Recovery Week #6: May 8-May, 15, 2013

Week Six:  May 9 – May 15, 2013

“Our greatest glory is not in never falling, but in rising every time we fall.” –  Confucius

I was able to play my flute three times for five minutes!  The vertical head joint is strange, but I’m so grateful to have it.  It was made by Sandy Drelinger and so graciously loaned to me by Alexa Still.   There is a thumb rest piece that attaches to the foot joint for the right hand thumb, similar to oboe, clarinet and saxophone.  The clamp that attaches this to the tube is extremely difficult for me to close since it requires pressure from both hands.  There’s a left hand support piece that I’m not using because I don’t want any extra weight on my left hand index finger/thumb. There’s a plastic key extension, also a Drelinger creation, which snaps onto the rods for extending the first finger down the tube.  So my index finger is closer to the middle finger than a regular flute set-up.  This is a good thing because I’m still working to regain full range of motion with my interosseus muscles which spread fingers apart.  The key extension is on a higher plane than the other fingers, which is also a good compromise for now.  The right hand thumb rest piece also has a bit that rests on your knee, so in theory, your leg should be supporting most of the weight of the instrument.  My new flute weighs 2 pounds, 3 oz, which doesn’t seem that much.  In reality, that’s significant for a surgical reconstruction.  Again, it was interesting to observe how things that happen to you change your perspective.  So, with this setup,  the base of my left index finger doesn’t contact the tube at all!  Perfect for now.

Due to the way flutes are designed, the left index finger is down for all but 8 notes in a 3 octave range.  It doesn’t take much for to close the key, but the issue is that it has to remain closed.  Press and hold, as opposed to press and let go for typing on a computer.  My index finger started to wobble at shake, which is a sign of weak muscles trying valiantly to do what is asked of them.  There was no stabbing pain, just slowness, clunky movement and stiffness, all of which are normal for this point in time.

Boring old long tones never sounded so good!  Except it sounds weird.  The new headjoint and the sound coming from in front instead of right side are both strange, plus it’s the brand new flute anyway.  I can’t complain though.  It’s a start!

I’ve learned to use how well I can feel the vibration of the flute under my fingers as a way to monitor the coordinated use of my whole body.  When one clamps down on the keys, like when a fast, notey, scary part is coming up, you can no longer feel the vibration.  With the vertical setup, I don’t feel the vibration in my right hand ever.  Perhaps that’s a function of the way the thumb rest piece attaches to the tube.  So, I did a little test.  Put the regular flute headjoint on, took the other stuff off, added a chopped up piece of clear plastic water hose to increase diameter of the tube for base of index finger and played an F.  Hallelujah!There’s my flute sound, my left hand can do it and vibration of the tube is restored. It was only a test, BeepBeeBeep.

The other therapy exercises were fine.  Trying to do the dexterity balls with my palm down was difficult at first.  I figured out that this was also causing my hand to hurt.  When middle finger goes up and index finger goes down (and vice versa) it was hurting in between the two knuckles.   I dutifully did my bicep curls and tricep extensions with my 1 lb. weight.  I tried with my 2 1/2 lb. baby plates from my weight bench, but the way I was holding it (middle finger down, first finger up) was no good.  Still stuck in the buddy wraps and can’t wait to be free of them!

The swelling in my finger is down a lot, but it makes the joint look like a golf ball in comparison.  More ice throughout the day seems to be helping.

