The Flute Examiner Articles
by Kelly Mollnow Wilson
Week Seven: May 15 – May 22, 2013
“Knowing trees, I understand the meaning of patience. Knowing grass, I can appreciate persistence.” – Hal Borland
It’s very nice to be free of the buddy wraps (velcro straps holding index and middle fingers together), so I can do things “normally.” I continued to do my exercises, working on recovering full range of motion and was able to start strengthening exercises. The therapist told me my goal was 3 sets of 15 reps of 5 pounds for bicep curls and tricep extensions. Like an idiot, that’s exactly what I did on Day #1. Hurts… hmm, what a surprise. My poor little atrophied arm was complaining like crazy, which is exactly the point. Gripping the bar is the most painful part of the whole thing. Good news is that the swelling is down enough that I can jam my official weight-lifting gloves on. Hello, old friends… haven’t seen you since October. Nice to be able to wash both hands without having to take off straps or splints. If something could be done with my left hand, I tried to do it that way, as an exercise. Part of my job is to retrain my whole hand to work as a unit, rather than favoring a gimpy finger. This means using all fingers on the coffee cup handle, and holding the fruit with all fingers.
On Saturday, I tried to plant my herb garden and discovered that my hand was done by 9:30 AM, with only 4 plants in the ground. So I messed around weeding, trimming,etc. all with my right hand. Had to come back later in the afternoon to plant the marigolds, which keep the bunnies out. Did lots of extra ice and a minimum of stuff for the rest of the day.
Spent Tuesday AM in the ER with my 5-year old with a severe reaction to cashew nut. Food allergies are something that I’ve dealt with my entire life and my 8 year old was diagnosed with peanut/egg/banana allergies when she was 8 months old. I spent the morning without a shower or coffee, covered with my kid’s vomit, and hoping that the reaction didn’t get any worse. I didn’t do my routine of soaking in hot water, exercises, strengthening, and ice. Discovered that if you don’t do the “stuff,” then you pay the price. Oh well.. 1 step back for me, but I’ve made that up over the course of the next few days. I did notice that “Hey, I’m using my hand without thinking about it” in the course of the whole ER experience. My kid needed my attention for the rest of the day and it was the first day since my surgery that I didn’t do what I was supposed to do.
Flute playing is full of ups and downs. I like the way my index finger doesn’t have to touch the tube with the vertical headjoint, but I can’t stand the sound. I can’t seem to find the “sweet spot” on my face for that headjoint. I did play for a few minutes with the regular headjoint and the sound is so much better. I was fortunate to have a Skype lesson with my friend, colleague and mentor Amy Likar, who gently reminded me that my whole body is involved with the flute and that I can’t focus exclusively on what my index finger is doing. She asked a question about my thumb…”Umm…. don’t know what they were doing.” Very interesting to observe this in myself when one of the basic tenets of what I teach as a Body Mapping teacher is the absolute necessity of whole body awareness. Encouraging whole body awareness even with the weight lifting – don’t hold your breath, stop pulling head down, etc. Glimpses of the incredible amount work that will need to be done to integrate my wounded wing back into the whole of me. On the other hand, I’ve come a long way from a plaster cast and Percocets every 4 hours.
May 22, 2013 – OT #8 Wow!!! I doubled my finger strength on one of the 4 tests measuring grip strength in 1 week. The therapists were very excited about this. All of the grip test numbers were higher. Last week, I was relieved to find that my right hand could grip with 61 lbs. of pressure and my left was at 27 lbs. So there was a mechanical reason for why I was dropping things. I was given another set of strengthen exercises for muscles in my forearm and I finally had to buy a 2 lb. weight. Of course, it only comes in pink and I absolutely hate all shades of pink! Bah humbug…. I bought a green 3 pounder too and am hoping to move up to that one soon. It has a foamy grip and it’s a bigger diameter, so it’s much more comfortable with my hand. I also graduated from weekly therapy and am now going every 2 weeks. My therapist said there’s not much else she can do for me now that I’ve got all the exercises. I just have to put in the time. She also told me that scars change for up to 2 years. The adhesion that I have is still normal for this point in time and I just have to keep up with the scar massage.
Key things I learned during this stage of my journey:
1) Recovery continues to take lots and lots of time. How do people do this when they’re working a full-time job? My kids and husband get it. There’s Mom again, sitting at the table doing the hand exercises. Oh yeah, she takes forever to get ready in the morning because she has to soak, exercise, lift, ice before she can shower. I understand how professional athletes do this, they have the best of the best as physical therapists and have somebody else to attend to much of the little stuff that has to be done. Kind of like supermodels who have nannies, housecleaners, personal trainers and chefs.
2) Slow is good. I’m able to do most everything in the kitchen, but I’m slow. I’m usually moving so fast, it’s not bad to slow down and be a little more mindful.
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.
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!
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.
Week Three: April 17-24, 2013
“Let us rise up and be thankful, for if we didn’t learn a lot today, at least we learned a little, and if we didn’t learn a little, at least we didn’t get sick, and if we got sick, at least we didn’t die; so, let us all be thankful.” (Hindu Prince Gautama Siddharta, the founder of Buddhism, 563-483 B.C.)
I guess the theme for this week would be unhappiness and frustration. When will my hand stop hurting? 3 months from now, 6 months, never? It was so disappointing to feel my whole hand stiffen up in a claw shortly after finishing a set of exercises. Will this ever go away or will I be dealing with this forever? Yes, I know… have faith, be patient, healing takes time. I know, really I do.
I decided to quit the Tylenol/Codeine cold turkey, which was probably not the best idea. The regular Tylenol didn’t do squat for the pain and nasty withdrawal symptoms, which included GI issues, headaches, shakes, being cold all the time, and generally feeling like I was run over by a bus, lasted for almost 4 days. The bonus was that I could drive and mental fog has cleared! The downside was that my baseline pain rate was higher. Driving with the splint on proved to be exhausting. Why should this have been such a problem with short little trips like to preschool and the library? It was marvelous to regain some freedom to go where I want, although it took twice as long to get ready.
