A Fall becomes a Set Back and a Shaggy Dog Tale

Yesterday’s events brought back a memory from 1962 when I was a student nurse in Exeter. I especially recalled a young man on the orthopaedic ward who had a talent for inappropriately releasing the cot sides from his bed. He was recovering from an above the knee amputation but, to his mind and nervous system, the phantom lower limb was far too tangible. Eventually he became an expert user of crutches as he scooted around the ward and, he was soon performing acrobatics on these supports. This young man later returned, on several occasions, to offer encouragement to children both preparing for and having undergone lower limb amputations.

These days with all my sundry aches, pains and other ailments, I envy that resilience. What brought those memories to the fore last night was my having a fall, in the living room at home. I’d just decided to go for a shower but, after the first step I suddenly felt as if my right ankle and foot had just disappeared. No sooner had the thought occurred than I plummeted to the ground, my head landing on the dog’s snout. The dog was on the sofa near the door and, as I fell I heard a growling bark very close to my ear. That growling bark was the dog’s defensive call as this figure fell directly in his direction.

My beloved’s immediate reaction was a desire to drive me down to A&E at the District Hospital but, as I still had no sensation of there being anything below the calf of the offending limb I was reluctant to venture out. Whereas the young man, referred to in the opening paragraph, fell because of the imagined / phantom lower limb. My fall was because I had an intact limb but had suddenly lost all sense of there being an ankle and/or foot there.

We phoned the out of hours doctors number from which we were referred to the 111 service, (? against using the word service), to whom my wife first spoke about me having a fall due to loss of sensation in my foot and ankle. They then spoke to me and went through their usual script – attempting to detect a stroke or the like – but I became increasingly frustrated as she questioned whether I’d had the numb sensation before I got up to walk, despite my constant reiteration that the loss of sensation and my fall were a simultaneous occurrence, even though the numb sensation was still present. She then asked if there was any bleeding and I mentioned I’d had a little bleed from the base of the ear but, that was probably due to falling onto the shocked dog. There were also the usual questions about whether I was running a temperature, “place your fingers on your chest do you feel as if you’re running a temperature” was their suggestion. I explained that in my case I’ve been diagnosed with an infection by a GP even when there was no sign of me running a temperature. Ever since I succumbed to ME (myalgic encephalomyelitis) some 14 years ago, my body thermostat has proved somewhat erratic).

The person on the switchboard then returned to the stroke detection questions – can you raise your arms above your head, can you smile, is your mouth twisted – to which I replied that I didn’t think it was anything like a stroke, having witnessed my mother when she had a major stroke and several TIA’s but, it wasn’t like what I was experiencing. I was just concerned about the loss of sensation in the right foot and ankle and the consequent fall which had proved most unnerving.

I eventually became rather fed-up with the inane repetition of questions I’d already answered from a person who on their own admission had no medical experience, nursing or otherwise, but she did have a list of questions she had to ask. Eventually in frustration I hung up. A short while after that, they rang back to say that there was an ambulance on its way. The ambulance duly arrived expecting to see a dog-bite victim who’d had a stroke!

The paramedics most conscientiously carried out tests on blood sugar, blood pressure, pulse rate and a couple of ECGs. Blood pressure was rather high and the one carrying out the tests did at first wonder if there was a sign of AF. They suggested that I contact my GP on Monday to arrange for a review.

The setback, referred to in the posts title, is that temporarily at least I’ve had to once again resort to the use of walking sticks, albeit as a precaution against a further fall. The shaggy dog tale / story is I believe even more obvious.

 Even an hour after the fall, as feeling gradually returned to my foot, it felt as though I had a crepe platform shoe on that foot, whilst the evidence of my eyes and the rest of my nervous system reassured me that my foot was actually touching the ground.

