Saturday, April 30, 2016

My Journey as 3 Paw

March 18 - April 30, 2016

   On March 18, 2016, I trekked down to a favorite fishing hole in search of beauty and browns. I soon held a Brush Creek brown in my left hand and took a picture, already hoping to return again the following afternoon. However, by mid-morning on March 19, I'd suffered an injury to the proximal phalanx (about 1.5 inches of bone) of my left index finger & would not be holding brown trout again anytime soon. On April 4th, I was able to take pictures of my hand and the 7 K-wires holding the 15-20 fragments of bone together. The surgery had occurred on March 29, but since March 21st I had been (& still am) immobilized from my mid-forearm down to my 2nd & 3rd fingertips.  

   Yesterday (4/28), I was told that the doctor wanted the wires to remain in the finger for 2 more weeks. Seven total weeks of immobilization.  It's official; my index finger is going to have all of the flexibility of a carrot. Occupational Therapy began yesterday to my wrist, hand, & other 4 fingers. My middle finger is very rigid & everything else is tight. My goal is to regain 50% of my range of motion (ROM) by my next OT appointment on May 2nd and to have enough movement to tie flies at our club meeting on May 1st..

   Life deals us problems or challenges, & most of the time we get to pick our hand.  Our hand is also known as "attitude."  So far, I have decided that I have a challenge, and I decided to figure out how to fly fish (nearly) 1-handed.

to be continued...

   During April 13-17th, 5 of us gals made a roadtrip, spending much of our time at Mountain Home, Arkansas' Sowbug Roundup. I observed a double haul casting class & took notes by using voice-to-text to send myself emails.The fly tiers & other people in the region were friendly, & the bbq was great. We got to meet Tom Schmuecker, owner of Wapsi Fly, Inc., and tour the business. Tom is also one of the founders of Hawkeye Fly Fishing Association, the club that 4/5 of us belong to. My friends spent some time fishing the White River, & I spent a morning with the hook cut of of a Guelk Nymph, honing my new 1-handed casting technique. I could cast & shoot line out fairly well.  But despite coming up with a 1-handed system to strip line under tension, I still resorted to stripping in line between my left thumb and the part of the hand below the index finger.  Located above this area were two wires helping to hold the bones of my index finger together.  A friend and I returned to the cabin to fashion a baggie over the stripping area to prevent my splint from getting wetter.  It was then that I decided to stop casting for the day, knowing both that I should not be using the left hand and that I currently did not have the discipline to only use my right hand.  I yet thought that I would fish another day, but another good opportunity didn't arise.

   The day prior to the trip I used a piece of cane to mimic a fly rod and discovered that placing the butt end in a waist pack with my left arm wrapped around the upper portion of the "rod" gave it enough support to allow line stripping with the right hand.  After Googling 1-armed casting, I noted the assistive devices often incorporated a strap around a thigh to aid line management.  I used a long and a short carrying strap, & the sheath for my long-nosed pliers to make my own line-management system. The longer carrying strap connected the shorter strap buckled around my lower thigh to my wading belt or waist pack, keeping the shorter strap from falling.  My woman's shape would prevent the thigh strap, which the sheath was attached to, from riding up too much.  I mimicked stripping in line, wrapping it below the sheath to get tension & then releasing that same section of line just as I grabbed more line to allow me to strip again.  Due to my nature to overthink things, I hoped that one evening in our Arkansas cabin we could come up with ways to simplify the 1-handed casting system.

   The first night at the cabin, Scott, a MN friend and invited tier to the Roundup, paid us a visit.  Scott has made his own dubbing tool, among other things, and was the perfect person to simplify the casting system.  After his suggestion, the leg strap was removed, and the sheath was attached to the right side of my waist pack. The line was stripped, and then wrapped only below (not around) the sheath to provide line tension but still allow an aggressive fish to take line out.  Scott also suggested using a cord to attach the rod to something on my body. Due to the inability of my left hand to grip the rod, there was a chance the rod could dislodge from the pouch of my fanny pack.  Taking the small coiled cord from the unused pliers, the cord was looped around my rod and reel and the opposite end could be clipped to my clothing.  Near the end of the evening, Scott mimicked a hooked fish flopping around on the floor, to test how I would contain him and remove the hook. During this visit, Scott also dubbed me with the moniker "3 Paw."  I liked it.  

to be continued...