May 15, 2013 – OT#7  I hauled all the flute pieces/parts into the office for therapy and my formal appointment with my surgeon. I realized that hand therapists don’t necessarily know and understand the specific needs of a flutist.  Their job is to get my hand back to functioning.  My job is to be very clear with what I need my hand to do.  All of the therapists came to check out the vertical headjoint and all the other ergonomic bits.  All were amazed at what professional flutes cost (they asked and I told them. One said, “that’s more than my car.”  Umm… yeah.)  In fact, one of the therapists wanted to know if I had a piccolo and if I could play the thing from Stars and Stripes next week.  My response was “Are you kidding?  Next week?”  I said that I’d love to play it in another month or two and would happily march up and down the hallway annoying everybody in the immediate vicinity.  I was given more exercises for active strengthening of my finger itself and my whole arm, which I’ll write about in next week’s  post.  The doctor was pleased with what he saw.  The annoying ache between middle and first fingers was normal for this point in time, same thing for the places along the incision line where adhesion is still a problem.  My flexion at MP joint was up to 90 degrees!  Dr. H. said I can play vertical headjoint or regular as long as I “don’t be crazy and stick with baby stuff, not notey flute stuff with low load/high frequency.”  Translation – 5 minutes at a time throughout the day.  The ideal would be to leave the flute on the flute stand, come by play it and put it down.  Come back the next hour and repeat.  I can’t do that with an expensive flute and 2 young children in the house.  And the final bit of good news, the buddy wraps are history!  I no longer need to wear them unless I’m doing something where I need extra support, like raking in the garden.  That was the example my therapist used, why would I want to use my fledging hand skills for garden raking?  Sorry, garden, it’s not going to be your year.

Key things I learned during this stage of my journey:

1)  Even my children noticed the lack of flute playing in the house.  Maybe they noticed because of their mother’s grumpiness?  My older daughter came downstairs one day when I was doing my 5 minutes and said “That sounds good, Mom.  I haven’t heard any flute since Halloween.  Hey, why’s your flute look like a clarinet?”  Cool… she actually remembered what a clarinet looks like.  Maybe the world is really missing my flute playing.

2)  Returning to flute playing is scary.  Random thoughts like “I hope this isn’t going to hurt” and “Is this hurting or does it just feel weird since I haven’t done it for a long time” and “How about now?”  Trusting myself is difficult because the desire to play the instrument is so high.

3)  Recognizing, yet again, the importance of my iPhone in my healing process.  At first, the alarm was set for 3 AM so my husband could get my pain meds out of the bottle, so I wouldn’t miss a dose.  As if my hand would have let me miss, ever!  Then, the timer was used for icing purposes and then for timing the hot/cold water soaks with the contrast hydro-therapy.  Also using calendar to keep track of therapy, chiropractor and acupuncture appointments.  I’ve used Siri to input much of these posts into notes which I then email to myself and cut/paste. Now the trusty iPhone keeps track of my time and I also recorded myself one day playing one of the Trevor Wye’s long tone warmups.  It’s not pretty, not in tune, and not especially musical, but to me, it’s priceless.

 

Recovery Week #5: May 1-May 8, 2013

Week Five:  May 1 – May 8, 2013

“Rivers know this: there is no hurry. We shall get there some day.”  – A. A. Milne, Winnie-the-Pooh

Everything was better this week, I’m definitely moving in the right direction.  However, I still wish my improvement was more rapid.  Waiting has always been hard for me.  I like to be in perpetual motion, like the ever-flowing stream in our backyard.

Some cool things that I was able to do this week:

1)  I realized, while lying down on the carpet, that my incision site was actually touching the carpet and that was ok!  I didn’t feel the need to jerk my hand away from the contact.  Interesting, I guess the friction massage does work to desensitize the area.  I didn’t actively doubt my hand therapists, but it’s always nice to discover that what they said is in fact true.

2)  I noticed, while chasing the soccer ball around the yard with my daughter, that I was running and my hand wasn’t hurting!  Fantastic discovery.  I went to my regular park the next day and ran my 3.2 mile usual path.  I refused to keep track of the time, I was just happy to be able to do it.  I was also able to walk the next day, which was a bonus!

3)  While waiting for my acupuncturist to come remove my needles, I realized that my fingers were thinking dominant seventh patterns.  I say “my fingers” because I wasn’t consciously trying to do this.  My index finger was moving right on time and in the right direction.  The last time I did this was in the hallway from the surgical staging area to the actual OR and it was octatonic scales. Sometimes, I just visualize the finger movement and other times my fingers actually move.