There was a time when calling my out of hours doctors number would put me through to the out-of-hours doctors clinic at the hospital. There also used to be a service called NHS Direct which had a far higher proportion of medically trained staff dealing with enquiries than is apparent in the 111 service. After this experience I’m rather pleased that for many of us it is, at present, still possible to have a face to face appointment with a flesh and blood GP even though the waiting time is sometimes a problem. I have never felt much adept at communicating with a telephonically disembodied voice, especially one that is so obviously reciting questions from a script!

on the mend and back again

Well, I’ve got to admit that my recovery after the arthroscopy was much quicker than I’d anticipated and, within three weeks I was back to being able to walk the dog on pavement, footpath and fields almost as before the operation. I have to use the assistance of a walking stick at present, but that was the norm until a year ago, but I’ve not had to don my knee supports. Yesterday afternoon, I had a follow-up appointment at the Orthopaedic & Fracture Clinic at the District Hospital and was discharged back to my GP.

During the op they had discovered some degree of arthritis (which hadn’t shown up on the X-Ray), considerable wear and tear of the cartilage and some bare bone into which they drilled two small holes. Incredible what can be achieved through keyhole surgery and, I’m just grateful for our wonderful NHS which the Tories are still intent on destroying.

The only difficulty, if I can call it that, whilst at the hospital was a need to rush to the loo whilst waiting for the appointment; sods law timing of a side-effect from the antibiotics that had been prescribed, the previous morning, for a non-related ailment. It all adds a little (off-)colour to life’s already abundant tapestry.

Now, the back story to the antibiotics: Late on Tuesday afternoon I started to get pains in the upper abdomen, right under and along the rib-cage. At first this felt more like a dull bruise but gradually intensified to a more searing pitch but, I’d had a similar, not quite so acute, sensation a couple of months back which was resolved by a prescribed doubling up of my omeprazole. I’ve long been plagued by digestive and sundry bowel and abdominal problems so, I’ve become accustomed to spasmodic disconcerting abdominal pain and discomfort, alongside other chronic pain symptoms. During the evening this more intense pain seemed to spread into the right-hand side of my back, from just below the shoulder blade into the small of the back. The discomfort & pain reached such a degree, untouched by my usual painkillers, that I had to keep changing chairs, sofas, posture etcetera,  throughout the evening, in an attempt to alleviate each recurring moment of increased intensity.

On Wednesday morning, following a telephonic triage by a practice nurse, I was granted an emergency appointment with a GP. I was amazed, and relieved, that the doctor gave me such a thorough examination of over twenty minutes duration and, judging by my reactions to the examination, he suspected an infection of the gall bladder. The doctor also arranged for a nurse to take some blood samples whilst I was at the surgery and, prescribed a course of Co-amoxiclav. He also asked why I hadn’t gone to A&E the night before, although my beloved OH had suggested that. I explained that I felt A&E were already overburdened and I didn’t want to add to it. The docs response was “but you are really ill!” and, if I experience similar pains again I shouldn’t hesitate in getting down to the hospital.

Early on Thursday morning the GP phoned me to check up how I was feeling and informed me that the blood inflammation flags were rather high and, felt that we were on the right course of treatment. I have to arrange for another blood test in a couple of weeks. Once again, my thanks are due to, and gratefully proffered for, the NHS!

MEDICATIONS Mess Up - Contra-indications

The two previous posts refer to this same topic! I suppose this is simply an update.

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MEDICATIONS: Current state of play. I've now stopped taking both amitriptyline and sertraline ('cold turkey' as followed GP's advice to return unused ones to pharmacy - that was before I'd read the leaflet with the Trazadone that he recommended I started that evening) but am not taking Trazodone.

My beloved OH visited my GP's surgery to point out the information warning me not to take the Trazadone; the receptionist took the details saying the duty doctor would contact me this afternoon. Mid-afternoon one of the practice receptionists called me to say that the duty doctor said it had to be dealt with by the GP I saw yesterday but he won't be there until next Monday. It seems obvious to me that contracted GPs are afraid to challenge even wrong decisions by a practice partner.