Dialysis, Carpel Tunnel and Jogging

Well, it’s been two weeks since the carpel tunnel surgery, and I now have both hands mostly functional.

I have become quite adept at waterproofing my hand and wrist with a plastic bag and a rubber band (I tend to go for the bags you get off the roll when buying fruit and vegetables – they are a good size, tend to stay waterproof and when put on inside out, are quite clean).  Accompanying this skill has been one-handed showering (and other toilet activities).

However, now that I’m back to two hands, these skills may well fade away.

Carpel Tunnel surgery scar

The bandage came off after three days and the stitches out after two weeks (two days ago).  The cut looks clean and dry and not too ugly, though a little wider than I expected.  It still feels tight, even without the stitches, and both a little numb and sensitive to touch, but otherwise quite functional.

I must say that while the carpel tunnel has not yet departed, my hand feels quite different.  It still pretty well locks up during the night and I gradually get it opening and closing with a little exercise and massage.  The touch is also different but better: still pins and needles but not so much numbness.  Flexibility has improved: I had a big moment yesterday, when with some concentration, I was able to button up my left sleeve, all by myself!  Some people I have spoken to say that recovery can be almost instantaneous; others that it can take up to a year.  I think maybe the second opinion is the more likely.

The surgeon said that I should exercise it as much as possible, opening and closing it into a fist.  Eventually I should advance to a stress ball.  This should stop it locking up in the open position.

For the first time in weeks I went for a run yesterday morning. This is a reflection of how well I feel at the moment. My cold/flu is gone, I’m off painkillers.  The BigD is effective and uneventful:  I’m back to reading, practicing a little Mandarin and in the last hour, watching a video (currently Primeval, which is quite diverting).

I have a range of courses for jogging, starting with the Short and Sweet (twice round the bed), the Getting Back Into It (once round the block – about 10 minutes) and the Just Enough (two blocks and two hills – about 25 minutes). I was feeling pretty up for it yesterday, so I did the Just Enough.  It was a triumph.  I really enjoyed my breakfast: it tastes so much better when I have been so virtuous!  The only down side is that now I have to do at least the same next time, maybe more.

One interesting thing came from the run. Before the surgery, I would run about 10 minutes and my hand would go completely numb.  This time I decided to exercise it as I ran, stretching it flat, then making a fist as I powered (trotted) along.  Then something interesting happened. My body decided to synchronise both activities.  I found that about 10 minutes into the run, my hand would close as I breathed out and open as I breathed in.  It was quite strange, because it felt like I was squeezing a little phantom pump that controlled my breathing.  Squeeze faster, breathe faster; squeeze slower, breathe slower.  I quite enjoyed it, jogging along in my own private world controlling my breathing with my hands (my other had joined in by this stage).

I’m looking forward to my next run, just to see if I can do it again.

Isn’t it strange what you can discover when you do something different?  Whether the difference is forced upon you, or you create it yourself, there’s always something if you take the time to notice it.

Dialysis and negotiating the Carpel Tunnel funnel

I spent the last two weeks checking out my numb/tingly fingers.  My thumb, first and middle fingers have been tingly and at various times numb since I had the fistula rebuild back in February.

I revisited the vascular surgeon who rebuilt my fistula and after examination, he suggested a blood flow review test.

This test was done via ultrasound, where the technician looks at each artery feeding blood into my hand and makes sure it is flowing in the right direction (ie into my hand and not into the fistula).  Two of the three main ones were, and the third mostly was, with a small percentage being stolen by the fistula.

I went back to the surgeon to have the results interpreted.  He said that a small steal was both inevitable and normal, and that it was not enough to cause my symptoms.  He told me to go to my doctor and arrange a Carpel Tunnel test.

About a week later (there was a cancellation!), I fronted up to a neurology clinic for the test.  The test involves triggering the nerves that go through the Carpel Tunnel to see how quickly they respond to stimulus.  The faster the better. If the response is slow, then the nerves are either blocked or damaged.  Carpel Tunnel syndrome is pretty common generally (it affects about 20% of long-term BigD-ers), so they have standard tests with lots of data about what the results mean.

The technician was very experienced. She had the right words to say at the right time and moved efficiently through the testing.  There was even a trainee doctor there to learn all about it.  He also talked a lot.

The tests involve “stimulating” the nerves.  This means triggering small electric shocks at one end and measuring how quickly the shock reaches the other end.  They start with electrodes on the fingers and a receiver just below the wrist.  Shocks are small but steadily increase until they are uncomfortable. But being a macho man, I could handle it.

But that was only the start.  Then she reversed the test direction.  She taped a receiver to my fingers and used a mini-tazer to jolt the nerves into action.  The jolts got progressively bigger until my hand jumped around of its own accord.  Once I understood what was happening, I found myself sweating, heart beating faster, anticipating the next jolt, just like a lab rat only bigger. ( Not so macho now…)

She ended the test with a stream of jolts sent by the computer.  They went on for a very long time (maybe 5 seconds or more!)  It drew sweeping, curving graphs on the screen, which she interpreted for the trainee and presumably for me.  Not great responses: definitely Carpel Tunnel.

As I pulled down my sleeve and started to get out of the chair, she said she was only finished with that hand: now for the other.  She repeated the test and found that the left hand was also a little slow, but nothing like Carpel Tunnel.  Just a little advanced wear and tear, probably on the outer linings of the nerves, probably caused by the BigD.

In came the neurologist to interpret.  Yes, Carpal Tunnel, yes, slower responses in the left arm too.  Carpel Tunnel can be dealt with in three ways:

1. If it’s mild, live with it.  Exercise the hand and wrist and see how it progresses.
2. Semi-severe: have Cortisone injections into the tunnel.  This provides temporary and sometimes long-ish term relief.
3. For severe Carpel Tunnel the best approach is to operate.  It is a relatively small operation, with a very high success rate.  Best to find a neurosurgeon that specializes in this kind of thing, and ideally one who has experience working with fistulas.

Option 3 was what he recommended for me.

OK he said, show me the leg tests.  Oops, wasn’t sure it was necessary says the technician.  Yes, we need a datum for next time (next time?).  So off came a shoe and sock, out again with the mini-tazer and we’re off.  Even more violent jumps and kicks later, it really was all over.

So, now I can add nerve response tests to my list of medical tests, probes, indignities and humiliations.  This one goes with the Not-All-That-Comfortable group (a surprisingly large group).  I have long wished that we were issued a medical passport at birth, and that every test came with a special stamp for the passport (or perhaps a postage stamp sized picture of it being done).  Such memories.  Such bragging rights.
Maybe in the next life.

Well, the next step is to arrange to surgery. More to follow…