Monday visit with a new hand specialist at OAA

I can’t believe what a magnificent, crisp and sunny March morning today has become. I spent the weekend working on the final tidbits of Thurston Gill’s devotional coming out this month at Parisian Phoenix Publishing, visiting the Lafayette College Store to purchase Echo City Caper books for an upcoming meeting, delivering marketing materials to author Larry Sceurman and his wife Barbara, writing how-to instructions on how to leave book reviews online (do you need instructions like that? If so, read them here.), and proofreading the latest anthology from self-published author, R. (Rachel) C. Thom(pson). In between these activities, I did laundry, vacuumed my room, continued a book rearranging project, and stripped/remade my bed.

All with my pinky in a cumbersome splint.

Southern Candy came to visit yesterday afternoon. We played three wicked games of Uno with the Teenager. I won two and The Teenager won one. It felt good to laugh.

Southern Candy and I both had doctor appointments today that kept us out of work, so we met at Bethlehem Diner for breakfast before I headed to OAA Orthopedic Specialists on Centronia Road, behind Josh Early Candies, on Hamilton Street in what I think is South Whitehall Township with an Allentown mailing address. [Note on the diner: speaking of Rachel, I’ve dined with her at that restaurant before she moved to Florida and looking at the dessert case, I must go back for coffee and baked goods.]

The finger is looking and feeling much better. Discoloration and swelling has greatly reduced. The bruises on my leg look worse than and feel worse than my finger.

I saw a new doctor today. While waiting in one of the exam rooms at OAA– the same practice that treated my mallet finger last spring– I noticed a framed newspaper article on the wall by someone I know. So I texted her. We had a brief exchange and that was a wonderful reminder of how small the Lehigh Valley can be.

My new doctor informed me that the OAA offices recently had a ransomware virus and they traced it to a fake xray disc, so now they have to be very carefully how they look at images. It makes me wonder if soon we will be going back to the days of oversized manila envelopes and transporting films.

He then very kindly and patiently described my injury in a way that I wished I remembered better. He believes I almost dislocated this pinky, and probably bent my ringfinger back. The momentum probably caused ligaments to pull, and dislodged a scrap of bone like a piece of dirt clinging to the roots of a weed when you’re cleaning the garden. That’s the exact description he used. It looks like a fracture of the phalanx but it’s more like a chip off the bone where the ligament was holding on. So it’s a sprain.

He saw the mallet finger in my file from last year, and we talked about the folks at the Institute for Hand and Upper Extremity rehab, because he wants to refer me there and follow up in two months. He ditched the splint from urgent care, and said all that will do is make my finger stiff and increase the chances that my knuckle will get swollen and bulbous.

Instead, he wrapped my ringfinger and pinky snugly together with some velcro so my ring finger can be the new splint. “Wherever the ringfinger goes, the pinky tags along,” he said.

I told him the hand rehab people did a fantastic job overseeing my recovery from mallet finger so I am happy to visit them again. He pointed out that people often underestimate the importance of the pinky, and don’t realize it’s role in overall grip strength. And that injuries like the mallet finger and the one I have now have much better outcomes with swift and proper treatment, but too often people let them go a week or two before seeking care.

That made me feel a lot better, because I felt a little silly seeing a fancy hand specialist for a pinky. But, as I told him, as someone with cerebral palsy, I’m a little too aware of how quickly one injury can spiral into different complications.

Free the Finger! Cast-free after 9 weeks

I was very apprehensive and so excited to see my doctor at OAA today to get my damn cast off for an evaluation of my mallet finger.

The teenager texted me as I sat in the exam room.

“Free the finger!”

They had a devil of a time cutting it off— apparently after even five weeks in the same cast it was firmly on.

Both the hand/orthopedic specialist and the hand rehab office it’s unusual for patients to maintain a finger cast for so long. That doesn’t make sense to me, because why wouldn’t you do everything in your power to maintain agility and strength in your finger?

Free the Finger!

the Teenager

And don’t give me that “it’s too hard” or “I need my hand to do stuff.”

I work in the Stitch Fix Bizzy Hizzy warehouse folding clothes. And after my brief stint on short term disability to deal with my balance and hip issues stemming from cerebral palsy (and made more complicated by now not being able to rely on the left side of my body with this temporary injury), I went back to work and performed at 100% and higher with my finger in a cast and restricted hand movement.