My younger daughter and I walked the mile long trail at the park, which was great to be outside in the sunshine. I drove myself to to acupuncture. I discovered that I can’t get the produce in the plastic bags very easily at the grocery store. Good thing I had a little helper. I went to my older daughter’s 3rd grade concert and had a near panic attack while seated in the bleachers in the gym. It was one of those weird Ohio spring days, almost 80 degrees. The music teacher part of me was thrilled to see the bleachers packed. The mom in me with the wounded wing was panicked because there were so many people packed in like sardines and I was afraid somebody would whack my hand. At least everybody else was sweating too, so I didn’t stand out.
There was some dissent showing up in the ranks here at home. I still couldn’t do much in kitchen because I couldn’t grasp anything heavier than a kid’s t-shirt or dish towel. I certainly couldn’t hold onto soapy wet dishes or food to cut with a knife.
As far as the actual exercises went, I did see improvement in range of motion! It was nice to not have the burning sensation of the sutures pulling on the new skin. The scar massage was definitely not fun, but tolerable and necessary. I typically have sensitive skin and had trouble with multiple different kinds of lotion and cocoa butter on my scar. Now I suspect that I was outside without sunscreen and my new baby skin fried in the sun. Needless to say, ice was my friend.
April 24, 2013 was my appointment for OT#4. This time, I was with a different therapist, actually the same one who took my cast off. I thought the appointment was for 30 minutes, and I ended up in there for 90 minutes. Wow….. was this appointment frustrating and painful. No more easy stuff, now I have to really work. My numbers were all better for range of motion. My exercises are working for full range of motion and also using my left hand to do things like shuffle cards and squish paper. More about that in my next post.
Key things I learned during this stage of my journey:
1) This too shall pass. Sometimes you just have to put your head down and just get it done.
2) It could be worse….
3) Hand surgeons are amazing. There are so many small structures packed into a little space. It’s amazing that a surgeon can go in there and fix some parts without messing up 5 other things in the process.
4) The amount of energy the human body spends trying to heal itself is no joke. I have a new empathy for those in chronic pain for whatever reason.
5) It’s ok to be embarrassed, frustrated and angry that you can’t pick a penny off the table. YET!
“I never saw a wild thing sorry for itself. A small bird will drop frozen dead from a bough without ever having felt sorry for itself.” – D. H. Lawrence
There is no energy left over feeling sorry for myself. The horrible situation this past week at the Boston Marathon makes it almost ridiculous to concerned about moving a finger. Some people lost their lives, other lost their feet or legs and their lives will never be the same. I have lost nothing, my injury was repairable and will be no big deal in a year or so. But still, it’a daily challenge.
The weather was beautiful for part of this week. Walking around our 2.5 acre property was a new morning activity. We have several trails that form a loop and my younger daughter loves to do laps with me. One day we saw cardinals, nuthatches, a gold finch, doves, blue jays, a downy woodpecker and our regular red-headed woodpecker who visits our feeder. The bird songs are refreshing, a true sign of spring. There must be an iPhone app that lets you record bird calls and then push a button to find out what bird is making the sound, but I haven’t found it yet. We also came upon a medium size garter snake, sunning itself in the middle of the path. It seems like many creatures are happy to be done with winter. Sunlight seems to have healing properties of its own. At one point, my daughter ran ahead and lapped me on Lap 3 of 5 and said, “Come on, Mom. Run, it’s fun.” I know it, as running has been my personal opiate since I could walk. There’s a park nearby with a 3.5 mile loop right next to the lake and I would run after dropping my daughter off at preschool 3 times a week. I’ve run there before kids, while pregnant, while pushing a jogging stroller, postpartum and now finally by myself! Another devastating effect of this injury is that I haven’t been able to exercise in the ways I like. In the winter, they were concerned about me falling on the ice and damaging the joint that was supposed to be healing. Kettle bells and weight lifting – all off of the table because gripping even with the unaffected fingers stimulated a flexor grasp in the index finger. I can do the exercise bike inside, but I hate it. I feel like a hamster, endlessly spinning its wheel. I’m looking forward to being cleared for running again.
As far as actual rehab for this week, there wasn’t as much rapid improvement. I noticed a tingly feeling in the tip of my thumb, index finger and middle finger that spreads down the back of my hand when doing my exercises. It didn’t hurt and there was no numbness. Increased blood flow? Nerves recalibrating themselves? Who knows! I experienced a feeling of release in palm, sort of between the base of the index and middle fingers. In order for extensor tendons to do their thing, the flexor tendons on the other side have to release.
A pattern was noticed with my exercises. The 1st set of the day is “crunchy”, everything is stiff. The 2nd is best, 3rd set is ok and the 4th set sucks. There was really no surprise here, everything seems worse at night. My one new exercise, palm flat on table moving tip of index finger side to side, was doable without too much extra effort. I found that I was able to get more extension by placing a finger from the other hand on bottom finger bone and just feeling the touch. There was no pushing or helping the finger to move, just a reminder of that “there should be movement here”. The muscles in the hand itself (lumbricals and 2 sets of interosseus muscles) work together to help with extension and flexion, as well as side to side movement. Not surprisingly, most of these muscles attach right near the joint that was repaired. The stitches continued to itch like crazy and pull a lot during the exercises, which is really their job, ensuring that the incision doesn’t rip open due to the stress. I did discover a little trick, blowing air, exhaling really, onto the stitches seemed to short circuit the pain response. I did this at the every end of the moving into as much extension as I could get. Sounds silly, but it worked for me. Lotion, everywhere but incision, helped with the itching as well. The huge gobs of dry flaky skin have stopped.
