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Doctors Lounge - Surgery Answers
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| wibblypig
- Sun Jun 03, 2007 3:28 am |
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I am 31 yrs old, female. A long, thin, sharp wooden foreign body under the skin / in the soft tissues of the head/neck/shoulders region retained for several years. Apologise for the lengthy description, but please bear with me to get the whole picture.
Nov 1994: While sitting on an old wooden bench, I felt a sharp pain under the upper thigh. Stood up and felt (with hand) a sharp, thin stick protruding slightly out of back of thigh and pushing onto the underside of my (short) skirt. However, as there were many people around, I did not pull it out.
Subsequently over the next few days, I felt a long, thin, sharp foreign body under the skin down the length of the back of the thigh and upper calf, even while walking. Estimated length: abt 1 foot in length, quite near skin surface.
Whenever I squatted (we had a squatting type of toilet), I could feel the foreign body being pushed higher up under the skin due to the squatting. After abt 1 week, it had been pushed up to the buttocks area and whenever I sat down, I could feel distinct sharp pain in that area.
Over a few mths, felt the object slowly shift/slide upwards under skin into lower back area. Whenever I sat down, felt upward pressure under the skin caused by the foreign body. However, there was no pain, only discomfort, pressure and the feeling of something under the skin/in the tissues, which was not supposed to be part of the body. (One cannot feel one’s own bones and muscles.) The object felt like a long, thin and sharp stick consistent with the wooden stick/shaving from the edge of the bench I had sat down on.
I consulted a doctor. As she pressed my back, I could vividly feel a long coiled up and thin object being pressed and pushed higher up my back. It felt quite near the skin surface.
Over the next few mths, felt the upward pressure of the foreign body under the skin at my back whenever I sat down, but there was no pain. Slowly, it settled into an area under the shoulder blades and was stable/did not move for some time.
As such, I thought perhaps there wasn’t any foreign body in the first place. So proceeded to do more physical actions like bending e.g. sideways from a chair to pick up things, or carrying bags on one shoulder etc. However, these led to the feeling of the foreign body loosening up/sliding out of position, causing greater discomfort. I could feel the length of the object sliding slightly under the skin.
Over time, sitting caused the foreign body to be pushed higher up to collarbone area. The upward pressure of the object felt worse whenever I sat down. I consulted another doctor, who sent me for an X-ray, which didn't show anything. (Wooden material can’t be imaged by X-ray). Subsequently, I also saw another doctor, who sent for a CT scan, but it also didn't show anything.
Over time, the foreign body slowly shifted into a position around back of the neck, collarbone and shoulder area. As the neck and throat area is a very mobile region, where muscles move a lot, esp when eating and talking, I could also feel more vividly the sliding of the foreign body in the tissues, esp after swallowing or talking for some time.
Mid-2003: At a salon hair wash, I felt my head/neck position was slightly lower than my back. Over next few days, felt the foreign body slowly loosen up (likely to have been dislodged by lowered head/neck position). Part of it shifted upwards from the shoulder higher into the neck, causing more discomfort.
Current situation: Due to circumstances over the years, the whole length of the foreign body had slowly shifted/been pushed up along under the skin/fat layer in the back to the current position. Portions of it had reached the same height as the jaw region/base of the neck/below the hairline at the back of the neck. It feels like it’s entwined/lodged around back of the neck, with some parts in the shoulders and the ends of it at the sides of the neck. It feels long and extends to the upper shoulder area.
The pressure of the object under the skin can be felt all the time, except when sleeping. The discomfort is generally worse towards later part of the day (waking hours) or when sitting too long. I usually feel least pressure or discomfort when in lying down position on the back (e.g. after a night’s sleep).
As it's of substantial length, I can often feel it shift position/slide slightly in the tissues as a result of activities involving movement of the area such as swallowing, talking, moving etc. (But there's no pain).
If it shifts too near the mouth (e.g. sharp end pierces near side of jaw/gum), then it would cause discomfort there. On a few occasions, I could actually feel (with my finger) the tangible sharp, thin (not more than 1 mm thickness) and slightly flexible tip of the object pushing very slightly out from inside the gum.
