Beyond The Day Care Unit

Physiotherapy sits in a wasteland way up beyond most of the clinics I already know.  It’s deeper into the hospital than X-Ray or Pharmacy, both places where I’ve spent more hours on hold than I have with BT.  It’s beyond  Short Stay Surgical where I’ve sat in fear and trepidation waiting for catheters to be inserted and cameras on long flexible sticks to be turned on.  It’s out there, further than the cubby hole occupied by Radio Glamorgan, UHW’s own station.  Here Vince Savile, hospital porter and brother to the late ungreat and now late himself other Savile once deejayed.  Does anyone now listen to these enterprises?  There are nineteen presenters all beaming in the staff photo and twenty-three thousand visitors recorded as having visited the station’s new web site.  Local radio clearly rocks on.   Then there it is.  Physiotherapy announces the sign.  I’ve arrived.  The waiting room is dense with seats,  buff,  serried, uninviting.  There’s a rack next to reception where you can leave your crutches.  The art of the recycle. The places is like Lourdes.

I’m here to learn how manage.  What can't be fixed can certainly be accommodated.  So I'm told.

Rich, his name is on his badge, the man who will sort me out, is fitter looking that I was at his age.  In fact he’s fitter looking than I’ve ever been at any age.  With his huge healthy hands he takes notes, asks questions, learns about my case.  He checks my records, my graphs, my MRI scans on the hospital system.  He tells me that it’s the cyst that’s the issue and the way it bulges, flows, ebbs, and presses.  I had an idea it was. We can’t solve it here, he says.   But we can help manage.  Yep.  Manage.  Word of the age. 

I get a demonstration of lower-back specific exercises – stretches and flexes – things to help with the discomfort, when it flares.   He hands me a sheet showing the routine being done by a stick man.  Round head, smiling face, no hair, thin body.  Me.  To a tee.

Back home I do the stick man thing while staring out of the window.  Point hands at feet and hold for thirty seconds.  Sit up.  Bend back.  Breathe.  Repeat. 

Beyond are men here to build a new extension.  They have their hoods up against the cold and wear knee-high leather boots like they might have done  at the battle of Omdurman or when riding through the brush in the cowboy west.  Now it has stopped endlessly raining  they are digging up the patio.  They uproot plants and crack slabs into slivers ready for the arrival of the mechanical digger.  This wonder machine on tracks will excavate the footings.

  

By now, like me, this house had almost all of its innards explored and tested.  It’s old, it’s been around, it needs some tlc.  Rods have been inserted into cavities, coverings have been lifted to check the sub-structure.  Cracks have been discovered, stitched and sealed.  Roofs have been waterproofed.  Steps mended.  The framework has been stabilised.  Damp ingress excised.  Blood counted.  Temperature taken.  Wiring renewed.  Body declared to be about as okay as it’ll ever be “for a build of this age”.  It’ll all be okay for the medium term. 

Quite how long that medium term will be is no one is actually prepared to say.

The sky is cold, winter blue.  Uprooted plants and fragments of slab begin to appear stacked in the skip.  The dross we no longer need.  When they are done I’ll get the guy on the roof with the scraper and the claw hammer to have a go at Mr Synovial down there in my lower spine.   Hit it a couple of times, squeeze it out and then stick the incision back together with two screws, some hi-flo instant set grout and a metal strip.  Plaster over.  Allow to dry then paint.  You’d never know there’d been anything there.  Okay for the medium term.  That’s all I need.

I have a cup of tea and two naproxen.  Next week I see the neurosurgeon.  He does scraping out and re-grouting, so I’ve been told.  Does it with micro precision  and has an 80% success rate.  He doesn’t wear a hood and comes to work by BMW and wearing  patent leather shoes.   He probably doesn’t listen to a radio which has a large battery stuck to its outside with masking tape.  That’s my guess.  But how do I know?

How It Begins

In the pharmacy they ask me the question. Are you expecting three hundred Prednisolone tablets? It sounds huge number. I don’t know. Am I? To be safe I nod and, after checking that I am who I claim to be, they hand me the bag. It’s a huge thing like the sort the old used to get when I was younger. Prednisolone tabs by the packet load. Tubs of Calichew. Boxes of Omeprazole. And my favourite, the one you take weekly, standing up, Alendronic Acid.

I set off up the road. There’s late autumn sun shining on me but I don’t notice. Am I gripped by fear and apprehension? Not yet. The polymyalgia is still riddling my proximate muscle group, wrapping itself round my neck and making everything feel appalling. It feels like it’s time to give up.

There had been arguments at the doctors. I’d visited my local GP who has a surgery a ten minute walk down the road. I was convinced that this was some sort of reaction to statins, just like it says in the statin small print that comes inside the box. May affect some people. Me. All I had to do was give up my Simvastatin, wait a bit for the stuff to clear the system and everything would settle down. Only it had been eight weeks so far and things were now worse than they had been. Hard to get out of bed in the morning. Impossible to sit in a car for longer than ten minutes. Pains when squatting. No, couldn’t squat. Aches now starting in my upper arms. Hell on earth when I tried to sleep.

So it clears once you are up and about? It does. And returns when you sit still for a time? Yes. Getting worse? Certainly. On a scale of 1 to 10 how bad is it? With 10 being dreadful and 1 being clear. 7. Mmm. I think it’s this. She turns her screen to face me and there’s a description of Polymyalgia Rheumatica. I’ve never heard of it. It sounds like something you are born with, a disease of the nerves, something that creeps up out of the genes. A thing others develop. It usually affects older women, especially those over 70, the GP gently tells me. But I think it’s what you’ve got. She looks concerned.

I agree to two blood tests a fortnight apart. If my ESR and CRP rates show elevation then that indicates inflammation of the muscles, a PMR pointer. I see the nurse and take the first one. I don’t look as the blood enters the syringe. I’ve passed out before while casually gazing. Had to be brought round by nurses applying cold compresses. Once while having an ingrowing toenail excised fainted and had to be revived with oxygen. I have learned simply not to stare. Usually does the trick.

When the results come in they show elevation. The first test throws up an ESR of 19 and the second of 40. The CRP shows first 28 and then 30. On my return to the surgery the GP tells me that she’s pretty sure this is Polymyalgia but that luckily there is a treatment. And one that works every time. She doesn’t actually say there’s a miracle cure available but I can hear the words hovering somewhere above her head. I am given a prescription for prednisolone and then warnings about how prednisolone is a steroid and that steroids have side-effects. But remember that the condition, the PMR, is far worse than any possible side-effect and the steroid will see that off, says the GP. She sounds like she means what she says but I am unconvinced.

Can I have some more pain killers to get me through the night, I ask? I’ve been taking everything from Naproxen, a sort of super ibuprofen, to heavy dose Co-codamol. These knock you out, get you through the dark hours but during the day leave you in a permanent fog. You won’t need them, she says, smiling. Hard to believe, that answer. In fact I simply don’t.

So here I am, crossing Newport Road with my drugs bag. And my PMR description print-outs and my instruction leaflets and the notes I took during the consultation. And a load of fear getting in the way of everything. Putting the things down my throat comes next.