Three Is A Magic Number

Out of all the Schoolhouse Rock videos, this is my favorite. (I’m Just A Bill and Elbow Room are runners up.)

There is something magical about the number three. And that song (and the cover done by Blind Melon, too.)

But today, three is not a magic number. It’s the number of trigger finger releases I am supposed to have in a few weeks.

I say supposed to have, because like any empowered patient, I’m going to to do my research about having three fingers done on one hand when only one is actively triggering (although my pinky and my middle finger – hey!). I’ll ask around, look up information in medical journals and perhaps even get a second opinion by another hand surgeon. Why, you ask?

My Appointment Was Not What I Expected

The appointment itself was interesting, because if I had met the surgeon a few years ago, it would have been a different conversation. Here’s how it went (and my thoughts as it happened).

My appointment was for 12:10pm. Brought into a room by Jason with a M.A. on his name tag.

::What does M.A. stand for in this office? Master of Arts? I don’t think so.::

“So, why are you being seen today?”

::Does ANYONE read the reams of paperwork they make me fill out? Anyone? Bueller?::

I give him the lowdown. 

“How do you know that it’s trigger finger?”

::Again, paperwork. Four previous trigger finger release surgeries.::

“You’ll get an x-ray and then the doctor will be in to see you.”

From the time I saw Jason and got two X-rays on my hand, it was another 40 minutes before I saw the doctor.  He breezes in with a guy behind him wheeling a cart with a computer on it. His own personal stenographer for electronic health records.

He knows I have trigger finger. There are no questions. I didn’t get an opening statement in.

Because of my friends, Drs. Sean and Tamara Oser, who present an incredible session at Friends for Life, I know this statistic: 

In a well-known study of the survey phase, Beckman and Frankel found that physicians prevented patients from completing an opening statement 77% of the time. Those who interrupted their patients did so in a mean time of 18 seconds.

He beat this statistic to death.

“Hi, I’m Dr. X (not his real name, although that would be neat, right?). So, let’s see your hand.”

He examines it. Palpitates the area where it hurts. I wince. He keeps asking me to open and close it, telling me to make a fist.

::I can’t make a fist, dude. My finger won’t do that anymore. If it did, I wouldn’t be here.::

He pokes at it again, while I explain that I’ve had trigger release done before, but not here and not for this finger.

“O.K., so I’m going to give you a cortisone shot.”

Options

::Oh, no you aren’t.::Water Punch

::He didn’t even give me options. Ask me if I’ve ever had a cortisone shot in the FOUR other fingers I’ve had trigger finger. Explain that I could choose: physical therapy, cortisone injections, percutaneous release or open surgery release. Four options. I know which one would work for me, for most Type 1 diabetics, but HE DIDN’T GIVE ME OPTIONS.::

“Dr. X, I’m not doing a cortisone shot. It’s been proven and published that it’s not a successful treatment option for individuals like me with Type 1 diabetes. Surgery is almost always done in these cases following a cortisone shot.”

He looks at me, then turns to the steno guy, who is now looking confused.

“I’ve done the research. I am an e-patient.”

He looks at me again. He says:

“I’ve done over 10,000 release surgeries. Most people with diabetes do end up with surgery.”

The steno guy is wide-eyed. Dr. X nods to me, then tells the silent interloper with the computer:

“We’re going to do surgery.”

He turns back to me, starts palpitating my palm again and asks if there is any pain when he presses here or here.

::Yes and yes.::

“You know that you’re already showing signs of triggering in your pinky and it’s only a matter of time before you’ll have to have the pinky and the middle finger done. So, let’s go ahead and do all three while we’re in there doing the ring finger.”

::I am so over this trigger finger thing. Whatever.::

After this brief conversation, he leaves and I schedule surgery, but not before he popped his head in and told me that I would probably want to schedule it at one surgery center over the other he uses, because the anesthesia company he uses does not accept insurance at the one closest to my house.

::In my next life, I’m coming back as an anesthesiologist.::

If this had been a few years ago, I would have blindly accepted the cortisone shot, then floundered for weeks dealing with super high good sugars and staggering amounts of insulin to bring it down, eventually ending up in his office again, this time to schedule surgery.

I have done a lot of research, talked with my friends in the DOC, and had this done four times already, I didn’t go in blind. I just came out angry.

Angry that I wasn’t offered a choice. Angry that I had to state that I was going to have the option he didn’t initially present to me. And then I am angry because I am not even sure I should have three fingers released when I know only one needs to be done right now.

Questions

So, for those of you who have had trigger finger release surgery, has anyone had THREE fingers done at once? What would you do?

And maybe the other question I have is this: Is it wrong to expect doctors to have a conversation with you about options, because right now, I’m as confused as the poor steno guy?