Two acupuncture treatments this week again helped with pain and swelling. I continue to do the post-surgical protocol of vitamins and supplements. I also tried some ear seeds this week, tiny metal seed stuck onto acupressure points in my ears. The idea of the seeds is to help with pain control, so I can hopefully get off the Tylenol/Codeine soon. I was reminded about one of the great things of acupuncture, at least for me, is that it forces you into whole body awareness. As I was lying on the table, listening to the music in the office, I thought “what about recording a flute cd for meditation or for use with babies at bedtime. Would anybody buy it?” Years ago, my mother-in-law sent a CD of lullabies played by a cellist, all proceeds of which went to one of the children’s hospitals in Australia. It was played nightly for at least 2 years in my older daughter’s bedroom. This CD thought was significant because it’s the first thought I’ve had about future flute playing. Early in the week, even thinking about picking up a flute would send shooting pain into my hand. I first noticed this in an odd place, the restroom at a Panera around the corner from the hand therapist. My treat is a coffee on the way home. My daughter needed to go wash chocolate chip cookie off her hands in the restroom. She noticed the music playing in there and said “Mom, I like this flute song. Do you know what it’s called?” It was the Delibes’ Flower Duet from Lakmé, a beautiful piece of music which my flute duet partner and I have performed. The very next thing I noticed was that my fingers remembered which note comes next, at least in the arrangement I played, and that my hand was hurting. This too shall pass. I decided that this was my body’s way of insisting “Hey, lady, I’m not ready for that yet.”
Other rehab successes include: 1) accidentally folded a kid shirt using my index and middle fingers (I was zoning out while folding and then noticed what I was doing), 2) tied my little one’s sneakers (double knots even) for school, 3) sewed 2 buttons on the big kid’s shirt, 4) made some lunch for myself, consisting of heating up mushrooms, left-over rice, chicken, garlic in a frying pan, 5) holding toothbrush in left hand to squeeze toothpaste with right hand, and 6) holding iPhone in left hand!
Funny rehab moments that weren’t a success: 1) bra hooks, this was an experiment that failed and I’m staying with the sports bras with no hook, 2) skinny jeans – can’t manage the button with one hand, 3) washing a knife to use in the kitchen – can’t hold onto wet, slippery things yet, and 4) trying to put ponytail into little one’s hair. This one was a definite failure!
April 17, 2013 was my appointment for OT#3. I improved a little bit with flexion, but actually lost a little with extension on my index finger. This is not at all unexpected or uncommon, as my whole hand seems to be tighter as the healing process proceeds. All the stitches were removed, although it was a bit of work for 2 different therapists to get the little buggers free. I’m supposed to start with gentle scar massage for 3 minutes, 2-3 minutes per day after the scabs completely fall off. Yes, you’re actually supposed to rub the place that hurts on purpose! The idea is to prevent adhesion. I was given one new exercise to do involving a dowel rod about 4 inches long and 3/4 inch diameter. I’m supposed to hold it in my finger tips and roll it down to my palm, with no help from the thumb. Again, very specific instructions with how long I’m supposed to to this (3 times a day, starting with 1 minute and working up to 3). I’m allowed to do typing, actually using my index finger, for 5 minutes at a time. Now I’m allowed to use heat before doing the exercises and I’m hoping that it will really help loosen up the stiffness. I briefly saw my surgeon, as he was walking through the therapy room. He was pleased with my range of motion and corrected my form, on 2 exercises. Apparently what I thought was a neutral wrist wasn’t neutral enough for him. He’s the man though, so now I’m using my right hand to limit flexion in my left wrist so it doesn’t cheat and try to help the gimpy finger.
Key things I learned during this stage of my journey:
1) There are lonely stages on the path – kids and husband outside planting lettuce and kale, me inside doing hand exercises and ice. Emails, unexpected phone calls and visits from friends make all the difference. Now I will pick up the phone and call or send a message to people I care about.
2) I’ve already heard from several flutists who have read my blog and are dealing with similar situations. My experience is actually providing some help to others, which is very cool and exactly what I hoped would happen.
3) Some days are better than others.
4) Waiting is hard.
5) I was given this recipe for homemade ice packs: 3 parts water to 1 part rubbing alcohol in a Ziploc bag of choice. It doesn’t completely freeze, so it’s slushy and easy to form to the correct shape for my hand. It’s also not too heavy and gets very cold!
Now for the fun part! I was absolutely thrilled to get the cast off my arm at my first occupational therapy (OT) appointment post-op on April 3, 2013. I don’t have a picture of the cast, since I wasn’t planning on documenting this whole process at the time. It felt fantastic when my hand therapist cut through the dressing with regular old scissors, my pinky and ring fingers could stretch out again. “Hmm… I could have done that myself,” I was thinking. Looking at my hand was very, very difficult. It was swollen up like a paw and various shades of purple, blue and black and the incision was particularly upsetting for me. I misunderstood the orientation of the incision, I thought it would be the long way from index finger to thumb. Instead, it goes across the knuckle into the middle finger knuckle, perpendicular to the fingers. It was only 7 sutures, and not nearly as long as I had guessed. My hand therapist made me a splint for night time that holds my finger at a 60 degree angle to let the muscles rest in a balanced way. I got to pick the color of the velcro strapping – red, or course! Then she told me that I only needed buddy wraps, black velcro strips to attach middle and first fingers together, for the day time. I was shocked… “That’s it? You do realize I have 2 little kids at home?”
Then she gave me my exercises. My rehab consisted of 14 different exercises, all of which need to be repeated 10 times, with 4-5 sets of the whole thing per day. Wow… now the real work starts. The first exercise is forearm rotation. I teach this regularly as part of my Body Mapping course to musicians. This movement is an elbow movement and shouldn’t be a problem I thought. I quickly found out that I was wrong about this since all movements of my arm, wrist, hand, and fingers were compromised by the surgery and immobilization. Intellectually, I understood this. Practically, I was devastated that I had lost so much movement in such a short time. Before surgery, I had pretty much full use of my arm, wrist and hand. I learned to do things in weird ways to compensate for lack of pincer grasp. Complete and utter devastation. I felt like I was going to throw up while trying to do the exercises. Remember, how I said I stopped the Percocet? This was the wrong thing to do because the pain medication is absolutely necessary to get through the movements.
