Triggered

[Mik]

@george-k said in Triggered:

@axtremus

V for victory!

Oh, wait……

[jon-nyc]

So success???

[George K]

@jon-nyc said in Triggered:

So success???

Surgeon put in long-acting local. 5 hours later, index & middle with no sensation. Should get another 4-6 hours out of it.

Of course no pain, lol.

Transition to bandaid tomorrow and will know more.

[George K]

Saturday was a painful day. Pain at rest which woke me at midnight Friday night after the block wore off. No incisional pain, however. It's a really small incision, about 1 cm long. Tendon is all banged up, and any kind of motion was painful as well. I did my best to do the exercises (flex and extend) the fingers, but it really hurt.

Yesterday, Sunday was remarkably better. No pain at rest, and by end of the day, motion was limited by stiffness and swelling rather than pain.

This AM, no pain at all again. Stiffness is better, and I'm able to type as though nothing had happened.

But, here's why I'm following up.

Years ago, we were approached by a drug salesman who was touting Ofirmev, a new formulation of acetaminophen, Tylenol. It was high-dose, a gram, and to be given intravenously for pain control, and as a supplement during anesthesia. Being the curious type, I was eager to try it, and I was amazed at how well it worked. I found myself giving much less narcotics during surgery, and patients seemed to require less in the recovery period as well. The dose was 1 gram, intravenously, every 6 hours.

The major drawbacks to it were twofold:

1. this formulation was expensive, and the hospital didn't want us using stuff that expensive (I think it was $25 a dose), when cheaper stuff (morphine) was available. Never mind that one of the advantages was less opiod use and fewer complications because of that.
2. It made your liver fall out. Well, if doses were too high, it caused hepatotoxicity, so you were limited to 4 doses per day.

And then something interesting happened. People started looking at the effectiveness of acetaminophen when given orally, but in large doses - again 1 gram every 6 hours. It works just about as well as the intravenous route, and is dirt cheap.

So, in preparation for my procedure, I loaded a gram about 3 hours beforehand, and then got on a 6,12,6,12 schedule. It worked like a charm. When it wore off at midnight Friday night, that's what woke me. I took a dose, and I was pain-free in an hour, and slept until 5:30, when I needed another dose. I continued it through Saturday and Sunday. Worked great.

Today, I have no need for it, so I'm done.

Amazing drug.

[Jolly]

Glad to hear that. Less pain or pain free is good.

[Jolly]

On a related note...What about the 650mg extended release acetaminophen pills? Better, same or worse?

[George K]

@jolly said in Triggered:

What about the 650mg extended release acetaminophen pills?

No idea. I didn't have any handy, so I just took a gram q6h.

Total dose not to exceed 4g in 24h.

I suppose one of those q4h would be about as effective, perhaps with no dip. But, it's q4, and that's a PITA.

[George K]

Day 10 post-op.

Negligible pain, unless I fall asleep with my fingers flexed. Then, it takes some effort to flex them more and then extend them.

I'm somewhat disturbed by the fact that I still have some pain on the dorsal (back) of the affected finger, but function seems good, although I can't extend it as far as the other three fingers.

Wound looks good. No drainage, no pus. Minimal swelling. I have no dressing applied, and the sutures come out Thursday morning.

[Mik]

I use the extended release Tylenol now and then. Pretty good, much better with some ibuprofen. Luckily it’s only once every few months. My arthritis is very well controlled by meds.

[George K]

@mik the high dose acetaminophen is amazing for acute pain. One gram every 6 hours. Mrs. George has had dental extractions and (!) a joint replacement using little more than that for analgesia.

Don't exceed the dose, supplement with opioids and anti-inflammatories (which acetaminophen is not!) as needed.

As I've said before, I was impressed with the intravenous route for this drug, and now, it seems that the oral is just as effective.

If you can take it prophylactically, all the better.

[George K]

So, about 8 months ago, I started having symptoms on the ring finger of my RIGHT hand. Pain and "catching." I had it injected in June, and got a good response.

Then, about 3 months ago, it started catching again. Not bad enough to require intervention, but just annoying enough. 6 weeks ago, my right thumb started to trigger. This was accompanied by pain, and, in the last few weeks interfered with my trying to play piano.

I saw the hand guy yesterday and he injected both fingers.

"So, you've done the ring finger twice now. What happens when/if this recurs?"

"Chop chop." (He actually said that)

"Fuck (I actually said that). If you operate on the ring finger, and my thumb acts up again, as I expect it will, do you have to do a second injection, or can you do both fingers at once, just to save me the extra trip to the OR?"

"Yeah, we can do both. See you in the fall. I'll have them wipe the blood and rust off the scalpels. I'll be waiting for you."

[taiwan_girl]

LOL Hope that the injections work for a long time!!

[Copper]

I have arthritis.
Just over 6 months ago I got a cortisone shot in the left thumb metacarpal. It worked ok.
Now the pain is coming back.
They said I could get 3 shots separated by about 6 months. If it is still hurting, then they'll remove the Trapezium and toss it in the trash.
Then they'll rebuild the lost support by rearranging some tendons.

I haven't investigated exactly how this surgery works yet; I was hoping the cortisone would last longer.

[89th]

How does this impact your (cheap) scotch drinking motions?

[Copper]

You get a cast on one hand for a few weeks, but the other hand is ok to pour.

If that is a problem, just drink straight from the bottle.

[kluurs]

@Copper said in Triggered:

I have arthritis.
Just over 6 months ago I got a cortisone shot in the left thumb metacarpal. It worked ok.
Now the pain is coming back.
They said I could get 3 shots separated by about 6 months. If it is still hurting, then they'll remove the Trapezium and toss it in the trash.
Then they'll rebuild the lost support by rearranging some tendons.

I haven't investigated exactly how this surgery works yet; I was hoping the cortisone would last longer.

I have arthriitis in the same joint (thumb). At one point, I thought I'd have to give up the piano completely. My ortho doc asked what I'd done to mess up the joint so badly - beyond the arthritis.

I'm playing the piano as badly as ever but I'm playing - and it came from using a splint at night to completely restrict movement along with the liberal use of Arnicare on the joint just prior to putting on the splint. I've given the splint/arnicare combo to a few folks who have had a good measure of success. You might want to give it a try.

[Jolly]

1. Splints helped the wife at one time. Hers were custom fitted out of a foam that became rigid after molding.

2. Steroids are a temporary fix, in most cases. When you get them, they're like money in the bank. Spend wisely.

[George K]

@Jolly said in Triggered:

Steroids are a temporary fix

Yup. I am resigned to the fact that I'll need surgery on both fingers by the end of the year.

Interestingly, the injections helped the pain, but both joints are still triggering a bit almost 48 hours later. Hopefully it'll continue to improve.

I got almost immediate relief on the other hand, so I don't know what to make of it.

[Renauda]

Sorry to hear this George. It’s sounds to be mire than just the PITA you described a couple of years back.

[George K]

The ring finger continues to deteriorate. Painful for any activity (like piano) and I've really restricted my playing. I was hoping that the thumb would act up again as well, so that the surgeon could do both at the same time.

However, the thumb is fine for now.

So, the ring finger has had two failed injections - surgery is the next step.

I emailed Dave (the surgeon) and asked, "PLEASE, can we do another injection and hope the thumb acts up so you can operate on both at the same time? If the ring finger fails, and the thumb is OK, I guess I'm doomed to another operation."

He said, "Sure. One more injection we can do."

Bullet dodged - for a while, at least.