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: Cortisol injection

I went to see my rheumatologist and found out my chest x-ray was negative for TB. After all the negative TB tests, I thought he would finally admit that I didn't have TB. So. I asked him. He replied:

"There hasn't been any evidence of TB."

So, that grudging response is the nearest thing I would get to an admission.

He said the next step was a cortisol injection. He offered me the choice of having it injected into a muscle or into the wrist. It would be more painful to have it injected into the wrist so I opted for what a thought was the easy and comfortable choice of a muscle injection. I thought the injection would be into my arm. He sent me off to the nurse with a note. She told me to drop my pants as she was going to inject it up my bottom. I feared for my comfort returning on the bus that day.

It was a painful prick but I managed to sit down 10 minutes later. The injection has helped a bit although I do sometimes get shooting pains in my wrist, which I never had before. I wonder how long it will last. Next time, I might need the cortisol injected into my wrist.

I will be back to see the rheumatologist on 8/1/08.

Wrist Pain: Mantoux result - Spot the TB

I went to the hospital for the second time this week. (first time on Monday to get the Mantoux injection) I had a nice red spot at the injection point on my arm and the nurse looked at it. She got out her black felt-tip pen and drew 2 parallel lines with the distance apart equal to the diameter or the spot.

This highly scientific test takes its results from the spot size. More than 1.5 mm diameter and you've got a TB infection. Less than 1.5 mm diameter and you've not got the infection but have got the BCG antibodies ie a weak form of the infection.

My spot size was exactly 1.5 mm. The nurse wasn't sure how to interpret it. She consulted her colleague. Apparently even a large spot size might be a false positive!!

She thought about sending me for a chest x-ray which is another way of detecting TB. Why wasn't this suggested first. Probably because it's more expensive and has a longer waiting list. She wanted me to come back for it. I persuaded her to send me for one today, as I would have to take yet more time off work another day.

I went to the x-ray department and had to take a numbered ticket before I could speak to anyone. After 20 minutes the counter had ticked up to my number. I spoke to the receptionist. She said I was in the wrong place!! I had to go to the Accident & Emergency X-Ray department. Why couldn't I have been told that by the TB department? It wasn't obvious to me that I needed an x-ray due to having an accident or an emergency. I had wasted a lot of time.

I went to the A&E department but didn't have a long wait for an x-ray. Unfortunately, I couldn't understand the x-ray technician as English wasn't her first language and she wasn't anywhere near fluent in it. Let's hope she didn't over-expose the x-ray photograph and sterilise me in the process.

I'm going back to the rheumatologist on 11 December. Hopefully, he won't want to continue his hunt the TB game and I actually get some treatment for the arthritis. It needs to be tackled quickly as research shows that tackled late, it gets worse more than tackled early.

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: Awake Again

After being injected with a general anesthetic, I did actually wake up again after the biopsy.

I have a sore wrist in a sling, so I'm hunting and pecking with my left hand.

I'll write more about my hospital experience in a couple of days.

Wrist Pain: Morning warning

I was about to go out this morning when my mobile phone rang. It was an orthopaedic nurse from the NHS hospital. She gave me the good news that the hand surgeon had managed to find a space on list this Monday. So, my biopsy could be carried out in 3 days.

Getting an operation done for free in 5 days was due to persuasive argument and desperate pleading. Being a financial adviser on commission, not working means not earning and I haven't been working for over 2 months.

The bad news is that I was asked to get to the hospital at 0730 - I negotiated a later arrival of 0800. There will be lots of waiting around and I might not be cut open till the afternoon.

As I'm having a general anaesthetic, I can't eat after midnight and can't drink after 6am. So, no food for 24 hours :-( Otherwise, I might vomit or regurgitate and some of my undigested refreshments could flood into my lungs causing me to silently drown in my own food & drink.

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: 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.

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.

Wrist Pain: Off work

I'm off work today as I've had a pain in my wrist for the last week. My fingers seem partially locked and contracted and I can barely move my fingers or wrist.

I went to the doctor and he thought I might have been bitten by an insect which left a microscopic bite: i.e. too small too see. So I'm on antibiotics now.