Shackle-Free: Conquering De Quervain’s

Words cannot describe how happy I am to be able to write this entry right now. It’s been a while since I’ve been able to use my right hand (and eventually my left hand) pain-free. It feels a lot like getting the shackles off. It feels a lot like being free.

It’s no news that I had been having right wrist pain since over a year ago. It started quite suddenly. I just woke up one day and there it was, notably more intense whenever I tried to flex my wrist. Resting and splinting helped initially, as did the usual pain relievers, both oral and topical medications. I eventually learned to live with the pain, sometimes deciding to take off the splint altogether since it was such a bother to work with. My initial work-ups – x-ray and  MRI-showed basically nothing, anyway. I figured it would eventually go away with time. I was a writer, for crying out loud. And an aspiring surgeon at that – I took my elective splint-free. There was no way I could function at the OR wearing it.

But then, clerkship started. Let’s just say that the great work involved in direct patient care, all the monitoring, the charting, the procedures, took their toll on my hands. Yes, pleural – hands. Come my IM wards rotation, the splint was doing me absolutely no good already, so I removed it completely. Taking all my usual medications proved useless as well – I tried everything from paracetamol to mefenamic acid to dexketoprofen to  celecoxib to etoricoxib, nothing was working. I used all sorts of topical medications, the warming effect of some of which would temporarily be comforting but would eventually prove too short-lived. With my right hand in such pain, I tried relying on my left hand, an effort which eventually blew up in my face. Pretty soon, I was hurting from both hands. And it definitely did not help that the clerkship load of IM made it basically impossible for me to follow-up with my orthopedic surgeon.

For about two weeks, I would face my hospital work with a patience I never knew I had. I’d force myself to smile because there was no way I was going to face my patients with a painful expression. I’d struggle with completing my work, and during non-duty nights, I’d come home to my condo and break down in tears from the pain. I would cry myself to sleep. It was more difficult during duty nights. I’d take time to hide in the comfort room to wipe my tears and just take a breather before returning to battle.

There came nights when I really couldn’t take it anymore. I’d struggle to send a message to my parents, desperately asking them for what I could do since I really couldn’t take it anymore. My dad came rushing with medications, but again, there really couldn’t do anything about the pain.

Soon, I really couldn’t take it anymore. Every movement was painful. The tears wouldn’t stop falling. I had to opt out of school for a while to get my hands checked out. It turned out to be De Quervain’s tenosynovitis- the tendons of the muscles controlling my thumb were trapped, leading to much inflammation and thus pain – and it was now bilateral. Steroids were injected into my wrists, an attempt at conservative treatment. But as the days went by, the pain only got worse. I was still crying every day – this time, not only from the pain but also from the growing feeling of depression.

I felt useless. I couldn’t do anything without assistance or without feeling intense pain. How on earth was I going to become a surgeon now? How on earth am I going to write now? I couldn’t even hold a pen! I felt increasingly hopeless, but more than anything, I felt scared – scared for what was happening and for what was going to happen.

Seeing as my hands were resistant to the steroid treatment, my parents and I agreed to push for surgery.

Release
Being on the operating table myself felt weird. As I got an IV line inserted, I was mentally apologizing to every patient I ever hurt, especially those I failed to get on the first attempt. I asked if I could watch the surgery and sure enough, my surgeon opted not to raise the curtain separating me from the operating field. The surge of anesthetics that dulled my pain were able to bring perhaps the first true smile on my face for quite a while now. The surgery was over before I knew it – only 30 min. My poor tendons were released. The joint space effusion was drained – the doctor said that the synovial fluid had already changed in color because of how long my condition had been going on.
Post-op pain sucks. The pain is notably different from what it was before. After the surgery, there was incisional pain – it feels like there’s still a knife cutting through it – and the occasional pins-and-needles. Some part of my hand feels a bit numb, while others are tender to the touch. My right hand has quite a number of hematomas in the area where they operated on.

Of course, the effects of the surgery aren’t to be instantaneous. I was told I was going to have to avoid strenuous activity, repetitive wrist movement, heavy lifting – basically anything that would put further stress on my hands for at least 1 month. Hell, I was particularly told I couldn’t chart S.O.A.P. notes! It was the indirect way of saying that I couldn’t go back to my clerkship duties just yet. But truth be told, there was really no need to advise me to avoid doing anything. I can’t do those things anyway. Moving my hand was still particularly painful. The first few days post-op were a whole new struggle on their own. I’d have to say that taking a bath was the hardest thing to do. Eating was a battle too.

But now, at six days post-op, I am finally getting the old me back. I’ve missed smiling. I’ve missed laughing. I’ve missed feeling happy. I can hold a spoon with my right hand now! Certain positions are still a bit painful, but it’s fairly tolerable. I’m getting by without my round-the-clock pain meds now. I do self-rehab exercises everyday, patiently taking time to stretch my fingers as well as use the stress ball. I can manage without the splint – only using it at night now. I think I’ll be able to write again soon. As for my left hand, it is now in a splint of its own. I’m hoping to avoid getting surgery for it too.

I am immensely thankful to God for helping me get through what has been such a difficult experience. I am truly blessed to have my family by my side every step of the way. I hated seeing my suffering reflect on my parents, both of whom I knew were as affected as I was by this ordeal. Their worry was a pain in a whole new level on its own. Thank you, Mom, Dad, and Chino, for always being there for me through all this.

To all the friends I’ve caused to worry and for all your supportive words, both for now and for long ago when this whole wrist pain thing started, for this entire journey, thank you. To everyone who was affected by my illness and my absences, for the hurt, the confusion, the extra burden, I’m sorry and am thankful for your understanding.

Pain can change a person’s life so much, especially pain that goes in the way of your every day, pain that seemingly won’t go away no matter what you do and no matter how much you wish for it to be over.

I’m taking time to heal during my short leave of absence from clerkship, healing that would no doubt go a lot easier thanks to the support and love of my family.

I am eagerly awaiting the day of my return to the hospital with both of my hands shackle-free. :)

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