Monday, April 30, 2012


Our first game as the Sierra Mariners of the PSSBL was on Saturday afternoon.  Unfortunately, we came out on the short end of that one.  Much like the real Mariners, we got buried in one inning and could never quite crawl out of the hole. 

What was great was that my teammmates absolutely embraced me being there. I thought there would be some weirdness around me just kinda hanging out but there was none of that at all.  There were lots of pats on the back and words of encouragement the entire time. 

I did everything I could to just go about my routine as usual. I had my rubber tubing out to stretch my legs out.  I did my wind sprints. I stuffed myself full of Big League Chew.  When the team was doing. batting practice with whiffle balls, I was out there chasing them down and making one handed grabs. When the team took infield, I caught for the person hitting grounders. 

Best of all was just being out there with the team. It felt great to wear the cleats and to get the glove out of hibernation. It felt great to just yap about baseball with my teammates and to analyze the opposing pitcher. It was fun to see the umpires miss calls and bitch about the on the bench.  We're never wrong by the way. 

It was just flat out fun. Sure, there was a big part of me that wanted to pitch, but I have come to terms with that. I realized that what I really wanted to do was contribute and I felt I did that. Sure, I'd prefer to contribute with some scoreless innings, but I can't. Hell, I couldn't even grip a baseball until last week.  

It's better to be a part of something in the best way that you can rather than just forget it because you can't be part of it in the way that you want. It would be easier just to not worry about it and stay home every game but I won't do that. Even if I'm just shagging balls or keeping score, I am still contributing. And I am happy to contribute however I can

*side note*  I just heard George Sherrill is going to be joining the TJ fraternity.  I think this is the only frat in the world where I hate seeing new members coming in.  Good luck George!


Friday, April 27, 2012

Today I thought I would fire off a list of things that I can do and a list of things I still can't do.  All of the things that I can do are things that I couldn't do even two weeks ago.

 Now, I can:
Write relatively well.
Type with two hands
 Wear T-shirts instead of just baseball jerseys.
Raise and lower a cable on the weight tower at the gym
Open a can of tuna
Carry a cup of coffee
Go a day without taking an Aleve
Put on socks
Drive

 Unfortunately I still can't:
Wash my hair or face with both hands.
Sleep on my right side
Wear a long sleeve shirt
Turn doorknobs very well
Pick up more than a cup of coffee

I think this has been a pretty good amount of progress. For just a few weeks out, I am still noticing small things that are easier every day. It's great to be able to see a challenge and then overcome it. Makes me feel like I am accomplishing something. It makes that year seem shorter.

Wednesday, April 25, 2012

One Month Later.....

Among many other things going on today, I had a follow up with Dr. Trumble to see exactly how this little project is going.  

It was nice to be able to make it into the gym before-hand just to get a little activity into my body before I showed the professionals just how well I thought this was going.  

I thought the first thing they would look at would be the scar to make sure it was healing okay, but it was actually all based on mobility, strength, flexibility and other things.  The first thing they did was take a look at the actual bone to make sure that nothing was thin or strange around the tunnel (remember, the figure 8).  They did that through a machine I've referenced before called the fluoroscan.  This time, I managed to get a picture of this thing.



They did a minor stress test to make sure that the little gap that was there before no longer existed.  Remember when that ligament was torn, every time I moved my arm side to side, there would be a variable gap that occurred in the joint. So, under the fluoroscan they moved my elbow back and forth a bit to make sure there were no gaps in there.  Of course there weren't which was awesome.  That means that the surgery really was successful in completing its most basic job. See below...


See the little tunnel up there on the right? That's where the figure 8 is to hold this sucker in place.  You can also see how tight the joint is now too.  That gap used to be up to twice that big...occasionally more. 

They followed that up with some very basic stuff in my forearm to make sure everything was interacting properly between the elbow and the hand. They followed that up with a lot of strength tests to see how my muscles were holding up. I had to spread my fingers against resistance, move my wrist up and down with resistance, and then various grip tests.  

They were more than pleased with the results. I go back in six weeks to re-assess. Any time your surgeon grins ear to ear and doesn't talk in a condescending tone, you're probably ok.

Unfortunately, I am stuck in this brace for another two weeks. Oh well. There are worse things than that. It is awfully frustrating though.  I mean, it's impossible to wear long sleeve shirts and sweatshirts with this dopey thing on.  Plus, the Iron Man jokes will only get worse when the Avengers movie shows up.

