Blinking knee again!

July 26, 2017 at 9:01 pm | Posted in arthrits, arthrits, rheumatoid arthritis, fibromyalgia, joint pai, joint pai, Me, rheumatoid arthritis, rheumatoid arthritis, rheumatoid arthritis (RA) | Leave a comment
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Sorry – not my most inspirational blog post title, but I’m not feeling very inspired!

My knee has been playing up for a couple of weeks now – mostly the left one, as usual, with the occasional twinge in the right. At first I thought it had nothing to do with RA because the pain was in a different place – behind the knee, not to the front-right as ‘normal’, and there wasn’t much swelling … but over a couple of weeks the swelling has increased a lot (in its usual place) although the pain remained mostly behind the knee. My Pilates teacher (still loving the Pilates by the way) suggested it might be a pain caused by hyper-extending the knee, which I am prone to do, so  I spent a week very consciously NOT hyper-extending the knee and then realised that, given it was always significantly worse in the morning, and that it now involved significant swelling and  greatly reduced mobility, it was probably just good old RA again. So, today I plucked up the courage to phone the doctor. (It takes courage these days, believe me!)

It seems that the receptionists have now become triage nurses! I was not impressed. We used to get ‘Can you give me some indication of the problem if it’s not personal, so I can let the doctor know’ which was a reasonable request in my view. Today I got, ‘Can you give me a brief account of the problem please.’ Well it wasn’t personal so I said, ‘Yes, rheumatoid arthritis.’

‘Oh, you want pain relief then?’

‘No, it’s a bit more than that, I’m having an RA flare.’

‘Have you seen a physio? Do you think that might help?’

‘No, I don’t think so. I’m having a rheumatoid arthritis flare and I need to speak to a doctor.’

‘Oh … OK then …’

I actually wrote to the surgery via their contact form and told them what had happened and asked what training the receptionists, being non-medical staff, had if they were now supposed to be triaging to this extent. I said that I felt it was inappropriate and that the comments suggested a lack of understanding of the difference between RA and OA. I haven’t had a reply and I don’t expect one.

The doctor eventually phoned back at 11:30, meaning it was too late to go for the blood test that I should have gone for today, because you have to be there before 11! I explained the problem with my knee and he asked how long this flare had lasted. I explained that it’d been a while because I hadn’t twigged it was RA at first due to the pain being in a different place.

Now … this my American friends may find hard to swallow, but here goes … he asked about pain relief and I told him I was alternating paracetamol (Tylenol) and ibuprofen and it wasn’t cutting the mustard. He wondered about codeine and I said no (for stomach reasons). I asked about steroids and he said no, not yet, because ‘they can be problematic’ and then prescribed me a great big box of opioid pain relief tablets (meptazinol), 60 of the things! He said to try them out because if they helped it would be useful to know there was something else in my arsenal, which is true … and if they didn’t work, to come back next week and they would have me in for an examination and consider steroids … because all this was done over the phone.

So while you guys in the US can’t get an opioid for love or money now, or not without jumping through a million hoops, I just get handed 60 over the phone with a comment on the lines of ‘Don’t use them all at once. They’re only short term.’

He told me that the prescription would be with the pharmacy ‘in five minutes’. Luckily I took this with the pinch of salt it deserved because when I went to the pharmacy 1.5 hours later it had only just arrived!

Now he was probably, very sensibly, thinking ‘She’s had this two weeks, her flares rarely last even this long, it’ll probably be over in a few days and the pain relief will provide just that, relief, while it’s on its way out.’ And if he was thinking that, full marks to him because he’s probably right.

However, there’s a nasty, suspicious part of me that thinks even though the surgery says any comments and complaints won’t prejudice your treatment, he’s seen the comment I sent in and is thinking, ‘If I give her pain relief first, it makes what the receptionist originally said right …’ That’s probably nonsense – I’m prepared to admit to a tendency to be paranoid… but with the world going to pot in the way it seems to be at the moment, who knows!

I do have some comfort in the fact he’s a doctor I’ve seen before (actually face to face seen, a miracle these days) and do actually have some respect for, partly because I felt that he treated me as an intelligent person … so it’s far more likely he’s just easing me out of a flare with much reduced pain – and it IS much reduced. Of course it’s done nothing at all for the swelling or the lack of mobility in the joint, but it’s great to be relatively pain free and we’ll see how things go in the next few days.

