I’m reasonably lucky that in my life I’ve only ever had one ‘proper’ surgery, so when I was told that I needed an operation on my thumb I was nervous. My CAH means that I’m at a higher risk of going into shock and having an adrenal crisis, and it also means I have problems with coming out of general anesthetic (something we learnt from my first surgery when they couldn’t bring me back round!). Alongside this, HMS/EDS is well known for having problems with responding to local anesthetic as well as needing more stitches and having a longer healing process. Understandably, with these added complications I was scared.
Trigger thumb/finger is basically a condition in which the tendon in the affected digit becomes inflamed and swollen and then ‘catches’ on the tendon sheath (tunnel) that it runs through. The general symptoms are just clicking of the thumb and stiffness, although like mine, it can become painful and after having it for many years it can become stuck in a bent position and pop straight again, which take my word for it, is VERY painful. At school everyone thought it was hilarious to see my thumb ‘pop‘ and for many years it didn’t particularly bother me. We went to the doctors with it when I was around 11 years old but we were sent for an X-Ray and never received the results. It was only when I had to attend the fracture clinic for a dislocated thumb that the orthopedic surgeon picked up on my trigger thumb. There and then I opted for the steroid injection that they could give, as I was informed that 60% of people had their trigger fixed by this, and a further 30% felt improvement and needed a second injection to fix it. I was in the other 10%.
I saw a specialist at the hand clinic to follow up and I explained that rather than making the thumb better, the injection had made it 10x worse. After going into detail about my medical history we decided that a minor operation would be the best option for me, and I opted to have it done under local anesthetic. At the point of this appointment I’d not long had an adrenal crisis (the first one I’ve been conscious for) and so I was terrified to go under general in case the same thing happened again. The only down side to having the local anesthetic meant that I would be awake for the whole process, but I figured the risks were less than being totally ‘out of it’.
I waited 4 months for my surgery date, and was booked for the day after my birthday. The night before the operation I received a phone call from the ward manager to say that my surgery needed to be cancelled as they had a problem with the theatre I was being booked into. I was GUTTED. I’d been waiting so long, and had geared myself up so much for it that I just came crashing down. To reach the department’s ‘quota’ of appointments, I needed my surgery done ASAP and so I agreed to have my procedure performed by the registrar and a trainee surgeon as this meant that my appointment would be only a couple of weeks after the original. GULP.
We rushed to the ward for 7.30am and it was rammed to the point I was suprised there was a bed. This was my very first experience of an ‘adult’ ward, as I spend a lot of time in children’s hospitals and wards, and so felt a little uncomfortable being on a ward with 5 ladies all over the age of fifty who had had hip or knee replacements. It took FOREVER to get booked in as the person in the first slot of the theatre that morning hadn’t turned up
and hadn’t let anyone know- so we were all behind. Eventually though, we got there. The anesthetist had to come and get me from the ward and looked extremely displeased by the fact she had to wheel me down there, despite it being on my notes that she was holding in her hands that I simply couldn’t walk that far and that my pre-operative assessment said that I would need a wheelchair.
The actual surgery experience wasn’t pleasant at all, I have to admit. My anesthetist was vile and quite rude, and my surgeons and others in the room spoke very little English so I had NO IDEA what was happening. I couldn’t see what was happening- thank god, but the local anesthetic was DEFINITELY the worst part. I could feel the needle and the liquid being literally pushed and forced into my thumb and wrist and I’m not ashamed to admit I nearly cried. After that part was done it wasn’t too bad. I could feel the blades but it wasn’t painful, and being able to feel this made me a little anxious- especially as I was worried that I’d suddenly regain feeling. About 15 minutes in I hear the registrar ask the trainee if he’s happy with his work. He makes an unintelligible grunt as if to say no, and continues to say ‘I’m stitching up anyway’. Luckily the registrar came over to oversee and asked me to bend my thumb to see if it was any better. The consultant said he still saw the catching, and so he took over to remove some more of the inflammation. When he was done he asked me to bend it again, and I spoke up and said that I could still feel the catching in it- so he huffed and puffed and removed some more. FINALLY they were happy with it (40 minutes instead of 10-15) and I had 4 stitches into the base of my 4cm wound. Doesn’t sound like much? I still would never do it again. I’m just so glad that I opted for the local anesthetic, otherwise I’d have been through a surgery that hadn’t worked!
My thumb was dressed and bandaged, and I could finally put my dressing gown back on over the top of the undignified clothing that is an NHS surgical gown. I was wheeled back to the ward where the smell of the ‘food’ (if you’ve experienced hospital food you’ll know what I mean) was filling the rooms and I started to feel very strange, but I could finally have some water and some hydrocortisone. I ask for my medication, 20 minutes later I’m feeling worse and worse and I still haven’t been given any. When are hospitals going to understand the importance of steroids in adrenal insufficiency?! Luckily I’d broken the rules and kept an extra box hidden in my bag so I could take my own, otherwise we could have been in a bit of a pickle! I know how to play the game in hospitals and knew that to be discharged ASAP I needed to eat something and drink a lot of water. I knew that in reality I needed to be monitored in hospital for longer, but as I couldn’t be given my hydrocortisone and had overheard that there wasn’t even a doctor available for a few hours I knew I’d be safer at home. To be honest they were so busy that I think they were grateful to have an extra bed, and so I was packed off home with some extra dressings and a very fetching padded sling.
Fast forward to 2 weeks later and I had my stitches out at my GP surgery. I’d healed well but the wound was still slightly split in places, so I kept it dressed on and off for a week after. It’s been about a month and a half now and I still have a lot of stiffness and my scar is rock solid, so I need to keep up the massage with that. I’m so grateful that it’s fixed now that’s for sure. I still have another surgery to come in the near future for my wisdom teeth- nearly a year later and I’m still waiting for the surgery date- but that’s DEFINITELY being done under a general anesthetic!