Back to PT in the morning where I get to learn some resistance band training! 

Oh, one last picture.  Remember when I said this guy wrote the book on these surgeries?  Here's proof!


Tuesday, April 24, 2012

It has been a month!!!

Witness the magical month of recovery!

Perfect

Saturday, I got to witness the 21st perfect game in Major League Baseball history.  It was tossed by Philip Humber of the White Sox...a member of the fraternity.  He had the surgery in 2005.

His road to the majors was pretty spotty and full of potholes bouncing around in minor league camps of the Mets and Twins before finally landing with the White Sox. The White Sox called him up for a spot start when Peavy couldn't go and he's been hanging around ever since.  Even though Humber's story is at a high point now, there were concerns about him losing velocity after his surgery.  It looks like that may not come back and that he has figured out how to use his secondary pitches more effectively. The slider was looking like it was working amazingly well.

 I can't really be sure about throwing a slider after this surgery. That pitch requires a lot of torque on your arm.  I tend to throw to it with the elbow really far forward and snap it pretty hard. I have been wondering if I should go back to it honestly. Right now, my thought is that I won't throw it again. It's a great pitch for me as I am able to completely vary most aspects of it. I can change the velocity, tilt, break and location at whim usually.  At any rate, seeing a perfect game was amazing. Seeing Humber throw one post-surgery is really encouraging.

Thursday, April 19, 2012

Succeeding because of fitness and an update.

I was talking to Ken Roll, my physical therapist yesterday about Jamie Moyer.  Ken said that one of the reasons that Jamie is able to bounce back and endure is because of all of the hard work he does as far as conditioning and preparation go. It's well known here in Seattle that Jamie relentlessly works to keep himself in great shape. I remember so many of those stories being told when he was up here pitching....at the ripe old age of 41.  

I don't think that it's a coincidence that he has recovered completely from Tommy John at age 49 and that he has a such a strong fitness regimen.  I just can't believe that fitness is irrelevant when it comes to recovering from surgery or other trauma. 

The question is why.  Is it because of your mental mind set? Is it because your body is naturally used to recovering?  Is it because you have less body fat or more muscle?  We probably won't ever know but it is a pretty interesting question. Moyer is definitely lending some evidence that fitness greatly aids in recovery.  

On another note, my arm fully extends outward now (zero point zero degrees). It's also bending up at 138 degrees. My fellow TJ fraternity brother, Ryan Alvis, says that it's getting tougher as it goes along. He's ahead of me by about 3 months so his previews have been great. He was quite helpful and encouraging (and honest) when I talked to him just before surgery so I am sure he's right. 

For now, I am enjoying the successes.  I like to think I am ready for the challenges. 

Just like Jamie.

Wednesday, April 18, 2012

Well, if HE can do it....

It's a nice night in the Northwest where I am watching the Mariners show signs of having an offense. 

I watched Jake Peavy throw another amazing ballgame tonight.  He's one of my heroes and someone, as I have mentioned before, that I look to for inspiration as I recover.  Though he didn't have my surgery, he did tear his latissimus muscle nearly off and made it back fom that.  That's a worth a lot of respect in my book.  

So, on to Jamie Moyer.  Forget about the "oldest guy to win a game" stuff for a second.  Think more about 49 year old guy coming back from major surgery who pitched his way onto a major league team and continues to keep his spot by having outings like last night: Throwing a strong 7 innings...even though it was against my Padres.

I started watching Jamie when he pitched here in Seattle and admired how he continued to get batters out despite having lower velocity. He was really using that natural movement and making smart decisions on the mound. He became one of my favorites after a while. I continued to follow him when he left for Philadelphia and eventually the MLB network which is where I thought he would settle in once the UCL news came down. 

He swore he would come back and pitch after Tommy John.  He knew he could do it.  He told everyone he was doing it.  I'm pretty sure everyone nodded with a smarmy "Yeah, right".

But here he is back on the mound and beating my Padres. He's 49. He doesn't hit hit 80mph on the radar gun.  He is coming back from Tommy John surgery.  Think about all of those factors for a second. Any one of those could (and in some cases should) preclude you from pitching in the majors.  

But there's Jamie...winning ballgames.  