The new vision for the surgery’s journey

December 11, 2016 at 6:34 pm | Posted in rheumatoid arthritis (RA) | 2 Comments
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I do hope you enjoyed my buzzword-generated title for this post.

My local doctor’s surgery is ‘forming an alliance’ with two other surgeries in a town about 25 minutes’ drive way (when there’s no significant traffic build-up). This is, so they tell me, to help them recruit more staff so that in future they can offer new services to their patients which will help them avoid becoming ill in the first place. It will also mean that staff from the town B surgeries (obviously the town with me in it is town A <grin>) will work sometimes in our surgery and staff from our surgery will work in town B.

Well OK – I’m sure the staff won’t be thrilled about that, but I imagine they’ll live with it, and from a patient point of view all that sounds fine and dandy. So… why does it not fill me with seasonal comfort and joy? Well … if you’ve read any of my other posts about the surgery you’ll have an inkling already.

They welcome patient feedback and ideas, so here’s the letter I want to write them, but won’t.

Dear Surgery,

Thank you so much for your letter, sent to all patients registered in the surgery, outlining your new plans and apparently welcoming patient feedback. From past experience I am completely confident that you don’t welcome feedback at all but you know that if you don’t have a ‘consultation’ you won’t be allowed to proceed. However, since you have to ask for feedback, you might as well have some.

Any services offered to help patients stay well, as an additional benefit to what is already offered, will of course be welcomed. What will not be welcomed, and what again past experience suggests will probably be your next move, is being told in a few weeks, months or years’ time that ‘All patients with diabetes from here and town B will now have their monthly checks in town A’ and ‘All rheumatoid arthritis patients in both towns will now have their monthly blood tests in town B’, for example. This is of course something your letter is very careful not to state, noting instead that staff from town B will sometimes work in town A and vice versa.

Maybe you have no intention of forcing the mostly elderly and frequently infirm and, to put it politely, non-wealth patients from each town to go to the expense (often considerable since many don’t drive or can’t afford to run a car) of travelling to the other surgery for routine appointments once a month or even more often. If that’s the case that’s simply spiffing, splendid and super. I just have a feeling … Please tell me I’m wrong!

I still remember Mrs Practice Manager saying to me once how ridiculous it was that people objected to having to go into Norwich for the open clinic if they needed to see someone quickly. Well … yes, of course they do … given the local demographic, the fact it’s about a 40 minute drive (if you have a car and someone to drive you or you’re able to drive), the taxi return cost is about £55 and the demographic above, I’m not bloomin’ surprised!

Peace and good will to you and all men, women, children, penguin, cats and other animals,

 

Pollyanna

Bloody Surgery Again!

April 28, 2016 at 2:35 pm | Posted in rheumatoid arthritis (RA) | Leave a comment
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That’s doctor’s surgery, not a need to have surgery, I’m very glad to say!

I put in a repeat prescription two days ago, went in to collect it today, only to be told they didn’t have it in at the chemist. (The usual route is for me to deliver my requirements to the surgery, and they pass it on to the chemist, who is thankfully very nearby, for collection in 48 hours.)

So I went to the surgery and said, ‘I put in a prescription two days ago but they don’t have it at the chemist.’

‘Oh well, it can be up to 48 hours.’

‘It’s been more than 48 hours.’

‘Well it can be up to two days, if you put it in on Monday morning, it might not come out until later today.’

‘Why say 48 hours then? It’s been longer than 48 hours. Please could check on the system and see if it’s been done.’

Rather unwillingly she checked the system and said, ‘Yes, we issued it on the 19th,’ and sat back with a satisfied smile. ‘We issued methotrexate, folic acid, hydr… hy… hydrer … can’t pronounce it but we issued all that stuff.’

Deeeeeep breath … ‘OK, well they don’t have it at the chemist. What now?’

‘Can you go over to the chemist and check?’

Really deeeeeeeeeeeeeeeeep breath. ‘As I said, I’ve just come from the chemist.’

‘Well could you check again. It might be there.’

Well, it’s only up the road, not like I have anything better to do … oh wait, yes I do … never mind. Back to the chemist.

‘Could you check on the shelf please – the surgery say they issued it on the 19th. It’s happened before that it wasn’t on the database but it was on the shelf.’