My doctor gave me a prescription for Tylenol with codeine, as it was stronger than the plain Tylenol and not as strong as the Percocet. It literally felt like my hand was ripping apart inside. My therapist said there was nothing I could do to damage it as long as I moved my index finger only with it’s own muscles, with no moving it with my right hand. Many questions were asked so that I was crystal clear about how to find the line between appropriate effort and “too much.” My plan was and is to go right to the line every time.
Trying to do my first set of exercises at home was one of the most frustrating experiences of my life to date. Sending the signal to my fingers to move and having absolutely nothing happen was terrible. Then I started to get angry. I kept at it though with beads of sweat appearing on my forehead and gulping glasses of water. How can this be so much freaking work when nothing is happening? In my head, I was hearing Jim Valvano’s voice, “Don’t give up, don’t ever give up” from his ESPY award speech. This is the clip shown often with the Jimmy V Classic basketball tournament to raise money for cancer research. I was utterly exhausted and didn’t do any more sets that day. I figured the exercises at the office counted, plus my prescription wasn’t filled until later that day. That’s the only time I’ve skipped exercises.
I decided that I needed to work smarter, not harder during the exercises by applying what I’ve learned about how bodies are designed to work through my Andover Educator training, as well as information I’ve learned through Alexander Technique and Feldenkrais. My mantra has become “I will not be denied.” I will get this done and get back to flying.
My Steps to Working Smarter
Step 1: The first thing was to find out exactly which muscle(s) should be working for each exercise, as well as which muscle(s) should not be trying to help. Muscles are usually found in pairs, when one contracts, the other releases into length. I used the Visible Body Muscles 3D app on my iPad as well as Trail Guide to the Body by Andrew Biel and Anatomy of Movement by Blandine Germain-Calais. I went through each exercise and wrote on instruction sheet the name of the muscle, its origin and insertion points. A ha…. there’s a reason that wrist adduction/abduction was difficult. Flexor carpi radialis attaches to the base of the index finger! And so on… the revelations just kept coming. I’ve studied hands and arms a lot, but I guess I never needed to know with this much accuracy and detail. Body maps can be continually refined and knowledge is power.
Step 2: When doing the exercises, I looked at the page in the Trail Guide that shows synergists… all the muscles that work together to execute a movement. Visually, I was able to direct my focus to where the muscle in question was supposed to be moving. Even if there is no movement at the finger tip, the muscle can still be working.
Step 3: I reminded myself continually that these exercises are whole body movements, not just finger or hand movements, and that I always needed to keep the part within the context of the whole. I forced myself to have feet on the floor, butt firmly in the seat balanced on rocker bone, leading movement with my head. I didn’t allow myself to hold my breath.
Step 4: Accepting the nasty, swollen, stitched, discolored, gross, disfigured finger/hand as part of my whole body was absolutely essential. Again, it was a return to emphasis of the part within the context of the whole. It wasn’t my finger’s fault that it’s been through trauma and it’s no happier about the situation than the rest of me.
Step 5: Once I was able to remove all pieces/parts of my dressing, I was able to do much better with the exercises. Just being able to visually see the joints and the movement (or lack thereof) was tremendously helpful. The pain meds blocked the pain, but also blocked kinesthetic awareness, at least for me.
Step 6: I started doing the exercises with both hands, mirroring each other. I remember one of my teachers telling me to use the good side to teach the bad side. It is amazing how much my gimpy left hand movement in general, as well as fluidity of said movement improves with the help from right hand.
Step 7: One day, it occurred to me that I’ve spent many hours of my life in gyms…. Medina Rec. Center, OSU weight room, Baldwin-Wallace weight room, various garages of homes I’ve lived in and the living rooms of my various apartment and I’ve never worked out without loud, pounding rock music. I cranked some up vintage Van Halen on the trusty iPod and got to work. Sounds stupid, but it helped and I was open for every bit of help from anywhere.
Step 8: I borrowed from my weight training experience again – you should exhale on the hardest part of the movement and inhale on the easy part. So for a bench press, inhale when the bar is moving towards your chest and exhale when you’re pushing the bar back up. For me, this translates to exhaling when trying to bring my index finger back up straight to full extension. Right now, it feels like my whole hand is ripping apart inside when do this, 14 exercises x 10 reps x 4 sets = 560 times per day. Reminding myself to channel my inner Adrian Peterson – fight, grind, work. See previous post for more about this guy.
Step 9: Warning — geeky music statement coming up. I figured out that I can keep track of what I’m doing when I count in triple meter. I’m supposed to hold each movement for 5, so here’s what I’m thinking “1-2-3 4-5-6, Up-2-3- 4-5-down; 2-2-3 4-5-6, Up-2-3- 4-5-down etc. The movement happen on 6. Sometimes this is a mental challenge to do with the music cranking out of the stereo. Counting out loud helps. Keeping a steady pulse helps. Counting the repetitions the same way musicians count rests helps (1-2-3-4, 2-2-3-4, 3-2-3-4, et.).
For this whole first week, my exercises were taking around 1 hour and 15 minutes per set, including ice time. My schedule was to take the pain med, wait 45 minutes, then start. Rinse and repeat. Yes, do the math and it was taking 5 hours per day. But there was no short cut.
I was exhausted. There was not much energy left over for anything else when it’s all going into healing a certain area. My first acupuncture treatment at 8 days post-op was fantastic. The amount of pain relief was amazing. I also had a chiropractor appointment on the same day and head, elbow and SI joints were now happily aligned. My father is a Reiki practitioner and I had that too. As I said, I was happy to take any help offered. These three events happened on a Friday and on the following Saturday morning, it was like having a new hand! The swelling was down so much overnight. Simply incredible how much more movement there is when the swelling isn’t around to interfere.
There was and continues to be a brain fog that goes along with the narcotic use. For example, my husband asked where my expenses were for the taxes, since he only had the income. My reply, “Uhhh… what? Huh????” Any other day, I would have known exactly where the computer file was that contained this information. The constant disorientation was and still is reminiscent of the mental state of mothers nursing newborns every two hours and wondering if they’ll ever sleep for more than twenty minutes at a time. Driving isn’t allowed while on the narcotics either. At this point, it was a non-issue since both of our cars are manual transmission and I couldn’t grip the steering wheel with my left hand, yet. Another instance of having my wings clipped, I haven’t had to depend on another driver since I got my driver’s license.
