Sunday, May 23, 2010

Digital ulcer, digital sympathectamy, & a pinky straightening

I have had Raynaud's episodes from the beginning.  They've never been completely gone.  As soon as the temperatures dip in the lower 70s, I have blue fingers.  I've gotten used to it.  Well, not used to it.  I don't notice them as quickly, but when they get bad enough they hurt something fierce and I have to do what I can to warm up.  I've learned to bring mittens, a sweater, and/or chemical hand warmers with me to restaurants, events, and the grocery store.  Even in the summer.  In the winters I know I have to dress like "Nanook of the North" and still be prepared for an episode. 

The episodes cause digital ulcers on my finger tips.   Painful sores that appear usually on the pad of a finger, or near the edge of the nail.  They take a long time to heal.  Sometimes months.  We go through lots of bandages and Bacitracin.  The following pictures are what ulcers can look like.  These are not my ulcers, but pictures I have found on the web and look exactly like what I normally get.

Towards the end of the IVF cycle I developed a Raynaud's episode in my right ring finger that just didn't go away.  For almost a month, this one finger would stay blue about 90% of the time.  We increased a medication trying to increase blood flow to the finger, to no avail.  This was the most severe episode I had ever had. 

This occurred right around our wedding and into our honeymoon.  We spent our honeymoon road-tripping throughout the southeast U.S., in July.  The episode still didn't really go away.  I managed to suffer through the pain and enjoy our honeymoon for the most part.  I didn't say I did a good job at it, I just managed.  I cried at night.  I cried in the car.  I had multiple meltdowns.  I still had a good time ... melt downs and crying aside.

Because I'm stubborn (to a fault) and wouldn't go to the ER on our vacation, by the time we returned home my finger had developed a severe ulcer that looked like this (these are actually my fingers) ... 

and I was in 24x7 pain.  I got an appointment with the rheumatologist, who immediately sent me to another specialist who gave me a nerve block shot on both sides of the base of my ring finger to ease the pain and episode.  

There are vessels in each of the fingers and there are nerves attached to them that tell the vessels when to constrict and when to open.  For whatever reason those nerves were "freaked out" and thought they were cold when they weren't, causing this particular 24x7 Raynaud's episode.  The shot was to block those nerves and ease the episode.

It worked.  Until I got home.  By that evening the episode and pain had continued.

We saw another hand specialist who indicated I needed to a digital sympathectomy.  In this procedure they make a z shaped incision on the inside of your hand, peel the hand open, and go in to strip the nerves away from the vessels in the affected location.  Allowing the vessels to open back up and the blood flow to continue.  My finger was getting normal color back and I had no pain as soon as the anesthesia was wearing off.

 (again, not my finger., just a representation)

In addition, the pinky finger on that same hand had been bent at a permanent 90 degree angle (visible in the pics above with the ulcer) for some time now, causing me to hit the knuckle on everything, which, causes more ulcers.  While the surgeon had me under for the sympathectomy, he straightened my pinky for me.  They go in, cut out the big knuckle in the finger, fuse the two remaining bones together and put a pin through then end of the finger into the bones to hold them into place until fusion is complete.  Then I went back in a few weeks and he pulled the pin right out.  Pretty cool actually.

The nail on my ring finger grows weird and the tip of the finger has a weird feeling these days, but has healed wonderfully.  If you look at the inside of my hand, you can barely see the scar from the surgery.  The main part of my pinky finger is straight, but for some odd reason, the tip is now bent.  Oh well.  Such is life, I'll deal!

1 comment:

simone said...

Hey there! I've only gone through a fraction of what i've seen happen with your hands. And I know how all-consuming the pain is. Piercing. Demanding attention. 

And then - you go through all this. Take care of the problem. Cope. But the knuckles still flare up. Are sensitive. And then the next blue spot appears. Out of spite.

You deal with it so well... Not letting it hold you back.