I hope to meet him one of these days and let him know that he's one of my heroes. 

Monday, April 16, 2012

Brothers in Surgery

This weekend I went to the Mariners game with my buddy Adam.  He's pretty generous with his season tickets and I definitely appreciate it.  It's nice to be able to watch some baseball especially when I can't play it. 

We always start by hitting the 'Pen.  The 'Pen is Safeco Field's best kept secret.  It's an area behind left centerfield that has a string of eateries and drinkeries. Grab yourself a burrito, a giant slice of pizza, or even a Crepe' and set your beer on the rail right behind the left centerfield fence. It even has a little "lounge" section where you can relax on couches next to a fireplace.  Sometimes, it's a handy thing when Seattle is being Seattle.  When it's sunny, grab a beer and head to the patio where you can enjoy this view:


One of Adam's friends eventually met us down at the railing there.  He was a young guy that had pitched at UW and was a pretty good pitching prospect.  During his freshman year he tore his UCL and had to recover in the dorms.  He even told a story of his arm sliding off of the bed about 3 days removed from surgery and he was in such pain that it brought him to tears.  

I get that. I'm probably one of the few that does.

He also said he never fully recovered from the surgery. He got back to 80% in less than a year but never got that last 20% or so that really makes a pitcher complete.  He gave it up after that as UW didn't want to pay for a second surgery and he didn't want to go through it all again. Can't say I blame him there either.  

When you meet someone else who has had this done, there is definitely a camaraderie that immediately presents itself. You're now a member of a very small club.  A member that understands what others in the club have been through.  You can talk to each other in real terms instead of trying to explain everything hypothetically and hoping to use a good analogy so that they understand.

No, when you meet a brother in surgery, you can just say it like it is and they get it. I'm looking forward to meeting more people in our little fraternity.   

Friday, April 13, 2012

Few Quick Hits

It has been 3 weeks since surgery and everything seems to be healing nicely. 

I have taken to wearing those basketball shooter sleeves under the brace. That way, I can sweat under the brace without having to offend my office neighbors every morning. I just pull the sleeve, wash it, and put the other one on.  

I have two sleeves. One is my dressy black sleeve.  It's used for nights on the town and blends in well under the brace.  The other is a very nice blue that I think looks best under a Mariner or blue Padres jersey. They are pretty comfortable.

I have confirmed that I can lift a half pint of weight now.  

I ended up dropping about 5 pounds.  Unfortunately it's probably a lot of muscle weight.  Lots of thanks to Katy for not letting my ice cream consumption go nuts.  

It's a beautiful day here in Seattle. Going to be a great weekend for baseball!  I'm ready to go see my teammates tonight in Bellevue.  It has been way too long.  Usually, I've already thrown and hit quite a bit.  Not practicing has left a little void in my life

That's the scar at 3 weeks.  It's really healing well.

This is my pillow setup at work.  I use one pillow when I'm working and two when I'm doing my physical therapy.  I took this right before my noonish PT session.


This is the ultra-sexy blue sleeve flanked by the ever-popular Erik Bedard Mariners jersey.  I think they go well together.  

I believe Sunday I'll be wearing my Bucky Jacobsen jersey with the blue sleeve to accent it.  I'm guessing the compliments will flow.

Just sayin'.

Thursday, April 12, 2012

Q&A

I have been getting a few questions sent my way as a result of this blog.  It's been fun to see what people are wondering.  I'm always happy to answer questions and you should feel free to submit them.  You can reach me via email at evillemon@gmail.com, on Facebook, or on Twitter via @tyjroberts.

Did you throw up when you saw the surgery pictures?

No, but I couldn't look at them for a few days. I think it was Sunday that I finally looked. Now it doesn't bother me.  I think the dry skin thing is almost more gross.  

What was the first thing you did after surgery?  

I ate an Otter Pop.  Then another one. Then Katy showed up and gave me a protein bar.  Basically I ate.  The first real thing I did was go see The Hunger Games on that Sunday. Saturday was mostly worthless but I was going stir crazy by Sunday.  

Do you miss baseball? 

It hasn't sunk in yet, but it's starting to. My team is starting to have practices. The schedule is coming out.  There's a scrimmage coming up.  I will definitely miss it but I am going to do my best to get out to the games and support the team. I am planning on making up for it by going to more Mariner games. In fact my buddy Adam is giving me his spare ticket for Sunday's game. 