I had some new goals for OT: 1) learn to tie my own shoes so I can go running once the throbbing subsides, 2) learn to floss my teeth without having to use those stupid plastic flossers, and 3) safely shave my right arm pit. Interesting revisions since, when asked by my therapist what my goal was, I said “to return to full time flute playing without limitation.” No question about that being the long-term goal, but there are many other things that must be accomplished before that’s even in the realm of possibility.
Wednesday, April 10, 2013, rolled around and it was time for OT#2 with my hand therapist. She asked “How are you doing?” My reply, “I feel better, but I don’t know if I’m making the kind of progress that’s expected since I have no point of reference.” To make a long story short, I hit it out of the park! She said, “You’re a hand therapy rock star!” All 3 therapists and surgeon were thrilled with my progress. Apparently, at 13 days, I had the range of motion of somebody 4 weeks out. Too bad, I didn’t have the reduction in pain that goes along with that. Every other suture was taken out, because the incision area is under constant stress with the movements. The thread wasn’t cotton, it’s a plastic synthetic black thing and itched like crazy. Definitely more movement and less pulling with half of them out and I can’t wait for them all to be history. Interesting fact I learned: the therapists can tell which doctor put the sutures in by looking. Apparently each has his or her own signature stitch. Who knew?
Key things I learned during this stage of my journey:
1) The value of working smarter, not harder. See previous list.
2) I developed a healthy respect, admiration, and wonder for this thing called a hand. What a fascinating and marvelous design!
3) My fantastic results this week didn’t happen by accident. It was a team effort involving a good surgeon, acupuncturist/naturopath doctor, chiropractor, Reiki practitioner, appropriate extra vitamin supplements, support at home, and maximum attention and effort by me to complete the exercises assigned by my hand therapist.
4) It’s humbling to teach a child to open a child-proof medicine bottle since you need the pain med, you can’t open the bottle yourself, and you’re the only adult home at the time.
The following quote by legendary UCLA coach John Wooden is one of my favorites: “Failing to prepare is preparing to fail.” – Coach Wooden led the UCLA men’s basketball team to an unprecedented and, so far, unrepeated 10 NCAA championships. I’m a college basketball junkie, both men’s and women’s teams, and loved coaching my own team, even though it was seventh grade.
The big day, March 28, 2013, finally arrived and I was feeling good about my preparation. My twin sister came help with child care person for our girls, ages 5 and 8. I had spent the previous 3 days cleaning our house like a maniac since I didn’t want guests sleeping on the basement futon in the midst of spiderwebs, colossal dust bunnies and general kid junk. I even vacuumed out the nasty stuff that had accumulated on the bottom of the wire shoe rack in my bedroom closet. Who cares? Me… probably only me since my husband and children don’t ever notice. Grocery shopping was done, laundry caught up, calendars were made showing kid activities and directions for a driver other than me. The giant pile of papers and “stuff with no official home” was cleaned off of my desk. My surgery day was the last day of school before 11 days off for spring break and I knew I’d need to schedule things for my girls to do to prevent behavior problems due to boredom.
Part of my preparation involved acupuncture treatments and a pre-surgical protocol of vitamins and supplements given to me by my acupuncturist, who is also a naturopath. The purpose of the protocol was to increase the rate of healing following surgery and to minimize scar and adhesion formation. Beginning 3 weeks before surgery, I started taking vitamin C (1000 mg 3 times a day), Zinc picolinate (30 mg a day), copper (2-3 mg a day), citrus bioflavonoids (1,000 mg 2 times a day) in addition to my high-potency multi-vitamin and giant dose of probiotics. I also started a supplement called EZ Flex which contained high doses of B vitamins and tumeric. My surgeon is a big fan of huge doses of vitamin D, so I was already taking 2500 mg daily. I also visit a chiropractor regularly and had weekly treatments before surgery.
I googled Minnesota Vikings running back Adrian Peterson’s recovery from his knee injury extensively, reading everything I could find about what he did with his rehab. Peterson tore his ACL and MCL in December 2011 and was expected to miss the 2012 season. Well, Mr. Peterson worked his butt off and was named the NFL MVP for 2012. He played his first game 8 1/2 months after surgery. His recovery is amazing and almost a freak of nature. Obviously, he had the advantage of all the physical therapy and medical attention that professional athletes get in our society, but the bottom line is he pushed himself to the limit day in and day out. “The things you guys don’t see is how much I work and grind and fought through different situations to get back,” Peterson said. “Mentally, I was able to push through when I was tired and didn’t want to do anything.” He acknowledges that “90 percent” of the rehabilitation process was mental. He also mentioned the time it takes for muscles to learn to work in coordination again, in addition to regaining strength and flexibility.
I have had 4 broken fingers (all through playing high school sports), have had bunion surgery on both feet, ripped a toenail completely off which required stitches all down the side of the toe, and have given birth to two healthy baby girls. I love to run and work out with weights, kettle bells, Tae Bo type things. I played varsity basketball and soccer in high school and have run in 5K and 10K races. I understand about playing through pain and was anxious to get to a stage where I could actually do something to get better, instead of just sitting around waiting. At this stage, I was looking forward to the pain because it was necessary to for healing. Bring it on!
