Wednesday, 31 July 2013

Best Laid Plans ...

Anyone following this blog (all two or three of you!) will have noticed that the series on salads stopped abruptly about half way through with a couple still in draft, and I haven't been on here for about 6 weeks.

Well, the best laid plans, as they say .... My knees were already feeling a bit sore and creaky by the second week of June, and then suddenly my left knee flared up and would not take my weight properly.  I started to take my painkillers, then worked up to the maximum dose without the desired effect.  When I ran out, I went to the GP and got more, stronger, and had an interesting discussion with the pharmacist.  As she put it, 'once the pain door opens and you step through it, it's very difficult to shut it again'.  In other words, you have to take the maximum dose in anticipation of the pain in order to get on top of it and stay there while you rest, ice, elevate, compress, apply heat, etc to the joint and carry on doing range of motion exercises.  It rather begs the question about how you know when to stop taking painkillers. At the time, I had a month's worth of dance classes to give before the summer holidays, and the Essential Skills course I was attending to finish. I rested as much as I could, cancelling workshops and haflas which I had intended to go to (curses!), and taking a higher dose of painkillers than previously, which left me feeling a bit woozy. Everything else pretty much went on hold until I could stand to stand.  No work on the garden, no sorting out, cleaning and redecorating, little cooking, the bare minimum of housework. The weather has been outstanding - I don't remember it being so hot and dry for so long since I've lived here, but I could not enjoy it. To my mounting frustration, the flare would not switch off and still hasn't.

I have found a new friend in a physiotherapist/Pilates/aerobics teacher who works in a local community centre where I teach. She has been giving me some physio and Pilates exercises, in exchange for belly dance lessons. The physio helps, but only temporarily, in the same way that doing my range of motion exercises in a hot bath leaves my knee feeling great - until I put my weight back onto it the following day. We seem very much on the same wavelength with regard to anatomy.  I love the peer-to-peer sharing and that I can explain belly dance moves in terms of the muscle groups being engaged, and we have interesting little discussions, like the possible role of the iliotibial band in patellar tracking.

Last week, I had my long-awaited operation to help with the osteoarthritis in my right foot.  When I was 17, I came down hard and with a horrible click on my right big toe in gymnastics class, just before the summer half-term holiday.  The joint swelled up, but the usual advice at school was to run it under the cold tap, take an aspirin, stop making a fuss, stiff upper lip. There were signs that the joint had been damaged and movement was limited by my late 20s.  (My GP at the time told me it was gout, and that if I didn't accept his diagnosis, we had nothing further to discuss.) Thirty five years later, and the bone around my big toe joint had grown so much over the years that I could scarcely bend the toe - hallux limitus/rigidus. When walking, I could not use my foot properly, and it was affecting my gait.  Dancing was painful, as my foot would 'sickle', my weight transferring to the outside of the foot and causing pain in my foot, ankle and knee and back.  I persuaded the consultant to do a cheilectomy, cutting away the excess bone with a view to restoring range of motion in my big toe.  The joint shows severe osteoarthritis, and this may only be a temporary measure; normally they would pin and fuse the joint, which would be sufficient for walking but not really for dancing, and could still affect my gait and create knock-on effects for my other joints. Unfortunately, I'm not yet a candidate for surgery on my knees.

I was so nervous when I went into hospital, but there was no need. The orthopaedics unit at Prince Philip Llanelli seem to have it all worked out. I wouldn't say I enjoyed it - that would be a bit strange, but I think it went as well as it possibly could have. The nurses were nice, efficient with their rounds of observations and concerned for our comfort. I was in a ward with other lovely ladies, all in there as day or overnight cases for foot related problems. We had our details checked, saw the anaesthetist, physiotherapists, consultant/surgeon and one by one had our pre-ops and went down to theatre. I had a spinal anaesthetic, and meant to take an interest, but with a sedative and some headphones on, I went to sleep and woke up in recovery, with a brief snatch of Dire Straits' 'Sultans of Swing' before the headphones were removed by someone asking if I was awake. I suppose I must have been, but was enveloped in pink fluffy clouds of deep relaxation and don't remember going back to the ward. I woke up properly being transferred to bed with my foot encased in a big, padded bandage and resting on an extra pillow. I had a late lunch of a tuna sandwich with a cup of tea, dinner was a potato, almost baked to oblivion, with a plain salad, and drank an entire jug of water. A friend came at visiting time and I went home at the end of visiting time with her, the only one on the ward to go home the same day.

