Knee

I hurt my right knee when out on a long run, about 20 years ago, tripping over a tree root and having to jog/limp about 5 miles back home. I had damaged a cartilage, and had keyhole surgery to remove the damaged area.

I suspect that rather a lot was removed, and I have had a bit of soreness and increasing stiffness since then.

I eventually gave up running and started cycling - rotational rather than impact. Seemed to work. Then, during building work at home, I slipped off a low wall and landed on my right leg with my leg straight and knee locked.  Seriously painful, over a couple of weeks the pain eased a bit but by no means enough. So I limped along to the GP surgery.

Very professional and communicative doctor (new to me) who agreed it was a soft tissue injury and recommended a scan. So far so good.... until I received a phone call a couple of weeks later to say that the request for a scan had been turned down, as I was over 55 and my knee was almost certainly arthritic!

Dear NHS - so if you are over 55 and active, but get an injury, you are basically written off as not worth treating?

So I go for an x-ray. No feedback and after a few weeks ring a GP. Someone (new to me) calls back. "Oh, did no-one ring you? You have severe arthritis in all 3 compartments of your knee and probably need a knee replacement".

That was a bit of a shock, but by now 2 months have elapsed and I have started some self-help, having found some knee strengthening exercises on a NHS website and have also restarted a bit of steady, low-force cycling on my turbo trainer.  I go along to see a GP and am told, after internal discussions with the practice expert,  that I will be referred to a consultant to discuss the replacement operation. I'm on another NHS conveyor, at the end of which there is a big sign with flashing lights saying "knee replacement'.

I'm unconvinced. I can't exercise much and don't feel so good as a result.

Three months pass by. My exercise regime seems to be working and I am either cycling or walking every day. I can cycle 20 miles and more, or walk for 2 hours with no limping and manageable pain. No communication from the NHS conveyor.

Eventually I get an appointment. I assume it is with a consultant. But no, and this is good news, I see a physiotherapist whose job it is to assess the injury and make recommendations to the consultant.

It's 6 months since the injury and I'm much better. The assessor agrees and shows me the xrays - quite a bit of cartilage left, some arthritis - but is unable to understand the 'replace it' recommendation. Best bet is that radiologists are trained to look for arthritis, guess what they found? But they do not look at the joint as a whole. So why an immediate recommendation after the xray?

Now the recommendation is physiotherapy. The affected knee has slightly limited range and tips inwards slightly.

I'm told that if the knee gets a lot worse, there is a progression, something like:
Painkillers to manage the pain and allow me to keep active
Steroid injections, although they lose effectiveness over time
Last resort - knee replacement

It's 7 months by the time I get an physio appointment, my knee is pretty good by now.

First physio appointment - fortunately I take along the letter from the assessor as this hasn't made it through to the information the physio has. Various tests and checks, recommendation to strengthen my hips as well (specific exercises) as well as emphasis on various knee exercises. I'm happy with this, but why on earth did it take 7 months to get this far? After 3 appointments I'm passed back to my GP and have a list of exercises to continue.

In my view much time and resource has simply been wasted. But the exercises are helping (and I've just started a pilates class too).

Update after almost a year since the injury. Still improving, a bit of pain but I can walk 8 miles plus, cycle for 2 hours / 30+ miles. Pilates is helping, as are the exercises recommended by the physiotherapist. On the advice of a friend who has had similar knee problems I have bought a Bosu Ball which is helping with joint strength and balance.

Exercise makes a massive contribution to my sense of wellbeing.

General practice

I've been with the same practice for 30+ years.

Overall, pretty good. I've never had a problem with any of the doctors or nurses I've come across; some are better at communicating than others and the best ones, in my view, are those who treat me as 'not stupid', explain problems and actions clearly, and respond to any questions and concerns clearly and in a positive way.

The practice has grown over the years and few of the original doctors are still there. It's not a problem, as I don't always request to see 'my' GP - this depends on urgency and availability of course. In any event, I'm not sure if a doctor in such a busy practice can remember individual patients.

I've been fairly impressed with the use of technology - records are computerised and appointments can be booked online. There is an on-site pharmacy and resident physiotherapist and travel nurse.

What could be improved?

The waiting room is small and stuffy with no external light or, it seems, much ventilation. It feels exactly like a place where you go to catch something!

And (I know I'm not alone in this) it is not nice to be told that your appointment has been cancelled when you arrive a few minutes - less than 10 - late due to traffic problems (particularly having phoned on the way to explain that I would be late). Then, the next time I go I have to wait more than half an hour beyond the time of my appointment. I did mention this to a GP and received a letter of apology, so good follow-up.