 

 

 

 

 

The Wrong Finger

1283953_23864084One of the lovely little complications that you can get from having diabetes is stenosing tenosynovitis, affectionately known as “trigger finger”.

What is Trigger Finger?

À la Wikipedia:

a common disorder characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain. A disparity in size between the flexor tendon and the surrounding retinacular pulley system, most commonly at the level of the first annular (A1) pulley, results in difficulty flexing or extending the finger and the “triggering” phenomenon. The label of trigger finger is used because when the finger unlocks, it pops back suddenly, as if releasing a trigger on a gun.

Let me add on:

The pain of trigger finger can become so bad that it wakes you up in the middle of the night. The locking of the finger in a curled position to an open position can make you see stars and clench your teeth and make you lose your breath. The inability to flex the finger renders it useless.

Trigger finger is not one of those items on the list of complications that you learn in your quest to understand what diabetes does to your body. Kidney disease, blindness, cardiovascular issues… they get all the attention. Those get hammered home in all the media and resource information.

Trigger finger isn’t even on the first page. In fact, until the first time it happened to me, I had no idea it was a complication at all.

Ain’t My First Time At This Rodeo

About ten years ago, I got “hitchhiker’s thumb”, which is trigger finger… except it was… yeah. My thumb. Both of them at the same time. (Long story. You can read it here.)

After The Kid was born, it was my index fingers. Both of them. Repetitive motion can trigger (sorry for the overuse of the word) trigger finger, and I was changing a lot of diapers. By the time I dragged myself to the orthopedic surgeon, I couldn’t change a diaper or move them much at all.

Well, it’s back. Just one finger this time. My ring finger on my right hand. And it’s the wrong finger. (I’d much prefer not to have it at all, so any finger is the wrong finger.)

How Do You Fix Trigger Finger?

First line of defense that many people try is: NSAIDS (anti-inflammatory meds), splinting, and steroid injections into the tendon.

While for non-diabetics, the injections of steroids can help and make this issue go away, it’s not a successful course of action. Surgery is recommended to most people with diabetes: percutaneous release or open release. (The first is done via a needle inserted without cutting open the hand.) Open release surgery has been my only option, where the surgeon opens up the sheath surrounding the tendon and as it was explained to me: “the gunk gets cleaned out so that the tendon can smoothly move back and forth”.

So, right now, I’m splinting it and taking NSAIDS. I’ll most likely have surgery as soon as I find one I trust in the area (I moved last year…).

In the meantime, my typing is slow and a little very painful and I am apologizing to John about the level of cleanliness in the house. Unloading the dishwasher is a joke that isn’t funny. I can’t cut my own meat. My right hand is becoming less useful. I am having problems typing, which is why I haven’t written a blog post recently.

This has happened over the last few weeks. No warning. But I know the ending. And that it will most likely happen to other fingers in the future.

I’m hoping next time it’s one of my middle fingers. Because that’s what I want to give this complication.

Ouch.

 

"Is The Patient Unconscious?"

356463_9547“911. What’s your emergency?”

“28 year old Type 1 diabetic with a blood glucose of 33 mg/dl after three juice boxes. It’s been over forty minutes and it’s not coming up.”

“Is the patient unconscious?”

“I am the patient.”

Silence greeted me at the other end of the line, then the emergency operator croaked out:

“Wow. All right. Paramedics are on their way. Can you unlock the front door?”

In 1998, I made the first and only 911 call (so far and knock on wood) about my diabetes. Dinner was vegetarian chili and a beer, and before the pump came into my life, it was the ol’ fast and slow acting insulin show. What was injected in was going to be acting for a long time.

I didn’t count on my food not acting at digesting well – or in this case, at all.

While I was living with someone, he worked nights in the ER at a hospital across town. I was alone. A few hours after I finished my meal, I felt overwhelmingly sleepy, so I got up to check my blood sugar before snuggling down into bed.

32 mg/dl.

Before I see a number like that on my meter, I’m not panicking. It’s that fuzzy thought of: “I’m probably a little low,” that turns into: “Oh. Oh. Oh. No.” I’m fine before and then I’m not. All rational thought flies out the window. It’s go time.

The first juice box went down easy. I remember intently studying the carb count on the side of the box, willing that 24g of pure apple to kick into gear. I knew I would need to ingest more than 24g, but it would get me out of the weeds.

I watched the clock. Tick. Tick. Tick. Precisely fifteen minutes later, I checked again.

35 mg/dl.

My inner monologue was a little salty and blue. The second juice box was choked down. Did you know that you can make a game of pulling a juice box straw in and out of the hole, trying not to pull it out of the box? I lost the game a lot, but it was something to focus on as I sat on the floor of the bedroom, blatantly ignoring the rising adrenaline and cortisol levels.

