Life went on.

When I was 16, I was hospitalized for gastroenteritis and had an IV in my left wrist for a couple of days. Afterward I told my doc that my wrist was very sore and I had trouble moving it. Without even a glance, he told me that I probably had some phlebitis from the IV and it would go away soon.

Since it's the nature of the beast to have good days and bad days, it did get some better.

Life went on.

Eventually I settled in to thinking that I'd inherited arthritis from my dad. When his arthritis flared up, so did my wrist. I lived with that assumption for years.

When I was 21 and living in a bigger small town named Texarkana, Texas, I tripped and fell. At the doc's office, the doc was baffled by my x-rays. He thought someone had made a mistake and given him the wrong pictures. They couldn't have been mine because they were of an 80 year-old's wrist. He personally walked me back to x-ray and supervised the retakes. Unfortunately, they really were my x-rays. He sent me to the best (possibly only) ortho in town.

I walked into the ortho's office the next day. He asked me one question and only one question. It went like this:

"When did you break your wrist?"

me: "Around 3:30 yesterday."

(remember, he didn't have any of my old records, just the current x-rays)

"No you didn't. You didn't break it yesterday at all; you only aggravated it. Sometime about 10 years ago you broke it. It didn't show up on the x-rays because it was a hairline fracture but it hurt like the dickens. It didn't get treated and the blood supply to the wrist was shut off so the bones died. All of your wrist bones are affected, but we call it Avascular Necrosis of the Lunate. There's not much we can do. We could put in an artificial bone, but since you're so young, it would deteriorate and you'd end up just like you are now. The only thing we can do is fuse the whole wrist into one piece, but you'll lose all movement in the joint, so I don't recommend that you do that until you can't stand the pain anymore. Until then, wear a wrist brace when it gets uncomfortable."

The end. He'd asked one question and I'd given one answer. He deduced the rest. I thought he was a god to be able to do that.

Again, life went on.

Sometimes I'd have pain and I'd wear a brace. Sometime it would get really bad and I'd talk a doctor into giving me pain meds. I moved to other towns and went on in that fashion for years.

When I was 27, I married and moved to a big city, San Diego.

Two days after I turned 30, we'd had a spot of rain and I slipped in the parking lot. I was on my way to pick up my husband from work several miles away. I landed full on my left arm, the one with the KD, and pretty well shattered it at the wrist.

I was able to wrap an old brace around it and drive to the office with my not-quite 2 year-old. My husband then took me to Scripps La Jolla (our regular hospital).

I wasn't on the top of the priority list - there was a stabbing victim and a heart attack there at the same time - but they were still attentive and wonderful. They gave me something for pain, so I was able to be patient with them. Besides, I knew things about what was going to happen that they didn't know.

I told them, "If the ortho isn't in the hospital, you'll need to call him in to read my x-rays. I have a 'condition' in my wrist."

They sweetly, but patronizingly, told me that the radiologist was well qualified and that they probably wouldn't need to call in the ortho.

Oh, the chagrin when the nurse came back in to say, "We're waiting on the ortho to get here."

I don't know all the terms for what I had done to my wrist. The doc said I'd "destroyed" it. He put me in a plaster splint with instructions to see his office partner, a hand guy, the next day. It was December 22.

So on the 23rd I saw him. He said I needed surgery. I had 4 pins put in my arm on Christmas Eve. Happy Holidays.

I was casted for 2 months. I went to PT and gained back a lot of strength and movement.

Life went on.

Three years later brings us to the present. Earlier this year I started having god-awful trouble. Pain and limitation were the norm. I went to see the guy who did my surgery, Dr. Richard Brown at San Dieguito Orthopedics. I like his manner.

He took pictures and confirmed that I have every right to be in terrible pain. He offered cortisone shots or surgery. The surgery would be a planned Proximal Row Carpectomy, but if the cartilage wasn't good he'd have to do a total fusion instead. If that was the path we wanted to take, he said, he'd have to sit down with us and talk about it in depth.

My husband, John, got laid off a little over a year ago and we have no insurance, so I opted for the cortisone shots.

At that visit the doc had also confirmed CTS in that wrist, so he gave me one shot on the underside to relieve the CTS (the tingling and coldness), and another on the top side for the KD.

I'd had cortisone shots before and they'd done some good, but this one, the one in the top side, sent me into immediate pain. I screamed (literally) when he was doing it, and cried for some time after. I was in bad shape for well over a month after. Closer to 2 months, I'd say.

Then, as it goes with this problem we have, it got better. I call it a remission.

So now I'm in remission and dreading the day when it kicks up again. I know I'm closer and closer to having the surgery, but I'm still putting it off just like my small town doc advised. And I know that the longer I put it off, the more likely it is I'll have the fusion instead of the PRC, but that's what I've been mentally preparing for anyway, just like my small town doc said.

Dr. Brown advised 200mg/day B6 and some glucosamine to help the joint and cartilage. I take them religiously in the hopes that I'll save the cartilage for the PRC, and wonder if they aren't in some way responsible for the current remission. It's possible.

Stage 4 is just like any other stage in that it's a little different for everyone. I didn't know what I had until it was stage 4, so I can't honestly compare it to anything. I have good days and bad days. Actually, it's more accurate to say I have good months and bad weeks.

I have a degree of pain at all times, a tiredness and soreness that don't go away, and a significant loss of motion, but I've learned to compensate. I use my forearm to lift, I dip my shoulder to avoid turning my wrist. Most people have no idea that there's anything wrong. Other people see the brace I sometimes wear and assume it's Carpal Tunnel. Now that I've developed that as well, I can honestly say that's what I have to avoid going into an explanation.

Now comes the new chapter. This is all unconfirmed. As we know, KD is the death and collapse of the lunate. At some point, I had that. It was bad enough that the 1990-ish diagnosing doc said my only option was a total fusion.

In the intervening years, and this is where the older xrays will come into play, my lunate dislocated. It is now completely displaced dorsally. It sits on the top side of my wrist, not in the cup of the radial head.

More important than its placement is the fact that it appears fully intact and viable. If that is actually the case, technically, I no longer have KD.

Additionally, comparing the post-op xrays from early 99 to the xrays taken in 02, the lunate appears to be in better shape now than it was then.

Did the dislocation cause the lunate to revascularize? Did I inadvertantly give myself a radial shortening when I fractured the radius? Did the fracture to the area cause an increase in bloodflow to the wrist that helped the lunate? When did the dislocation occur?

There are far more questions than answers at this point. I won't bother my doc with this right now. No sense going just so I can get a name for something I've had for so long.

The end result of a longstanding lunate dislocation seems to still be either a PRC or total fusion, depending on the condition of the cartilage, so there's no change there.

It's reasonably easy to determine that my history of 3 separate incidents of FOOSH (Fall On OutStretched Hand) could have weakened the soft tissues that are supposed to hold the lunate in place. So I don't have the question of how the dislocation happened. I just have a million other questions.