If part of it shifts into a position near the throat, then it would cause some discomfort after swallowing for some time, especially towards end of a meal, or last meal of the day (dinner). Once the object moves into a position that irritates the throat or mouth, the muscles usually automatically pull to try to dislodge/move the object away from the throat/mouth area. I can then feel the long thin stick sliding/pulling away in the tissues.
If I step too hard on the floor, i.e. the step is more forceful than usual, I can sometimes feel the impact/vibration of a long horizontal thin thing around the back of the neck under the skin (near the base of the bottom hairline).
During a holiday to Universal Studios USA, I sat on an “earthquake” ride, which involved our carriage jerking and tilting. After the ride, the feeling of discomfort caused by the foreign body became worse, as I felt it loosen up and slide slightly in the tissues/under the skin, caused by the jerking physical motions during the ride. As the foreign body shifted nearer the throat, swallowing was affected for some days.
I know wooden foreign bodies are very difficult to image, especially very thin ones, which is probably why it couldn’t be detected by X-ray and CT. Unless it can be detected by diagnostic imaging techniques, it’s difficult to get medical help, from my experience with previous doctors.
I understand my situation sounds very unusual. However, the above account are the facts of the matter. The pressure and feeling is vivid and consistent with the long thin foreign body described and has been constantly felt all these years. It generally worsens with external pressure on the skin, sitting too long and physical activities affecting the neck/shoulders.
Pls. advise what kind of imaging technique would have a higher chance of detecting such a thin wooden foreign body. I would appreciate any advice and hope for a reply. Thank you very much for your patience.
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| Dr. Chan Lowe
- Sun Jun 03, 2007 11:02 pm |
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 For wooden foreign bodies such as you are describing ultrasound is best. If you can feel the wood through the skin the ultrasound should show it quite well. Even if it can't be felt by direct palpation, the ultrasound should still show it.
If it is seen by the ultrasound I would recommend you talk with a surgeon about having it removed since it appears to have moved quite extensively. This is quite unusual for a sliver to do.
Best wishes.
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| maddawg63
- Tue Sep 08, 2009 11:26 am |
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Did you ever get this problem resolved? I have had a similar experience, still dealing with it as well! Let me guess,Doctors told you in not so many words that you were crazy! Did any of them laugh at you,and make snide remarks and left you to feel hopeless? That's some of the things that they did to me, plus more. Put myself in dept that lead to me losing everything that I had worked hard for, but what price do you put on your pride and dignity!I hope that everything worked out for you and that no other medical problems occurred. You have my complete understanding.
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| wibblypig
- Thu Sep 10, 2009 1:45 am |
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Thank you for writing. As my situation is so unusual and bizarre, I thought I was the only one with this problem. What is your case like? Do you also have wooden foreign body? How long have you had it? You mentioned “Put myself in dept that lead to me losing everything that I had worked hard for” – what do you mean? Hope nothing bad happened.
No, I have not managed to resolve the problem and am trying my best to live with it. From my experience, there is nothing the doctor can help, unless the foreign body can actually be imaged. In fact, a doctor I consulted even made things worse by pressing my back, causing it to move higher up the back. They are unlikely to believe the case unless there is actual evidence. Even my own family members/relatives are sceptical about it, except my parents.
I have done some research and it is nearly impossible to image wooden objects, esp. thin ones.
The doctors usually think it’s impossible for a foreign body to travel in the tissues, as they think it is just a small splinter. So, they think I am crazy or stressed, or it is another medical condition, which may result in taking unnecessary medication, which is harmful. This is why I have not consulted another doctor about this problem for so many years. I agree that a small splinter is unlikely to travel. However, my case involves a sharp and rather long thin stick and it is indeed possible for such a sharp object to move in the soft tissues/fat layer.
I am reluctant to go for an ultrasound scan or consult a doctor about this problem, as from previous experience, physical actions such as pressing on the skin actually makes it worse, i.e. the foreign body slides/moves out of position. (An ultrasound scan involves physical pressing on the skin). Also, the neck/collar bone area is an awkward area for ultrasound scanning as it’s very bony.
