My Injury: August-November 2013

The events leading up to my injury started with a new flute.  I finally bought the flute I wanted to have, as opposed to what I could afford at the time.  My old flute served me well through my undergraduate degree at Baldwin-Wallace where I studied with Mary Kay Fink, my graduate degree at the Ohio State University where I studied with Katherine Borst Jones, nine years of teaching in the Wooster City Schools in Wooster, OH, and my years of study leading up to licensure as an Andover Educator.  While performing and presenting at the 2012 NFA Convention in Las Vegas, I bought the flute of my dreams.  I decided to go with an offset G on the new flute because I’d read a lot about how it’s helpful for those with small hands as they age.  For non-flutists, an offset key puts the G and A keys farther out on the tube, so that ring and middle finger don’t need to reach as far.  With the benefit of hindsight, this was a big mistake.  I’d successfully played flutes with inline G for 31 years with no pain or problem whatsoever.  Note to self:  why fix it when it isn’t broken? The problems started after I got the new flute home.  I started to have pain at the base of my left index finger after practicing.  Granted, I didn’t ease into it slowly.  I went full steam ahead, retraining my fingers how to cover the holes with an off-set G.  Preparations were underway for a debut flute duo recital in October with flutist Denise Rotavera-Krain.  We’d been wanting to start a professional duo for years but raising our girls conspired to put this project on the back burner.  As a teacher of Body Mapping, I knew how my arm and hands are structured and was studying my own use to see if I was doing something weird to cause the pain.  I couldn’t find anything physically wrong with what I was doing, but the pain continued.  I noticed that the offset G put my hand in a slightly more ulnar deviated position, which means my hand was moving out of neutral alignment. My thumb was more inline with my forearm than my pinky.  With the size and shape of my hand, this slight adjustment delivered weight to the side of the base of my index finger, not the palm side.  Fortunately for me, Alexa Still now teaches at Oberlin, 45 minutes from my house.  She’s an fantastic teacher and custom makes cork thumb and finger supports for her students.  I watched her make two of these thumb thingees at her summer workshop and subsequently had her make one for my alto flute.   I consulted with her about the new flute hand problem and we tried a finger extension, a slightly different hand position, a right hand thumb support to take weight of left index finger, clear water hose to make the tube wider and Dr. Scholl’s corn pads stuck on the flute as a cushion.  None of these solved the problem.  One day while driving my youngest daughter to preschool I realized that my hand was hurting while grabbing the steering wheel and that the new flute simply had to go.  I had been trying so hard to make this flute work, since I was told by the flute company that there was no refund or exchange possible.  What followed was a long complicated process, but, as of December 2012, I now have a beautiful new flute with inline G, patiently waiting for me in its case and hopefully the gorgeous off-set G flute has a new home with another flutist.  I went back to playing the old flute with a Dr. Scholl’s corn pad as cushioning for the base of my left index finger.  The recital on October 20, 2012 was fantastic and I then decided to take one month off to let my hand heal and rest.

In the beginning of November, my hand was feeling great.  No pain, no problems, definitely getting better.  On the night of November 8, 2012,  it was bath time for my 4 year old.  I was kneeling at the side of my tub, put my right hand on the edge of the tub, and reached up to put the tubbie toys away, a movement I’ve done thousands of times with 2 kids who love their baths.  I failed to notice that my right hand was in water until I fell forward into the tub.  I dropped the toys with my left hand and threw my hand out to avoid falling directly onto my child.  My left hand contacted the bottom curve of the tub with fingers hyperextended, took the whole weight of my body,  and the main point of contact was the base of my left index finger.  Something went “pop” inside my hand.  Of course, where else would it be other than the site of the healing injury?  My daughter thought it was great because there was a giant splash and Mommy’s clothes were soaked.  It probably was fantastic from her point of view!