So very grudgingly the pharmacy assistant checked the shelf. It wasn’t there. ‘Well it wouldn’t be,’ she said, ‘ it wasn’t on the database.’ I’m getting really tired of repeating myself at this point but I said, ‘It’s happened before. Would you mind ringing the surgery and telling them, or shall I carry on being a yo-yo and go back and tell them again?’

‘Would you mind going over? It’ll take us ages to get through to them!’ Well I had to concede that was a fair point so I went back over. By this time I had lost any vestige of patience i had. Funny, my mum thinks I’m very patient… but that’s just an indication of her extreme impatience!

I went up to the same receptionist, glared my most menacing penguin glare and said, ‘I’m back.’

‘Oh … it’s not there then?’

‘Funnily enough, no.’

‘But we issued it on the 19th.’

‘You said.’ More glaring.

‘Well have you had the methotrexate?’

‘No, of course not. I haven’t had any of it. That’s what I’m saying. It’s not there.’

‘Well …I can’t understand why they keep disappearing …’ HA! So it’s not just me this is happening to then, marvelous! Good old surgery ****’s up again! ‘Well, I’ll print it out right now.’

‘I’m going to run out of my medications by tomorrow night – I can’t wait 2 working days.’

‘Oh no, we’ll get a doctor to sign it and send it over this afternoon.’

So I’m waiting to see if they get it right this time – good job I have spare methotrexate as it takes the pharmacy three days to order it in!

 

So angry my glasses are steaming up

February 22, 2016 at 12:23 pm | Posted in rheumatoid arthritis (RA) | 4 Comments
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At the behest of the hospital rheumy nurse, I’ve just been down to the surgery to have a blood test, since as I’m hopefully now getting more methotrexate into my system with the injections, they need to make sure that I’m not overdosing.

I got to the surgery, I went over to where the board hangs up where you collect your number and wait to be called for a blood test – no board. I headed back to the reception queue – the MASSIVE reception queue, the slow reception queue – in fact it wasn’t slow, it was immobile.

It took me 20 minutes to get to the front of the queue to say, ‘Where are the blood tests?’ only to be met by a blank look and, ‘Isn’t there a board …’

‘No, that’s why I’ve been standing in this queue for the last twenty minutes.’

‘Oh … well one young lady went home sick so perhaps they’re not doing them.’

‘It would have been helpful to put a notice up to save me queuing, and probably halve your queue at the same time!’

‘Oh, isn’t there a notice up? I’ll talk to someone about that right now.’

‘Don’t bother – they finish at 11 anyway and it’s 11 now.’

At least I needed to go anyway to get a printout of my new repeat prescription with the Metoject pen and then put that in to be reviewed by a doctor.

I sympathise with the sick phlebotomist; I sympathise with the rushed off their feet reception staff; where I draw the line is attempting to sympathise with blatant incompetence. How much effort would it have been for one of the receptionists (perhaps while she was getting coffee, as one of them did while I was queuing) to write a quick note saying, ‘No blood tests today due to staff sickness. Please try tomorrow but ring first.’ Not long I suggest. It also wouldn’t take long to inform all the receptionists (all three of them) that there are no blood tests, and yet clearly that hadn’t been done either.

It’s a good job I wasn’t going for a blood pressure check as my blood is boiling – at least it’s keeping me warm on a cold day!

You know you’re stupidly busy when …

June 9, 2015 at 11:04 am | Posted in arthrits, Me, rheumatoid arthritis, rheumatoid arthritis (RA) | 1 Comment
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… the only time you can arrange to meet with your mum to give her some important advice about embroidery is at the doctor’s surgery!

In fairness, it’s partly because she’s stupidly busy too and away for the rest of this week!

We both needed a blood test, and we knew there’d be a bit of a wait, so we met, appropriately enough, in the waiting room! You may remember from my last post, things hadn’t exactly gone according to plan with the blood test attempt, but this time it couldn’t have gone better! When I got there, mum was actually having her test, having arrived a little while before me. It couldn’t have worked out better. As I sat down, she came out from the phlebotomist, we had just enough time to go through her needlework problem and I got called in!

I only waited about ten minutes to be seen and I needed that ten minutes to sort mum out!