That finger had so much caked dead skin and here’s the really fascinating part— my knuckle no longer has wrinkles because it has not bent.

In the beginning of my treatment, I found my doctor cold and impersonal but as he gets to know me I like him more and I get more personable interactions from him.

He told me I should gradually increase my finger flexibility with care not to hyperextend it (otherwise known as don’t bend it backwards) and splint it at night. For the splint, I could take my cast back. And tape it in at night.

“It’s cheap, but it’s dirty,” the doctor said.

Yeah, no thanks. I lived with that grimy thing long enough.

“The other option is to return to the Hand Institute and they’ll make you a splint.”

(Which, coincidentally Cigna, my insurance, does not cover. But as I do not cheap out on my medical care, I will pay for. Because right now my HSA is empty because having a disability and doing everything you can to keep yourself ahead of that disability is expensive. So please, consider this and how lucky I am that I can support myself because if I had to really on family and government benefits to subsidize my care, I’d be crippled.)

I imagine there’s a third option— buy an over-the-counter splint. And I was going to consider that. But to me, the cost of the custom splint comes with the knowledge and enthusiasm of the people at the Institute for Hand and Upper Extremity Rehabilitation. These people love and know hands.

And if I can only teach others one concept about your health, it is this: invest in yourself, meaning, find the right medical providers for your team that understand your needs and share your personal philosophy and concerns. This requires being vulnerable in a way that might be uncomfortable and it might mean having difficult conversations with people you don’t like. But it may also lead you to better understanding of yourself and of those people who seemed like callous know-it-alls disinterested in you.

I peppered my hand specialist with questions today— rapid fire as he typed my splint referral into the computer. And he respected them. The questions.

How much movement is okay? What should I watch for? I pack boxes and fold clothes and put things on conveyer belts. Should I splint the finger at work if it starts to feel weird? Is there certain motion I should avoid?

“There are no rules,” he said. “Just be careful and the occasional splinting wouldn’t be bad. I’ll see you in a month.

He made eye contact with me as if to say, “you know your body. Follow your gut.”

But he also knows I’m the patient who kept a finger cast on longer than the average Joe. So maybe, just maybe, he trusts me.

For previous installments on my finger injury: click here.

Also: a YouTube video

Four week mallet finger update

My soul, although surrounded by so much goodness and spring happy vibes, trembles in stress most of every day.

2022 has challenged me.

And that’s okay.

Today I visited my hand specialist for my first monthly follow-up of my ruptured tendon in my left ring finger, an injury known as “mallet finger” or “baseball finger.”

Here are some of my previous posts about the injury:

My specialist removed my cast tonight and announced my performance at holding my finger up is halfway there.

Then he also announced I’d need a splint or a new cast.

I made the appointment for my follow up at the office close to home only to have him call me and tell me I need to see the hand institute by his office on the other side of the valley. 30 minute drive.

At the end of a very busy week that includes my birthday.

I have to take some foster cats to the vet at 1, and run over to my occupational therapist’s office for a 3:30 appointment. I called from the parking lot of the specialist.

Then I had to come home and crate 3 cats for their vet appointment so now my temporary splint is very fuzzy.

I’ll update later based on what the next phase of treatment is. Whatever it is, I hope we can wash my hands first.

Treating my mallet finger

It’s Tuesday and my life has been turned upside down by my “mallet finger” injury acquired Friday night, taking off my socks as I chronicled here.

I filed for short term disability leave based on what Patient First told me about the injury. Since my work week starts on Sunday, and the accident happened Friday night I thought it best to get the incident in the system as soon as possible.

With it happening on Easter Weekend, I was told by the doctor at Patient First to make an appointment with an orthopedic hand specialist Monday.

The doctor at Patient First explained that I had pulled the tendon out of my knuckle and that I needed a specialist to determine whether it would heal or if I needed surgery.

And I did my best to work around my enormous splint and changed the tape once Sunday night.

Even on Sunday night, I had no pain, minimal swelling and no bruising or discoloration. The nail was fine, too. And I was amazed at how the angle of the finger had improved.

Some recommendations came my way from friends and everyone recommended the same doctor at OAA Orthopedic Specialists. Unfortunately, he was booked into July. So I accepted an appointment with one of his colleagues, at an office 18 miles from my house. I called at Monday morning 8 a.m. and the only appointments they had this week were Tuesday at this office in the Allentown area.

