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: 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 & Blood Test results

I went to see the rheumatologist again today to discuss my MRI scan and blood test results.

The blood tests were fine.

He said there is lots of inflammation and fluid in the wrist. Well, I could have worked that out without an MRI scan.

Here are a couple of views of my wrist taken by the MRI. The scan took lots of slices at different depths of the wrist and from different angles, eg top, side.














[view from top]











[view from side]

Unfortunately, some of the little bones in my hand have been "disrupted", which means that the ligaments which are supposed to be holding them in place are all over the shop and the bones are out of position.

Possible causes are TB (Tuberculosis) or arthritis. Apparently the BCG injection I had in school doesn't protect against getting TB in a joint and there's a lot of it about.

He suggested having an arthroscopy and a biopsy. That means he thinks I should go to a hand surgeon to cut open my wrist and poke around to see what's wrong which apparently the MRI can't show. Then, on the way out, he'll cut off a bit of my wrist for analysis.

I can just imagine the CSI CGI - whirring circular saw cuts through flesh like butter, blood spurts out, we fly with a camera plunging into the wrist and zoom into the bones and ligaments. The camera is rapidly withdrawn to be replaced by a shiny sharp scalpel that, with a flick of the wrist, cuts a chunk of flesh which is grabbed.

Wrist pain: MRI data check

As I'm going to pay for another costly visit to the rheumatologist, I thought it would be a good idea to make sure he has received the MRI scan results & interpretation. I phoned up several times yesterday but was repelled everytime by a busy line.

Today, I phoned up and managed to penetrate their defences. The doctor's private secretary didn't take my call so her replacement had to go and check to see if my MRI info had arrived. Fortunately it had.

So, my 2nd visit to the doctor on Friday is going ahead. I'll write up more then.

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: Private patient

I went to see the rheumatologist at the private hospital today.

He prescribed blood tests and a MRI scan. I asked him how much the scan would cost. He said between £200 & £700. I asked him about the difference between them. He did not give me a clear reply. So, I decided to go for the cheapest option. If that isn't good enough, I'll go for the most expensive. I reckon the extra cost of the cheapest + the more expensive is only 22% more than the most expensive. So, if I can get away with the cheapest, I will have saved several hundred pounds and if I can't I will only have paid 22% extra.

Wrist Pain: Private patience prerequisite

After 2.5 weeks of waiting and phoning, I still have received my referral to a NHS rheumatologist. There was no answer at the end of the phone. No doubt they are still on holiday.

So, I'll pay to see the same rheumatologist in a private hospital. The GP stay it might cost me £150. I phone up the private hospital and am told it will cost me £180 for a first appointment.

The receptionist helpfully tells me that an injection will cost £80. From how long it takes to give an injection, the doctor's hourly rate is about 5K!! Yes, that 's right. Of course they don't do many injections but still it is ridiculously high.

I still have to wait nearly 2 weeks to see him. It seems that in the private sector you pay to wait less than in the public sect0r and you know how long the wait is.

Wrist Pain: The drugs don't work any more

After 2 weeks of antibiotics, most of the pain in my wrist is still there. I can now move my wrist and fingers a bit. I didn't believe the microscopic bite story.

I went to my doctor and he see he could refer me to a rheumatologist or I could pay to see one: he obviously thinks it will be a long wait under the public service.

I said I would wait to hear how long I would have to wait for the public service to give me a referral.