Some uncool things I discovered this week:

1)  I happened to look at myself in the mirror and noticed the atrophy in my left upper arm.  I’ve lifted weights fairly regularly since high school and have wide shoulders for a little girl.  It’s often a problem because my arms are too big to fit in the regular size armholes on women’s shirts.  This makes total sense, another example of the effect of separate parts on the overall functioning of the whole.  It’s ok… I know how to fix this once I can grip the bar and am cleared for this by the therapist.

2)  I was given permission to try the vertical headjoint flute.  The only problem is that I can’t put it together.  I’m not able to close the little clamp-like thing that attaches onto the flute tube.  My husband did it for me, but I thought “if you can’t put the damn thing  together, then you’ve got no business trying to do this yet.”  Disappointing, but not unexpected.  The physical pull of my entire being towards the flute is so strong.  The want to pick it up and play like I know I can just hits me in the gut when I look at the case.  Patience, my friend, it’ll be your turn soon.

May 8, 2013 – OT#6  Everything was good and the therapist was pleased with my progress.  I got 2 new exercises to do, both of which are variations on previous exercises.  Now I’m supposed to roll the dexterity balls around my hand with my whole arm extended, both palm up and palm down.  Palm down is tricky because gravity is no longer working for you.  The second variation is to use a skinny marker in addition to the dowel for rolling down my palm.  The smaller diameter makes it a lot harder to do and demands more flexion in all the finger joints.  Buddy wraps need to stay on for a while yet.  I was also cleared to do 30 reps of bicep curls and tricep extensions, with a one pound weight.  I don’t even have a 1 pound weight, but I do have a can of beans which weighs 1 pound, 2 ounces.  Close enough.

Key things I learned during this stage of my journey:

1)  Patience, patience, patience, patience.  Repeat.  Don’t push the river!

2)  Any improvement is improvement.

3)  This whole process is so insignificant in comparison to what other people are dealing with.  I’ve been following the story of Adrianne Haslet-Davis, the professional ballroom dancer who lost her foot in the Boston Marathon bombing.  She was interviewed on Dancing with the Stars and she said that this is the longest time she’s gone without dancing since she was 2.  She said that she’s going to dance again.  Of course she is, it’s who she is and every fiber of her being demands this!  Her life will never be the same.  In comparison, this stupid little hand surgery is going to be one of those things looked back on as a “pain-in-the-ass”,  a stumbling block, and a temporary time-out, rather than a defining moment in my life.  I look forward to seeing Adrianne dance with Derek Hough some day on DWTS!  You go, girl!

 

 

Hand exercise

Recovery Week #4: April 24-May 1, 203

Week Four:  April 24 – May 1, 2013

“When one tugs at a single thing in nature, he finds it attached to the rest of the world.” – John Muir

This week was so much better than the previous one.  It’s about time and I’m thrilled to have made visible progress.  I noticed, again and again, how the disfunction in one joint of one finger had global effects on the functioning of my hand as a whole, my whole arm, and therefore my whole body.  This was not a new discovery, but it was nice to finally see improvement in one part that led to better coordinated movement of all of me.

