End of the line for physio?

June 26, 2010 at 4:04 pm | Posted in arthrits, rheumatoid arthritis, fibromyalgia, joint pai, fibromyalgia, Me, rheumatoid arthritis (RA) | 2 Comments
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OK, here’s the thing – the geniuses at my local NHS physo department (or should that be genii?) have decreed that in order to ‘be in line with the private sector’ they will only give any patient a maximum of six appointments before they kick them out. (The last three words are, of course, my terminology and not theirs!)

I asked Lovely Physio how this was ‘in line with the private sector’, as I had had to have quite a bit of private treatment before I got into the NHS programme and oddly enough they hadn’t been anxious to see the back of me after six appointments. No surprise there – I was paying them. Why would they want to be shot of me? She said something like, ‘I have no idea, but that’s how they’re presenting it to us!’

I suspect the idea is that by ignoring the fact that there are people with chronic conditions who can benefit enormously from regular therapy and pretending that everyone they see can be ‘cured’ in six appointments, they can massage their figures by getting the waiting list down from the current five weeks to a more ‘in line with the private sector’ one to three weeks.

The complexity of the system emerges from the fact that it’s general practitioner budget that pay for this treatment, but once you were being treated, until now, it was up to each physio to decide when and if to discharge. The GPs had little or no say, but they had to pay. So the idea is that you now have your maximum of six appointments and then go back to the GP if you feel you need to still see a physio, to get re-referred, as I mentioned in the previous post. The GP can, of course, say no. I suspect if I see the one that knows me she would say yes … we’ll have to wait and see, but even if she does we’re looking at a five-week waiting list right now.

One silver lining in the cloud – they have an SOS system whereby if I need to see my physio in the next couple of months I can phone and make an appointment saying I’m on the ‘SOS list’. I can then go in under that and have maybe six appointments then before getting kicked out! Hopefully I won’t need to see her in the next two months, but last time I thought that I only lasted three weeks …

Unfortunately I feel I have very little fight in me at the moment – I don’t know if that might be something to do with the thyroid issues i might or might not have, but that’s the way it is!

The good, the bad and the mildly irritating

June 25, 2010 at 3:53 pm | Posted in rheumatoid arthritis (RA) | Leave a comment
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I was on my way to my six-monthly (ish) hospital appointment this morning, and feeling distinctly glum, most definitely not wanting to go, when the news came on the radio and cheered me up slightly. Some excellent news for UK RA patients generally, I’m delighted to say: NICE has reversed its ludicrous policy of refusing to treat patients who failed on one anti-TNF with another. Anti-TNFs are not all the same, so saying that because a patient fails on one they won’t benefit from a different one is patently absurd, but that’s exactly what NICE, the patently absurd National Institute for ‘Clinical Excellence’ had decided to do. From later this year though, patients who fail on one anti-TNF will be allowed another go. (I think only one more go, but that’s better than none!)

Hopefully I shall never need to worry about this from a personal point of view as I seem to be doing well on the methotrexate. Inevitably the three-week flare I’ve just come through has now passed (just in time for the hospital appointment, of course) and didn’t show up in the bloods, so it’s not being taken at all seriously. Still, on the bright side it DOES seem to be over, so next time I shall just have to gird my loins and nag the hospital while I’m HAVING a flare, if only so they get to see it!

So that was the mildly irritating.

The bad is physio – not my physio of course; she’s still lovely. But apparently, ‘In order to be in line with private practice’ they are going to restrict all patients to a maximum of six appointments before a re-referral is required. It’s a very confusing system which I’ll explain in another post, but I can probably get re-referred. However, if I normally have physio twice monthly, I’ll have to get rereferred every three months and then wait around five weeks for an appointment, where presumably I won’t be guaranteed to see my lovely physio and will be reassessed each time, even though after a couple of years I think between the two of us we have a pretty good idea of what works! (Anyway, more about this whinge later!) The bright side is that I have at least had her for around two years, and when I started seeing her I thought then that they’d kick me out after six appointments, so I suppose I can’t complain. (Oh wait – yes I can …)

And here’s the pet Bee Orchid!

June 17, 2010 at 8:52 pm | Posted in Me | 1 Comment
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bee orchid flower

Bee orchid flower closeup

bee orchid with cat in background

Bee orchid, with Enormous Cat in the background!

Younger bee orchid in bud

Bee orchid in bud

Bee Orchid anyone, lightly mown?

June 17, 2010 at 12:20 pm | Posted in Me, rheumatoid arthritis (RA) | 2 Comments
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Flare notwithstanding, I managed to get myself up to the north Norfolk coast again to stay with Weeny and her hubby and go orchid hunting last weekend. I had several rest and stretch stops on the drive up, and once there we stuck to relatively local places to keep the drives short, and pottered slowly! We were particularly on the hunt for Bee Orchids and Early Marsh Orchids.

