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"walls of the city" logo conceptualized by Oleg Volk and executed by Linoge. Logo is © "walls of the city".

not a good enough balance

Highlight of the Weekend: Having three separate people – and gunny folks at that – ask me at three separate times where I bought this holster. Oh, and I got to shoot another .50 BMG rifle, which brings my Lifetime Total Rounds Fired Through a .50 Caliber Rifle to… two. Plus about 20 rounds through a Ma Deuce.

Lowlight of the Weekend: Having Doctor 3 (see here for a reminder) functionally throw up his hands and give up.

After having my whole right hand in a compression glove and my pinkie finger in a compression wrap for the past two months, he has concluded that the pulley is a "red herring", to use his terminology, and may not actually even be ruptured (the MRI report reads "There is palmar dislocation of the flexor tendon, the distance between the middle phalanx and flexor tendon is 7mm. There is disruption of the A2 pulley best seen on axial series 3 image 24 and sagittal series 4 image 5." and two other doctors disagree with him on that point). In any case, despite that month of compression and physical therapy, the swelling in my finger has not gone down, and he is unwilling to operate on it when it is swollen.

At this point, he guesses it might be a fungal infection of some type, courtesy of a rather nasty cut I received to the proximal interphalangeal joint – the one closest to the A2 pulley – about six months before my finger really started hurting. I braced my pinkie on the edge of a pull-top can lid, came away with about a dime-sized semi-circular cut, washed the crap out of it, bandaged it up, and was told by a PA that I did the right thing and there was nothing else they could do. X-rays have shown no infection, and if something showed up on the MRI, you would think they would notice.

They drew blood for the usual tests, but given that the finger is already swollen, the doctor does not figure it will not tell us anything we do not already know. The only way to prove it is a fungal infection is actually to slice the finger open and take internal biopsies from the top and bottom of the joint, and then wait six weeks for the cultures to come back, and even then the doctor considers that entire idea an improbable "long shot". Apparently a bacterial infection would have consumed that joint and moved on by now if it were that.

For now I have given up wrapping the finger – the doctor indicated it was pointless, and the mobility is about he same regardless; the finger swells without it, but the wrapping keeps it from flexing much anywise. And by "keeps it from flexing much", I mean "in neither case can I get the tip of my pinkie finger past the distal interphalangeal joint of my ring finger… on a good day". I cannot make a fist, I cannot properly grip a pistol, typing is still a bitch, and the PIP joint is bigger than any joint on my middle finger.

Oh, and the real kicker in all this? The doctor telling me, emphatically, that I can "live with it". His exact words were something along the lines of, "If it is not something we can mechanically fix, or some kind of disease we can treat, you can live with it." That is all good and well, except we literally do not know what is wrong any more, apparently.

And that is… well, that. Doctor 3 was the last driveable doctor who appeared to be any good and would bother conversing with me from a distance, and it is simply not feasible for us to fly out to another doctor for a diagnosis, fly back for a consult, and fly back again for the actual surgery. Yeah, I will stop whining now and crawl back in my hole.

11 comments to not a good enough balance

  • Man, that sucks. And I know I ask this pretty much every time, but what would happen if you just had them take the dang thing off? It doesn’t seem like you’re getting anything but pain out of it, and if they can’t fix it, at least you’d have a way to tell stories like “Oh that? That was from the time I saved a bus full of children from a rampaging grizzly.”

  • Swami Rabbitima

    Louis CK’s story – kind of along the lines of yours…(LANGUAGE WARNING)

    http://www.youtube.com/watch?v=ey4WSb-BVDQ

  • Volfram

    @ bluesun: I was thinking this but not willing to say it. Perhaps a candidate for a robo-finger.

  • @ bluesun: Given that your pinkie can account for between 25% and 40%, depending on person, of your grip strength, I am still bitterly clinging to the notion that I will be able to get it to work right again. I am hoping a more… normal… method of determining an infection – like, say, sticking a needle in the joint and pulling some fluid, rather than slicing everything up – might answer some questions. I have no idea.

    @ Swami Rabbitima: Wow. That was pretty much exactly the conversation I had with my doc… only I am 30. Fuck.

    @ Volfram: So far, my understanding is that prosthetic fingers are… less impressive.

  • Volfram

    @ Linoge: hence why I was happy Bluesun said it first. We’re at least 5-10 years away from viable replacements on things like fingers.

  • Travel. Find someone that knows their stuff and go. I won’t be cheap, but it’s your hand.
    That sucks and I’m sorry you are still struggling for answers here.

  • The trouble is “where” and “who”? Two of the places we went – Vanderbilt and Jewish Hospital – supposedly have some of the best hand surgeons in the country, and they have wildly different opinions as to what is wrong and how to fix it. Like I said, without an actual diagnosis, we would first be travelling to procure one of those, and Lord knows how long that is going to take.

    My mother-in-law talked with a retired orthopedist in their area, and given the symptoms I have and how long they have been lasting, his first impulse was to, as the previous doctor recommended, slice open the finger, clean it out, take biopsies, and see what grows. I guess that is two opinions in one direction, which is more than any other direction has received yet, so maybe that is what we will do.

  • They want to do exploretory surgery on my left knee. I keep refusing. But in my case I’m in no pain on a day to day basis, and have full range of motion. I can’t run on it, but I can’t run on my left knee either, so thats not really that big of a restriction.

    As much as I hate to say it, in your case that sort of surgery may be warrented. It IS affecting you daily, and its clearly not going to get better on its own. Looking at the scans isn’t getting you anywhere. It might be worth having them open it up, scrape out whatever they want for testing, clean out as much else, check and make sure everything’s connected properly, and see what else they can find. Cause well, its mostly useless to you as it is yes? And removing it is a fairly final option.

  • Yeah, I think we have fairly concluded that we are going to go ahead and open it up, pending the doctor agreeing to fix anything he finds wrong in there. Just seems damned silly to have to undergo an honest-to-God surgery to get a diagnosis.

  • @ Linoge:

    I have to admit your situation sucks, but I’m old enough to remember the days of exploratory surgery. Without our modern imaging technology, many times that was the only way to finding out what was wrong. And even with all our tech, sometimes nothing beats the Mk. I Eyeball. This, plus getting the cultures, may be one of those times.

    Good luck with it.

  • Yeah, I know, First World / Gen-X problems… but it still seems stupid, in this day and age, to have to go scraping a bone just to figure out what is wrong with it.

    That said, my surgery is now scheduled for the 30th, so I guess we will hopefully be finding out.



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