   I keep my hand out of the splint as much as possible, and I stretch and exercise my fingers and wrist... at home, while working out on a recumbent bike, while visiting a friend, when at the library, etc.  I try not to attempt too much movement of the index finger, but it can't move much anyway (carrot-like, remember?). I also have mixed feelings about the very skilled doctor, who was on vacation when my injury occurred but gave me surgery right after he returned & also changed surgical sites to ensure my insurance covered the surgery.  Yet, after a surgery and 2 visits to the clinic, I don't think I've seen him a total of 10 minutes.  To him, I am the severely comminuted finger fracture and feel I received the human patient assembly line instructions.  When you don't see a doctor enough to communicate with him, you don't know why you can't move a joint, and it becomes challenging to follow doctor's orders.  The OT will be my bridge to the doctor, since the OT will also treat my muscles and tendons, and consider how well my personality, my discipline, and patient goals will figure in to my treatment.  I wish I'd insisted on having OT ordered 2-3 weeks after my surgery, but if wishes were fishes...

   My next OT appt is tomorrow and I will see the doctor or his PA again on May 12th, when the wires will likely be removed.  On May 20 I leave to meet up with a friend in Michigan where we embark on a long-planned group trip to Canada to fly fish for trophy pike, and walleye.  I accept that I will have plenty of challenges, and I hope for no problems. 

First Real Fishing Expedition

   Yesterday (4/30), I went smallie fishing on a creek close to home.  Shortly after hitting the water, I hooked one but quickly lost it.  I hadn't honed my 1-handed technique yet and was unable to keep enough tension on the line.  I spent hours on a cool day walking and fishing.  I had more chases but no further hook ups, yet still had a great day.  I believe I thought every day last winter about springtime smallmouth fishing and summer float trips for smallies, and I am one day closer to my first smallie of the year.


   I keep my promises, even ones made to myself, and a few weeks ago I promised myself I wouldn't use my left hand in a manner to risk injuring it.  My left arm can stabilize the rod when the rod butt is in my waist pack, and I use the tip of my splint to slowly wind line on the reel when I'm moving to the next hole.  But when I'm actually fishing, the left hand and fingers are currently out of a job.  The right hand initially wrapped the line around the lower part of the sheath with each strip & captured more line.  It was slow and awkward.  Now, I strip line, let go, and immediately catch more line with the hand.  I occasionally reach line back to the sheath so I am still in practice for when I need to manage and strip in a tauter line, i.e. line with a fish on it.  Still not ideal but fly fishing 1-handed isn't ideal.  I haven't waded, and I don't know that I will, since wires entering the skin are also the same areas where bacteria could enter.  However, I haven't made myself any promises.

   I kept the rod, rigged up, in the car along with my other gear.  It's a chore to get ready to fish, so I wanted to take that out of the equation.  Besides, I might not be able to break the rod down without assistance. ;)  However, now it's been raining and the creek will be running too high for a couple days, so it is time to find more morels. ~April 30.

to be continued...

May 1

   Part of the reason I am writing this is because I work in the healthcare profession.  I want to share that sometimes our bodies change and we can't do things in the manner we previously had.  But, our greatest tool is the brain.  If one is willing to be creative and flexible, we can often come up with a way to still do the things we love and do them safely, too.  

to be continued...

May 6

   Went fishing yesterday at the same area. One can usually sight fish and find smallies here, but I only saw suckers. No luck at all except that I met "Ken," who gave me a good tip on where to find sizable smallies. I guess it is a little treacherous in a rocky way to get to the hole, so I will either go with a friend or wait until my wires are removed...unless I get a wild hair.