The idea was that I would have sorted out the garden and put up my swing seat, so that I could easily potter out there and lounge in the sunshine, and make it easy to do some moth recording.  As it is, everything has exploded into growth in the six weeks where I couldn't work on it, my swing seat is still in its box, and anyway it keeps raining! I did manage to pick up a couple of bolster cushions from a charity shop, did my best to tidy up a bit and remove the main trip hazards, and found a couple of extra pillows for the foot of my bed.  So now I can lie comfortably on the sofa, with my foot raised higher than my hip, or lie comfortably in bed, and the maximum dose of painkillers sends me to sleep, with the added bonus that my knee is being rested too.  I have to keep my foot clean and dry at least until I see the consultant 2 weeks post op, staying at home with the weight off and the foot up as much as possible, but doing my range of motion exercises for my knee, and various exercises lying down with my legs up to promote circulation (and work on my lower abs 'zip').  The cats have realised something is up, and are a bit worried by me clattering my way around on crutches and lying around sleeping.  They keep bringing me voles and are quite put out when I put the poor, dead, furry things back outside, repeating that I don't eat that sort of thing.

My foot is aching a bit, so I should stop sitting at the computer and go lie down again, although it's not possible to do anything creative in that position. In fact, it's time for bed. Sometimes, you just have to go with the flow.

Tuesday, 30 July 2013

A Pain in the Neck

One of my aims or resolutions was to sort out some of my health issues, so while I was waiting for a date for my foot operation, I decided to chase up a date for the minor operation to remove a cyst from my scalp, behind my left ear.  It was a teenage acne type spot which didn't heal properly when I was about 15 and has been steadily growing since then.  Years ago, my then GP said that I couldn't have it removed on the NHS because it was cosmetic, as it was covered by my hair.  Since then, it had grown to a size where it was noticeable, uncomfortable to lie on, and got inflamed every so often.  Luckily, one of the doctors at my current surgery can do these sorts of minor ops and I had a discussion with him about it late last year - then nothing happened.
So I asked about it, and found that I had not been scheduled. The surgery were mortified to have missed me, and sorted it out as soon as they could, giving me a date in the second week of June.
The day came and off I went, and it was fine.  The local anaesthetic was the worst bit, as there isn't much skin to inject into and it stings abominably until it starts to work - and on me it seems to take longer than expected.  Still, once comfortably numb, the doctor got to work, removed the cyst (which was larger than I expected - at about 2 cm diameter, the size of a small cherry tomato) and sewed me up again. I had to sit quietly with a cup of water for a while, and it turned out that stopping me bleeding was a bit tricky. A change of dressings, with additional pressure from a crepe bandage round my head, and I went off home with instructions not to turn my head much, not to wash my hair for a week, and to return in a fortnight for the stitches to be removed.
I had nothing planned for the evening, but the nurse was a little alarmed that I was driving myself home, lived alone and wasn't taking a few days off work - as I'm self employed, it's not like I can call in sick or just decide not to work!  The doctor, bless him, called me a couple of times during the evening, to check that the bleeding had stopped, I was feeling okay and tell me I had his permission to just sit quietly on the sofa watching a DVD. The nurse called the following day to check up on me again, which was nice, although if I hadn't been okay, I don't know if they would have been able to send someone out or not - there doesn't seem to be much provision for home visits.

As it turned out, the bruising and stitches made turning my head really quite uncomfortable, but the incision healed well.  It was in a place I couldn't see, but I took a few photos to check on the wound. I debated adding one here, but decided no-one would want to see that, yuk!  Unfortunately, by the time the stitches were to come out, they had become infected. So I ended up on antibiotics and then antifungals to deal with thrush as a side effect of the antibiotics, and lots of probiotic yoghurt while I tried to re-establish my gut flora and deal with the side effects of the painkillers I was taking for my knee osteoarthritis flare.

Once off the antibiotics and with only a couple of weeks to go to my foot op, I decided I needed to do a bit more about my fitness, and went to the beach for a swim.  I had a bit of an earache, but after half an hour in the cold, sandy water with bits of floating weed and crabs' legs, I had completely had enough.  I went home, had a hot bath to get the remainder of the sand off me and went to bed with my ear no better. By the following morning, my ear was swollen and I felt a bit deaf. With the earliest available appointment the day after that, I went back to the GP, to confirm that I had an outer ear infection, and needed another course of antibiotics to knock it on the head, so to speak, and ensure it cleared up before my foot op, otherwise the latter would have to be postponed. It took the full week of antibiotics to resolve it, but at least I didn't have any other side effects this time.

All in all, it's been something of a pain in the neck, but with the weight loss as an ongoing work in progress, I think I can now say that the aim has been achieved!