Surgery example
For those people who prefer a personal account of what is involved in surgery to lots of statistics, this very comprehensive account of a carpal tunnel operation was provided by one of our patients and is fairly representative - neither the most trouble free process nor the most complicated. It is exactly as written by the patient except that I have anonymised it.
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Thank you so much for referring me to Dr.xxx and thereby ensuring that I had my op. quickly. I feel 20 years' younger and no longer permanently bad-tempered, as a result of having had a good, uninterrupted night's sleep every single night since the op. on June 20. It's like a miracle.
I promised to report back on the op. I presume that you want to know about the aftermath, rather than just the op. itself, so I have covered that, too.. I did keep a computer diary afterwards (typing with my unoperated left hand at first) so I think that my recollections are accurate.
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DAY 1
I was asked to be at the health centre, at 9 for 9.30 am and my son drove me there, but Dr. xxx had a number of other patients to see before me, so was slightly late in admitting me to the operating theatre, for which he apologised. I didn't mind the delay, because it had enabled me to chat to a young woman who also had grade 5 CTS, who was operated on before me and who was so relaxed and cheerful that I felt very reassured. She said that Dr.xxx was "lovely", and "a wonderful doctor" and that the only pain that she had felt, briefly, was when he had injected local anaesthetic.
Dr. xxx was accompanied by his nurse, whom I had met at my pre-assessment. Before starting the op., Dr.xxx asked what my INR reading was. I told him that, as instructed, I had stopped taking my warfarin 3 days' previously and an INR reading the following day had shown that my INR had already dropped from 2.3 to 2. On the basis of my experience with other ops., I reckoned that it would now be well below that figure. Satisfied, Dr. xxx proceeded with the op.
I was asked to lie flat on my back, without a pillow, on a high bed, with my right arm outstretched, palm upwards, on a table beside me. Dr. xxx explained that he would first clean my hand with antiseptic solution and then inject a local anaesthetic, which would hurt, momentarily. It did - the pain shot from my wrist up to my shoulder but only for a couple of seconds. Dr. xxx explained that he would make an incision in the base of my palm towards the centre, and then sever the ligament that was squashing my median nerve and causing me such pain.
Because I am a terrible physical coward and very squeamish, I did not watch the operation but kept my eyes firmly shut. I usually feel a little pain despite being given a local anaesthetic but did so just once this time, when I involuntarily said "Ow". Dr. xxx said that he had touched a nerve. Throughout the procedure, I heard a frequent bleeping noise and asked what caused this. Dr. xxx said that it showed him where I was bleeding because, unlike some surgeons, he did not stem the flow of blood by applying a tight tourniquet to the top of the arm, as he regarded that as "operating blind". He said that he preferred to "follow the bleed"
The operation over and the wound stitched up, Dr. xxx showed me a small,slightly blood-stained piece of gauze, indicating how little blood I had lost. He dressed my hand with a bulky dressing of cushioning gauze and wool and crepe bandages, leaving the fingers free, and his nurse put my arm into a high sling. Dr. xxx told me to keep my arm elevated above my head, and never to walk with my hand dangling by my side or sit with it folded in my lap. He stressed the importance of exercising my fingers to prevent them from becoming stiff and said that printed material that he was giving me included full details of these exercises. He asked if I had any questions and I asked whether I would need to take painkillers. He said that if I did, paracetamol would be ok. He also recommended moisturising the scar with non-scented moisturiser once the plaster weas removed. I also asked if I would be able to cook. He said that I should be able to make a cup of tea and heat up meals in the microwave.
He asked when I wanted to have my left hand operated on. I said that I would prefer to wait and see how long it took my right hand to recover before setting a date and he said that that was fine - I could ring the Appointments Line when I was ready, tell them that he was prepared to operate, and ask them for a date. He then checked that I was not going to attempt to drive my>self home.
Dr. xxx told me to make an appointment for a nurse at my GP surgery to examine my wound and apply a new dressing in a week's time and another appointment, to have the stitches removed, in a fortnight.
The nurse helped me off the bed, telling me to take my time as I felt a little giddy, and offered me a drink of water. She asked me to drink it outside, in the waiting room, and to wait 15 minutes before going home, just to make sure that I was all right. I did but felt fine - and was able to reassure another patient, in my turn!
My son drove me home and while he prepared a snack meal for lunch, I managed to make a cup of tea, using my left hand. Four hours after the operation, the effects of the local anaesthetic wore off and my hand now felt very sore (although the pain was nothing like the agonising pain that I had been experiencing before the op.) so I took two paracetamol. I watched TV but fell asleep and slept for two and a half hours.
At 6pm, I tried to take my usual warfarin dose but found that I could not open the packet with just one hand, so had to wait for my son, who was out, to do so later. I did, however, manage to make a ham sandwich, using ready-sliced bread and buttering it with my unoperated left hand. I tried to do my finger exercises - Dr. xxx's printed material contained some very helpful diagrams showing these - but my fingers were very swollen and hurt too much.
I slept again for 3 hours, then took two more paracetamol and went to bed, where I slept from 11 pm right through to 6 am for the first time in months.
DAY 2
I woke feeling good, despite the fact that my hand felt very sore.The fingers were now less swollen. I strip-washed with my left hand, with a large plastic sock over the operated right hand. I dispensed with back-fastening bra, as it was impossible to do up with one hand. Using my left hand, I made porridge for breakfast, a sandwich for lunch and a boiled egg for supper. I also started a computer diary of my progress, typing with left hand. I did my finger exercises frequently and my fingers became more flexible and less sore, but I still needed to take the maximum daily dose of 8 paracetamol. I slept often but for shorter periods. I once again had seven hours of uninterrupted sleep that night.