That was today. The splint Patient First gave me is enormous— and I was very anxious to get not only news and a treatment plan, but also something more reasonable.

I filled out all the paperwork I could online, and headed out of the house for the 30-minute drive to the doctor. On Monday, I had already gathered my x-rays and reports from Patient First, a release of medical information form, my return-to-work form for the Stitch Fix Bizzy Hizzy and the FMLA/short-term disability insurance paperwork.

(I also tried to clean the Tupperware cupboard, loaded and unloaded the dishwasher and made an enormous homemade Crunchwrap with homemade tortilla chips.)

I cried all the way down the highway. I miss my dad, who passed away in December, and I’m struggling with a lot of life right now. And I snapped driving to the specialist.

But when I arrived— h*ly sh*t. The orthopedic office shared a plaza with the Lehigh Valley Hospital Cancer Center and the Steel Fitness Premier Facility. The scheduler told me they had free valet parking but damn I did not expect that. It was a big hospital facility.

I went in, read the directory and discovered my office was on the second floor. And when I got to the second floor, I saw about ten check-in/ receptionists. Damn.

One checked me in and I was told to proceed to waiting room seven. The whole arrangement vaguely reminded me of the Beetlejuice scene where the dead people wait to see their counselor.

But they moved me right along and I met my doctor very quickly. And I was told getting dressed and undressed is a common way of getting injured.

The doctor produced a brochure from a nearby drawer. And it was the same information from the same hand specialist professional organization I had found online.

He explains that there are two tendons in each finger, one running along the top from knuckles to fingernail, and another running under the finger. I overextended the top tendon at that tip-top knuckle, tearing it from the joint.

Because I did not damage or break free any bone, this means I don’t necessarily need surgery. That immobilizing the finger at the top knuckle will allow the scar tissue to reconnect the tendon. And then occupational therapy will get that tissue usable.

The mallet finger brochure

The doctor said there are three treatment options:

  1. Splint
  2. A surgically-placed pin
  3. A finger cast

He recommended the finger cast. For eight weeks. And that he will see me in four weeks.

Paperwork and work release proved to be more complicated. He simply gave me a note asking me not to use the finger and that I could return to work today. I don’t think that’s enough for the folks at the Bizzy. So I asked the staff to please fill out the two forms— the one for the Bizzy Hizzy and the one for disability insurance— and told them I had read the sign and would gladly pay the $10 per form.

They wanted fax numbers or for me to pick up the forms, but I’m not driving 30 minutes back tomorrow or whenever they get the forms done. I think I found the fax for the disability folks and finally reneged and let them mail the form to my warehouse.

They also told me the forms should be in my portal so when they are done I hope I can download from the portal and send them where they need to go. If that doesn’t work, I have to call the Bethlehem office and make arrangements to pick them up there.

The OAA office also called The Institute for Hand and Upper Extremity Rehabilitation (a mere mile away) and arranged for them to see me. When I arrived, they were on the phone with my insurance company.

The staff at The Institute were beyond friendly, and every staff member apologized for making me wait. But I was impressed at how smoothly they ran and how they managed to balance the walk-ins and the scheduled patients.

Even more impressive, they had a binder promoting the small businesses they have “interacted” with— I hope I can leave one next time. I forgot by the end of my visit.

The Institute has one main rehab room so I got to see other patients at work, and every therapist acknowledged me, and apologized that I was waiting. One therapist, fitting a patient with some sort of brace or sling, was chatting with me about my injury.

The casting process was fascinating as I had never heard of casting a finger before and the person helping me also explained my injury. In this day and age when medical professionals usually don’t explain things, I was amazed at how many people took time to explain.

Mallet finger cast

My finger was only 15 degrees floppy today, which is a huge improvement from Friday. BUT if anything bends the injured area of the finger that could start the recovery clock back to zero as it could tear the scar tissue (which is why the hand specialist recommended the cast).

I certainly don’t relish the idea of eight weeks in a finger cast, nor do I enjoy the paperwork hurdles I now have to jump, but I’m relieved to have moved on to the next stage of the process.

The staff at the Institute also commended me for seeking treatment right away, as most people wait a week or more to address it and that causes more stress and damage to the healthy parts of the finger and can make the healing process more complicated and less successful.

My professionals:

OAA Othopedic Specialists

The Institute for Hand and Upper Extremity Rehabilitation