Saturday, 29 May 2021

DBT, PRACTICAL ITEMS, & BRAVERY IN HOSPITAL ADMISSIONS | MY FINAL TENDON SURGERY

So, I was recently admitted to the Royal Victoria Infirmary (RVI) – a hospital under the Newcastle Upon Tyne Hospitals NHS Foundation Trust – for a final surgery on my thumb and it made me think and realise all the different elements you need when being admitted to hospital. And that they don’t have in evolve around packing a toothbrush and chargers for your phone!

Why I was admitted…

Unfortunately, I broke my wrist in November 2019, and apparently that injury can lead to what happened with my thumb on Boxing Day (December 26th) 2019. I was using my thumbs to try to wiggle the cork of a bottle of Prosecco loose when all of a sudden, I couldn’t move my right thumb (you can read my first post about the injury here)!

It wasn’t as though it was sore, and I couldn’t move it because it’d hurt, I just genuinely couldn’t move it. It was so frustrating because I could feel my brain telling my thumb to lift up, but it just hung there, powerless, limp and lifeless. It was definitely one of those things where you don’t appreciate what you’ve got until it’s gone! I really hadn’t recognised just how important my thumb was to my general movement and ability to do things until I couldn’t use it.

I instantly knew I needed to go to hospital and so I went with my Mum to my local Minor Injuries. The Nurse Practitioner examined my thumb and predicted that it wasn’t broken or dislocated but agreed to do an x-ray anyway. I was convinced she’d be proven wrong and was shocked when she returned with the results and diagnosed me with a frozen muscle/joint and recommended my Mum encourage me to put it in warm water and to slowly try to start moving it. And I just wanted to say that water would make no difference – it wasn’t going to move because something was wrong with it. After showing me the x-ray in an obvious attempt to placate me, my Mum and I went home and I was left feeling terrible for ‘spoiling’ Boxing Day, but Mum obviously reassured me that wasn’t the case at all.

When my thumb still wouldn’t lift upwards a few days later, I decided to take a chance and went to Accident and Emergency (A&E) at the RVI. Booking in at reception I was worried that I’d either be laughed at for attending for the sake of a thumb or told to just go along with the Minor Injuries advice of warm water. So, when the Nurse Practitioner called me through and his first words on seeing my thumb were: “something’s wrong with that!” – I felt so validated and relieved that a professional could finally agree with me and felt hopeful that in doing so, it heightened my chance of actually receiving treatment for it and the chance of it recovering.

After another x-ray the Plastic Surgeon was called and explained that I’d either tore a ligament which would take months to heal or I had torn a tendon which would need surgery. Either way, he gave me an appointment to attend the outpatient Plastic Surgery department the following day.

After a quick examination the Surgeon determined that my Extensor Pollicis Longus (EPL) tendon has torn and that I needed surgery that day to ensure I didn’t lose the function of my thumb! Honestly, I was obviously upset and scared at the prospect of surgery, but I was also very angry that the injury had been misdiagnosed (I talked a bit about this, and the impact my physical health was having on my mental health here).

I thought that after that surgery, that would be the end of it but the tendon repair tore and within a month I was faced with the prospect of more surgery (which I blogged about here). My Surgeon was hesitant to go in and do another, bigger surgery so early on and recommended that I try to adjust to the loss of mobility over the next few months and then re-assess whether it’s still worth operating on. Honestly? I was a bit put-out because a lot of my Surgeon’s recommendations were off the back of other patients with the same (to a certain degree) injury and that made me worry that she wasn’t grasping just how much it was affecting me and just how desperate I was to have the surgery.

Then, unfortunately, my mental health deteriorated and after two surgeries to repair my radial nerve after severing it during self-harm, my Surgeon decided that she wouldn’t do the tendon repair until there’d been no instances of self-harm for six months. She explained that her reasoning for this was her being concerned that she might operate and then me basically ‘ruin’ her work! At the time it was really frustrating because I thought that getting the mobility back would actually support my mental health and encourage safer thoughts which were the direct opposite of those around self-harming. Looking back though, and now being at almost 300 days self-harm free, I can totally understand and appreciate her way of thinking.

So, when I had an appointment with my Surgeon not too long ago, I actually felt really proud to tell her how long I hadn’t self-harmed for and was really grateful that she kept to her word. She did an examination to check the mobility and asked me a few questions about how it was impacting my life and the things I’ve had to learn to do differently because of my thumb. She agreed to add me to the wait list for the surgery which she explained would be a tendon transfer.

My understanding of that, until right up to my last examination with her on the day of my surgery, was that we have one tendon in each finger except your index finger and thumb (where you have two in each!) and so the surgery would mean replacing one of my torn tendons in my thumb with one tendon from the index finger. Honestly? I feel like it just screams pain! Like, just to hear that process sounds painful. And when I’ve been asked by friends and family what the surgery would be, they’ve all either wrinkled their faces with disgust or widened their eyes with the amazement of the things medical professionals can do these days!