Torn retina

Out walking on a cold day, a sharp pain in my eye. The following day a cloudy stain spreads across my vision in that eye. I ask my wife if there is anything visible, there isn't, so I ring my optician. Go to your doctor immediately, I'm told. Good advice.

I ring my GP, and am told to go straight to the eye clinic at the local hospital. The GP has rung ahead (thank you) and I am expected. A short wait, eye drops administered to dilate my pupil and I'm seen by a very bright, young, doctor. Checks my eye, talks to the consultant - it's definitely a torn retina. The doctor then takes me to a separate area where a repair (by 'laser welding') is attempted.  Excellent communication throughout; I'm squeamish at the best of times  and by now rather tired and stressed. This isn't fun but I'm helped through it. It's now quite late, around 5pm.

Doctor explains that the tear has been repaired but is almost inaccessible and that I should come back the following morning to see the consultant who has gone home for the day but has more experience and will make sure all is well. I am assured that things will be ok until then. I'm asked to turn up at 8am the following day and am given my notes to bring in - I'm told to hand them to reception when I arrive.

In the circumstances, excellent treatment. I'm impressed by the doctor's communication and approach, and say so.

So, the following morning I arrive well before 8. Hand my notes to reception as requested and state that I have an arrangement to see the consultant (named) at 8am.  Eye drops administered. I am asked to wait.

Nothing happens. At around 825 the consultant walks into the clinic, outdoor coat on. Time passes, I'm still waiting. At 845 the consultant comes out and shouts my name. I go to the room, where I'm given a loud telling off for not arriving on time and not bringing the notes. I explain the facts, and mention their arrival at 825. This does not go down well. I am given very abrupt treatment, accompanied by moaning (eg, the amount of work for the day, my eye drops are wearing off (I wonder why, silently)), continual sighing and loud criticism when I explain at one point that I am in some discomfort.

A truly dreadful experience this time, and I'm unconvinced that a good job has been done.

I come back for a checkup a couple of weeks later and it seems that all is well with the repair.  I'm told to come directly to the eye clinic if I have further problems. However.......

A few months later I think that I have another small bleed in the same eye and go to the eye clinic. I explain the history but am in effect turned away - told to go to A&E. So I do. And wait for >3 hours, to be seen by a very pleasant doctor. I explain the history (they don't have access to my records from the eye clinic), and my eye is checked with the equipment available in A&E. More waiting.  The doctor then tries to call the eye clinic for advice. More waiting. Eventually a discussion takes place. I'm told there is probably not a new problem.

That all took more than 5 hours and consumed a good deal of NHS resource. A 5 minute check at the eye clinic would have saved  a lot of that resource and a lot of my time. Not having my records available doesn't help, either.

Heart rhythm problems

I try to keep fit.

Years ago I did a lot of running but had to give that up due to knee damage - more on that later - so in the last few years I've taken up cycling.  Mostly road with a bit of mountain biking.

A peak distance of 7500 miles in one year, more than 3000 in each of the last 5 years.

I use a Garmin computer with a heart rate strap and can track a range of statistics including HR.

When training for the bike leg of a 2 person duathlon, I notice that I get some periods where I can feel my heart fluttering, with a high HR being reported by Garmin; this is mostly under certain specific conditions - for example, when I reach the top of a hard hill and ease off both in effort and breathing intensity. There is no pain, discomfort or breathlessness, just a mild fluttering sensation.

I print out a few example Garmin traces and go to the GP. Sensible recommendation - wear a medical-quality monitor for 24 hours. So I'm referred to the local hospital, the monitor is fitted. I can replicate these events at will and do so, and can pinpoint the time by cross reference to the Garmin trace.

A month later I have an appointment with a consultant to discuss the results. Apart form a fairly crude line of questioning to gauge if I'm really thick or not, I get a very clear explanation of how my heart's electrical circuits operate and what may be happening. An investigative operation is recommended, and I agree.

This takes place, after the necessary preparations. General anaesthetic, drugs administered in an attempt to provoke the problem, sensors posted through an artery in my groin to see what's going on.

No fault found!

Follow-up with the consultant. I explained that I am able to manage the problem, mostly, by careful breath control, and I'm returned to my GP as 'no further action needed'.

I still get spikes but with care these do not get into dangerous territory. But I can't attempt to get to higher HR zones without seeing higher spike levels. Therefore, more slow and steady and less high intensity training.

Update April 2016 - after 6 weeks of winter sun in NZ, and lots of walking and clean air, I found that the spiking had pretty much disappeared when I restarted cycling on my return to the UK mid-March.     I can still provoke spikes still by silly effort levels with limited breathing, but even then there is an improvement. I wonder why?

Gallstones

I've had a dodgy digestive system for some years, and have been prescribed Ranitidine (aka Zantac), which is a proton pump inhibitor, to control the production of stomach acid.

