Friday, November 16, 2012

ProPatient: Carpal Tunnel Surgery

Monday I had open carpal tunnel surgery. I had a hard time finding personal resources on what to do, what to expect, and how to plan before and after. So here is my experience, along with whatever advice I have for other folks going through the same thing. Be warned, I am an asshole, so for folks finding this in a search, this material will reflect me.

Read more after the jump. This is a long one!



What were we talking about? Oh, yeah, the realities of open carpal tunnel surgery recovery. Thanks!

The best article I found was here, and I highly recommend it. It was the best material pre-surgery, and post-surgery I still think it is the best thing going.

Please keep in mind I am writing this piece while just a few days into recovery. This means my surgery hand is wrapped with ice, my other hand is in a regular brace, and my mind is still slightly scattered. I decided better to write it now while it was all fresh in my head rather than wait for better conditions.

Remember, I am not a doctor. This is what they call an "anecdotal account" which  means that it is my story, not official medical advice. The medical advice that I recount from my experience and my team may not be the same as what you get from yours. In the end, I can give you the best of what I have, but you retain full responsibility for the advice you heed as well as disregard.

I want to take a moment to say that my surgery team consisted almost entirely of awesome, and that makes a huge difference. I felt like I was seen as a person working with other people to improve my health, not a cardboard stereotype going through the motions with other caricatures so everyone could go home on time - like  so many health care experiences.

Prep


My surgery was Open CT Release: this means a full incision is made in the hand to open up to the ligament and a scar is left behind. I asked that if I have to have a scar, make it a cool, neat one. I have no reason to pretend the surgery did not happen. The body is a life canvas, and mine has plenty of stories. Turns out, the surgeon said that the way she does it, it will eventually mostly blend in with the lines on my hand that are already there. 


This was the second time I was e-mailed a link to My-Emmi, which has videos that help prepare you for surgery with information, particularly detailed information about the risks of your procedure, which you can get additional details if you want. You can also flag something for discussion with your medical professional, which is terrific.

A lot of preparation is asking questions and getting answers, so that will be the next section. Always ask your team about anything on your mind regarding the work you are getting done. Remember, they have arranged their professional lives around this subject and should not only be willing to talk about it, but may enjoy it too. They may have valuable insight beyond their standard instructions!

The rest is arranging your real life around what you had done, and I will talk about that too.

Questions


Here are some of the questions I had before the surgery, and some of the answers I received. Feel free to use any of these to help you build your own list. You should make a list, so you do not forget any of your concerns. The better educated you are, the better prepared you are and the better your experience and recovery will be for it!

-Can I take my morning medications day of surgery? 
Usually no, unless the medications are for diabetes or blood pressure. If so, with only a sip of fluid.
-What do I need to buy? I have: i
ce packs, pillows, working braces (do I need a night one?)...

  • Ice packs are great, and I found you need several (3-6) so that you can cycle through them. I ice about once every 1-2.5 hours and they need time to get usefully cold again.
  • Pillows are very useful to help keep swelling down, which in turn helps with healing and keeping pain managed. You only need one or two to keep your hand above your heart in bed, but 4-5 for sitting on the couch.
  • The team left me wrapped in a soft cast and while they gave me a sling to get my arm home safely, I did not receive (or need) any other braces.
  • When you buy groceries for the week, keep an eye on easy preparation and consumption. One of the hardest things to do is cutting food on a plate or in a bowl.

-What do I need for wound care?
What I was told is that I do not need to worry about wound care, the opening should be healed by the time the soft cast is removed.
-How long do I need to leave the original dressing on? /
When will the stitched be removed, first follow up?
They will remove the dressing/soft cast at the two week follow-up visit.
-Do you have a arranged list of what I can do when? 

Nope, they did not have a good list of what I could expect, but I will give you one here in just a bit...

-What exercises should I do? When? How often?

They did have a list for this. They were finger exercises and a couple will difficult and painful for the first couple of days. By day four I could do them all easily.
-What are the signs of trouble? At what point should I call you? Or visit the ER?

I was told there are only two things that are signs of real trouble: excessive bleeding and a high temperature/fever. The thresholds for calling your surgeon's office may vary.

Real Life


So the things that you really need to know to prep for recovery from a surgical procedure are often the things that your surgeon's office will know little to nothing about through experience. So this is the nitty gritty. I want to emphasize, especially if you are a caregiver, that this is a time where your focus needs to be on you and your healing, and in the best situations that will be the focus of your home-mates and loved ones, too!

Transportation: not only can you not drive home from the surgery, but you may not be able to drive for a week or two. This is one of the few things that they will have explicit instructions regarding and that is a good thing not just for your safety but for the public around you, too.

Sleeping: sleeping can be difficult the first couple of nights. Arrange your sleeping space so you can have pillows for elevation on one side and a tray for the things you need handy on the other. Depending on your living situation, you may feel more comfortable the first few days in your bedroom, or you may need to sleep on your couch or futon or what have you to keep yourself situated as you need.

Electronics: after just a couple of days I could type briefly, especially since I try to keep that wrist floating rather than resting on the keyboard. Get a trackball. I swear by trackballs, and think they helped me put off this surgery compared to if I had used mice for the past couple of years. Most trackball designs will let you rest your hand in a cupped position, the only one my post op hand will do comfortably right now. I am using my bean bag "wrist" rest to rest my elbow/forearm on so my wrist floats free with no pressure, and I may keep it that way after I heal, it is pretty comfortable.


A stylus let me use a tablet and apps on a phone much sooner than I would have otherwise, so get one of those too, if you can.

Relationships: batten down the hatches. If you are like me, even in the best case scenario an activity like surgery will set off an emotional roller coaster. So will getting frustrated with an ever-changing ability level. So if you have some outstanding emotional issues with your loved ones, go ahead and tend to those if you can. 

Entertainment: you may not think this is important, but I assure you it is. Particularly for the first couple of days, when you cannot do much, it is a good time to feed your brain some good stuff you may not usually have the time or the inclination to digest. Rent or borrow from the library or set up your Netflix queue those films you always meant to see, those important documentaries, some comedy you always thought you would check out some day. 

As far as reading goes, it took a couple of days to be able to comfortably hold a book, and even at day four I can only do it for a while before I have to put it down for a break. I recommend e-readers or tablets, since you can hold it in your non-surgery hand and brace a stylus in your other (or crockedly cock a finder at your screen).

Summary


Above all, I want to stress patience and perseverance  Get your questions answered. Be kind to yourself and your loved ones. Take a moment to thank everyone along the way that behaves well towards you, it reinforces that behavior for the next person.

Plan. Work ahead. Catch up a few of those things you always meant to do around the house or in your hobby or for yourself so that you go into this period of forced and necessary rest with a sense of accomplishment. Get in touch with your spiritual reality so you have a sense of peace. Before or after, when you are just sitting around, get in touch with the folks that mean something to you, just to catch up and chat.

Do you have a question? Ask it below, if not for you then for the next person looking for answers. Maybe I have one, if I do then it is yours.

Peace and love!