On the day of my surgery, my Surgeon explained the actual procedure a bit more and it turned out I hadn’t exactly understood it very well. Now, whilst my surgeon hasn’t told me every incision and stitch etc step by step, this link seemed to be the most accurate to what I was told: https://www.assh.org/handcare/condition/tendon-transfer-surgery

Why it’s ok if packing your bag is important…

Whilst the title of this blog post and the theme of it, is that a hospital admission isn’t only about preparing an overnight bag; I won’t deny the importance of ensuring you have the practical things packed.

I’ve talked a lot before on I’m NOT Disordered about being labelled materialistic and superficial – particularly when it comes to my passion for makeup, handbags, shoes, and my reliance on technology! Over the years – mostly due to undergoing Dialectical Behaviour Therapy (DBT) – I’ve learnt a lot about recognising and respecting the coping strategies others find helpful in managing their mental health difficulties. It’s left me believing that if I find doing my makeup soothing and helpful in deterring thoughts of self-harm or suicidal ideations then that should be appreciated by myself and by others. It shouldn’t be used as a judgement tool to decide that I ‘mustn’t have been that suicidal’ for something like that to have helped me.

So, I’ve made a few little images of favourite items to take on a hospital admission (apologies that some of these may not be appropriate for everyone!):

Overnight Bags:

RI Embossed Barel Bag: £55

RSD Barrel Bag: £70

White Monogrammed Suitcase: £75

Black RI Barrel Bag: £45

Beige Weekend Duffel Bag: £55 (MY ACTUAL BAG)

Wash Bags:

RI Embossed Vanity Case: £35

Guess Cosmetics Bag: £16

Fenella Smith Cosmetic Bag: £9.99

Skinny Dip Lemon Makeup Bag: £7.99

DKNY Cosmetics Bag: £12.99

Essential Items for Your Wash Bag:

LED Travel Mirror: £27.99

Makeup Brush Set: £11.99

Ted Baker Mini Set: £15.50

Travel Toothbrush & Toothpaste Set: £7

Travel Hairbrush: £4.99

Other Essentials:

Fluffy Bed Socks: £13.99

5 in 1 Plug: £16.99

iPad Keyboard Case: £28.99

Everything Disordered by Aimee Wilson: £18

Mindfulness Book: £2.65

Why planning the transport around my admission helped…

The practical part isn’t all about packing a bag though either; it can also be about transport to or from the hospital. I decided not to get the bus there for two reasons:

1.      It would’ve meant getting up earlier than I really needed to

2.      I’d just had coronavirus swabs and was worried after testing negative for them, a trip on the bus might turn any more positive!

So, one of my very lovely and kind best friend’s; Georgie, took me to hospital and then obviously having had the surgery I really didn’t feel up to getting a bus home, so she picked me up, waited with me until my discharge papers were ready, and took me home.

Having that plan and preparation for something that might seem so simple and insignificant was actually really helpful in lowering my stress levels. I think a large part of that stems from the fact that throughout this whole… ordeal(!) I’ve felt that things have been so out of my control. I mean from everything like the actual injury to the recovery time! And as someone who has struggled a lot with control, this has been challenging on my mental health too.

Why I had to prepare for trauma triggers…

In that loss of control around the injury, I think that a big difficulty was that I have become so used to being responsible for something being ‘wrong’ with my body. For years, I have been the one to have inflicted pain on my body and so I very easily came to the mindset that no matter when the aftermath of the injury, I knew I was to blame for it. And this way of thinking stems right back to the abuse and the realisation that my abuser might neither take responsibility for what he did to me nor suffer any real consequences for his actions. So, I’ve found that blaming myself and having me be responsible for what happens to me, is a much more straightforward feeling than any frustration or anger I’ve experienced when another person isn’t accepting any responsibility.

Through DBT, I learnt a lot about blame and responsibility – particularly around the abuse. I learned that whilst it might seem easier to blame yourself, it isn’t healthy. Rather than do it as a coping mechanism, you really need to learn how to cope safely with any feelings toward the person who is responsible. But how do you cope when there really isn’t anyone responsible?

In considering the abuse and relating it back to my tendon injury and the surgery, I also think that I’ve struggled with coming to terms with the fact that I hadn’t wanted the pain (in both the abuse and the tendon). It wasn’t as though I was struggling with my mental health and it was providing me with so many reasons to inflict pain on myself and to self-harm in some way.