The surgery itself was uneventful. My room at Lutheran Hospital had a great view of Cleveland landmarks: Lake Erie, Browns stadium, the Jake (now known as home of the Cleveland Indians Progressive Field, but I liked Jacobs Field better), the Carnegie bridge and the historic buildings of Ohio City. It was interesting that the restaurant where my husband and I had our first date and the Great Lakes Brewery, where we had our wedding rehearsal dinner, were just one block away. I told him that he could go have a beer while I was on the table. I was anxious about having a senior anesthesiologist, rather than some kid fresh out of medical school. I picked the best hand surgeon to be working on my hand, so why shouldn’t I have the best person putting my arm to sleep? I had a great anesthesiologist who did a fantastic nerve block. I had a regional nerve block, which involves lots of shots into your arm pit, and wasn’t really that bad since I already had some sedating meds going through the I.V. Off I went to the O.R. Next thing I know, I’m in recovery. The person on the other side of the curtain was whining her head off about pain. I supposed I should have been sympathetic, but I wasn’t. I only wanted her to stop. I was feeling no pain because of the fabulous nerve block. I remember thinking that my left arm was on my stomach, same as the right arm. When I finally was coherent enough to peek under the blankets, I only saw one arm. I asked my nurse, “Where’d my arm go?” She said, “It’s right here, honey, don’t worry” and pulled the blanket back so I could see it right there next to my body. I also asked her when the nerve block wears off and she replied, “Well, honestly it’ll go from feeling just fine to ‘holy shit”’in about 30 seconds.” I appreciated her honesty. I was taken back up to my room and discharged after an hour or so. I had a bulky dressing, which is a plaster cast on the outside of my arm and dressings on the inside, that went from elbow to fingertips. I had to wear a sling for the first day since the nerve block was still in effect and I had no idea what my arm was doing.
I listened to my doctor talk with my husband after the surgery, but don’t remember much of the discussion. I asked my husband to use the voice memo app on his phone and record the whole thing. The surgeon was expecting to have to reconstruct the radial collateral ligament using a piece of tissue from my forearm and bone anchors. Surprisingly, this ligament was actually intact, but very loose. He tightened it, using the same technique as face lifts. The sagittal band was “a mess”, but he was able to sew it all back together. No extra hardware or parts necessary. This was the best possible scenario.
Arriving home from the hospital, my 5 year old was scared to be in the same room as me. She was afraid of the cast and the sling. Sad for me, but not totally unexpected. For the rest of the day, the the worst pain all day was hitting myself twice in the lip, twice in the forehead and once on the bow of my glasses with my cast! I thought my arm was on the table or pillow stack and didn’t realize it was moving until impact. Loved that nerve block!
About midnight, the nerve block wore off and I quickly learned to love the Percocet for pain control. I concurred with the recovery room nurse’s professional opinion, “holy shit” was accurate. For the next week, I surfaced from my Percocet haze to have my ice bag refilled (I had ice on my arm 24/7 for the entire week), take my medicine and vitamins, push some food around my plate, visit the bathroom and drink water. Luckily for me, my team was in place. My husband and family took care of everything else that needed to be done, mostly with a smile on their faces and not too much grumbling. Our old TV was brought upstairs and hooked up so that I could watch the NCAA basketball semifinals and I didn’t miss a game! Although, I couldn’t follow the action like I usually do. Without narcotics, I can keep track of how many timeouts are left, which players have how many fouls, which direction the alternating possession arrow is going, etc. This time around, not so much. My trusty iPhone timer was set every 4 hours so I wouldn’t miss the pain meds, which really wasn’t all that necessary as my hand had it’s own time schedule of when the medicine was due!
On Monday night (day 5), I experienced a panic attack directly related to the Percocet. My heart was pounding, I was hyperventilating, and couldn’t stop thinking “I have to get this damn thing off my arm because it’s too tight.” It was not too tight, since my surgeon showed us how to check this. I knew I was being irrational, but I couldn’t help it. I felt so out of control, it’s a terrible way to feel. I stopped taking the Percocet and went to plain old Tylenol, which didn’t do much for the pain. In my mind, I’d rather have it hurt than deal with the irrational panic. I found myself wondering if my grandmother felt like this when she suffered through the early stages of Alzheimer’s disease and felt chagrined that I should have felt more compassionate rather than annoyed with her.
Key things I learned during this stage of my journey:
1) I can’t do this alone. Feeling completely helpless is no fun for anyone. Feeling completely helpless as a parent is even less fun. I couldn’t cut my own food, fill up the damn ice bag, replace the toilet paper in the bathroom, get the top off the toothpaste or shave my own armpit. I found a pink Disney tooth flosser that one of the girls got from the dentist and decided to use it. I promptly got it stuck in my back teeth and had to have my husband yank it out. My sister had to chop the arms off of some shirts for me to wear and then had to guide the arm hole over the cast.
2) The value of saying “thank you” when people are helping or trying to help.
3) Pain medication is prescribed for a reason – take it sooner rather than later. My experience was that I needed to stay on time and ahead of the pain. Once I missed a dose and it’s very hard to get the pain back under control.
The events leading up to my injury started with a new flute. I finally bought the flute I wanted to have, as opposed to what I could afford at the time. My old flute served me well through my undergraduate degree at Baldwin-Wallace where I studied with Mary Kay Fink, my graduate degree at the Ohio State University where I studied with Katherine Borst Jones, nine years of teaching in the Wooster City Schools in Wooster, OH, and my years of study leading up to licensure as an Andover Educator. While performing and presenting at the 2012 NFA Convention in Las Vegas, I bought the flute of my dreams. I decided to go with an offset G on the new flute because I’d read a lot about how it’s helpful for those with small hands as they age. For non-flutists, an offset key puts the G and A keys farther out on the tube, so that ring and middle finger don’t need to reach as far. With the benefit of hindsight, this was a big mistake. I’d successfully played flutes with inline G for 31 years with no pain or problem whatsoever. Note to self: why fix it when it isn’t broken? The problems started after I got the new flute home. I started to have pain at the base of my left index finger after practicing. Granted, I didn’t ease into it slowly. I went full steam ahead, retraining my fingers how to cover the holes with an off-set G. Preparations were underway for a debut flute duo recital in October with flutist Denise Rotavera-Krain. We’d been wanting to start a professional duo for years but raising our girls conspired to put this project on the back burner. As a teacher of Body Mapping, I knew how my arm and hands are structured and was studying my own use to see if I was doing something weird to cause the pain. I couldn’t find anything physically wrong with what I was doing, but the pain continued. I noticed that the offset G put my hand in a slightly more ulnar deviated position, which means my hand was moving out of neutral alignment. My thumb was more inline with my forearm than my pinky. With the size and shape of my hand, this slight adjustment delivered weight to the side of the base of my index finger, not the palm side. Fortunately for me, Alexa Still now teaches at Oberlin, 45 minutes from my house. She’s an fantastic teacher and custom makes cork thumb and finger supports for her students. I watched her make two of these thumb thingees at her summer workshop and subsequently had her make one for my alto flute. I consulted with her about the new flute hand problem and we tried a finger extension, a slightly different hand position, a right hand thumb support to take weight of left index finger, clear water hose to make the tube wider and Dr. Scholl’s corn pads stuck on the flute as a cushion. None of these solved the problem. One day while driving my youngest daughter to preschool I realized that my hand was hurting while grabbing the steering wheel and that the new flute simply had to go. I had been trying so hard to make this flute work, since I was told by the flute company that there was no refund or exchange possible. What followed was a long complicated process, but, as of December 2012, I now have a beautiful new flute with inline G, patiently waiting for me in its case and hopefully the gorgeous off-set G flute has a new home with another flutist. I went back to playing the old flute with a Dr. Scholl’s corn pad as cushioning for the base of my left index finger. The recital on October 20, 2012 was fantastic and I then decided to take one month off to let my hand heal and rest.