Hurrah for the surgery – and I don’t often say that! When things run well, they run really well … a pity they don’t run well a little more consistently!

Three-monthly blood tests

November 19, 2013 at 9:56 pm | Posted in arthrits, rheumatoid arthritis, fibromyalgia, joint pai, Me, rheumatoid arthritis (RA) | 7 Comments
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The hospital has decreed that patients on methotrexate for RA no longer need monthly blood tests – they will now be three-monthly instead. Now I don’t have a problem with having my blood tests every three months – as yet I’ve never had a single blip in my tests and if the hospital say three-monthly is safe I suppose I have to believe them and not just assume this is purely a cynical money-saving exercise: ‘Hey, what’s the odd life lost compared to a few thousand pounds saved, eh? Let’s do it! Right lads, down the pub …’

What I do have a problem with is the fact that they can’t book tests three months in advance, and yet we’ve been told to contact the rheumy nurse to make the next appointment. There IS NO WAY to contact her except by making an appointment to see her … a bit of a circular argument! My sensible and lovely nurse realised this straight away and in fact pointed it out to me with a comment on the lines of ‘I’ve told them ALL individually in reception, so don’t take any nonsense if they tell you that you should have booked it through me!’

OK, so that’s hopefully sorted out even before it becomes a problem, but how crazy that we can’t just book the tests when we see the nurse!

The surgery have also arranged monthly ‘walk-in clinic’ tests for the months we don’t see the rheumy nurse … but that’s a whole nuther story … a post to come in a day or so.

Bloodless penguin – and more surgery hassles

September 24, 2013 at 9:57 pm | Posted in rheumatoid arthritis (RA) | 3 Comments
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I mentioned to the facilities manager as I left work this morning that I was off for a blood test. When I saw him later he asked, ‘So did they manage to confirm you had blood then?’ Well – actually it was a bit of a struggle! The first attempt to prove I had blood was a dismal failure – in went the needle, out came … nothing. The rhuemy nurse waggled the needle about – nothing happened … except that it hurt … she waggled it about some more … OUCH! We mutually agreed that perhaps trying another spot would be better. It wasn’t. Hmm … I’d walked in rapidly and everything, the blood should have been flowing … but perhaps the problem was that it had all rushed to my head a moment before! 

‘Why would it do that?’ I hear you cry. Because she’d just told me that the system of monthly blood tests was changing – in fact it was going. The new guidelines from the hospital are that we only need three-monthly blood tests done by the rheumy nurse. Well OK … that’s fine by me… but here’s the rub. 

At the moment I go in for my blood test, have a chat about my arthritis and general health, query anything that’s bothering me rhuemy-wise (usually not a lot, ’cause I’m lucky most of the time!) and book the next appointment. Now the appointment times are being reduced, so I will only see her every three months and have less time for a chat about how things are going because she will have less time per patient, even though she’s not seen us for three months. On top of that – she can no longer book the next appointment – because, mind-bogglingly, ‘the system’ won’t allow booking three months ahead!

I do wonder how much this has to do with the computer system and how much it has to do with the fact that the further in advance appointments are booked, statistically the more patients are likely to fail to attend! So now, instead of a simple month-by-month process of blood tests and booking, I have to remember to do an extra thing – phone about three weeks before my next test is due and book it.

Well, that’s not so bad – after all it’s only three-monthly, isn’t it? I’m still spending less time than I was before attending monthly? Not so fast … I am also supposed to attend in the two intervening months for a 2.5 minute appointment with a phlebotomist, who will just have time to say ‘Hi’, take the blood and throw me out again – but on top of that, that won’t even be an appointment but a ‘walk in’. So if they’re not busy (hah, what are the chances of that, especially as I happen to know they’re short staffed) I could get seen straight away, but if they are busy I could be waiting who knows how long.

I told my nurse I would probably simply not bother attending the phlebotomy walk-ins and she said she thought I would not be alone – she’d heard the same from a number of patients! Of course you could say, and quite rightly, that we’re putting our own health at risk doing that and the service is there … but in six years I’ve never had a blood issue, and I do have a full-time job and I don’t have time to sit about for an hour waiting for a blood test, so … we’ll see.

Anyway, back to today’s blood test – when she scraped me off the ceiling and calmed me down and got the blood flowing round the body again, she was finally able to draw blood … which, I hope, will be fine as usual!

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