Fallen down between the cracks
Dear Dr Bland.
My referral, following my tests on 1st June, appears to have fallen down between the cracks somewhere. My GP asked that the results of the tests be sent back to him/the practice and subsequently another GP there requested I be followed up with the likelihood of an injection. However, it appears the correct form wasn't filled-in so I am not 'on the system'. I understand from the practice that the form will be completed tomorrow and forward to you. When you receive it, please will you allocate me an appontment as soon as possible as my right hand (grade 4) is driving me around the bed.
Many thanks
Martin
Many thanks. I have an appointment at 12.30 - fortunately near the hospital - so might I be seen in time for that? Do I come to the same place I came for the tests? MW
If you can make it to us between 10:30 and 11:30 you should have ample time to get to anywhere nearby by 12:30. JB
Good evening Dr Bland
Following my visit to see you on 5th July and subsequent injections in both hands, let me firstly thank you for seeing me so promptly. I had a note to log on to the forum and provide an update - so here goes.
Overall there was an immediate improvement. That night, I had the best night's sleep I had had for months. The pain I had been experiencing in both hands simply disappeared and over several days the articulation of both hands improved markedly. I can clench my left hand and the right almost. The swelling I was experiencing overnight has gone. Now the detail...
The left hand (Grade 3) has improved to such an extent that, apart of slight numbness at the top of my ring-finger, it's almost back to normal.
The right hand (Grade 4) is a different matter. Whilst the pain has disappeared, the swelling has reduced significantly and the articulation has improved, I still have considerable numbness on the face of the thumb, index finger, middle finger and ring finger. The numbness, however, on the palm of that hand has all but disappeared.
So, in summary, a terrific improvement already but I think I will still go for the operation on my right hand in the hope it will sort the residual problems still evident there.
Let me know if you require any further info.
Best regards etc.
Interesting difference in response betwen the two sides isn't it - at least in this case it sort of makes sense with the neurophysiological grading. It's not always like that. I think we would be happy to arrange surgery.
Two academic/scientific questions occur to me 1) have the nerve conduction studies changed as markedly as the symptoms and is there a difference in neurophysiological response between the two sides as well? 2) would the more severe hand respond to a second dose of steroid, as was done in a Spanish trial a few years back. If you are able to come back and see me for another set of NCS in a week or two that would be interesting. JB
I'm more than happy to come back for more NCS tests. When would you like me to come / how do I arrange this? I am scheduled to have surgery on the right hand on Sat August 6th. Should this be delayed? I am scheduled to have my pre-operative visit this Saturday (23rd July). Please advise?
MW
I can fit you in to Friday morning's clinic as an extra if you like then we have a chance to have a chat before you go to the pre-op visit on Saturday. If you want to do that it's probably best to come along earlier rather than later (between 9 and 10 am) before the day gets too busy. JB
Good morning. Thanks for that. I'll be with you at 09.00 tomorrow (Friday). MW
It's often a bit of a mess when GPs do not refer people to my clinic for treatment but simply ask for the test results. A few GPs know what to do with them but generally it is not realistic to expect every GP to be expert in managing CTS. We need to have a discussion about what to do with yours as at grade 4 there is a fairly strong case for at least considering surgery. Can you drop in tomorrow morning for a discussion - we can probably fit that in between 10:30 and 13:00. JB