The end of Carpal Tunnel: Time for more surgery.

If I had died at the age of 41, I would have died with just one surgery on my record.  That was a  tonsillectomy that took place when I was about 6 or 7 years old.  That's even more interesting given the fact that most doctors consider  the tonsillectomy an unnecessary procedure in this day and age.  It's an artifact of a bygone era, and a mistaken approach of an archaic past.

As it happened, I lived past age 41, and I have had 3 surgeries in the past 3 years.  Really, it's more like 3 surgeries in the past 26 calendar months.  I've had both knees done, and the gastric bypass.

Guess what?  It's time for more.  Surgery number 4 & 5 are on tap over the next two months.  Dr. Eli Ziv, a buddy and partner of Dr. Bachner, will be cutting into the palms of my hands.  I was supposed to contact that surgical scheduler Friday to set the date for my right hand.  I hesitated.  I'll get to him Monday.  We'll get the left hand next...  Dr. Ziv is the hand specialist in the orthopedic surgery group Bachner is partnered with.  His mother-in-law also happens to work for my company.

I am a little queezey, but grateful.  This will be the end of the Carpal Tunnel that's (1) holding me back and (2) driving me crazy.  Although I detest going under the knife again, this syndrome can't end soon enough.  The sooner the better.

So just what is Carpal Tunnel Syndrome (CTS), and how do you fix it surgically?  First, CTS is not tendinitis created by typing all-day-long.  To be frank, it's not even a repetitive stress injury.  Incompetent doctors of the 1990s characterized it as such when it was a very trendy diagnosis in the new era of info-tech employees.

True CTS occurs when the transverse carpal ligament in the palm of your hands grow stronger, larger, heavier, or inflamed.  When this occurs, the ligament applies a crushing pressure on the median nerve that runs along the Carpal tunnel of the wrist.  This crushing pressure effectively cuts off the electrical signal from the brain to portions of the hand.  The solution is to surgically bisect the transverse carpal ligament.  Cut in half, the transverse carpal ligament can no longer apply a crushing pressure to the carpal tunnel or the median nerve.  The condition is eliminated.

So you slash a tendon, leave it slashed in half, and you release the pressure.  Whooooooaaaaa!  Slashing tendons permanently?  Isn't that going to cripple your hands?

Nope.  It turns out that the transverse carpal ligament is an evolutionary vestige of biological epochs long gone.  It is just like the appendix in your intestines.  It now serves no purpose.  Anthropologists, of whom I am one, believe that this vestige was once used by human ancestors who walked on all fours, on the palms of their hands.  The transverse carpal ligament helps the palm of the hand function better as a heel, but not much in this day and age.  It has degenerated considerably.

Ergo, you can slash it without any long-term ill-effects.  In the short-run it hurts like a sonofabitch.  More hydrocodone.

When Doctor Ziv explained all this to me, my natural response was "Well shit, Doc!  You shouldn't have told me that!  I have a perfectly good Spyderco ZDP-189 knife right here in my pocket.  I'll fix that nasty transverse carpal ligament right here, right now.  I am DIY guy!"

Nah!  Just kidding.

So the question remains:  how in the world does the transverse carpal ligament grow strong, heavier, swollen, or inflamed? How the hell does any tendon grow thicker and stronger?  Through exercise and heavy use, that's how.

Who knows what it was in my case.  Was it the shake weight?  Was it the kettlebells?  Was it push-ups and pull-ups?  Was it the ROM?  Was it Elliptical Cross Trainer?  Was it Olympic Rowing?  In sooth, I shall never know.  The key point is that I subjected myself to a vast array of exercises over the 10 months prior to the eruption of this problem, and all of them could have contributed to the strengthening of this ligament.

Dr. Ziv also mentioned that hormonal changes could contribute to the thickening and strengthening of this ligament.  What hormonal changes?  To the best of my knowledge, ligaments and tendons only respond strongly to one hormone:  HGH, human growth hormone.  This is released in great quantities during weight loss, and body building.  Many of the substances I use promote the release of HGH.  I am sure that the quasi-natural supply of HGH in my body is way higher now than it was 1 year ago.  This is why I am doing the Benjamin Button thing.  HGH is the key hormone in age-reversal.

Unfortunately, even this blessed condition can have unwanted side-effects.  I hit the Jack-Pot again.  This means I get to have surgeries #4 and #5.  Shit...