Over time though, I have an increasing number of episodes in which a painful 'ball of something' seems to move slowly from my stomach and through my intestines. Eventually, these episodes become more frequent and painful and I'm laid low with severe pain coupled with what, from the symptoms, would seem to be gout in one shoulder and one knee (joints that have previous damage).

If you've ever had gout you will know that it is excruciatingly painful.

So, off to the GP. Immediate suspicion of gallstones (although the gout symptoms are 'odd') and I have blood tests which confirm the likely diagnosis. A scan at the local hospital confirms that I have gallstones and these are way too big to be expelled naturally. (The blood rests indicated impaired  liver function which might explain the gout symptoms, but that remains a bit of a mystery).

Removal of my gallbladder is the only recommendation. I see the potential surgeon and am given a very clear explanation of the problem and also why the stones cannot be dissolved or disintegrated as is done for kidney stoned. Good detail on what's removed, clipped, etc. So I agree to the operation, which is billed as keyhole surgery (turns out to be 4 large keys!) on a day ward.

Pre-op assessment done and passed, I arrive at 8am for the operation and am given heavy-duty paracetamol to take, dulls the edge of post op pain, I'm told. I'm not informed of timing but when I ask it seems I am second on the list, about 10am. The paracetamol sends me to sleep. I wake up at 1030, nothing happening, no contact beyond the initial induction. Just after 11 I'm wheeled off to the surgical area.

I'm in the room where anaesthetic is administered. Suddenly 4 people come in and start doing stuff. They are talking to each other but not to me, unless they are about to stick something in my hand. Very impersonal. I go to sleep......

.... and I wake up back where I started in the day ward, feeling woozy and sick, very thirsty. No-one around and no button to press.  Day ward nurse eventually comes round. I ask for a drink of water. This arrives but I am then left but do now have a button to press. Still feel very dozy.

Eventually the ward nurse comes back and encourages me to get up and walk around. I ask for another drink - my throat is dry and sore (tubes down it during the op?) but my kidneys are not working... lots of liquid sloshing around my stomach. I try to explain, but body language from the nurse basically says "I'm just waiting for you all to go home so I can get away".  Much rolling of eyes and sighing when I ask for another drink - I'm informed that drinks are available "down the corridor".

So I get out of bed, no help provided, and shuffle around, get a drink, eventually go to the loo and start to feel a bit more human. Eat a sandwich which just about stays down. There is no follow-up visit from the surgical team. The nurse calls by again with discharge notes, takes my blood pressure and says I can go - 'any problems call your GP'. So I get dressed, phone my wife and shuffle along, alone and carrying my bag, to the waiting room.

A rather painful few days, no problems and I start to get more mobile. Absolutely no follow up from the hospital or GP.

Dear NHS - the day of the operation gave me the impression that I was on a conveyor belt. very little human interaction and minimal attention and care. It may only be day surgery, but it is still a tad traumatic and you feel pretty sore and woozy afterwards.

A few months on, my body has got used to the new flow of juices. I have to be so careful with what I eat, and when, as it takes much longer now to digest meat and fatty foods. But much better in terms of stomach pain, which was the point of the exercise. No recurrence of the gout symptoms, thankfully.

Update after 18 months, all is well. I still need Ranitidine for stomach acid and have to be *really* careful what I eat, but my general health is better.

Introduction

I'm getting on a bit.

Born in the late 1940s, things are starting to creak and go wrong, with the result that I'm using more and more NHS resource.

The NHS has been described as the nearest thing to a UK-wide religion. It currently employs one in fifteen of those in employment in the UK, and this is forecast to rise to one in eight over the next 20 years. It's the worlds 5th biggest employer, behind only the USA and Chinese armies, Walmart and McDonalds.

I'm concerned that this growth is unsustainable, and that costs are already close to unaffordable. Is it possible to maintain the current NHS services and add new techniques and treatments as medical science and technology advance?

This blog is intended to give an insight into my experiences of the NHS, good and not-so-good. It is not intended as a forum for any or all of praise, criticism or complaint. No names are provided and I've not included dates as I do not want to see any attempt to follow this through.

I've not really attempted to draw conclusions or recommend solutions although some of my comments may head it that direction.

I am grateful that the NHS exists and provides the medical support needed, although not always in a timely, pleasant or effective way.

One general observation, though, that I find unavoidable - NHS staff at all levels must have excellent interpersonal skills, and in particular a positive and caring attitude. Most do, some don't and the latter damage attitudes and perceptions of the service as a whole. And I hate being patronised.... it happens.

Of course, NHS staff need patience when dealing with some of the less pleasant patients I've seen in A&E and elsewhere. I don't envy staff members then........