One yet another level, the “tug” of my hand injury has effected the whole “rest of my world.”   It impacts my relationship with my family, as in I can’t do what I usually do (yet).  I can’t play basketball or spot my kid on her back handspring.  I can’t wash dishes or hold food well enough to work safely with a knife in the kitchen.  I can’t do as much volunteering at school because they need adult helpers with two functioning hands to help build the sets for the big wax museum project!  I can’t do the gardening or put air in the bike tires.  I think, ultimately, that this is a good lesson for my girls to learn…. Mom isn’t indestructible and sometimes her stuff needs to come first.  I’ve changed how much time I devote to volunteer activities with two non-profit groups that I’m heavily invested with, and that’s not necessarily a bad thing in the big picture.  With 4-5 hours per day still going to rehab exercises, soaking, ice baths, scar massage, etc., I’ve been forced to really figure out what is the most important thing required of me each day.  As a result, our house is a disaster.  The dust bunnies are collecting, the sand from the sand box is everywhere, dirty little kid footprints show up in weird places, the glass bottles and the paper haven’t been taken off to recycle place.  And guess what?   The world didn’t come crashing to a halt,  the sun continued to rise each morning.  Too bad the cleaning fairy hasn’t included us on her rotation.  The dirt and clutter will wait patiently for my attention.  Unanswered emails will also just have to wait.

Now, there were lots of new things that I could do.  I was typing without my buddy wraps, using 8 fingers and 2 thumbs exactly how they’re supposed to be used on a keyboard.  I could hold a coffee cup (small one, instead of the usual monster size to hold my elixir of life) in my left hand.

I could hold silverware and fold laundry without thinking about it.  I could dry my own hair using a hair dryer in one hand and a brush in the other.  I could wash my kid’s hair and dry it.  I could tie my shoes and wear my wedding band.  I could drive without having to plan ahead about how I was going to steer, downshift, and turn the blinker on.  I could use the drive-through window at the bank and reach out an get the little canister thing without having to practically climb out of the car.  Woo hoo!

In retrospect,  think my breakdown at therapy last week was 95% mental.  I was so angry that I couldn’t do what she was asking me to do.  I was mad that she changed the rules without telling me.  I had been working to get my finger straight (full extension).  All of a sudden, now I’m supposed to hyper-extend.  Yes, I need that movement and yes, it needs to be recovered.  However, it’s not fair to ask a finger that’s been restricted from that movement for 5 months, to all of a sudden work.  Same thing for spreading my fingers apart.  I’m also highly goal oriented and was totally floored by the fact that there’s still stuff I can’t even begin to do.  That’s why it’s a 3-6 month recovery, not 4 or 5 weeks.  So, being shown again how much work needs to be done, I got down to serious work.  Lucky for me, my therapist gave me things to do to help with all of the problem areas.

Here’s the cool stuff I was supposed to do as part of therapy, including a picture of the contents of my therapy box.

1)  Gentle assist on MP joint with same old tendon gliding exercises.  My therapist explained that the only way to regain the length is to move to where it starts to pull, then gently assist with the other hand to move a little more, and then stay like that for 20-30 seconds.  Hooray, finally something to “do” to actually help instead of sitting around passively waiting.

2)  Tissue paper – I had a sheet of tissue paper that I put flat on the table.  Then I was to use my left hand only to crinkle it up into my palm.  Then I could flick it across the table, same technique as launching paper wads through the uprights formed by a friend’s fingers when the teacher’s back is turned.

3)  Dexterity balls – 2 balls made from some type of putty that I was supposed to roll around in my palm, both clockwise and counterclockwise.  This took some figuring out to go clockwise – the secret is that the pinky finger needs to push it over far enough for thumb to get in place.  In order for that to happen, fat old swollen index fingers needs to get the hell out of the way.  Loved this exercise and do it frequently when I was doing something else that required only 1 hand.

4)  Dowel rod – made of the same putty.  I had been using this for a while with the instruction being to roll it from finger tips to palm with no help from thumb.  I couldn’t do much at first, but now I can do much more.

5)  Pennies – the instruction was to pick up a bunch of pennies with index finger and thumb only and hold them in my palm.  Then slide them off first finger into a stack.  This one blew me away at first, I could pick them up, but the stacking was hard.

6)  Knots – I was instructed to find a flat old shoelace and tie knots in the whole thing, mainly with left hand.  Then undo the knots.  Hmm… I didn’t know how to tie knots left-handed since I’m a righty.

7) Nuts and bolts – I was instructed to find some clean, not greasy, nuts and bolts and practice tightening/loosening with only index finger and thumb.

