Giant Pins Ripped from My Bones

We’re three weeks out of my surgery and today I had the k wires removed. I also finally saw an x-ray!

I did not see this until after they yanked those bone piercing railroad spikes. I did see the spikes themselves and I still don’t understand how they fit inside my fingers.

Check out the fake knuckles! It’s weird. They’re weird.

The sutures are doing ok (yay, hydrocolloidal bandaids; get ’em and use ’em):

So, alignment looks good but we didn’t see much range of motion improvement from last week. Removing the pins might help. I have some new guidance on the old exercises and will add in some passive stretching.

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Augmenting Hearing with Earbuds

Given the prevalence of mics, wireless connections, and earbuds, it’s not surprising that we’d see attempts to augment hearing with these.

I’ve tried two thus far, IQBuds and Jabra Elite 65t. The IQBuds did better on bringing in the outside sound and suppressing non voice sounds but they didn’t really work. They were also falling apart. Most importantly, they would screech with feedback a lot. Anytime I touched them with the mics on (eg to control them) it was high risk. The Jabra have better sound and better mics for making phonecalls, but the pass through isn’t brilliant and they have no noise filtration.

Apple is going to let you use your phone mic to augment your hearing. That’s a great idea! Your phone’s mic is very good. It has noise filtration. You can position it close to the source. I’ve been wanting this for a while!

I hope they open it up to all earbuds. AirPods are cool, but they don’t provide noise isolation.

Gross Progress

No, not Pruitt’s resignation though he’s gross and that’s (temporary) progress. I had a follow up today to remove my stitches! And ditch the hot, sweaty, stinky dressing! I won’t be able to immerse the hand until the pins come out next week but I can sponge bath most of it! Even the incisions tomorrow after the stitch holes heal.

The X-Rays said everything is still where they put it so yay. The incisions are healing nicely. We finally took a range of motion measurement.

Here’s a photo:

You can still see the tendency to deviate toward the ulna. Hence the need for nigh 24hr splinting (dynamic during the day and resting at night). The surgery is supposed to give the therapy a fighting chance of getting everything into a stable and functional dynamic.

And here’s the incisions with stitches. Tomorrow when I take off the bandaids we’ll see my knee fake knuckle future!

Unmoored Claims About the NHS

I’m not sure why the views of a descendent of a politician who shepherded legislation creating the health service are worth reporting, esp when they involve speculating on what that politician would think, but here we are:

The Prime Minister who created the NHS would be “horrified” that patients “abuse” the health service by turning up drunk at A&E and missing appointments, his granddaughter has said.

Jo Roundell Greene, the granddaughter of Labour leader Clement Attlee, said when the health service was created people were “so grateful” but now some people take the system “for granted”.

The “for granted” is supposed to explain why people miss appointments or show up drunk at the A&E.

This is utterly ridiculous. Are people more likely to use NHS services now than when it started? I wouldn’t be surprised! Presumably when it started people didn’t know about it or were unsure about it or the range of services were less, etc. (Maybe not! But it’s plausible!) We’d need to know how the rates of “misuse” have changed over time and probably normalize it to the population. (We might just have a higher percentage of the sort of people who don’t keep appointments.)

Even instrumentally, I’m pretty skeptical that this scolding would have a beneficial effect.

And now a different bugaboo:

“But I think it’s like so many things, you sort of take it for granted,” she said in an interview with the Press Association. On people missing appointments she added: “I just think it’s a real problem.”

“So if you can address the cost problem at the front end it might help with the cost problem of these very expensive drugs. Because every time somebody misses an appointment it costs a lot of money.”

According to NHS Digital figures, patients in England did not attend almost eight million hospital outpatient appointments in 2016/17 – or 6.7 per cent of appointments.

NHS England has said because each hospital outpatient appointment costs the NHS around £120, that means almost £1 billion worth of appointments were missed.

This last bit is the most judicious phrasing I’ve heard. Usually, I get a text like:

We are expecting you at Wrightington Hospital, Wigan Tue xx Jun 2018 xx:00AM. Not attending costs NHS £150 approx.