Well we found Early Marsh Orchids in abundance, and Common Spotted Orchid, and possibly another one I haven’t identified yet but might be Southern Marsh Orchid, but not a Bee Orchid in sight. Since we have a bad habit of dismally failing to see what appears to everyone else (usually in the butterfly line, as at least orchids can’t fly away) we assumed it was just us being dense, but after spending all morning at it Weeny wandered off to get a couple of ice creams (handily sold in the nature reserve building) and got chatting to one of the volunteers who told her the Bee Orchids were late this year and there’d been no sign of them at Holme so far.

The chirpy chappy then said, ‘But if you want to see some pyramidal orchids, there’s loads of them just down that path, at the end of the pine trees on the right … ‘ Well … they’d done the butterfly thing and flown away I reckon, or as Weeny suggested pulled up their roots, packed their suitcases and wandered off when they saw us coming!

Clearly it wasn’t going to be our day for orchid hunting …

Cut to Wednesday night -hubby and I are off for the weekly shop. Hubby is frowning at the lawn and starting to mutter about mowing it. This happens about once a month – the rumbles start a few days before the actual mowing as a rule, and I was trying to persuade him to see sense and leave it another two or three days until the gardener comes. Not sure comments like, ‘It’s so long already that another few days won’t make a difference’ really helped my cause! Anyway, I’d dragged myself off to the car, and suddenly heard a yell behind me, only to see hubby squatting on the front lawn going, ‘Penguin – come here a sec … is this what I think it is?’

Can you guess what it was?

Yes, we’ve only gone and got Bee Orchids growing in our front lawn!!!

We’ve only found two so far but there might be more if I can just keep hubby and the gardener away from their manly mowing duties. What is it about men and an obsession with short grass? The one that hubby spotted first, which is in flower (will post photos later) has clearly already been mown once – you can see part of a leaf and the top of the flower spike has been cut off!

Throwing thyroid into the mix

June 15, 2010 at 9:10 pm | Posted in Me, rheumatoid arthritis (RA) | 5 Comments
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I went for monthly MTX blood tests today and remembered to ask if the thyroid results were normal – I’d assumed they were, since no one at the surgery had bothered to contact me. They weren’t.

Having said that, they weren’t all that abnormal either, so what are we doing about it? In their case nothing as yet, in my case getting rather confused …and cold …and tired … and achy … but mostly just confused. Until I went in and asked for the results I thought a thyroid test was just that, one test, one answer – OK, not OK, whatever. But no … it turns out there’s a test for thyroid stimulating hormone (TSH) which is produced by the pituitary gland and stimulates thyroxine production from the thyroid gland. Then there’s tests for the two types of hormone the thyroid gland itself produces, thyroxine (T4) and the other one whose name I can’t remember (T3). Counter-intuitively, if you have lots of TSH sloshing about it means your thyroid might be UNDER-active, because you have to produce a lot of TSH to get the thyroid to do anything at all. If you have loads of T3 and/or T4 (produced by the thyroid gland itself) then you obviously have an overactive thyroid as the thyroid is producing loads of the stuff. If you have very little then clearly you have an under-active thyroid.

Symptoms of the latter include feeling cold when it isn’t (box ticked), weight gain or difficulty in losing weight (box ticked), muscle aches (box ticked), abnormal menstrual cycles (oh yeaaaah!), decreased libido (what’s libido again, somebody?), irritability (well … erm … guilty) and memory loss (not sure, can’t remember). However, my levels of T-whatever – not sure if they tested for T3, T4 or both, are in the normal range. My level of TSH though is just outside the normal range – just a smidge too high. As a consequence the docs have decided to wait and see. I can totally understand the logic of this – apparently it does fluctuate and it’s not as if it’s wildly off the scale, so try again in another month and see if it’s still high, and if the levels of T-whatsit have decreased or not.

Really – I can totally understand that – but it’s just sooooo frustrating, as I sit here grumpily shivering, with period pains! (Oh yeah, and a flare just to increase the fun.)

One interesting thing – apparently the most common cause of hypothyroidism (under-active thyroid) is an autoimmune problem. Surprise, surprise!

As to the confusion – I’ve just about got it straight in my head that there are all these tests and roughly what they’re for, but nowhere can I find clear guidance as to what is and isn’t normal range for any of these tests – it seems that for TSH it used to be considered that up to 5.5 was OK, now they reckon about 4.5, or maybe 3.5, or sometimes 2 depending on who you ask, and apparently some authorities in the UK reckon up to 10 is fine! I’m just going to go off and find a nice sandpit to bury my head in for the next month.

