Wrist Pain: Occupational Health Interview

My company asked me if I would be referred to a company to discuss my illness. I had no good reason not to go so I agreed. The stated reason is to help me with my illness and ensure that I can continue working. My cynical take on it is a check to see if I've been pulling a sickie and they will be getting data from my doctor.

I had a morning interview with the outsourcing occupational health company in central London. I discussed my wrist pain with the doctor interviewing me. She asked me what treatment I had. I told her that I had had a cortisol injection.

She asked me, "Did you have it injected into your wrist?"
I replied, "No, it was injected into my bottom", in a deadpan manner.

Without batting an eyelid, in true professional style, she countered, "So, it was an intra-muscular injection."

She dictated a letter into her dictaphone to my GP asking for details of the injection. She wanted to write to the rheumatologist but I said I thought he was too busy too reply and she agreed saying that rheumatologists are very busy.

Wrist Pain: Third Time Unlucky?

I finally saw my usual rheumatologist - free for the first time. He seemed to take a different view from the other rheumatologist and wasn't interested in talking about drugs to minimise the arthritis symptoms. After negative blood test and biopsy results, he still wanted to do a further test to eliminate TB. He seems to be hoping I've got TB rather than arthritis and keeps looking for evidence for it.

So, I've got to go back to the hospital next Monday to get the Mantoux test administered by injection and then on Wednesday to see if there is a reaction to the injection.

In any case, I'm going back to work tomorrow. The plan is to work 25% part-time in week 1, 50% part-time in weeks 2, 75% part-time in weeks 3 and back to 100% in week 4.

Wrist Pain: Diagnosis

I turned up on time. I had to wait 1.5 hours. Even though the rheumatologist I had seen privately twice and his name was on the letter, I didn't get him but got someone else, as I predicted (He was just the "consultant presiding" but doesn't turn up). She went over the biopsy results.

The good news was that I didn't have TB.

The bad news was that I didn't have TB.

I have arthritis in the risk. It isn't rheumatoid arthritis so it seems to be a generic inflammatory arthritis that can't be positively identified as the rheumatoid variation.

It's incurable and progressive.

She said that there were different drugs to try and deal with the symptoms but didn't know what her male colleague was going to suggest. I said I should have seen him or she should have spoken to him before I arrived. She agreed. She was keen to offer me leaflets for different options, instead. She seemed to be fobbing me off and procrastinating making a decision on which drug.

There were leaflets for 2 options. From the Net, they take up to 3 months to work but only work in less than 50% of the patients and have significant side-effects.

Sulphasalazine
Possible side-effects:

• nausea
• diarrhoea
• abdominal pain
• dizziness
• headaches
• rashes
• drop in fertility
  
• turns urine, sweat & tears orange

Methotrexate
Possible side-effects:

• nausea
• hair loss
• ulcers
  
• rashes
• fatigue and feeling like having the flu
• increased risk of infection
  
• liver damage (exacerbated by alcohol)
  
• lung damage causing breathlessness
  

She looked at my wrist. At the time of the biopsy, I was told that the stitches were dissolvable. Now, we could see the black stitches were still there and she thought they were nylon so would not dissolve. So, I hadn't been given an appointment to take out the stitches!!

Furthemore, I had to wait 1/2 hr to get them removed and I will have to go back to the hospital on 13 November to see the first rheumatologist, to find out what drugs he thinks I should take and stop boozing.

Wrist Pain: 3rd time lucky?

I received a letter for purporting to give me an appointment with the rheumatologist to discuss the results of the biopsy on 30 October. This will be the 3rd time I see him but this time the NHS is paying, not me so I wonder if I'll be fobbed off with a junior doctor instead as I'm not paying to see the main man.

Hopefully, whoever I see will be competent enough to interpret the biopsy results. They might show that I have TB (a good result as it's treatable), arthritis (a bad result as it's not treatable), something else or nothing at all (the worst result of all).

Wrist Pain: Biopsy Diary

0700: I woke up and broke my fast with a glass of water. Muslim practice had been forced on me during this time of Ramadan. I rushed to the hospital for my biopsy. I was running late so took the Tube rather than the bus as I'm appalled that the metro costs 73% more than the bus. My biopsy is considered to be a minor operation which should only take 1/2 hr, so I was to be operated in the Day Surgery Unit. I'd be kicked out before bedtime.