DAY 3
Woke feeling fantastic and decided to try to use shower over bath, instead of strip washing. Managed to get in by pressing down on side of bath with my left hand. Plastic sock over right hand as before. Tried to shampoo hair but found that I needed two hands to squeeze out shampoo, so gave up. Made simple meals as before, using left hand and did washing up, using plastic sock. Kept doing finger exercises and fingers rapidly became more supple. Checked e-mails but did not reply as typing with 1 hand took too long. Spent half hour dead-heading roses with left hand. Still needed to take 8 paracetamol during day because of very sore hand. 2-hour nap in afternoon, then full night's uninterrupted sleep again.
DAY 4
EUREKA! No pain at first in my hand so I did not take any paracetamol until 6 pm, when pain was bad. Showered, found easy-opening shampoo to wash my hair. Made breakfast as before, managed to put ready-meal in microwave and remove it using both hands. Hung out son's washing on line, using tips of fingers on operated right hand to hold clothes in place while pegging them on with my left. Still doing finger exercises. As day wore on, the middle finger felt very sore and the base of the hand was very painful. Removed outer dressing as instructed in Dr. xxx's notes but the operated site was so sore that I felt that it was vulnerable to knocks, and replaced the dressing. Two hour nap in afternoon, to bed at 10.45 pm with 2 paracetamol - slept right through to 8 am!
DAY 5
Shower, meals and finger exercises as before. FOR THE FIRST TIME, DID NOT NEED TO TAKE PARACETAMOL. Did my own washing, and pegged itout, as before,
Fingers now much more supple ,though area around incision still sore. Another good night's sleep.
DAY 6
Shower as before but now managed to squeeze out shampoo using both hand, MANAGED TO USE BOTH FINGERS TO FASTEN BACK-FASTENING BRA FOR FIRST TIME SINCE OP. Used tips of fingers on right hand for this, avoiding squeezing the still-painful palm. Breakfast and repeated finger exercises as before. Friend took me out to lunch, then to GP surgery for INR test - below target at only 1.8 - and for nurse to inspect wound and apply new plaster. Nurse said wound was healing marvellously - she could see no sign of infection or bruising. She replaced plaster but said I should now remove the dressing and could use the hand freely. I privately decided to continue using only the finger tips and to avoid squeezing the still sore palm. No paracetamol needed, however, and I stayed up late. Another good night's sleep.
DAY 10
Surprised to get note from booking service telling me that Dr. xxx had said that I had agreed to have my left hand operated on and offering me July 14 or August 15 for this. I explained that I had told Dr. xxx that I wanted to see how long it took my right hand to heal before having the left operated on and that he had said that when I felt ready, i should ring and ask the appointments service for a date. After consulting a colleague, the staff member said that this would be all right,
DAY 14
Able to peel an apple with operated hand for first time since op. Spent four and a half hours dead-heaing roses and other plants with pruner and shears. Wrist on operated hand ached afterwards and left hand was uncomfortably tingly.
DAY 15
Stitches removed by gp pratice nurse, who was very impressed with how well the hand had healed. I noticed a small gap at both ends of the incision but the rest of the skin had closed up. The nurse echoed Dr. xxx's advice to use non-scented moisturiser on the scar if it felt sore and said it was now ok to get the hand wet.
DAY 17
Scabs now forming at top and bottom of stitched area. Stirring porridge painful today - wrist and palm aching. TRIED TO WRITE WITH PEN - TOO PAINFUL AND SIGNATURE VERY DIFFERENT. Lifting door latch with right thumb hard. DROVE FOR FIRST TIME, TO POST OFFICE STORES AND BACK,
DAY 18
DROVE WITHOUT DIFFICULTY TO AND FROM GP SURGERY FOR INR TEST.
DAY 19
Fed up with overgrown hedges so used hedge-cutter. Bad mistake - the incision in my hand opened to a depth of 3m and hurt. Washed it and applied plaster.
DAY 20
Drove to hospital for medical appointment without difficulty or pain.
Edges of scar already beginning to weld together but skin over incision peeling. Removed plaster, thinking skin would heal faster if exposed to air. Scar spotted by a nurse at hospital during pre-assessment for a hip replacement. She said broken skin was at risk of infection and that the scar should be covered
DAY 22
Scar still covered Using rubber gloves for washing up now, Doing normal tasks but getting stabbing pain in palm and wrist by end of day.
DAY 25
Sides of incision welding together, scar now a livid pink. Still some broken skin along edges so applied new plaster. Palm of hand now less sore.
Left hand now uncomfortably tingly, having had to work extra hard,
DAY 27
Incision healed, plaster removed.
August 10
It is now seven weeks since the op and the scar is gradually becoming less visible. I can write with a pen and have for the past week been carrying heavy shopping and heavy watering cans with the operated hand. This does not hurt at the time but at the end of the day, I find, if I have overdone the weight-carrying, that I have stabbing pains in my wrist and palm. My index finger, middle finger and ring finger are still numb but flexible. Dr. xxx did warn me in advance that because the nerve endings in those fingers had died, they would remain numb.
I have not set a date for the op. on the left hand,despite being so pleased with the result of the op. on the right, because my son is having a major op., on August 14 and I shall be looking after him after his discharge from hospital. Then on September 17, I am having another total hip replacement, so the op on the left hand will just have to wait. Meanwhile, I continue to be so grateful that agonisng pain no longer wakes me every night!
Yours sincerely
Revision date - 5th March 2017