Plus, I just keep telling myself I am going to come back stronger. That's what keeps me going.  It sounds dumb but seeing myself back on the mound next year is really keeping me motivated.

It seems like this hasn't been very tough....true?

Mostly true. It's definitely been easier than I thought. The surgery wasn't bad at all.  The recovery has been more frustrating than difficult. The physical therapy has been pretty easy so far.  There hasn't been a bunch of pain or anything. 

The hardest part is opening yourself up to being vulnerable. You have to understand and remember that  you are recovering and that you aren't 100% healthy.  If you have a partner you have to remember that they are doing their best to help you. You have to let yourself be vulnerable and open to accepting the help that your partner is trying to give you. 

That part doesn't seem like its hard does it?  It is. Imagine having to ask your fiancé to open a jar of pickles or having them wait while you shower because you can't reach around to dry yourself off.  Accepting that you are not able to do certain things is really difficult. The quicker you get over yourself, the better off you and your better half will be.  That may even be a life lesson there kids. 

That's it for the questions.  Thanks for the submissions and for all of the support.  I really appreciate everyone being so awesome.

Wednesday, April 11, 2012

Back to the Gym: Dull Blog Post Edition + NEW PHOTOS

This post is honestly sorta dull.  I know...that's why I decided to spice it up with GROSS PICTURES!!!



I have started my full workout week this week. The workout I am doing is a repeated circuit that consists of 7 exercises with no rest in between.  They are all dumbbell based so that I don't even have to convert anything or lift any plates.  It has been a nice successful program for me when I feel like I need to lean out and build a little strength. I also generally have time to bookend two 10 or 15 minute cardio sessions here as well. I have one more of those workouts on Friday and then a free for all extended workout on Saturday. I have physical therapy again on Thursday.

I am emphasizing the workouts because I firmly believe that being physically fit has significantly helped my recovery.  I think it's a critical thing because your body is used to recovering. Every time you lift weights, your body gets a little bit damaged and then repairs itself.  Your body is used to being challenged.  It looks at this recovery as just another challenge. 

I honestly have no basis for this at all besides my personal experience. It could be that my surgeon is incredibly skilled as well.  Logically, it's probably a little bit of both. 

So, on to the interesting photos:


Here's a shot we took on Friday with the stitches out and the brace off.  It's healed insanely well.  


Remember when I said my skin was dry?  I wasn't kidding.  It's gotten a little bit better since I took this and I've also removed the surgical tape because it was bugging me.  My friend Jen Kramer, who went through a very similar surgery told me that Vitamin E will really knock this dryness out of the park.  Make sense to me.  Plus, girls seem to be pretty dialed in to skin care.

Tuesday, April 10, 2012

Yesterday was the first day of physical therapy.  For those curious, I am going to Mar Ran physical therapy and seeing Ken Roll.  Ken has done PT work with lots of various throwers including a bunch of the Mariners. He really seems to know what is going on and has a great idea of what to do with me.  You can tell that this isn't his first rodeo. 

Yesterday was mostly evaluation stuff. He ran me through a lot of deterministic tests to see how straight I can get my arm. I believe he said I could extend out to 5 or 10 degrees and up to 110 degrees. That means my arm is extended out nearly straight.  It also means I can flex up past 90 degrees.  He seemed to think that I was healing much quicker than normal.  

I have to do all six of the exercises three times a day.  I can tell they are working because today my muscles are actually sore.  Though, judging by my little girl arm, I think any work I do is going to make things hurt in there.  

I am not going to miss a beat with this stuff though.  I am determined to stick with this no matter what. I really think the hard work will pay off.  

After all of that hard work, I get to relax, play Triple Town, and have my arm iced and electrically stimulated.  

Saturday, April 7, 2012

Back to the Gym: The Trial Run

Friday was my first unofficial day back at the gym. I didn't really have a plan going in but knew I would be hitting cardio and core. I figured that would be a good trial run to see how things were going.

First thing I should mention is that going to the gym with a giant brace on your arm is going to elicit a question or two. I don't mean that sarcastically, I mean it's the same two questions over and over again.

