Tags: aches, arthritis, doctor, exercise, flare, flare-up, GP, joint pain, medicine, methotrexate, NHS, pain, physio, physiotherapy, R.A., RA, rhematoid arthritis, Rheumatoid arthritis, rheumatoid arthritis (RA), steroids, stiffness
This perfectly innocent post title, no double entendres intended, is supposed to set the 1950’s scene for you. Maggie (friend and frequent commenter on this blog) has always said that the town where I live is like stepping back into the 1950s, and generally I reckon this is a pretty good thing. The 1950s is a pretty nice, cosy, friendly place to live; that is until you get hit by … da da da daaaa, 1950’s Doctor Man.
Alas, the knee has continued to flare and I decided, after having a lot of stiffness and pain yesterday, that I really should go back and say a) the steroids worked but they ain’t workin’ no more and b) can you ask the physio to have a look at the knee please? So I did. Of course, as I’ve mentioned before, if you make a ‘same day appointment’ (and the choice is same day or 2.5 weeks away if you’re lucky) then you can’t choose your doctor; you just see whoever is available.
Now when I did this two weeks ago I hit the jackpot with Dr Locum Eye-Candy, but alas, this week my luck ran out and I got 1950s Doctor Man. Now don’t get me wrong, he was pleasant enough in a dried-up old stick kind of a way, and true to his 1950s roots he did listen patiently and he did actually bother to examine me properly (two things you certainly can’t count on these days in the NHS!), but then the downside of being in the 1950s kicked in, and I got the 1950s lecture about RA. I thought things had come on a lot since this kind of thing: ‘Well, that’s the nature of the disease. It’s a progressive disease I’m afraid and it will flare now and then. Now, I’m not trying to depress you but really that’s just the way it is and there’s not a lot you can do about it. You’re on a high level of methotrexate and other medication already, so … ’ And so on, and so on, for about five minutes.
I’m not actually saying he’s entirely wrong, by the way – fundamentally that’s probably true, but he didn’t make one single suggestion about sensible things I could do. OK, I wasn’t expecting him to suggest Reiki or a gluten-free diet or anything else that your average 2011 British GP would consider a bit ‘far out’, but what about, for example: exercise … or rest, apply heat … or cold, consider a steroid injection in the joint, come back if it gets worse, have physio, get hubby to do all the cooking, washing up, shopping etc. for the next few weeks. <Grin – of course he wouldn’t suggest that! Not the done thing at all in the 1950 to have a man doing all that!>
I must admit I wasn’t feeling very ‘with it’ and I damn near forgot to actually ask what I’d gone in to ask, which was since I was doing a 50 minute round trip every week for ultrasound treatment on my shoulder at the moment with the physio, could he please ask the physio to treat the knee too? Finally I did remember, and, give him his due, he agreed immediately and not only that but he actually wrote me a note (with his very smart 1950′s fountain pen) to take in with me, hopefully circumventing the need to wait five weeks for the next official appointment for a knee referral, by which time the flare will probably be over.
I did also ask him whether I should be exercising it or resting it, and he said definitely resting it … but is this right, I wonder, or is this just more 1950s medicine. Not that long ago the only recommendation for RA was ‘bed rest’!
Tags: aches, acromoclavicular joint, knee, physical therapy, physio, physiotherpay, R.A., RA, rhematoid arthritis, Rheumatoid arthritis, rheumatoid arthritis (RA), rheumatology, shoulder, steroids, stiffness, ultrasound
Well … half-an-hour’s drive, ten minutes or so waiting, thirty minute consultation … and the answer turned out to be, for the moment anyway, not to physio! Aaaaaaargh! I’ve only waited since January for this appointment. Still, there were perfectly sound reasons not to physio – and at least I had a fun time in the waiting room reading old copies of National Geographic!
There was one small thing I hadn’t accounted for … I’ve just started a (very) short course of oral steroids for a very swollen knee, and the physio that works for me, or has always worked for me in the past, is ultrasound. Obviously the steroids are busy trying to reduce the inflammation, and equally obviously that is intention of most treatments including the ultrasound. Aye, but there’s the rub … (talking or rubs I must rub some of that nice ‘Nature’s Kiss’ ointment into my knee … I keep forgetting about that … but back to the main point), the way that ultrasound works (putting it simply, which is the only way I know!) is that it apparently INCREASES the inflammation quite rapidly in order to trigger the body to go ‘ooh, that’s inflamed’ and kick into place a process for doing something about it.
So … if I had ultrasound, my physio basically thought that I might well be either inadvertently cancelling some of the steroid effects or, at very least, wasting my time because the steroids might counteract the ultrasound without it being able to do anything.
Now the physio wasn’t at all sure about this, and neither am I, but we decided it was better not to risk it so I’ve got to go back again on Tuesday morning!
The more I think about it the more I’m not convinced by this whole argument … but I’m way too tired to work out why now, so I’m off to bed and I’ll give it some thought tomorrow!
Tags: aches, arthritis, doctor, flare, flare-up, GP, joint pain, joint stiffness, NHS, oral steroids, pain, prednisolone, R.A., RA, rhematoid arthritis, rheumatoid, Rheumatoid arthritis, rheumatoid arthritis (RA), rheumatology, steroids, stiffness, stifness
I’ve read a lot on the net about oral prednisolone and generally I’ve thought, ‘Hmm, glad I don’t need any of that then …’
Me and my big mouth …
Anyway, here’s why. I woke up Tuesday morning and my left knee, which is where I had the major, major, MAJOR problems in 2008 but which has been relatively OK since, was stiff … I mean REALLY stiff, as in couldn’t straighten, couldn’t bend. Oh well … it didn’t last long. It stayed a bit stiff until about lunchtime and then wore off. It didn’t hurt at all so I decided not to worry about it. ‘One of those things,’ I said to myself, ‘one of those little unpredictable joys of R.A. No doubt that’s the last I’ll hear from that knee for a year or two.’