8)  Cards – I was instructed to shuffle playing cards, left handed.  Uhhh… what?  I was fortunate that I could do it right-handed to see what the fingers actually need to do.  I was assigned to play card games or board games with my kids, but I had to always deal.  I also had to always pick up my piece or cards with left hand.

9)  Turning pages – I was instructed to turn all pages of books with left hand.  I read a lot, to myself and to my kids.  This slowed me down…. why would anyone turn a page with their left hand since your whole arm has to cross your body?

10)  Sponge – I found a piece of old foam (left over from making a custom case for my Irish flute) and soaked up water from one bucket and squeezed it out into the other.

11)  Ball toss – I was instructed to start with a pair of kid socks, rolled up into a ball.  Toss and catch, both underhand and grabbing it out of the air.  I’ve since moved on to Nerf ball.

12)  Stretching hand by spreading all fingers as far apart as possible.  My therapist traced my right hand on a piece of paper, held it up to a window to get the reverse on the other side.  My assignment was to make my left hand fit inside the yellow lines.  I could use a small bottle and a can to stretch various hand parts.  Very quick response with this method.  Here’s a picture.

Why does this set of therapy tasks seem so much better to me?  The answer is that it’s a game!  I’m probably one of the most highly competitive individuals to walk the planet.  I guess that comes from having an identical twin, so I can say that I’ve had years of experience and am a trained professional.  I love any sport with a ball and a clearly defined goal.  News flash — this is probably helpful for the therapists to know.

Scar massage continued to be no fun.  It hurt, but it was and is absolutely necessary.  I was given a thin sheet of plastic stuff called dycem.  I put that over the scar and then you press hard with a finger on the scar line.  Then slide north for 5 seconds, then south, east and west.  All without moving the finger on the skin.  The dycem provides friction.  This is basically ripping the scar tissue free from the bones and other connective tissue.  It hurts…. well, yeah, that’s sort of the idea.

I’ve been having trouble sleeping, waking up 8-10 times each night.  No reason… just awake, and feel exhausted the next morning.  I think I’m reacting to the sensation of the sheet making contact with the incision.  One component of the friction massage is re-education of hypersensitive nerves, which need to just calm down and stop freaking out because the area is being touched.

Much of the pain remaining isn’t stabbing, vicious, achy pain.  It’s the annoying, pulling, swollen, too clunky to move freely type of thing.  I can definitely feel the pull of my extensor complex trying to move under the scar.  The adhesion is definitely limiting the movement.

My swelling is down tremendously and the greenish yellow tinge is gone from my hand.  I had acupuncture again, the full complement of needles that would actually go in my left hand.  I also had some needles in my face for the spring time pollen allergy-caused sinus headache.  Again, amazing results!

May 1, 2013 – OT#5.  I improved with all the angles when my therapist measured my hand.  The MP joint of started out at 25 degrees, and now I’m up to 75.

The goal for now is 80 degrees, but I have 88 degrees in my right hand.  The picture just shows movement of the other two joints without help from other fingers. She was pleased with my progress, but I still have to stay in the buddy wraps.  Hopefully, next week I can be done with those and start the actual strengthening exercises.  We’ll see.  She said my adhesion wasn’t terrible and definitely wasn’t the worst she’s seen, but it remains something to get after often.

Key things I learned during this stage of my journey:

1)  Keep going, even if it doesn’t seem to be getting better.

2)  Patience…. trust in the process even when it doesn’t proceed on your chosen time schedule.  Sometimes, the “process” is hard to believe in.  This seems to go against everything we know about pain:  “if it hurts, don’t do it”  and  “leave the cut alone, let it heal without picking the scab.”  Here, it seems exactly the opposite… “yes, you must move it when it hurts if you ever want to move it again” and “yes, massage the most painful spot… over and over again.”

3)  If I follow the directions given to me by the people whose business it is to know, I get better.

 

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