1. What happened?

2. How long does that take to heal?

In fact, everyone is going to ask the same questions. Just remember that people are asking because the care and they are curious. It's not like they are trying to ask the same questions over and over, but they simply care. With this surgery it's a little different. Lots of people have heard of Tommy John surgery but very few people have met recipients of it. It's interesting and fascinating to people especially your athletic friends and your baseball buddies.

Be patient and be informed. People just care.

The gym was overall pretty good. I did an elliptical for 15, then core and shoulder work, then an inclined walk on the treadmill for 10. It was a total of about 50 minutes or so and I didn't push myself too hard.

The elliptical was tougher than I thought. The bouncing movement didn't feel too great so I ended up resting my arm on the side for most of it. That seemed to work out fairly well.

Core work was 3 supersets of weighted leg raises for lower abs and a variation on a twisting crunch on a giant ball. My abs are sore so I think they worked. I then moved over to work with tubing and did some simple trunk rotations mixed in with interior and exterior shoulder rotations.

I finished with an incline walk on the treadmill at just a 4.2. It was an easy finish. That means indeed to find something different. Doing stair work should quickly solve the "too easy" problem.

One thing I discovered is that I can't use the cables and pulleys which are usually a pretty strong go-to for me. It takes two hands to adjust the height of the cable and two hands to switch out the attachment on the end of the cable. So that was a little frustrating but the backup plan was ok. That should just be temporary.

Thursday, April 5, 2012

Happy Opening Day aka the day after I got my stitches out.

Big day today.  Really good day. 

Lots of stuff happened. Lots of awesome stuff.

Weird first few sentences.  Really weird first few sentences. 

I went for my follow up appointment today at Bellevue Bone and Joint.  I saw both my surgeon Dr. Trumble and the physical therapist, Clyde. The PT removed my stitches and tested my range of motion. I am able to move at nearly full range.  I have also been cleared to return to gym activities and begin active movement in my right arm. This is huge news for me. My gym is my refuge and I have missed it terribly.  I will return on Friday morning and then start planning workouts for next week. Obviously I can't do any weight on my right arm. I actually can only lift a can of soda right now. Still, I am stoked to be able to do some cardio and core on Friday. 

So remember the outer arm burning issue I have been describing?  Yeah that's due to the irritation that the surgery may have caused and may last a few more weeks. The dry hands are also due to the surgery.  That's the worst news I have though.  The list of things I can do has far outweighed the list of things that I can't do. 

So exciting! Folks, no more wraps.  I have a little sleeve thing now. Stitches are gone so they can't be ruptured anymore. My range of movement has doubled. I can almost completely straighten my arm out now. I can get back in the gym! I can shower by myself! I still look like Iron Man!

This is less than two weeks after surgery. 

In the office, the PT had started removing stitches.  Katy couldn't even watch and was entirely focused on making sure I was ok.  The girl that I thought was so squeamish began watching with interest once the last 5 or 6 stitches were getting pulled out. It was kind of funny. I think once she realized I wasn't going to die, she decided that this wasn't so bad after all. Then taking the pictures got easier.  

So, be aware that the next few pictures are kind of gross.  They are pretty awesome though and have already been seen by the squeamish on Facebook. 

This is before the stitches came out.  You can see where it seeped a bit and how tight that wrap was.  The older fellow in the back was awesome.  He was getting his hand worked on and was really curious about my injury and surgery.  We all ended up talking about Jamie Moyer.

In case you don't know, Jamie at 49 years old, made the Colorado Rockies rotation in his first comeback attempt from this surgery.  He's quite an inspiration.

The stitches are out here.  You can't quite see the incision in this one.  I'll get a better picture up soon. 

This gives you a good idea as to how quickly your muscle tone can go away.  My arm has really deteriorated quickly since it hasn't been used at all in a few weeks.  Hell, I've been posting most of these by typing into EverNote on the iPad one-handed.  

I'll tell ya...I slept great too. Everyone was surprised at the range of motion I have now.  It sounds like I'm ahead of the curve....pardon the pun.  It's Opening Day after all.

Wednesday, April 4, 2012

What Not to Wear

Clinton and Stacey would shoot me for what I am about to say.  However, they have also never had to put an apparatus the size of a Buick through a sleeve. 

Let's talk about how to get dressed and what is easy to wear.  

1.  Wear short sleeves and big sleeves.  I have been living in baseball jerseys lately because I can get my arm through very easily.  They are also really easy to take off.  Big T-shirts are pretty good too, but can sometimes be tough to take off.  Be careful with sweatshirt style things as they are tough to get your arms through and the Velcro from your brace will tend to stick to the inside of the sweatshirt.  