I find that the foreign body is still as sharp as ever after all these years (since end 1994) and also very mobile in the soft tissues. In fact, I recently felt the sharp end stick slightly into my throat for a few weeks and it caused great discomfort. Luckily, it has since moved to another position, but still very near the throat. I have to avoid eating or talking too much at one time to prevent it from moving too near or sticking into the throat (and sometimes mouth/upper soft palate).
I am worried that in the event the foreign body does cause medical problems and I need to seek medical help, it’s going to be very difficult, as the doctors don’t believe the case and wood can’t be imaged. Also, surgery on neck/throat area is dangerous. So, I’m trying to prevent it from becoming worse by avoiding the causes that worsen it – mainly physical actions that are likely to affect it.
How are you dealing with your situation? Did you manage to research any imaging technique that can image wood (non-metallic/non-bone)? BTW, I have cultivated hobbies/interests to help me cope with this physical problem. Maybe you can try this method.
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| Dr.M.Aroon kamath
- Fri Oct 02, 2009 7:55 pm |
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 Hi wibblypig,
You should have consulted a specialist long ago(it is an incredible 15 years since the foreign body entered your thigh!).
There are certain aspects which are intriguing to me.
a) metallic foreign bodies(needles,wires Etc) certainly tend to migrate for prolonged periods. But the wooden foreign bodies absorb water from the tissues and become soft, sodden and lose their stiffness over a period of time - thus they become less likely to coil, uncoil or move much.
b) wooden foreign bodies are less likely to retain their sharp tip(digestion by body defences) - again hampering their ease of migration.
I urge you to consult a specialist soon and get it sorted out once and for all.
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| wibblypig
- Sun Oct 04, 2009 2:36 am |
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Thank you for your post. What type of specialist do you suggest?
As my case is so unusual, it is not easy for most doctors to accept my explanation of what had happened, as not everyone is as open-minded as yourself. (Pls. refer to maddawg63’s post on 8 Sept.)
From my past experience, unless the foreign body can actually be imaged, the doctor can’t help. In fact, a doctor I consulted even made things worse by pressing my back, causing the foreign body to move higher up. That was about a few mths after it first entered. Physical actions such as pressing on the skin make the discomfort worse, by causing the foreign body to slide/move out of position.
I understand through some research that it is difficult for wooden foreign bodies, esp. thin ones, to be detected by diagnostic imaging techniques. What imaging technique (other than ultrasound) do you recommend to image a long, thin wooden foreign body?
(Dr Chan Lowe previously suggested ultrasound, but this involves physical pressing on the skin. Also, the neck/collar bone area is an awkward area for ultrasound scanning as it’s very bony. If the scan cannot successfully detect it, then I will be worse off, because the foreign body would have been moved by pressing during the scan and cause more discomfort, but yet can’t be detected and removed.)
As for the 2 points you mentioned:
I agree that the foreign body is likely to have absorbed water and become softer, but the current position is around the bony parts of the body, i.e. near or around shoulder blades, collar bones, throat, possibly windpipe, jaw areas. This area is very mobile as we talk, eat and move during the day. So the foreign body also moves when the muscles move. This is likely the reason why it usually feels better after a night’s sleep.
(The foreign body has been in the neck/throat/shoulders region for most of the 15 years).
I also agree that the sharp tip is likely to be less sharp than when it first entered, otherwise it would have caused more damage, e.g. although I can sometimes feel the sharp end stick slightly into my throat or mouth/gum, but it doesn’t really poke/pierce through.
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| Dr.M.Aroon kamath
- Mon Oct 05, 2009 9:26 am |
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Hi,
It would not be entirely right to say that a foreign body can't be removed unless it can be imaged.We do at times remove easily palpable, superficial foreign bodies even if they don't show up on imaging.If it is troubling you so much and is impossible to image, i see no other way for any surgeon except to explore and remove it after obtaining an explicit informed consent from you - as the risks of leaving it alone in the neck are not worth taking. I do not think i have any more to suggestions to offer at this juncture. However, you can feel free to write to me.I would be glad to be in touch.Kindly think about it rationally.Good luck!
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