   Tomorrow is the annual local fly casting clinic, held in Bettendorf. Dan Johnston, St. Croix rep, is the main instructor, and others give him a hand.  I'm looking forward to providing instruction, and this can be done 1-handed.  It will be a pleasure to help others again, especially since so many folks have offered to help me since I became a "3 Paw."  

   I watched the latest episode of "The Voice" tonight while using lotion and a wash cloth to scrub off what seems to be the tenth layer of dead skin from my hand. There is definitely muscle atrophy up to the forearm and some swelling remains to the fingers and hand, but at least it now the appendage looks alive.  I think "the Voice's" season finale is on May 24, and I will be well into a big pike fly fishing vacation in Canada by then.  My buddy John called tonight to discuss food ideas for the trip.  My hope remains that the wires will be gone, and that I will have a splint that will allow me to manage line with my left hand.  I can manage a rod fine with either hand, but double hauling with a 10 wt has mostly always been a L-handed affair.   

   I wonder if I will wake up tonight doing range of motion to my hand with it out of the splint-- as I had managed to do in my sleep a few nights ago.

May 9

   Our casting clinic went well. I want to be a better instructor. Still learning too much there! LOL! ...The OT is happy with my progress. I am hoping wires are removed on Thursday, otherwise 2por1 margarita celebration will be 2por1 margarita bit%# and moan session... I layout the newsletter for our fly fishing club, and it will be finished tomorrow. Time to set sites on Canada trip for big pike!!! (still need to post hilarious pics from Sowbug)

to be continued...

May 12

My finger has turned into a carrot, but the final 6 wires have been removed (the last 2 required a little twisting and harder pulling)! More protective splinting and OT to come. Weird sensations in the broken area at times that make me jump like I just  realized something was crawling around in my shirt with me, but overall not too bad. Celebrated with margs & Mex then went to the monthly "Music Night" in my friends' basement.

Trying desperately to find intermediate line prior to Canada. Time to start packing and will likely have to skip an invitation of trouting and camping for this weekend so I know I can be ready for the big trip.

More gross pictures to come...
5-12-16: Wires are removed!!

Finally landed smb 5-13-16. OT made splint
after wires removed 5-12-16.

Friend John met me at the stream.
May 18

I've been able to fish a little locally and finally landed some small smallies. I'm wearing a less restrictive splint on my hand to protect the finger that is always rudely pointing. It is challenging managing the fish since I can't sufficiently pinch, grip or lip yet, with the fingers on the left hand. But, casting is improving and all is slowly progressing. 
5-17-16, took pic to show OT the movement
 I can force at the joints of my finger.

Sinking (type 6) and intermediate lines have arrived.

Tied 4 Clousers, so far, for the trip. After 3, the middle finger and wrist are sore.

After small modifications to my 2 splints, one feels worse and the other rubs in new places. Must return to clinic again tomorrow. Going out to practice cast again tonight to make sure no other concerns with splint I'll wear when fishing in Canada. I leave on Friday for Michigan and a friend's house. We leave for International Falls and Canada on Saturday.

to be continued....

May 20-29

Driving to SW MI solo and then MI to/from Sioux Outlook, north of International Falls, with friends, and from Superior, WI, to home solo I spent most of my time exercising my finger by forcing it to bend at a single joint or at multiple joints, or by moving it the little it would go under its own power.  Listening to audio books makes all my travel time for fishing trips go much smoother.  I stopped wearing a bag over my finger when showering at our cabin, located along Lake St. Joe, Eagle Island, in Ontario, Canada.  I also got my personal-best Esox, had another +40 follow the final morning, and did get one walleye on the fly, too.  

See my post titled "42" about this great trip with 4 other fly anglers.  My splint worked great, allowing me to double haul, pull up the anchor, and eventually remove flies from my own pike, safely.

Safest way to then pose with my personal-best Esox

Another friend John who consistently casts beautifully.
In winter, he invited me on the trip & kept faith that I would still go
following my injury. This and timeliness of my recovery was something
I had  to choose not to worry about.

