Thursday, March 20, 2014

No mindfulness for me

I had signed up for an 8-week mindfulness based stress reduction course. I was looking forward to it, I thought it might give me some of what I needed. But it has been cancelled due to low enrollment. I am very disappointed. Unfortunately I live out in a semi-rural area these days and there aren't a lot of groups going on. I think I really need a group.

My hospital has a depression support group- I don't know if it free or paid group- but it is in the middle of the work day, so that won't work anyway. DBSA has two groups about a half hour drive away from me that I could make- if I am able to get out of work right on the dot and have no traffic, etc. Which never happens. And I have been less than impressed with the groups. I think I was spoiled- the group I went to in the city was just so good. And there were more people there who were in a similar place as I am.

I've thought of trying to create a group on for peope with mood disorders- but I am too afraid that no one will show up and I will be left feeling depressed and lonely at whatever venue I choose. But maybe I will, eventually.

Things have been challenging recently, in part because I messed up my meds when I went out of town this weekend. I think that yesterday was the first day I started to feel like I was getting back to equilibrium. I actually left work early on Monday my headache was so bad.

But I am excited because I am going to a hand therapy conference starting on Saturday. I love going to conferences and courses. I always come back so inspired. Except for the ones that I have gone too extremely depressed when I was wiping away the tears half the time. Those were bad. But this won't be like that.


Unknown said...

I have a hand therapy question for you. My BIL's mom asked me to look at her hand today. She had a carpal tunnel revision in July and since the surgery has had pretty severe muscle wasting in the thenar eminence, decreased senation (touch only), very limited grasp and almost no pinch/grasp strength at all (I doubt it would register on a dynamometer). She has to physically place her hand around a glass using her other hand to place the fingers and then she can't lift it.

I told her to see a different hand surgeon. I'm assuming her median nerve was cut in surgery (?). I thought maybe estim but based on how limited my knowledge of hands is I imagine she needs a CHT, which may be in short supply in the middle of nowhere, Ohio. I know the stim would need to be very specifically applied.

I don't know enough about hands to tell her much more than this. I know there is something about thenar eminence wasting and CTS but I can't pull the information up right now. Even so I don't think it is for something as severe as what she has.

Do you have any suggestions? I really suspect the median nerve may be gone as she had NO pain post-op and was using the wrist at least and partially the hand pretty normally (minus the grasp and lifting) the day after her surgery.

I have only treated a few CTS patients and they were mostly being seen for breakdown of excessive scarring. I vaguely think I've seen this once, like back when I was first practicing and that I should remember something from that but I don't. I think I had a patient with something similar and asked my boss to help me and she taught me a lot that I can't pull up nearly 15 years later.

Just Me

Jean Grey said...

I think she needs a nerve conduction study. It is possible that the nerve was damaged during surgery- or that she has some nerve problem more proximally that the surgery did not address. Usually after a complete laceration of the median nerve at the carpal tunnel people have some grip because the extrinsics are still enervated. She might also have an ulnar nerve problem- you can have wasting with that, as well as trouble with grip and pinch. E-stim only helps if the nerve is intact- it it has been lacerated there is no point. And even then, I don't think there is enough research to really support it- but sometimes I do it, if for no other reason than to remind the patient what it feels like to use a recently re-enervated muscle again.

Unknown said...

Thank you! I'll pass this on. I Hope that it is something that can heal; she is having a hard time doing her job because it is her dominant hand. I really hope she can find a CHT.