When the problem changes, re-evaluate the diagnosis.

And the diagnosis is:   I do not know.  One thing seems evident:  it wasn’t a hematoma (ruptured blood vessel).  

Things really changed in the next two days after I posted last on my poor hand.  The swelling became greater, the finger more red, and a spot near the first bend in my finger started turning white (i.e. dead –- white = no circulation).  It began to look like a hot-dog with two rubber bands around it.  It looked bad, and felt worse.

Finger 11-22 When I went to bed that Sunday night, I took a culturette swab in case it burst during the night.  I wanted to see what was growing in my finger.  It didn’t burst on its own, though.  This picture is the next morning on November 22, before I went to the doctor.  It had to be an abscess (pocket of pus).

That afternoon, the surgeon looked at it and said, “I think that is MRSA.”  [Methicillin Resistant Staph Aureus, a bad bacteria to have]  He split the swelling down both sides to drain “a lot of pus”.  I wasn’t looking —  just gritting my teeth, looking the other way and moaning softly. 

He took a swab to culture the mess, then irrigated the pocket to remove as much debris and dead tissue as possible.  I already knew this from my own patients, but local anesthetic doesn’t work in an abscess, so the process of opening and cleaning it out is pretty painful.

After lancing 11-22 (2) The wound was packed with Prisma, which is a cool material made of collagen (the body’s natural connective tissue) and treated cellulose.  This eliminates the dead space in the pocket and absorbs new crud that forms.  That is, it absorbs moderate amounts of drainage.  There was a little more than “moderate” draninage on the first day.  By the time I returned to the office, the bandage was already soaked.  I had to apply another layer to keep from contaminating other folks, and from wicking new bacteria in through the wet bandage.

He also prescribed antibiotics, pain meds, and suggested taking extra vitamin A, C, and zinc.  I complied.

The next day, the dressing was changed, the wound flushed, and the packing changed.  This feels a little like having a rasp up your nostril, pain-wise.

After Debridement 11-24 The next day, he had to remove some more dead tissue.  This time the local anesthetic did help a little.  Since I had experienced so much drainage before, he gave me a more impressive dressing.  It looked like a boxing glove.  The culture results were back: normal skin bacteria, no MRSA.  No MRSA is good, but (in the words of the surgeon, and I concur) “this makes no sense”.

Other than the weight-lifting a week before, I can recall no trauma of any kind: no splinter, no cut, no scrape, no nothing.  Was there some “micro-abrasion” during weight-lifting?  My weight-lifting gloves have open fingers.  I’ve ordered new ones that cover my whole hand.

Two days later, after Thanksgiving, another bandage change, new packing.  The pain is subsiding, and I can bend my finger, but things still don’t look good.  I made myself look this time, but no picture.

That packing was supposed to come out with a bandage change three days later, but the surgeon’s wife went into premature labor and had to have an emergency C-section.  The guy put his family ahead of my finger, so I had to wait an extra day, but things went okay [finger, momma , baby, everything]. 

Fingers Dec 1 (2) Here’s a picture on December 1.  There’s enough improvement that I can change my dressings myself now.  The wounds from the lancing haven’t completely healed yet, but they are getting there.  The surgeon tells me that being a  non-smoker and a non-diabetic have been my saving grace.  I just wish I knew what the inciting cause was, so I could make a serious effort not to repeat the mistake.  At this point I am mystified.  It could be a spider bite, or maybe alien abduction.  I'm open to suggestions — constructive suggestions, I mean.

Fingers 12-5-10 Here is today's picture.  The finger continues to improve.   At least it feels better, though it still looks pretty rough.  It’s functional – I played the recorder for a Renaissance Feast last night, and I can do surgery (though my right hand needs a size 8 glove, instead of the usual size 7).

This is why I am pretty careful not to bad-mouth the previous doctor when I see a case for a second opinion.  Sometimes the problem looks  a LOT different  when I see it a week (or a month) later. 

 

4 thoughts on “When the problem changes, re-evaluate the diagnosis.

  1. Darlene Girard says:

    hey Doc, I ‘m glad to see you are healing up .. that was weird, no previous injury and all.Thank goodness, it didnt end up being a necrotizing fasciitis. Just thought I’d drop you a note to say how my Nov went .I dropped a pot of Boiling water off the stove, onto my right foot last month.. Ho yes it hurt. 2nd degree burns all over my right “good” foot [ the left leg being previously paralyzed]. by the time I got the sock off the skin was changing, peeling and blistering. I had one blister that was the size of a Toad, a large toad, I even named it. ‘Jello’ cause it wiggled whenever I tried walking. I live alone, and that made everything a lot harder. People dont realize how lucky they are, when they have a helper living with them. It was a long 5 weeks waiting for my foot to heal up.. still have some scabs clearing up on it.. its certainly is a timely reminder of how us normal people take our health for granted. I’m glad you didnt lose your arm. BTW.. the dog spleen story.. very entertaining.. love the photo [ick].. Regards and Joyeux Noel

  2. Lorraine says:

    Hi, I seem to have the same issue- just wondering if you figured out the cause. Would love an update on your finger. Mine itched then grew and now is purple. I also have trigger finger on sand finger. I have had itchy bump before 3 other times but never had it so big and last so long and turn purple. Desperate for answers. No injury so I don’t think burst vessel. Thanks!

  3. Doc says:

    Hello, Lorraine.
    I never had a clue as to what caused it. Getting the full-coverage weight-lifting gloves was a precaution.

    Full recovery, no recurrence. There are two scars where the finger was opened for drainage, but you’d have to know they were there to look for them.

    If I were really lucky, it wouldn’t have happened. As it is, I feel fortunate to have no residual damage. I went back and re-read the post. I had forgotten how bad it looked, even though I remember the “hot dog with rubber bands around it” thing.

    I hope you heal as well.

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