What followed was a long, frustrating journey through the our medical system.  I am extremely lucky that I live close to the Cleveland Clinic, which does have a number of doctors who are part of PAMA (Performing Arts Medical Association).  I went through four doctors before I could get a definitive diagnosis.  If I followed the first doctor’s advice, I’d have gotten a cortisone injection which would have done nothing to heal the tear.  The first three doctors (two of which are big names and very well respected in their fields) all said “hmm.. there’s something going on in this area and it’s a soft tissue problem.”  The 3rd doctor put me in a splint to restrict the movement of my MCP joint to allow the area to heal on 11/30/12.  It was fantastic to watch the hand therapist custom make this splint for me.  Little did I know then that I would come to depend so much on the skill of my hand therapists.  splint 1 sideAfter three weeks, I followed up with the 4th doctor, another orthopedic specialist who works with musicians’ hand.  He was finally able to diagnose me with a partial  tear in my radial sagittal band on the MCP joint of my left index finger within a few minutes by looking at my hand.  The MCP joint is the metacarpophalangeal joint or the big knuckle where the finger meets the hand.  The sagittal band is connective tissue that’s part of the extensor complex, goes around the joint capsule and keeps the extensor tendons tracking over the middle of the knuckle when you make a fist.  The extensor tendons are the ropy things you see on the top of your hand when you make a fist. They should be centered over the knuckles.  In my case, the extensor tendon of my index finger was pulling towards the valley between index and middle fingers, “the valley of doom” according to my doctor.  My diagnosis was a bit of a challenge.  At that time, he didn’t think it would require surgery and the conservative treatment was another 8 weeks in the splint. splint 1 palmThis doctor, who is also now my surgeon, knew the difference between an offset and inline flute without me explaining it!  He was also able to explain how  playing the offset flute probably caused this partial tear, which was healing on its own, and then was further traumatized by a fall on the same area.  There’s a little bony projection on the bottom of my finger bone at this joint in my left index finger, just an individual difference.  Normally not a big deal, but with the slight adjustment to the offset flute, this little bony projection was acting like a saw blade under the sagittal band.  It was a relief to know that there was a structural cause to this whole thing, rather than just a black hole of self doubt, as in “did I do this to myself?”

On January 11, 2013,  I followed my hand therapist’s advice and played for 5 minutes.  I was instructed to play for the 5 days preceding my appointment and see what happened.  Day #1 was fine.  Day #2 was fine.  Day #3 was hell, and I stopped after 30 seconds.  The therapist was sufficiently concerned at my next appointment to request an informal consult with the doctor.  He said more time in the splint because this joint is very hard to heal because it’s difficult to fully restrict the movement and there’s not much blood supply there to promote healing.  So, back in the splint – still no flute.

On February 13, 2013, I met again with my doctor.  At this point, the conservative treatment had failed.  There was some structural issue that was not going to heal itself, leaving me with no other option to reconstructive surgery.  Upon manual examination, it was clear that there was some issue with the radial collateral ligament (holds the finger bone to the hand bone at the joint and prevents lateral movement) as well as the sagittal band.  I was scheduled for surgery and an MRI.  Up to this point, I had not spent much time considering my emotional reaction to all of this.  I walled it off and refused to think about it because I was going to get better with time.  Once the surgeon said “there are no more options”, then I realized that I couldn’t ignore this anymore.  I ended up sitting in the parking lot of a local organic grocery store, crying my eyes out.  I needed to compose myself before driving home, having to function as Mommy for two girls, and going to talent show dress rehearsal for my oldest daughter.

I continue to try to figure out “How can I use what’s happening now to make me a better teacher?”  I realized that the mental and emotional aspects of an injury can be just as debilitating, if not more so, than the physical aspects.  This isn’t a new idea, we all know this, at some level.  But now I KNOW this.  My perspective has changed, since I never experienced an injury that necessitated a complete halt to flute playing, piano playing and my ability to make music in some form.

Emotional/Mental issues that I’ve been experiencing:

Devastation – I’ve spent years and years learning my art form and now I can’t do it all for an indefinite period of time?

Guilt – Why should this injury be such a “Big Deal” to me when I have friends, relatives, and colleagues dealing with chronic health issues like cancer?

Anger – Why is the universe conspiring against me?

Lack of trust – So I did what the doctor and therapist said, 100% compliance with all instructions, and now I’m worse?  Is the diagnosis right?  Do these people know what they’re doing?