June 1

The day of another doctor's appt.  The surgeon, my OT, and I all agree that my goal to return to work by June 6 will not be met.  Progress is good considering the trauma and length of immobilization, but the finger is still too stiff and Dr. V wants to see more radiographic healing. Doctor actually giggled when viewing current Xrays. "Remember," he said, "that bone was smashed to smithereens."  He went on to detail the current, generally good shape of the bone and the good alignment between joints.

June 13

Doctor doesn't giggle when looking at this date's Xrays, he laughs.  He is very happy.  More healing present, but still a couple wider, darker (less healed) areas on Xrays that will keep me guarded and wearing my splints more often than not. My range of motion continues to improve and I have about 47* of flexion at PIP (middle knuckle). Moving 2-3 joints simultaneously is expectedly more difficult with less movement present. We still know a tenolysis (surgery to remove tendon from bone) is still a possibility, but we both agree that continuing therapy with OT and on my own is still the best option to see what other gains I can make. Doctor agrees that it is time for me to return to work. He didn't mention a splint, but my OT and I have one in progress that I've dubbed my "mini splint." I'm hoping to wear it without Velcro or other material needed to keep it fixed to my hand. Small enough to pull a glove over it, and hygenic and eassy to clean without any fabric-type of material attachments.

June 15

I return to work with all 3 splints available to me, but am blessed to be allowed to get all of my learning assignments on the computer completed first.  It takes all day. Tomorrow I begin patient care on my favorite floor, but it is also the floor where therapists see the greatest number of patients in a day.  I'm a bit nervous about that, but throughout this experience I've made decisions at particular times to decide not to worry about things and those things worked themselves out very well. A fortune cookie fortune I got during my recovery reads, "Fear is interest paid on a debt one may not owe."

It will be harder to make time now to continue to give my finger the intense amount of therapy it needs, but I must make time to do it, or suffer the regret later.

***** I sense this post is winding down, as I am more of a 3 2/3 or 3 3/4 paw now!  However, basic life challenges still exist, such as writing, cutting food, pulling my rod sections apart, etc. Work will also be challenging and my risk for re-injury is still very much present. There is still much modified fishing to do, but I CAN fish! ( I also rowed my little pontoon and caught LMBass at a local lake on my 50th birthday - June 10th. It was my best day on this lake. My friend kate paddled her kayak and hunted agates, also finding success.)

So, I will continue with this post until some of the fog of the unknown clears, such as will I heal without incident and how much range of motion can I get back (without tenolysis) after a crush injury and 7 weeks + 5 days of immobilization?

Remember you can often decide if you have a problem or a challenge!!!***** 

July 19

I went on a float trip for smallmouth bass yesterday.  It was my first one of the year and the first time I fished with Doug. We had a good time and my finger held up quite well.  I am still wearing a splint but can hold the rod in my left hand again.  That is very, very nice except that using a larger weight rod (and rowing!) in that hand with a splint on taxes my wrist and the 3 non-splinted fingers. Those fingers have to grip harder and move at an odd angle. So, I fished one day, not two, knowing it would be too hard to resist also casting with my left hand. I did lip a smallie for the first time with my left hand!  It took a bit to get my hand in position, but it was done. Near the end of the float a large smb catapulted up from the water to attack my chartreuse popper! It was hooked after the aggressive attack but I was managing line then with my left hand and I fumbled the line between the splint and my free fingers, failing to set the hook like I normally would. The biggest, most aggressive fish of the float was gone. I yelled something like, "Son of a fish!" and my tantrum was done.

I wear a different splint at work. I will be happy when I no longer have to wear this one but with the different splint needs at work, it does the job. Work can be challenging but it is getting easier each week. My co-workers still have difficulty reading my handwriting (with either hand), but some days that is better too.

