Sunday, May 30, 2010

That Boutonnière Deformity Guy

Nine months ago, I injured my finger while roughhousing with my six-year-old son.

(Most of you know this explanation isn't entirely true, but it's my new and improved and truncated account going forward. For the record: NO ONE loves to laugh at himself more than I do, but whenever I've gone
into greater detail, the reactions from friends and co-workers has been what can only be called a cross between "skeptical" and "litigious" -- Wait…what? You poked your son with your finger? How hard do you have to poke him to tear a tendon? So, it'll be "roughhousing" from here on out.)

Almost two months ago, I finally had an MRI. In keeping with my new brief, but borderline truth-obfuscating explanations,
the MRI went well.

Eleven days ago – some 260 days after the initial injury – a hand specialist spent 20 minutes with me and provided what four doctors before him couldn't: an accurate diagnosis.

(Admittedly, my medical expectations were tempered when my eye caught the unmistakable couch-sized sight of a dot matrix printer behind the desk of the specialist's receptionist. But, this doctor had obviously reallocated funds from 21st century administrative technology to extra night classes at
Hollywood Upstairs Medical College.)

I'm the proud owner of a left pinky finger with a
Boutonnière deformity – yes, like the flower a man wears on his lapel. And, I'd like to shout out everyone in my office who has brought back so many forced, unfunny floral jokes at my expense. It's been 25 years since Janet Wood last turned off the lights at her flower shop on Three's Company and equally as long since Hightower from Police Academy worked as a florist for strictly ironic reasons.

From the American Academy of Orthopedic Surgeons (AAOS) website:

Boutonnière deformity is an injury to the tendons in your fingers that usually prevents the finger from fully straightening. The result is that the middle joint of the injured finger bends down, while the fingertip bends back. Unless this injury is treated promptly, the deformity may progress, resulting in permanent deformity and impaired functioning.

Or, as my doctor succinctly stated:

"This is a complex injury. I wish we had treated you much sooner."

In fact, the AAOS website recommends treatment no later than three weeks after the injury or development of the deformity, ominously declaring it becomes "much more difficult to treat" after 21 days. I injured my finger in August 2009…am I still within the window?

The specialist didn't want to perform surgery before first sending me to 4-6 weeks of physical therapy. One thing I learned from last year's
Samter's Triad Storyline: doctors are determined to exhaust every possible co-pay before considering surgery.

Last Thursday, I went to my first physical therapy session.

Now, I know that I've got some readers in the industry, so try not to retroactively laugh at my ignorance here: I was mildly surprised to find myself sitting in such close proximity to other patients receiving physical therapy. No walls, no curtains, no privacy. I was filling out paperwork while a woman – not more than 15 feet from me – was in tears from the work being done on her neck and shoulder.

My physical therapist walked me through my issues and I appreciated his candor with regards to the previous months of medical missteps ("You were being treated for the wrong injury.") and the likelihood that physical therapy would help me avoid surgery ("At best, it's 50/50.")

One more thing I appreciated: I was required to dip my left hand in paraffin wax and then cover it with a hot towel for 10 minutes. Afterwards, even though my finger still looked rigidly mangled, it temporarily felt loose and free for the first time in forever. Mrs. Bootleg later told me that she pays "good money" (from her part-time job) for paraffin wax treatments. I'm this close to going with her next time, just to resurrect that tired
Chris Rock bit ("How much fo' one hand?!").

The physical therapist gave me a series of flexion/extension exercises to "stretch" the tendons and straighten out the finger. Friday morning, I performed these exercises for the first time. Initially, my finger turned purple – a "Black History Month" kind of accomplishment for an African-American – and then, my whole hand swelled like a latex glove filled with water.

The next few days haven't been nearly as bad, but tonight, Mrs. Bootleg had to turn away from the real-time color change that was occurring at the top of my injured digit.

I'm looking forward to holding my surgical scars just inches from her face in a few weeks months whenever.


Mrs. Nick'a said...

Usually a PT will hide the patients that are in tears in a private room if for no other reason than to avoid scaring new, naive patients like yourself away. Maybe office space is at a premium in San Diego!

The paraffin bath is always tough to sell to the men at first but inevitably, after the unveiling, they have to stop themselves from asking to do the other hand. Unless you're my husband (who has Costanza hands), your hand probably hasn't felt that soft in ages!

Seriously, though, I hope you make some progress with the PT.

Elena said...

I did massage with a physiotherapist in Sydney for a while, in a small clinic where the tables were only divided by hospital curtains. You could hear - couldn't help but hear - everything that went on in the next cubicle.

This physio... well, he was a wanker, full stop, but one of his more wankerish habits was to give his clients, male and female, a swat on the backside when he finished working on them. (Yeah, he was That Guy.)

Anyway, one day I was massaging a client in the cubicle next to where the physio was working on his client, an elderly foreign nun who was visiting the convent next door to the clinic. My client and I could hear him chatting a bit to the nun as he worked. He told her he was going to have her turn over in a moment, and then there was a sound I'm unlikely to hear again in my life: a large Greek physiotherapist's hand smacking down flat on the thinly-covered ass of a nun.

This was followed by the most pointed silence in the history of ever. My client sat up and looked at me in astonishment, and I just blinked at him, bit my lip to keep from laughing, excused myself and ran out to the front desk. The physio had been giving the admin girl a shit of a time earlier in the day, and I couldn't hold it in: I raced up to her, leaned over, and whispered, 'CHARLES JUST SPANKED A NUN!!!'

So you see, it's not always a bad thing to be able to eavesdrop on next door.

Yvonne said...

I finished the BK ribs post and now I'm losing it again in the comments of another one. Nun spanking! I think I'll log off of TBG for awhile so I can get on with my day.

BTW is this the PT clinic just around the corner off RB road?

Aaron C. said...

@Mrs. Nick'a - My PT actually tried to tell me that I only had to dip about half my hand into the paraffin. I jumped in and asked if I could do the whole hand. I thought it would look a lot cooler if I did the whole hand. Good to know I make PT decisions like any 10 year old would!

@Elena - I need to arrange some sort of patient exchange program with that facility in Sydney. I was running out of ways to NOT make eye contact with the four or five patients receiving treatment all around me. Nun bum-slapping? No chance I turn away from that.

@Mrs. Mex - Yup. It's the one up on Via Tazon with the mountainous parking lot speed bumps.

Mrs. Nicka said...

Discouraging the full hand paraffin and no private rooms... what other cost savings measures do they use? Do they still use the liquid white out? Do they make you bring your own plastic wrap from home to wrap your hand after the paraffin?

I'm not so sure about this place.