Frustration –  So there’s really nothing I can do except wait?

Disappointment – Having to turn down and cancel professional engagements is hard.  Accidents happen and people get hurt; however, we all work hard to get the gigs and who wants to have to cancel?  When will the next opportunity come around?

Financial stress – Luckily for me, my ability to feed and clothe my family doesn’t depend on my ability to generate an income.  This is not so for other musicians.

Self map issues – If I’ve mapped my self as a flutist, what I am without the flute?  If I’m a band director, what am I without a band?  How can I be a musician who can’t make any music?

Impatience – I know how to regain my playing skills, once the _____________ (insert injury) heals.  Come on, already!

Lack of trust in my own judgment – How can I teach other musicians how their bodies work when I hurt myself on my own stupid flute?

So, what do we do when students, colleagues, or friends talk with us about similar issues?  I’m not a psychologist or a medical professional.  What we can do is validate other people’s experience.  We obviously can’t say, “I know how you’re feeling.”  How insulting, to presume that you know what somebody else is experiencing!  Perhaps just acknowledging the feelings takes away their power and then we’re free to choose to focus on something different.

I had an MRI done on February 26, 2013 which was bungled by the MRI tech.  Let’s just say that one of the many problems was that she dropped the lid of the coil on top of the injured hand.  At my pre-surgical appointment on February 27th, my daughter’s 5th birthday, my surgeon agreed that the MRI was poorly done.  It didn’t show the either of the structures in question, but was helpful since it didn’t show any weird bony masses or anything else wrong with the joint itself.  At this appointment, I had a list of 21 questions for my surgeon.  I do my homework and wanted lots of information.  When I asked, “You’ve done this before for musicians, right?”  He giggled, in his surgeon-sort of way, and said that he’s done it for professional musicians, musicians who are also surgeons and surgeons on their dominant surgery hand.  I can’t think of a more high maintenance group of patients than other surgeons, so I thought that this is definitely the guy I want to be cutting up my hand.  Surgery was scheduled for March 28, 2013.

There were good things that happened during this time. Perhaps, these gifts that my friend encouraged me to find.

Key things I learned during this stage of my journey:

1)  I successfully taught a 2 day WEM workshop for students at Ashland University without playing a note on the flute.  It was frustrating to not be able to demonstrate the concepts, but it’s always good to add more ways of teaching a concept to your teacher’s tool box.

2)  Thinking outside the box – I learned to modify my old flute so I could play a few notes to successfully teach a workshop on extended technique for a student flute festival where I was the guest artist. I was unable to perform my solo piece, The Great Train Race by Ian Clarke.  So I played the composer’s own recording on a CD for the students, and then was able to demonstrate each technique found in the piece.  With my splint, I couldn’t even hold the flute properly.  For flutists out there, flute modifications that I made were 1) putting cork wedges under the foot for the C key and the thumb key, so they were closed by default, 2) putting plugs in the open holes, 3) plopping the whole thing on top of the splint,  and 4 ) carefully choosing notes to play that didn’t require left hand thumb or 1st finger keys to be open.

3)  I learned to appreciate the power of the pincer grip of first finger and thumb.  It’s not so easy to do things with middle or ring finger and thumb.  I was fortunate that I had almost full use of all fingers, except index finger, and thumb, as well as almost full wrist and arm movement.  However, restricting movement in one joint led to a whole series of compensations made by the whole arm and whole body.

4)  It was made clear to me through conversation with one of my former teachers that I did not fail myself as a Body Mapping teacher.  I knew something was wrong and did everything I did to fix it, including giving up that specific instrument.  I went to others for help and decided that I needed to make a change.  She wrote to me said to me, “I feel certain, and it seems that you do, too, that you would have solved this and be fine now if you had not fallen, so there is a lot for you to be proud of in how you handled the problem of choosing the wrong new flute. Also, you didn’t fall on your child in the tub!” Even musicians fall down.

5)  Do not stop looking for answers to a medical problem when you don’t get a definitive answer.  Keep asking questions.  Sometimes, it’s a matter of finding the right medical professional.

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