In the beginning of November, my hand was feeling great. No pain, no problems, definitely getting better. On the night of November 8, 2012, it was bath time for my 4 year old. I was kneeling at the side of my tub, put my right hand on the edge of the tub, and reached up to put the tubbie toys away, a movement I’ve done thousands of times with 2 kids who love their baths. I failed to notice that my right hand was in water until I fell forward into the tub. I dropped the toys with my left hand and threw my hand out to avoid falling directly onto my child. My left hand contacted the bottom curve of the tub with fingers hyperextended, took the whole weight of my body, and the main point of contact was the base of my left index finger. Something went “pop” inside my hand. Of course, where else would it be other than the site of the healing injury? My daughter thought it was great because there was a giant splash and Mommy’s clothes were soaked. It probably was fantastic from her point of view!
What followed was a long, frustrating journey through the our medical system. I am extremely lucky that I live close to the Cleveland Clinic, which does have a number of doctors who are part of PAMA (Performing Arts Medical Association). I went through four doctors before I could get a definitive diagnosis. If I followed the first doctor’s advice, I’d have gotten a cortisone injection which would have done nothing to heal the tear. The first three doctors (two of which are big names and very well respected in their fields) all said “hmm.. there’s something going on in this area and it’s a soft tissue problem.” The 3rd doctor put me in a splint to restrict the movement of my MCP joint to allow the area to heal on 11/30/12. It was fantastic to watch the hand therapist custom make this splint for me. Little did I know then that I would come to depend so much on the skill of my hand therapists.
After three weeks, I followed up with the 4th doctor, another orthopedic specialist who works with musicians’ hand. He was finally able to diagnose me with a partial tear in my radial sagittal band on the MCP joint of my left index finger within a few minutes by looking at my hand. The MCP joint is the metacarpophalangeal joint or the big knuckle where the finger meets the hand. The sagittal band is connective tissue that’s part of the extensor complex, goes around the joint capsule and keeps the extensor tendons tracking over the middle of the knuckle when you make a fist. The extensor tendons are the ropy things you see on the top of your hand when you make a fist. They should be centered over the knuckles. In my case, the extensor tendon of my index finger was pulling towards the valley between index and middle fingers, “the valley of doom” according to my doctor. My diagnosis was a bit of a challenge. At that time, he didn’t think it would require surgery and the conservative treatment was another 8 weeks in the splint.
This doctor, who is also now my surgeon, knew the difference between an offset and inline flute without me explaining it! He was also able to explain how playing the offset flute probably caused this partial tear, which was healing on its own, and then was further traumatized by a fall on the same area. There’s a little bony projection on the bottom of my finger bone at this joint in my left index finger, just an individual difference. Normally not a big deal, but with the slight adjustment to the offset flute, this little bony projection was acting like a saw blade under the sagittal band. It was a relief to know that there was a structural cause to this whole thing, rather than just a black hole of self doubt, as in “did I do this to myself?”
On January 11, 2013, I followed my hand therapist’s advice and played for 5 minutes. I was instructed to play for the 5 days preceding my appointment and see what happened. Day #1 was fine. Day #2 was fine. Day #3 was hell, and I stopped after 30 seconds. The therapist was sufficiently concerned at my next appointment to request an informal consult with the doctor. He said more time in the splint because this joint is very hard to heal because it’s difficult to fully restrict the movement and there’s not much blood supply there to promote healing. So, back in the splint – still no flute.
On February 13, 2013, I met again with my doctor. At this point, the conservative treatment had failed. There was some structural issue that was not going to heal itself, leaving me with no other option to reconstructive surgery. Upon manual examination, it was clear that there was some issue with the radial collateral ligament (holds the finger bone to the hand bone at the joint and prevents lateral movement) as well as the sagittal band. I was scheduled for surgery and an MRI. Up to this point, I had not spent much time considering my emotional reaction to all of this. I walled it off and refused to think about it because I was going to get better with time. Once the surgeon said “there are no more options”, then I realized that I couldn’t ignore this anymore. I ended up sitting in the parking lot of a local organic grocery store, crying my eyes out. I needed to compose myself before driving home, having to function as Mommy for two girls, and going to talent show dress rehearsal for my oldest daughter.
I continue to try to figure out “How can I use what’s happening now to make me a better teacher?” I realized that the mental and emotional aspects of an injury can be just as debilitating, if not more so, than the physical aspects. This isn’t a new idea, we all know this, at some level. But now I KNOW this. My perspective has changed, since I never experienced an injury that necessitated a complete halt to flute playing, piano playing and my ability to make music in some form.
Emotional/Mental issues that I’ve been experiencing:
Devastation – I’ve spent years and years learning my art form and now I can’t do it all for an indefinite period of time?