Ten GOOD things to do during a flare … if you’re me

June 10, 2010 at 5:24 pm | Posted in rheumatoid arthritis (RA) | Leave a comment
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In the spirit of this blog being positive, here’s the antithesis to the post below. Ten good things to do during a flare – but of course it only applies if you’re me, ’cause everyone’s flares are different!!

1. Take it easy.
2. Take time off work.
3. Really – take time OFF work.
4. Listen to your own excellent advice about taking time off work.
5. THINK – try to be slightly more aware of hands and feet BEFORE you do dumb things!
6. Keep as active as possible – but don’t force yourself.
7. Do everything you can to get to sleep and stay that way at night! E.g. Take 5HTP, take paracetamol just before going to sleep even if you’re not sure you need them, listen to Bill Bryson reading one of his books in his gentle, soporific voice (or Tim Piggot-Smith reading David Starkey, or anything by Stile Antico)
8. Eat sensibly and TRY not to comfort eat!
9. Learn to count.

This flare I have managed to take note of 1-4 and 6-7 this time, and I am feeling A LOT better. I’ll try harder next time and see if I can manage all ten … well nine … well eight really …

Ten things not to do when you’re having a flare

June 10, 2010 at 4:29 pm | Posted in rheumatoid arthritis (RA) | 2 Comments
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1. Say “Of course I can carry the tray!”
2. Run downstairs wearing only socks. (It feels like you’re walking on marbles.)
3. Say, “No – don’t you come up. I’ll bring the dress down for you to look at.” (’cause then you have to take the dress back up to keep it away from the cats … and then come back down.)
4. Tell yourself a browse around the local garden centre won’t hurt a bit.
5. Push a big, heavy door open with the flat of your hand.
6. Assume you can overtake the little old lady with two sticks walking in front of you along the street.
7. Get depressed when you can’t overtake the little old lady with two sticks walking in front of you along the street.
8. Swing your arm up without thinking to get something off a top shelf.

Actually I think that’s all the dumb things I’ve done over the last two days pertaining to my flare, but I think eight is enough – don’t you?

p.s.

June 8, 2010 at 12:59 pm | Posted in rheumatoid arthritis (RA) | 4 Comments

In case you hadn’t figured from the post below, I’m having a bit of a flare at the moment!

I give up!!

June 8, 2010 at 12:58 pm | Posted in rheumatoid arthritis (RA) | 2 Comments
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I think that now is the time to admit defeat … talking of which my feet are admitting defeat too, but I’ll come back to that in a minute!

Ever since I was diagnosed with this dratted thing I’ve been trying to see if my RA followed some sort of pattern – diet, stress, tiredness, weather, hormones … and every time I try to keep some sort of log and think I’m getting somewhere, the pattern just falls apart after a while. I think I give up on trying to find out exactly what it is that makes my RA worse – not because I don’t think the patterns are there, but because I think they’re just too complex. I suspect that tiredness AND weather AND stress AND hormones AND diet probably all play a part – but my analytical abilities (or record-keeping abilities for that matter) just don’t stretch to trying to work it all out … especially when I’m feeling ‘carp’ anyway!

It would be really interesting to keep a log of all the different factors every day and try to analyse it – anyone up for the challenge, ’cause I’m not!

On the bright side, I have an outfit (minus shoes of course!) for the wedding of Mr and Mrs Mooseface (aka my brother and his fiancée). This is why my feet have admitted defeat – not that I’m going to give up on shoes (don’t panic Mr and Mrs M, I’m not coming barefoot although that has been suggested!) Just that my friend Debbie and I had a NINE HOUR shopping trip on Saturday (including the drive to Norwich and back, which Debbie did thank gawd!) and my feet have given up as well since then!

We had a terrific time, and a successful outfit hunt, but as my dress has black in it I thought ‘Aha, I probably have some shoes at home that’ll do the job!’ Well y’all know how much I love shoe shopping (not), so I thought that seemed like a cunning plan. Got home, tried on the outfit, showed Hubby (who liked it, thank gawd!) and tried on the shoes. These are pretty un-fancy black sort of court-shoe/pump things that I’ve had for years, with a harmless-seeming one-inch heel. I thought perhaps a shoe-bow in one of the other colours in my dress, or in silver to match the shrug I got to go with it, would smarten them up.

Well – the shoe trying on session was NOT a success. I have one thing to say about it. OOOOOOOOUUUUUUUUCH!!! Actually the heel on them was really ugly, so perhaps it’s for the best! Anyway, looks like it’s flats for me! (OK, that was more than word … I don’t care! I ache! Stop getting at me! Waaaaah!)

So … will have to have a shoe shopping day some time in the near future! Probably not this weekend as am hoping to fit in another hike with Weeny, hunting butterflies and orchids to photograph … at least the feet will be in walking boots for that so I can probably cope, if the weather improves. It’s continuous rain at the moment.

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