "good luck" finger tip for a while you might be able to cultivate another one of those lumps on it?

Let us know what you figure out. As you can tell by now, I am most happy to share what I learn.

:kiss

oramar · Jan 4, 2004

What a terrible story. I am on Celebrex for ten days and it is helping. For me it is just a case of using different digit or pencil to punch keys.

Rapheal · Jan 5, 2004

After two days of working in a row my hands are terrible. Swollen, numb, shooting pains. I use Ibruprofen and or apirin and limit use for awhile. It is terrible when your hands hurt. My sympathies.

Editorial Team / Admin · Jan 5, 2004

I've had RSI of the right wrist for at least 10 yr. It's pretty stable, only flares up now and then. Ibuprofen doesn't seem to help it, and the wrist stabilizer drives me bananas, plus seems to worsen the discomfort.

Last time it was inflamed I went the usual route: PCP, X-rays, EMG, then referral to Ortho surgeon, who happened to practice where I worked. I was not impressed by him. He recognized me, -- and spent all of five minutes with me. I asked him about the possibility of cervical or elbow/brachial involvement, as some of the pain happens when the wrist is neutral and without stress, but the elbow is stressed. . . he said the inflammation can travel retrograde, back up the nerve. Then, after doing a nerve test by squeezing my wrist and seeing how long it took to go tingly, he asked "Does it hurt you?" Of course, I answered yes. "Then you should have surgery. If it hurts, you should have surgery."

OF COURSE a surgeon is going to recommend surgery! Needless to say, I didn't have surgery. That was almost 4 yr ago, and I am still hanging on . . . I guess, like all of us, waiting for a miracle breakthrough to occur that will replace surgery!

One of the Alternative Practice MDs I was acquainted with at the hospital recommended an exercise to increase the chi flow (his colleague -- also Asian -- calls it "VooDoo medicine," lol!). But after I did the exercise diligently one day of increased discomfort, the pain lessened considerably. Which makes me wonder about alternatives, which is why I haven't had surgery yet . . .

Call me chicken. Whatever.

Bottom line? You have my sympathies about your hand probs, as I can at least partially relate. Let us know what happens. We do use our hands A LOT, and they are our bread and butter! Take care. -- D

oramar · Jan 7, 2004

I am seeing an chiropractor. It is helping also.

Owney · Jan 7, 2004

:)

Do not rule out surgery I have gotten several good reports on surgical interventions in carpal tunnel. My friend Linda is a mecical research PhD, and is married to a physician. She had sugery 6 mos. ago after losing all grip strength in her right hand.

I have trouble with my knees. Since both of my parents suffered with arthritis shoud I be surprised? I am bow-legged, or have a varus-(sp.?) deformity of my legs.

A nurse colleague has the opposite problem, pigeon-toed or vagus(sp.?) deformity. I went to see the same guy she saw. He is an orthopedic surgeon, who of course scoped my right knee and scraped the medial articulating surfaces. My knees have swollen several times and I have treated with a knee immobilzer, NSAIDs, elevation and a Cryo-cuff. My arthrop(sic) wanted to saw my tib-fibs in order to straighten my legs to slow down the DJD process.

Since it took 6 weeks to resolve the swelling the last time I went to OR, I decided that that guy wouldn't touch me again until I become unable to walk.

This happened 8 years ago, and I have not had any disability since--thank God.

I do notice that at the end of a 12 hour shift both of my knees feel warmer on the medial aspect. For prophylaxis I wear athletic knee pads under my work clothing. In addition to the support and warmth, they also protect my knees, as I frequently kneel to do venipunctures.

Thank you for starting this string. I have learned a lot from the posts. Maybe we should change the name to Ortho or Occpational Ortho for Nurses.:kiss