Sunday, 01 August 2010 22:57

Dialysis and negotiating the Carpel Tunnel funnel

Written by  Greg Collette
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I spent the last two weeks checking out my numb/tingly fingers.  My thumb, first and middle fingers have been tingly and at various times numb since I had the fistula rebuild back in February.

I revisited the vascular surgeon who rebuilt my fistula and after examination, he suggested a blood flow review test.

This test was done via ultrasound, where the technician looks at each artery feeding blood into my hand and makes sure it is flowing in the right direction (ie into my hand and not into the fistula).  Two of the three main ones were, and the third mostly was, with a small percentage being stolen by the fistula.

I went back to the surgeon to have the results interpreted.  He said that a small steal was both inevitable and normal, and that it was not enough to cause my symptoms.  He told me to go to my doctor and arrange a Carpel Tunnel test.

About a week later (there was a cancellation!), I fronted up to a neurology clinic for the test.  The test involves triggering the nerves that go through the Carpel Tunnel to see how quickly they respond to stimulus.  The faster the better. If the response is slow, then the nerves are either blocked or damaged.  Carpel Tunnel syndrome is pretty common generally (it affects about 20% of long-term BigD-ers), so they have standard tests with lots of data about what the results mean.

The technician was very experienced. She had the right words to say at the right time and moved efficiently through the testing.  There was even a trainee doctor there to learn all about it.  He also talked a lot.

The tests involve “stimulating” the nerves.  This means triggering small electric shocks at one end and measuring how quickly the shock reaches the other end.  They start with electrodes on the fingers and a receiver just below the wrist.  Shocks are small but steadily increase until they are uncomfortable. But being a macho man, I could handle it.

But that was only the start.  Then she reversed the test direction.  She taped a receiver to my fingers and used a mini-tazer to jolt the nerves into action.  The jolts got progressively bigger until my hand jumped around of its own accord.  Once I understood what was happening, I found myself sweating, heart beating faster, anticipating the next jolt, just like a lab rat only bigger. ( Not so macho now…)

She ended the test with a stream of jolts sent by the computer.  They went on for a very long time (maybe 5 seconds or more!)  It drew sweeping, curving graphs on the screen, which she interpreted for the trainee and presumably for me.  Not great responses: definitely Carpel Tunnel.

As I pulled down my sleeve and started to get out of the chair, she said she was only finished with that hand: now for the other.  She repeated the test and found that the left hand was also a little slow, but nothing like Carpel Tunnel.  Just a little advanced wear and tear, probably on the outer linings of the nerves, probably caused by the BigD.

In came the neurologist to interpret.  Yes, Carpal Tunnel, yes, slower responses in the left arm too.  Carpel Tunnel can be dealt with in three ways:

  1. If it’s mild, live with it.  Exercise the hand and wrist and see how it progresses.
  2. Semi-severe: have Cortisone injections into the tunnel.  This provides temporary and sometimes long-ish term relief.
  3. For severe Carpel Tunnel the best approach is to operate.  It is a relatively small operation, with a very high success rate.  Best to find a neurosurgeon that specializes in this kind of thing, and ideally one who has experience working with fistulas.

Option 3 was what he recommended for me.

OK he said, show me the leg tests.  Oops, wasn’t sure it was necessary says the technician.  Yes, we need a datum for next time (next time?).  So off came a shoe and sock, out again with the mini-tazer and we’re off.  Even more violent jumps and kicks later, it really was all over.

So, now I can add nerve response tests to my list of medical tests, probes, indignities and humiliations.  This one goes with the Not-All-That-Comfortable group (a surprisingly large group).  I have long wished that we were issued a medical passport at birth, and that every test came with a special stamp for the passport (or perhaps a postage stamp sized picture of it being done).  Such memories.  Such bragging rights.
Maybe in the next life.

Well, the next step is to arrange to surgery. More to follow…

... http://bigdandme.wordpress.com/2010/08/02/dialysis-and-negotiating-the-carpel-tunnel-funnel/

Greg Collette

Greg Collette

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