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Wednesday, December 01, 2004

The wonders of the NHS

People who have followed by occasional ramblings for a few months will know that I occasionally post about how treatment for my ankle is going, though in fact it is mostly a chronicle of long waits. Well, I can now announce that things have moved forward, yesterday at the horrendously early time of 0830 I was sitting in the Orthotic clinic waiting for the (late) Orthotist to actually receive my orthoses. Here's a brief recap of how we got to this point. A brief proviso however - the dates are just from memory and so some of the details might be wrong. The first half of 2003 is particularly vague for me as well, so if there are mistakes, it is that period that I bet they are.

Oct 2000 - I slip on the penultimate step of some stairs and end up in an ungainly heap at the bottom, having hurt my ankle. After a few days of pretty consistent pain I go to my GP, who basically says "these things sort themselves out, see me again if it still hurts in six months' time".

May 2001 - I went to my GP sometime between these two dates, but can't remember when, but basically nothing happened. At this meeting however the GP referred me to some physios

June 2001 - About a month later, I can't remember precisely how long, I had physio appointment. Did variuos exercises, and the physio also used some ultrasound of my ankle. Great improvement. Physio stopped in Sept 2001 with nearly total use back.

Winter 2001/2 - Ankle aches a little over the winter. I don't really think about it much. Cold weather, joint injury, winter aches make sense.

Summer 2002 - Ankle starts to ache more persistently again.

Aug 2002 - Move south.

Sept 2002 - Register with new GP and explain about ankle. Get referred for more physio

Oct-Nov 2002 - Second bout of physio, but less satisfied. Some improvement, but not as great as before.

Winter 2002/3 - Ankle worsens (surprise surprise)

March 2003 - Go to GP again. He again refers me for physio.

April 2003 - Physiotherapist basically says, "it's chronic"

May 2003 - I report this to GP, who basically disagrees, and he refers me to an Orthopaedic Surgeon. Initially I am referred to Mr K, a foot/ankle specialist, but because of waiting lists am transfered to Mr O, a more general joint person.

Oct/Nov 2003 - My first appointment. Am referred for yet more physio, and to come back in Feb.

Nov 2003 - More physio. Interestingly, despite being to the Physio department here several times the physios are all different, and indeed I never recognise one physio from another. Basically no benefit.

Feb 2004 - Saw Mr O again. Over the winter my ankle has definitely worsened. He finally takes on board something I have been saying for months (that my ankle is particularly bad after swimming). This is apparently very unusual in 'ordinary' joint injuries, so he arranges for me to have an MRI scan. In the meantime he gives me an ankle brace, but because of the way this deforms my show I can't really use it most of time (basically it meant by Achilles' tendon was getting rubbed raw - not pleasant).

Apr 2004 - MRI scan. Quite interesting. Glad it was just my ankle though - that meant my upper body didn't have to go into the machine.

May 2004 - See Mr O. There is an abnormality there, so it's clear that I really do have a problem and its not just tendons, and it won't heal itself. Am going to be referred to Mr K, to whom I was originally referred. Much irritation.

Aug 2004 - See Mr K. Talk about surgical option, and orthotic option. I opt for orthotic option since I don't see the point in having surgery if I don't need to, and because surgery is always something that can be considered if orthotics don't prove efficacious.

Oct 2004 - See Orthotist, who before I entered the clinic room didn't even know why I was there. The nurse (actually a HCA) is scrabbling through various pieces of paper trying to find the referral slip, and to top it all off he ends up thinking I've got cancer (which I don't). Anyway, the result is he is going to have a pair of insoles and ankle-brace made for me. We make an appointment for the second week of Nov - I was given the option of going in the first week bit decided against it given the election and knowing I was likely to find it difficult to get up.

Early Nov - The brace is in, but the insoles are not. So appt delayed. Sigh, irritation, random thoughts of doing violence to NHS property just because. Can't fault the lady on the end of the phone though, good service that way - especially since she was clever enough to ring in advance so I didn't turn up for no reason. And no, given my experiences of the NHS I in no way take such common sense as granted.

Yesterday - Go and get orthoses. The insoles feel a little weird. They really just are for the arch and back of the foot, not the front third (indeed there is no bit covering the front). The left sole (my good ankle) is neutral, just to make things level for my right (bad ankle) side. The brace also fits the shoe.

The point of these orthoses is that, because of the original injury, my ankle is a little out of joint. Hopefully they will work to put it back in joint, so to speak, and then hopefully deal with the problem that is causing the pain, which is a small area of damaged bone and cartilige. I have to go and see Mr K again sometime in the New Year (probably Feb/March) to see how things are going.

The problem, as I see it, at the moment is that with winter beginning I would ordinarily be expecting my ankle to worsen. Indeed it already is. To some degree then it will be hard to judge how the orthoses are working. At the very least though I would expect to be trying them for a period of months, to give them a decent go - unless they are plainly making things worse.

So there you have it. The wonders of being held hostage in Britain's National Health Surface.

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