Low blood sugars suck. I’m one of those people who can still function (and I use function loosely, but I can still verbally communicate and stay upright) in a severe hypoglycemic state. I’ve never passed out from a low. In later years, I’ve had severe hypos when I needed assistance and ones in which my muscles contracted involuntarily, squeezing to get that extra glucose out to help save me. (That is NOT a pleasant experience.) But I had someone around to help me.

I was alone. And after the second fifteen minute mark, the meter was reluctant to show me where I was at.

33 mg/dl.

I picked up the phone and called my boyfriend at work.

“I’m low.”

He knew that I wasn’t calling to chat. He worked in an ER and I never called him there.

“How low?”

I explained, rambling a bit about how I was tired of juice boxes, and that I’m still not coming up.

“Here’s the deal, Christel. We can hang up and you can call 911 or we can hang up and I can call 911. Which do you want?”

We hung up. I placed the call and confused the operator with my 33 mg/dl and I’m still conscious and it’s me and not someone else. Paramedics showed up less than 5 minutes later and tramped into my living room with cases of equipment to find me watching late night TV, taking minuscule sips from my fourth juice box.

They offered IV dextrose and a trip in their shiny ambulance to the local ER. I asked them to wait with me for 15 minutes more and retest. We talked about what happened and then laughed at the informercial blaring from the corner.

55 mg/dl.

They stayed another 15 minutes and I admitted that there was no way I could put anything else in my stomach, so if my blood sugar went south or stayed that low, my veins were their playground.

73 mg/dl.

I felt like I won the lottery.

My boyfriend had called a coworker who was in our complex and had just gone off shift to come be with me for a while. She arrived, flirted with one of the paramedics, and hung out while I slowly drifted upwards to 104 mg/dl. We both slept in the living room.

I was diagnosed with severe delayed gastric emptying two weeks later. (I had other incidents after that, none as serious, where I would eat and go low after a high carb meal with a very slow response to treating glucose.) My stress levels were off the chart and the combination of my body rebelling from the stress and my diabetes manifested in this lovely lack of digestion. I was sent home with anti-emetics and some gastric motility drugs, wondering how I was going to live with this.

Happy to say that my stomach decided to work again after a while (and after the stress went away). But that 911 call is my reminder that no matter what, when you need help, pick up that phone as soon as possible.

Why do I tell you this story? Because I almost didn’t pick up the phone.

And no one would have been there to make that call for me.

 

 

Diabetes Hurts

1441012_62476745Diabetes hurts.

I’ve never heard anyone describe injecting insulin as graceful or gentle.

The needle bears down onto unblemished skin that begs to not be pierced. Nerves scream in anticipation as the metal bores underneath, invading the sacred temple of the body and pushes the very cells that give me corporal nourishment. It sears and brands the skin around it, leaving a physical scar behind as a permanent reminder of what I must do to stay alive.

If I told a stranger that I hurt myself on purpose daily, they would recommend psychological counseling immediately.

Not every needle insertion is a hot branding, but when you must, without fail, do this tortured dance for the rest of your life, knowing that you have endured over three decades of this, it begins to ache deeply. Even with smaller needle gauges and shorter lengths, no one has ever gleefully clapped hands and asked to be mutilated for their health.

Diabetes hurts.

Over and over, a lancet finds its target somewhere on a finger, slicing into the same tender skin that strokes my daughter’s hair as she drifts off to sleep. It’s become rote at this point, a slight turn of the head at the same nanosecond that the button is pushed to draw blood. A sting, temporary, to decide on the dosage of the drug that will keep me alive but could also render me unconscious or dead. That sting, several times a day, over time, is a weight that drags me to the bottom of the ocean, gasping desperately in my dreams.

Too much insulin and diabetes hurts. It starves brain cells and prevents me from making rational choices. The throbbing between my eyes competes with the violent contractions of my limbs to squeeze out the last vestiges of glucose within my muscles. My throat constricts, choking on the words needed for help.

Too little insulin and diabetes hurts. Toxic sludge sloshes through my veins, spewing poison into every organ and damaging the beautiful body my soul holds, shutting down the potential of a long life and health. The complications build an ugly monument where the delicate framework of what I am once stood.

The guilt crushes you, despite your best efforts of controlling what is uncontrollable. The questions of why build to a deafening roar. Labs slam your body into a corner, even when the results are expected. It infiltrates and infects those around you who love you and can’t live in your body or take the burden from you.

You may accept this disease. You learn to live with it, try to tame it, keep it in check and at bay. You talk about it, claim it, share your thoughts with those who understand.  But it bites and scratches and never relents. It will sink its viper fangs into you and not.let.go.

No one said it would be easy. I knew it would be hard.

But no one told me when I was diagnosed that diabetes hurts.