In verity and sooth, this isn't all that bad.  Dr. Ziv says that there is only about a 5% chance that the transverse carpal ligament can regenerate, and the CTS re-appear.  There is a 95% chance that he will slash my wrist, and I will never be bothered by this condition for the rest of my life.  When you think about all that I have gained (and lost) in the past year, this isn't such a high price to pay.  It could have been dramatically worse.

If everything works out for me, this will be a one-time-only fix, and I can go on about my business.

The Girevik broke his doctor's orders

So, after 4 days of doing little or nothing, I was going nuts with excess energy today.  I had to do something.  I was losing my mind and becoming depressed.

I got on my Elliptical Cross Trainer and busted 21 minutes for 324 kcal.  Numb hands and fingers did not stop me.  Before 5 minutes of rest elapsed, I got back on and busted another 15 minutes for 231 kcal.   This was was a nice round 555 kcal in 36 minutes of elliptical.

I didn't feel finished.  I jumped on the bike with intention of performing 10 minutes of cool-down cycling.  I did 18 minutes of meltdown cycling for another 184 kcal.  All-tolled, this was 54 minutes of exercises for 739.  This is an okay-level of production, but you know I did much more than that each day during the summer season.

After the Cowboy game, I was at loose ends again.  Way too much energy.  I decided to break medical orders and head to 24 Hour Fitness for a 5/3/1 workout.  I made one concession to medical expediency:  Rather than doing a barbell press, I used the Hammer Strength Decline Press machine.

I went big.  I went heavy.  I went hard.

1. 5 reps with 115 pounds on each side (45 + 45 +25)
2. 3 reps with 125 pounds on each side (45 + 45 + 35)
3. 2 reps with 135 pounds on each side (45 x 3)

According to the 5/3/1 pattern, I should have only done the final weight for 1 rep.  I went for two and got it.  I cycled through it all a second time, but I failed at stage 2, only getting 2 reps.  Incidentally, that final weight was at least 270 pounds, even if you give me no credit for the machine overhead.  This quantity would be 305 pounds in barbell terms.

It felt great to put three big wagon wheels on (each arm of) that machine and press it.  No NFLer would be impressed by that performance, but the dudes in the gym were.  I looked like a beast to these cats.  I guess I am a medium-size fish in a small pond.

It looks like the rest did me some good.  My strength seems to be increasing by leaps and bounds.  This is, in no small measure, the result of Kettlebell training.  For the moment, my fear of lost muscle mass is diminishing.  I am certainly not losing strength.  It's hard to loose muscle mass and not loose strength.  Conversely, it is difficult to gain strength without gaining new muscle mass.

The problem came after the pull-downs.  I finished my pull-down pyramid at 205 pounds.  I almost pulled that down twice.  Unfortunately, my right wrist feels a bit sprained and strained.  I think I done sprung it.  It was fine until I did the pull-downs.

Oh well, we'll see if I manage to sleep through the night, or if I have some problems with numbness.  A man's gotta do what a man's gotta do.  That's what I always say.

Let the soil go fallow for a Sabbath month

So I saw my orthopedic surgeon, Dr. Evan Bachner, yesterday afternoon about this awful numbness in my arms. It's been driving me crazy, waking me up in the middle of the night, not allowing me to sleep.

I gave him the fully complex of possible problems. He shot X-rays of my neck and shoulder. Those turned out negative. He went through a series of joint manipulations on my shoulders, elbows, and wrists. He found some sensitive spots in the shoulder motion, but this didn't alarm him.

The official diagnosis was Carpal Tunnel Syndrome in both wrists. It's worse on the right than the left. He handed me a pair of wrist splints, and instructed me to sleep with them on. I was skeptical. I didn't think these splits would do anything to prevent the numbness.

I fell asleep on my couch at around 6:00pm yesterday. I slept through until 2:00am. That was a brick solid 8 hour block. My fingers were a bit numb, but my arms were fine. This was nothing like the past several weeks. I was drastically better off. I was up for two hours, and then I went to sleep for four more hours. I caught up quite a bit last night. It was good.

The sleep without numbness is plenary evidence that Bachner was right about Carpal Tunnel Syndrome being the efficient cause of the problem.

The real difficulty is that he wants me to shutdown my exercise program for 4-6 weeks. This is the only way to promote natural healing, and prevent inflammation. This is a bitch, but there is no real choice here. If I intend to improve this winter, and be prepped for the Spring, I have to shut it down for a Sabbath month. I have to let the soil go fallow for a time, so I can be ready for a new growing season.