WRONG! Woke up yesterday morning and the knee was really stiff again, but instead of wearing of by lunchtime it didn’t wear off all day! It still didn’t hurt so I thought, ‘Oh well, maybe it’ll be OK tomorrow.’
You guessed it – this morning it was really stiff again and it hurt (just a bit, but it did hurt). It also felt as though someone had strapped a great big lead weight around it, which says ‘swollen’ to me, although it’s not actually noticeably hot or inflamed. So I gave in and took the doctor lottery – i.e. ‘same day appointment with a member of the same day team. We can’t tell you who you’ll be seeing and it may be a doctor or a nurse.’
Well it was obviously my lucky day because I saw Dr. Locum Eye-Candy, and apart from being eye-candy he also seemed pretty switched on and sensible and (mostly) listened to what I had to say. OK, so he got slightly confused and when I’d said, ‘This started on Tuesday’ that somehow got translated in his brain to, ‘This is an ongoing problem I’ve had for months’ – but hey, we got that straightened out pretty quickly, so I’ll let him off! (Also perhaps I got a little confused. He was GORGEOUS – made it hard to concentrate on why I was there … Hmm, hubby will proofread this for me later. Perhaps I should take it out … nah … )
So here I am about to experience my first ever oral prednisolone – oh lucky me !
On the bright side, I am taking minimal quantities and assuming it works I will only be on it for three days, so I don’t anticipate any problems. In fact I anticipate a miraculous cure. Let’s hope I’m right. I don’t always hate it when my predictions come true!
Also, on the really, really, really sunny side, IT’S NOT AN INJECTION INTO THE JOINT! (Or indeed an injection into the bum, which is always mildly embarrassing, and would have been ever more so if Dr. Locum Eye-Candy had been giving it to me!)
Tags: Add new tag, arthritis, doctor, doctor's receptionst, doctor's secretary, GP, knee, knee joint, knee pain, Rheumatoid arthritis, steroid injection, steroids, swelling
Just went to the doctors to pick up a letter the doc said he’d write so that I could send it to the train company in the hopes they’ll refund the tickets for a trip to Wales I had planned, but had to cancel because of the state of my knee. ‘Pick it up early next week’ he said. So I thought well, I’ll leave it until Wednesday to make sure it’s done.
Went in this evening – explained to the receptionist. She looked in the file. ‘I’m sorry, it’s not here.’
‘He did say I should pick it up early in the week.’
‘Well it’s only Wednesday now love.’
‘Well to my mind early in the week means Monday or Tuesday, and I left it until today just to make sure it was done.’
‘Well it depends how you look at it really, doesn’t it love? Early in the week could mean Wednesday too.’
‘No, not really. I’d call that midweek.’
‘Oh well, nothing I can do I’m afraid – it’s not here.’
‘Well could you at least check my notes to see if he’s made a note to do it?’
‘Well … I don’t know if …’ Sees the steam coming out of my ears, ‘Well, I’ll have a look … Oh, well it says here it was done yesterday. Thing is the secretaries have all gone home now and perhaps they haven’t typed it yet. The only thing I can suggest is that you call and ask for Dr Dashes secretary, Debbie, tomorrow, and she’ll be able to tell you exactly what’s happened to it.’
So off I go, fuming and steaming, not to mention limping, only to get home and find a letter on the mat addressed to me. Open it and what do you think is inside? The letter from the doctor.
Soooo thoughtful of the secretary to realise that she’s writing a letter about someone with a very swollen and painful knee, and wouldn’t it be a kindness to post it? Such a pity the doctor wasn’t equally thoughtful … as he’d told me to pick it up.
There, feel better for the rant!
More importantly my knee is also finally on the mend – I think the steroid injection, however painful it was at the time, has really done the trick.
Tags: joint injection, knee, RA, Rheumatoid arthritis, steroid injection, steroids
Well I went and saw the GP today – she rolled her eyes when I told her about yesterday’s phone conversation and commented that they used to be quite happy to see people and anyway what else was it going to be. ‘Funny you should say that,’ I said, ‘that’s what I said.’ I can only assume that with all the budgeting stuff that goes on now, the hospital would rather the GP was paying for the injection and they didn’t have to spend the money at their day unit.
But the good news was that my doc was able to do the injection at the surgery, and try to draw off some of the fluid as well.
The bad news was that she didn’t manage to draw off any fluid and it hurt like blazes. I shall have to remember, if I ever need one of these things again, to apologise in advance for any swearing, screaming, moaning or kicking that might ensue! Alright, kicking is a slight exaggeration and I think I just managed not to swear, but I’m really not someone who’s squeamish about injections and I normally pride myself on not being a total wimp! So doc and I had a mutual apologising session and then she did the actual injection.
She did warn me, and she was right, that it would probably feel marvelous for a couple of hours thanks to the local anaesthetic but that then it might well feel worse as the steroids wouldn’t kick in for perhaps 24 hours, and that I should rest it for at least that long. Perhaps fortunately for my knee, I was also starting to develop a corker of a migraine, so although I went back to work for a little while I soon went home and spent the day in bed.
Only time will tell, but so far although it’s hurting slightly I’ve already got a lot more movement in it than I did this morning, so it looks hopeful.