Over the years of self-harm, I’ve experienced a lot of instances where I’ve caused some sort of pain to my body but have found myself still suffering the consequences of that even when I no longer wanted the pain. This was particularly true for the occasions when I self-harmed to a degree that I severed the branches of my radial nerve because I had to have surgery days later. I remember crying when the Plastic Surgeon said I needed the operation and that whether I had surgery or not, the damage may be permanent.

It was frustrating but being the ‘glass-half-full’ type of person that I am, I managed to put a positive spin on things and started to view that frustration as motivation to fight thoughts and feelings around self-harm. When that mindset would creep in, I reminded myself that I’ll have to live with the consequences of whatever I do as a bid to get through that one moment I’m struggling with. It helped that the Crisis Team taught me not to regret these things if I have been able to learn from them.

In coming to terms with all those difficult reminders and the connections to self-harm etc, another trigger I worried about was that I was being admitted to the same ward I’d been on when hospitalised for self-harm. In fact, the last time I’d been on that ward, I hallucinated and self-harmed in the bathroom and was put under strict observations of having a member of staff sat with me through my entire admission. So, of course going back there stirred up some anxiety and worry in me…

Finding bravery from DBT…

Coping with the anxiety and panic around the possibility of being triggered regarding my surgery and the injury in general, wasn’t the only reason why I needed bravery for my hospital admission. But I mostly found bravery in using my pros and cons exercise from the Distress Tolerance module of DBT. Typically, this exercise is used in making a decision so that it enables you the opportunity to sit down and really think about all the benefits and consequences to your decision. It’s sort of an attempt to really avoid any emotional and impulsive thoughts and feelings in making the decision. So initially I used the exercise to make the decision as to whether or not to even go ahead with surgery; but in questioning my bravery, I found that reading the pros to my decision actually really supported me in maintaining a level of courage. It really helped to motivate me in recognising that I had some very important reasons to be brave and to see this surgery – and the admission – through.

I’m definitely someone who benefits from having things written down in front of me and so creating the pros, cons, and middle ground graphic really helped to make all these reasons actually real and meaningful. It felt as though now they were solid and embedded in my mind so that if I found myself questioning my bravery again, I would have some ammunition to fight those worries and doubts.

As it turned out, it wasn’t just about triggering and upsetting memories of previous hospital admissions that challenged my bravery. There was also the very obviously blunt fact that I would be going under a general anaesthetic to have surgery that might not work! I mean, going into the anaesthetic room to be confronted by three anaesthetists, a nurse, and a ton of medical equipment; my first words were “oh God!” And when they tried to reassure me, I told them that everything looked so intimidating. Having those ‘pros’ of getting the surgery though, willed me to get up onto the ‘bed’ and lie still while they prodded me with needles to administer the anaesthetic.

After surgery, I was also faced with needing courage to manage the pain I was in. Of course, I had expected pain – I mean, it was surgery(!) and they were transferring some tendons so of course it was going to hurt afterwards! But even knowing you’ll be in pain from something, you can’t really have an exact and accurate expectation on just how much pain there’ll be and just how well (or unwell!) it’ll be controlled with painkillers.

Unfortunately, I’ve been on painkillers for quite a long time since the tendon first got injured, so the amount of medication they could give me after surgery wasn’t as beneficial as it might have been for someone who has only ever taken paracetamol! However, my mental health being as stable as it is, I was able to find bravery in understanding and accepting that this pain wouldn’t last forever – no matter how persistent it may seem.

My recovery plan…

Currently, I have an appointment next week to have my dressing/cast changed – at the moment the only solid, cast part of my dressing is down the underside of my arm from the elbow and then around my thumb. Across the top of my arm and over my knuckles is all soft dressing. So, at the appointment they’ll be doing a wound check of the incisions, and then putting on a ‘full cast’ which will stay on for three or four weeks.

At the end of June, I see my surgeon for the cast to come off entirely, to have her do an examination, and then have an assessment with the Physiotherapists to determine how intense my physio needs to be. To be honest, when I was deciding whether or not to have surgery, I really didn’t put much consideration into the idea needing rehabilitation after it. And I definitely didn’t think about a particular issue I’d need physio for because my surgeon didn’t tell me about it until after the surgery! She said that because the tendons were transferred, some people find it difficult to coordinate their thumb and forefinger in that sometimes when they intend to give a thumbs up, their forefinger will lift! So, physio will be about re-routing my mind in accordance with the new positions of the tendons.

Longer term, my surgeon has said that the expectations are that I have better mobility in so far as lifting my thumb, and that there’s ultimately little to no pain.

All the practical essentials for your recovery…

Peony and Suede Candle: £3.50

(similar) In-Ear Headphones: £14.99

Harry Potter Box Set by J K Rowling: £34.12

(similar) Sleep Eye Mask: £3.33

Kindle: £69.99