Guilt – Why should this injury be such a “Big Deal” to me when I have friends, relatives, and colleagues dealing with chronic health issues like cancer?
Anger – Why is the universe conspiring against me?
Lack of trust – So I did what the doctor and therapist said, 100% compliance with all instructions, and now I’m worse? Is the diagnosis right? Do these people know what they’re doing?
Frustration – So there’s really nothing I can do except wait?
Disappointment – Having to turn down and cancel professional engagements is hard. Accidents happen and people get hurt; however, we all work hard to get the gigs and who wants to have to cancel? When will the next opportunity come around?
Financial stress – Luckily for me, my ability to feed and clothe my family doesn’t depend on my ability to generate an income. This is not so for other musicians.
Self map issues – If I’ve mapped my self as a flutist, what I am without the flute? If I’m a band director, what am I without a band? How can I be a musician who can’t make any music?
Impatience – I know how to regain my playing skills, once the _____________ (insert injury) heals. Come on, already!
Lack of trust in my own judgment – How can I teach other musicians how their bodies work when I hurt myself on my own stupid flute?
So, what do we do when students, colleagues, or friends talk with us about similar issues? I’m not a psychologist or a medical professional. What we can do is validate other people’s experience. We obviously can’t say, “I know how you’re feeling.” How insulting, to presume that you know what somebody else is experiencing! Perhaps just acknowledging the feelings takes away their power and then we’re free to choose to focus on something different.
I had an MRI done on February 26, 2013 which was bungled by the MRI tech. Let’s just say that one of the many problems was that she dropped the lid of the coil on top of the injured hand. At my pre-surgical appointment on February 27th, my daughter’s 5th birthday, my surgeon agreed that the MRI was poorly done. It didn’t show the either of the structures in question, but was helpful since it didn’t show any weird bony masses or anything else wrong with the joint itself. At this appointment, I had a list of 21 questions for my surgeon. I do my homework and wanted lots of information. When I asked, “You’ve done this before for musicians, right?” He giggled, in his surgeon-sort of way, and said that he’s done it for professional musicians, musicians who are also surgeons and surgeons on their dominant surgery hand. I can’t think of a more high maintenance group of patients than other surgeons, so I thought that this is definitely the guy I want to be cutting up my hand. Surgery was scheduled for March 28, 2013.
There were good things that happened during this time. Perhaps, these gifts that my friend encouraged me to find.
Key things I learned during this stage of my journey:
1) I successfully taught a 2 day WEM workshop for students at Ashland University without playing a note on the flute. It was frustrating to not be able to demonstrate the concepts, but it’s always good to add more ways of teaching a concept to your teacher’s tool box.
2) Thinking outside the box – I learned to modify my old flute so I could play a few notes to successfully teach a workshop on extended technique for a student flute festival where I was the guest artist. I was unable to perform my solo piece, The Great Train Race by Ian Clarke. So I played the composer’s own recording on a CD for the students, and then was able to demonstrate each technique found in the piece. With my splint, I couldn’t even hold the flute properly. For flutists out there, flute modifications that I made were 1) putting cork wedges under the foot for the C key and the thumb key, so they were closed by default, 2) putting plugs in the open holes, 3) plopping the whole thing on top of the splint, and 4 ) carefully choosing notes to play that didn’t require left hand thumb or 1st finger keys to be open.
3) I learned to appreciate the power of the pincer grip of first finger and thumb. It’s not so easy to do things with middle or ring finger and thumb. I was fortunate that I had almost full use of all fingers, except index finger, and thumb, as well as almost full wrist and arm movement. However, restricting movement in one joint led to a whole series of compensations made by the whole arm and whole body.
4) It was made clear to me through conversation with one of my former teachers that I did not fail myself as a Body Mapping teacher. I knew something was wrong and did everything I did to fix it, including giving up that specific instrument. I went to others for help and decided that I needed to make a change. She wrote to me said to me, “I feel certain, and it seems that you do, too, that you would have solved this and be fine now if you had not fallen, so there is a lot for you to be proud of in how you handled the problem of choosing the wrong new flute. Also, you didn’t fall on your child in the tub!” Even musicians fall down.
5) Do not stop looking for answers to a medical problem when you don’t get a definitive answer. Keep asking questions. Sometimes, it’s a matter of finding the right medical professional.
I am a professional flutist, teacher and Licensed Andover Educator taking beginning steps on the long journey to recovery from reconstructive hand surgery. A good friend of mine recently told me that it takes time to find the gifts in things that happen to us. After pondering this for a while, I came to the conclusion that one gift I’ve received is the time to ponder all physical, mental, and emotional challenges aspects of my injury and recovery. I takes a team of people to help deal with an injury – doctors, nurses, therapists, family, friends, but at the same time, it’s a terribly lonely place to be. Nobody else can to work that getting betters requires. Hopefully, sharing my experience with other musicians recovering from career-halting injuries will help them to know that they are not alone. Another friend loaned me a book titled “The Hand” by Frank R. Wilson, a neurologist. Dr. Wilson writes “when personal desire prompts anyone to learn to do something well with the hands, an extremely complicated process is initiated that endows the work with a powerful emotional charge.” I burst into tears when reading this because it confirmed for me that other musicians experience emotional trauma along with physical injury and that I was not going crazy! On the next page, he writes “The musician in full flight is an ecstatic creature, and the same person with wings clipped is unexploded dynamite with the fuse lit.” Again, he captures exactly how I am feeling now. As I look out my windows in the beginning of spring in Northeast Ohio, red-winged blackbirds, a cowbird, a goldfinch, sparrows, nuthatches, cardinals, purple finches, downy woodpeckers and our regular red headed woodpecker all fly around near our feeder with reckless abandon. They don’t worry about what could happen to their wings, they just go, seemingly without effort, just intent. So many different bird shapes, all with different patterns of flight. An injured wing would very likely be fatal for any of these creatures, especially if wounded and confined to the ground with outside cats and coyotes in our area. For me, my injured wing is not fatal, but merely temporary and I will fly again.