2. Try to wear sandals.  Socks are ridiculously tough to get on your feet.  If you have to wear socks, you can get them on by sticking your hand inside the sock and splaying your fingers out. Once the sock is opened, you can usually wedge your foot inside.  It's tough though so try for sandals.  

3.  Avoid belts.  These are tough as well. Looping the belt through your loops can be difficult as can buckling the belt.  Remember you will have to buckle it several times a day so plan accordingly. 

Tuesday, April 3, 2012

Another tough night.

Last night was tough.  It was another night where I got up in the middle of the night in pain and had to take a painkiller.  I don't know why this keeps happening but it's the same pain as last time. It's that nasty fiery feeling that runs on the outside of my arm and goes from the elbow to the wrist.  Maybe I overused it.  I honestly have no idea why.  Ice helps but it comes in at night and keeps me from sleeping.  

This has been a frustrating one.  Hopefully tomorrow's appointment clears all of this up.  I will absolutely ask all of the questions.  

I just keep thinking that getting the stitches out and getting this wrap off will relieve some of the pressure.  

Monday, April 2, 2012

Telling a Stranger "Thank You."

Normally when you go through this surgery, the Palmaris tendon is used to replace the UCL.  However, about 20% of the population doesn't even have this tendon, myself included.  When this happens, a donor graft is used in its place. The donated piece is from someone who was a tissue and/or organ donor and who has obviously passed on.  

When this is done, you have the opportunity to write a thank-you note to the family of the donor. It makes you remember to be thankful that this even exists. If it were not for this person, I likely would have had a graft taken from my leg causing my recovery time to be lengthened.  

So, here is the letter I wrote to the family: 

Dear Donor Family, 

Let me first say that I am sorry for your loss. I don't know what it is like to lose someone close. I am truly sorry that you had to experience such grief. 

I want to take time to let you know that your family member has given me a great gift. Because of them, I was able to have my elbow reconstructed via "Tommy John" surgery.  This surgery is something that will forever change my life. This gift will let me continue to pursue two of my passions: baseball and working out. 

I cannot imagine never being able to play baseball again.  I cannot imagine simply never pitching to another batter or always worrying when my elbow is going to collapse in the gym.  I can come home after a baseball game and not be in constant pain.  I won't have any more days where my arm hurts "just because." I won't be scared lifting a weight or wondering when I'll feel that next tear.

These are truly gifts to me.  They are gifts that I will get every day for many years to come.  

I owe your loved one a huge debt of gratitude. 

Sunday, April 1, 2012

Ruby Ale is delicious and other Sunday thoughts

So, it has been just over a week since surgery.  I am happy to report that things seem to be progressing really well. I have my full brace- restricted range of motion; my arm hurts less every day; I am able to grip small things again; and I can do my hand exercises at will.  

I have also learned the concept of being mindful of things and putting more thought into whatever I do.  This came into play the other night when Katy wasn't home to help with dinner.  I couldn't have a turkey burger because I couldn't open the package. Even last night at McMenamins I had to cut my sandwich up because it was too hard to eat one handed.  

Trying to be mindful of the things you are doing and especially the people who are doing things for you is something I often overlook and take for granted. It's a humbling thing to have someone cut your meat and help you get dressed every morning. Remembering that you can't even eat what you want without help should make you more appreciative of the smaller things. 

It should also be noted that small children and dogs are quite leery of the brace. The little girl sitting behind us at McMenamins last night was very curious about Katy and I until she saw the bionic brace. I don't think she turned around again after that. 

My dog Ginger will often sit above me on the couch.  Since I have to elevate my arm a lot, I often put the arm up where she sits. She will still sit up there, but she will not face toward the brace. She doesn't seem happy with it. 

I guess there isn't really a lesson here. Cover the brace when you are around dogs and kids? Buy chicken taquitos if you're worried about dinner? 

Sure, those work.

Other notes: 
I get the sutures out on Wednesday and am hoping to return to some gym activity Thursday.
Jerseys have been awesome. Still pretty much exclusively wearing them since they are easy. 
We put the pharmacy back in the closet. No pills needed. 
My right hand is super dry and the skin is flaking. No idea why.