I am Wolf Schweitzer, born 1967, and in May 2007, my right middle hand started to exhibit a localized region of swelling that was painful. In September 2007, I started to get first medical diagnostics and surgery.

What happened?

The problem were recurring, increasing, locally spreading and locally metastasizing tumorous tissue proliferations, also with a cyst-like bone defect. Histologically, these nodules and sheets contained well formed, at times densely packed capillaries / blood vessels, synovial tissue and myofibroblasts without clear signs of malignancy but without a delineated capsule. No infectious parameters were identified in locally collected fluid, blood tests or in histology of biopsies.

The damage started between metacarpals II and III and ended up with metastasized spread between metacarpals II and V. Main complaint was recurring tissue growth, pain and subsequent insomnia. Pain levels started to become profusely excessive in October 2007. I slept little if any, around 2-3 hours a night, probably between beginning of October 2007 and April 15th 2008, with little exception. New occurrences of tissue growths were noted in January 2008 and in March 2008; two lumbrical muscles were removed that contained scattered white nodules (looking a bit like Amanita muscaria). Specialized anesthetic drug regimen were attempted to contain the pain (up to 400 mg Tramal, up to 2400 mg Neurontin, up to 6 x 500 mg Mefenacid, up to 6 x 500 mg Panadol, Transtec skin patches, Morphine injections, to name some of them) but only managed to cause temporary collateral liver enzyme elevation. 200 mg Tramal tablets would yield 1/2 an hour of peace. Some drugs that were tried made the pain even worse. The University hospital pain clinic specialist anesthesiologist suggested to not rely on pain medication but to take walks in the forest. As a complication and in addition to tumorous growths, tissue was - after the amputation, a lot later - found to also have contained extensive histiocytic reactions to surgical suture material (all Ethicon produced) and extensively thrombosed veins and capillaries. Massively excessive pain was, in hindsight, caused by recurring tumorous nodules containing vessel proliferations (known to be extremely painful) added by profuse thrombosis and extensive, post-surgery related inflammation. At the time, no one at the University hospital clinic thought of wide spread thrombosis being a possible cause, no coagulation issues were prevented, and no tests or treatments were performed for that. Also, no one considered Ethicon sutures as contributing to serious pain except one pathologist, whose remarks later were found to supplement the final path report that no one at the University hospital clinic really read at the time. What type of tumorous soft tissue process this was did not become entirely clear, particularly with respect to the question why it spread with metastasizing nodules or tissue plates. Both local University hand and orthopedic clinics were consulted but the doctors did not express any useful extent of interest in any of the aspects. Their head of tumor surgery of the University hospital clinic suggested that if I would just wait, maybe, it may go away. Infectious causes were not identified despite extensive testing. There was no indication for infectious, autoimmune, rheumatic or metabolic disturbance; a clearly elevated CA 72-4 tumor marker later normalized (after the amputation). After a total of six surgeries (Oct 07, Nov 07, Dec 07, Jan 07, Mar 08 #1, Mar 08 #2), some complications to my health status occurred, that involved unapproved and unsound prescribed drug dosages, as well as further unauthorized and uninformed, technically deficient medical interventions, both medical and surgical. Later, an insurance- and doctor-/party-independent specialist review board, expert reviews, as well as insurance found these drug related complications to be entirely "accidental" (upon which the relevant insurance stepped forward to voluntarily offer payment), related to the aftermath of a non-standard very high dosage drug regimen used during a gastroscopy on an outpatient basis that was done to investigate the question of a possible gastric primary tumor (CA 72-4). Surgical intervention attempts were tried by local University hospital hand clinic, but not only technically and functionally deficient, but also unauthorized / uninformed, and had caused further complications (venous thrombosis throughout the hand, severe inflammatory suture reactions, tendon suture failures, lack of sufficient postsurgical anticoagulation medication) that were neither recognized, assumed, tested, leave alone treated; these however appeared to make the already severe pain worse. So we sought help by an internationally renowned hand surgeon in a global reference hospital that had been recommended to me. It appeared that for the first time an actual specialist actually looked at the hand and expressed an actual interest in examining, understanding and considering treatment. Previous tests were reviewed, and all tests were repeated comprehensively over a number of days. Even though the type of growth containing synovial, capillary and myofibroblast cell growths was never sufficiently characterized to explain why it spread around locally, there is a rather clear risk factor in my biography: I had used both hands - but that right hand excessively - to manipulate patients' joints under an X-ray / C-arm machine when working in a small Swiss alpine hospital mainly dealing with sports injuries some 12-13 years ago. One surgeon who was part of the extensive review and re-testing process said this type of nodular metastasizing mixed tissue tumor was typical for situations that half a year or so later might typically end up yielding synovial sarcoma. Surgical excision with a large safety margin was found to be the only viable treatment option. Decision making in terms of properly defining informed consent then was taken seriously; as I had judged myself as (and was also judged as) to not be entirely legally competent to make my own decisions then, mainly due to more than severe chronic pain (painful tumor growths, extensive vessel thrombosis, severe inflammatory suture reactions) but also due to the overall stress situation, a close family member and the surgeon discussed technical options together after exhaustive medical re-testing and review going over several days, and they ultimately ended up deciding over my treatment. It was also a factor that I only was employed under single year / annual contracts, which in such a situation constituted significant extra pressure. A right below elbow amputation was performed on April 15th 2008. Initially and due to being overwhelmed by both the previous treatments and hospitalizations and the amputation, I suffered from post traumatic stress disorder and was not able to focus well, but I got treatment immediately and subsequently recovered from that. The marker CA 72-4 returned to normal after that.

We recently wrote up the experiences with comparison and tweakings, of both body powered and myoelectric technology, as scientific article. Check here: publication [link]

You can send me an e-mail to wuff at swisswuff.ch.

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - About; published July 14, 2008, 21:07; URL: https://www.swisswuff.ch/tech/?page_id=2.

BibTeX: @MISC{schweitzer_wolf_1585726728, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - About}}, month = {July},year = {2008}, url = {https://www.swisswuff.ch/tech/?page_id=2}}

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