Or

Rheumatology APPT REMINDER: On xx/06/18 at xx:30 at DEPT OF RHEUMATOLOGY. No shows cost the NHS £160.

(I think it’s gone as high as £180.)

Does it actually cost the NHS anything in the typical case? All these people are in salary. (Well, not as much under Tory stupidity. Using locums could raise such costs.) The utilities must run the same anyway. There’s always a fair bit of non patient work to be done. Often you can slot a patient forward. Etc.

Missed appointments are annoying and probably have an associated cost (esp if they reach a certain level) but this “it costs X for an appointment thus each missing appointment wastes X”.

If the system were more appointment efficient, perhaps we could shrink staff a bit. That would save real money that could be used elsewhere. But afaict NHS staff are already working at a very high capacity. If you magically reduced the total number of appointments by 6% it’s not clear you’d be able to cut/reassign any staff.

Now, perhaps there’s some standard health economic analysis that shows I’m wrong. I’d love to see that. But I’m not putting forth these claims! The proponents and repeaters owe us at least a gesture of justification.

Finally, there is a natural rate of missed appointments. People get sick. Their car breaks down. Their kid gets sick. Their work prevents them. Etc. It’s unclear how many missed appointments are avoidable.

Follow up: After writing this I googled a bit and found a discussion about these estimates:

However, Andrew Street, a professor at London School of Economics, previously told BBC Radio 4’s More or Less programme that while missed appointments were a problem, solving them will not necessarily save as much money as has been suggested.

Responding to a previous NHS estimate which suggested the average cost of an appointment was £120, he said: “It’s a massive overestimate of the true cost… A missed appointment costs closer to zero.

“That is only the true cost of missed appointment if staff stand around doing nothing if a patient doesn’t turn up. Outpatients clinics tend to be overbooked.”

Missing surgeries seems potentially more servers as the opportunity cost is higher and the number of slots less elastic.

It seems reminder texts help:

Aneurin Bevan health board said its text reminder service, launched in 2016, proved effective with the rate of missed appointments dropping shortly afterwards from about one in 10 to one in 20.

Its did-not-attend appointments fell by 8,591 from 2015-16 to 2016-17 – a notional saving of about £1.17m.

I’m not sure what the marginal gain is of the cost scolding in these texts (it has no effect on me; the reminder itself does all the work and I’m had of them).

In general, 6% seems to be a fairly low rate. It doesn’t mean it’s minimal but it’s probably not going to be a major source of cost savings.

Bionic Inside and Out

I had my first follow up with OT today and found out that all my knuckles are all artificial.

I’m less freaked than I thought I would me. It might be because I can’t really get at my knuckles to see the difference.

I have two k wires (ring and little finger). They might end up permanent!

I’m wearing a splint night and day. At night it’s a simple resting splint. During the day it’s a mechanical monstrosity of a dynamic splint:

I always enjoy watching OTs work esp when they construct splints. Thermoplastic is a godsend.

The splint mimics my extensor tendons…pulling my fingers back up to a good resting position. I have exercises to perform every couple of hours.

I’m definitely enjoying freaking people out with the splint.

My burns are progressing but still look nasty.

Surgery Day!

About 1.3 years after my first, failed, surgery on my right hand, we’re about to go again! Yay?

Of course, I didn’t sleep at all. That’s my way. It’s a bad, stupid way, but we don’t pick a lot of the way we are.

Last time, I was the only person to take before pictures. I bet I’ll be the only one again!

This gives you a rough idea. It’s a mess. The position you see is about the position I have. There’s very little range of motion.

I’m told that I may or may not end up with replacement knuckles. This squicks me the FUCK out.

So, exciting.

Last time I went in thinking I was going to have general anesthesia but ended up with a nerve block. Here’s hoping for a nerve block.

The worst outcome for me is no improvement. Well or a lifetime of searing pain. Or both!

The worst outcome for everyone else is that I lose the hand and end up with a hook. I would be such a pain in the ass with a hook.

We’ll see how this affects the blogging. Interruption for medical reasons is ok!