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.
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.