0805: I had managed to negotiate a delay in my arrival time from 0730 to 0800 - so I arrived 5 min late. As I checked in at reception, I got a phone call telling me that my operation was to be in the afternoon and I wouldn't need to arrive till 11am. Doh!! Apparently they tell everyone to turn up early in the morning and don't sort out the order of operations till the day itself. (I reckon they expect no-shows and don't want to plan anything till they know who bothers to turn up.) So, I had a long wait. I was told I could go home and come back later. I thought this was a bad idea as I would be tempted to succumb to the growls of my empty stomach. Instead, I waited in the waiting room with the other patients - non-patients are banned from occupying space there. I noticed a woman wearing a pink dress with a low-cut top. She looked dressed for a tea-party. I listened to The Corrs & Avril Lavigne on my MP3 player.

0900: I was upgraded into the First Class waiting room. It had a portable TV with a loop aerial. I dozed there for a few hours.

1130: the hand surgeon spoke to me. To ensure he attacked the right target, he drew an arrow on my right forearm, pointing to my right wrist. Soon afterwards, the anesthetist spoke to me.

1230: Working Lunch (the best daily business and financial programme) was about to start on BBC2, I was asked to get change into my operation outfit. It has an unflattering gap at the back and have cords to be tied together. After getting changed, I was ushered into the pre-operation waiting room.

1300: I was asked to lie on a trolley and wheeled into the operating room. The general anesthetic was injected into my left arm and it felt cold. That's all I remember.

1430: I woke up on the same trolley at in the recovery room amongst half-a-dozen other cut up people. The local anesthetic was wearing off and I asked for painkillers. The stabbed wrist was hurting more than it was before the operation.

1530: I was wheeled back to a semi-private room - I was to share it with an old man who had a hernia repaired. I was offered a sandwich - my first meal for 16 hours - and got a turkey one, with a cup of tea.

1545: My parents arrived.

1730: I was allowed to leave the hospital.

Wrist Pain: Eroded but not arthritic?

I went to see the hand surgeon today. He went into more detail than the rheumatologist about my MRI scan. Apparently, most of my wrist is in bad shape. Most of it is inflamed and not only have some of the bones been pushed out of place but they seem to have been chemically eroded by the inflammation (I guess by the production of "toxic" chemicals). Isn't the body wonderful.

The expert who reviewed the MRI scan wryly wrote than the only "normal" area is the one from which arthritis starts. So, maybe the good news is that I haven't got arthritis. I'm not raising my hopes too much.

The surgeon said that the arthroscopy that the rheumatologist recommended wasn't going to cut it. He frankly admitted that such a small cut meant that he sometimes couldn't get enough tainted tissue for analysis. So, to do the biopsy and get enough crap out, he wants to do a bigger, "open" cut, that'll probably leave a 2.5 cm scar.

The good news is that there's a slim chance of getting it done on the NHS in 5 days time. This would be quicker and cheaper than a £2000 private operation. I'm not raising my hopes too much.

I'll know by Friday.

I moaned about having a blood test, MRI scan and biopsy and still no treatment. I'm frustrated. If it's TB, they could give me the antibiotics saving time, pain & money. If it isn't, I wouldn't have lost less time or money, than waiting for a diagnosis.

I remember my school science. First, form a hypothesis. Then, carry out an experiment to test the hypothesis. Finally, analyse the data to see if it supports or refutes the hypothesis. In this case, it would be quicker & cheaper to try treatments to see if the hypothesis is correct.

The surgeon said that if it isn't TB, then the antibiotics could cause a problem but was vague on the consequences. I think he didn't like my idea of hacking scientific method.

Wrist pain: MRI scan

I went for my MRI scan today.

I got to the medical centre 20 minutes early - what a surprise. Sod's law was duly invoked and I was told the MRI scanner had broken down today. That's what I get for going for the cheap scanner. Actually it was going to cost me £250 rather than £200 - prices never drop, do they?

I was told it was now working but there was a backlog. I was asked if I could wait 30 minutes. I agreed but had to wait 45 minutes, instead.

There was a choice of music. I chose No.1 : Mozart.

I had to lie face down. My lungs were crushed and despite wearing a T-shirt, I felt like I was in a sauna. I was wheeled into the centre of the machine. There was the regular beat of the cooling pumps, accompanied by the staccato of machine gun fire, drilling machines and giants pounding the scanner. With my discomfort, I was warned I moved about too much. So, one set of images had to be deleted but another set was good enough.

I chatted with the technician and found out that the machine was old at 2.5 years. They get totally knackered by 5 years. He reckoned that private hospitals run their scanners into the ground and the NHS gets new ones. No wonder the waiting list is so long - they spend their money on new machines but not on people to operate them.

I did get to see the images - complete with white areas showing inflammation & fluid build up.

Now, I just need my blood test results.

Wrist Pain: Mental Mistake

After phoning up the NHS hospital everyday to find out what happened to my rheumatologist referral, I finally get an answering machine. I leave a message and someone kindly phones me back to tell me that I've reached the Mental Health Unit. Doh!! Although, I might be frustrated enough to need it.