Bigger than the pain.

Giving up was just not her thing, so she lifted the pen in a third attempt to take notes of her favourite lecture. But the piercing twinge in her wrist stopped her short. Disappointed, she lay her head on the desk and let tears soak the few scrawled lines that she had managed to write. Aditi had just turned sweet 16, but this pain in her life was only turning things sour.

Aditi’s right thumb had developed de Quervains (dih-kwer-vains) tenosynovitis due to excessive writing over the past few months. This condition is a repetitive injury syndrome to the thumb tendons, mechanism being very similar to how a rope wears off partly in places where it rubs over a pulley. In our body however, rubbing causes these tendons to swell up and become painful on movement.

Morning lectures were spent in failed attempts to write and concentrate in class, followed by further more futile appointments with doctors and physiotherapists in the evenings. Doctors said ‘PAIN KILLERS and CORTICOSTEROIDS’. Physios said ‘REST’, added, ‘COMPLETE REST’. No one said how long. No one explained how. No one seemed too sure. The pain got so disabling within 3-4 months that she couldn’t even hold a brush, use a spoon, pull a zipper or fasten a knot. Dancing, badminton and swimming had become things of the past.

Like it goes with all chronic pain patients, Aditi’s friends-family and several doctors started suggesting that she was ‘making up’ the pain or that it was sitting ‘in her head’. Meticulous class-work was replaced by borrowed xeroxed notes, peace of mind by stress and self-confidence went on an indefinite strike. She was broken in some ways, but not completely, not yet.

Aditi started practicing writing, eating and doing her daily chores with the left hand. This was a good move. Not only did it let the right hand rest and heal but also gave her a sense of accomplishment and independence. Classes were now a battle between the lecturer’s speedy delivery of information and her pre mature writing skills. But she loved the game. Miss Gandhi, a close friend helped her finish her half written notes during the break hours and evenings. Some people are just pure gold you know. Days went by. After several weeks of pleading, the administration of XIIth Board exams (CBSE) allowed her to use a scribe. Without a writer she knew she would have failed.

Right hand writing. (Left)
Left hand writing. (Right)

Meanwhile, an ill administered  steroid shot in the tendon worsened Aditi’s pain and thinned down her hand muscles. The swelling of the tendons subsided. But activity level suffered due to increased weakness. She had no one to blame for the side effects that showed up. It was an ill informed choice.

The brilliant thing about taking decisions is that, whether right or wrong, they are always fruitful.They are a step towards taking charge. The pain whose fate lay in the doctors’ and  physios’ hands once was now Aditi’s own. She seemed determined to drive away this illegal tenant. So this time when she met an expert therapist, she knew this was going to be the last attempt.

She met a series of therapists who were different. They restored the lost faith. Her pain was a deep concern to them and the sessions were more personal than they had been before. One of the senior most therapist taught her to differentiate between the physical and mental components of pain. The manual techniques they taught were different from what she had learnt elsewhere. So she re-learnt the old lesson that a part of her pain was in her head, but with scientific explanations this time. With a smile rather than an accusation. The mental component of pain, as she understood, was like the bank robber from the gang who escapes and hides in the high security vault. He might disrupt the machinery for a while, but is bound to be tracked down soon. She devised her own ways to deal with it. She forbade her close ones from asking any questions whatsoever about the pain, as if pretending that it did not exist.

For the physical part, a physiotherapist asked her to maintain a pain diary that kept track of pain score with the day to day activities. The occupational therapist made her a resting splint to use for a period of 1 month to completely rest out the tendon and let it heal. Alongside she got help from a friend who trained her to play Table tennis (new to her) with her left hand. She plunged without precaution into all her old hobbies except writing with the right hand. Her innovative grip style that involved no thumb movement and another one that used only the index and middle finger to hold the pen, helped her get back to writing with the right hand

From top clockwise. 1. Normal (painful) grip.2,3,4 of Aditi’s modified grips.

Now two years later, she plays right haded badminton smashes with ease. At table tennis however, the right one never learnt how its done so she continues to be a lefty. In the last hour of her university exam when her thumb decides to go into painful spasms, she chooses between left hand writing, gripping in a different style and releasing her thumb spasms with her other hand. She might not finish the paper as neatly as she did three years ago, but she doesn’t care. She is bigger than the spasm of a thumb, than the pain. She knows that now.

All praises to the dedicated people (medical and otherwise) who cared enough to care.

For medical professionals, find more details on de Quervains tenosynovitis here. And for the possible avenues of therapy, clinicians and therapists are welcome to start a discussion by dropping in a mail here.