July 23, 2017. Passive ROM
July 23, 2017. Active ROM
The range of motion of my finger continues to improve, especially the passive range of motion (PROM). By force, the pad of my finger can occasionally be made to touch the palm of my hand. Should I need the tenolysis surgery, it is very important to have the best PROM possible. Active range of motion (AROM) is improving but at a slower pace now, and one of the 2 muscles that bend my finger joints is being especially stubborn. This is attributed to the usual culprits, tendon adhesions.  I continue strengthening, stretching, and doing vinegar soaks. I also continue with Mark, a Certified Hand Therapist and Occupational Therapist, who has been fantastic. He also gives me iontophoresis, again using vinegar, AKA acetic acid, along with exercise/ROM. 

Unless Mark or I am forcing my finger to move, I have very little pain.  I did mow the grass without wearing a splint for the first time a few days ago. The vibration from the lawn mower started to cause me discomfort, so I will return to the splint for mowing.  It was a gentle warning telling me that that bone is still not healed enough to perform moderate to heavy tasks without added protection/support. As of today, it has been 4 months and 1 day since my injury.

I return to the doctor on July 21.  I will start to make plans for and learn about the tenolysis surgery while still working very, very, very hard to avoid needing it. I am guessing the doctor will want me to continue to wear a splint when I'm doing more aggressive tasks and that he will say I don't need it at night.  We'll see.  I will be curious to learn what else he has to say and wonder if he will giggle or laugh again out of happiness due to how my bone has healed.  I only hope I can do the same someday due to my tendons freeing themselves up from the bone and letting me move my finger more actively again.

Examples of things that remain awkward and/or hard to do: knocking on a door, using round door handles, brushing my teeth, using a zipper, lipping a bass or managing any fish. Anything that requires a grip is now challenging.  I believe I read that when one loses an index finger, around 50% of grip strength is lost.  So, I will continue to do all I can to get that finger moving better again.

November 12, 2017.... yes, 2017!

My final doctor visit was May 30th of 2017, over 1 year since the accident. My grip strength and pinch strength, but especially my range of motion at the 3 joints of that finger had improved sufficiently for the doctor to discharge me from his care and to happily report I would not need a second surgery.  

The 2nd joint (PIP) still feels tight, and I continue to stretch and do range of motion at the three joints but not as frequently. I can extend my finger until the PIP joint is fully straight (0*), but I cannot hyperextend it actively like I can with my other fingers.  The finger gets stiff in the cold, but remains usable with some TLC.  About 3 times this year my toothbrush has flown from my hand while brushing my teeth!  Thank goodness, no toilet landings. (:  I do have to be aware of my finger (pinch) position when stripping fly line. 
A much better "hook!"

I've recovered, to date, about 93% of my movement and even more of my strength in that finger and the hand, after being told I would likely need another surgery to free tendons from bone.  No 2nd surgery and a very good and continuing (as far as I'm concerned) recovery because of my very hard work, frequently and consistently throughout the day, every day, as the months went by after the surgery.  Of course my doctor and my OT played an important role in my recovery!!  But, as I tell my own patients, when it comes to recovery, others can guide, but the individual has to put in the work.  I never want to look back and think of what could have been if only I'd given my maximal effort. I gave all my effort to recovery and am happy with the results -- very functional movement and strength!  If I gain more ROM, time will play a role in thinning tissues that thickened due to the K wires being in place for so long. I may never hyperextend, but will continue to try. It won't really affect me unless I decide to play the piano... and that isn't going to happen! I do hope to gain more flexion if scar(?) tissue thins out which will gain me more control when brushing teeth and fly fishing.

Please look back at the first pictures.  Even after that final May doctor's appointment 14 months later, I still gained in strength and range of motion.  The greatest degree of recovery available was literally in my own hands.  I write this to encourage and inspire others.  IF you give it all you've got, you will get the best you can and won't have to think, "If only....."

I would never wish for this to happen, but the journey was rewarding.  Thanks for letting me share my journey with you.  I am happy to be back fishing and catching again and am happy to say that my casting is better than before the injury!  I've been working on that, too.

Comparing fingers, especially index. Left proximal phalanx and knuckle (PIP) are slightly larger.