chrishansenhome

Last Thursday I discovered that I had a mild case of cellulitis in my right leg. It was a bit pink and warm to the touch. I had had a high fever on Tuesday night, and a lower one on Wednesday. I thought it was the flu. The Foot Clinic prescribed an intramuscular injection of antibiotics for two weeks. They gave me the first one, in the butt cheek, and arranged with the District Nurses to come and continue this for two weeks.

However, HWMBO and I had planned for a month a day trip on Saturday to Liverpool, and since I had to wait for the District Nurse, I couldn't go. I was gutted.

On Saturday the nurse finally arrived at 2 pm, and I told him my tale of woe. He asked me, "Why didn't they show you how to do the injection yourself?" I was flabbergasted. I hadn't been aware that patients could do this. So I could have gone to Liverpool yesterday after all.

This afternoon he came by around 12:30, and taught me how to clean up beforehand, mix the antibiotic, draw it into the syringe, change the needle, and administer the injection. As the antibiotic is mixed with lignocaine, an anesthetic, I felt nothing, although I was aware of the antibiotic entering my thigh muscle. It was also interesting that I could tell when I was going through fat and when I hit the muscle solely by the way the needle felt as it was going in.



On reflection, I should have known that this was possible, as I have friends who are female-to-male transmen, and when they are on testosterone (or "T"), they do an intramuscular injection once a week, and are taught how to do that by their endocrinologist or the endocrinologist's nurse.

So tomorrow one of the District Nurses will come by to watch me do it and deliver smaller needles for the injections. Then I'll be left to do it myself. I shall have a quiet word with the Foot Clinic. Maybe it will help.

Now, as he's said before, London Stabbie yields to no one in his respect for the National Health Service and its doctors, nurses, and supporting staff. They do a tremendous job in the face of massive government cuts, insensitive patients, and inadequate facilities.

However (Stabbie is certain you knew there was a "however"), the events of this last weekend have been very hard on Stabbie and nearly shook his faith in the NHS to the core.

On Thursday of last week, Stabbie received a letter informing him that a bed had been found for his procedure and that he would be called on Sunday to be told where to go. Besides the fact that Stabbie is up for more than one procedure, the letter itself was misleading, making Stabbie think that he'd neglected to confirm his appointment. So Stabbie's first target is the person who wrote that form letter. As Stabbie is not particularly keen to shed any blood, what he does want to do is cut that person's computer up into tiny little pieces and restrict him or her to writing with a quill pen. It might allow him to actually think about what he's writing.

The call finally came at about 5pm on Sunday. Stabbie was to report to Vlad Dracula ward (the name has been changed to protect the guilty) at 7pm. Stabbie and his partner duly reported there and then Stabbie was left alone.

The procedure was an angioplasty of the leg, to try to improve the circulation to Stabbie's foot. While this procedure is carried out under local anesthesia, the patient is not allowed to eat or drink anything from midnight the previous day. Normally they would have hooked Stabbie up to a combined glucose and insulin drip from midnight until the operation. This is suboptimal, as Stabbie would have had to be woken up each and every hour for a blood sugar check. So Stabbie convinced the nurse to allow him his usual dose of long-lasting insulin before bedtime and only to hook up the machine in the morning.

Vlad Dracula ward has about 12 beds in the men's section. Stabbie's neighbour was a big man (around 6'5" tall and a bit heavy). When Stabbie tried to fall asleep (in the very inadequate hospital bed) his neighbour began to snore. It was probably a 90 decibel snore. This was not good. So when the snoring ceased, Stabbie was quite happy until it became clear that his neighbour has sleep apnea. After 30 seconds or so his neighbour's breathing and snoring would begin again, starting with a phenomenal sound of sucking-in air. Now Stabbie occasionally snores (but not often), and Stabbie's partner also occasionally snores (but not often), but this kind of snoring puts both Stabbie and his partner to shame. Stabbie is not one to cut up people who can't help being annoying, but perhaps an emergency tracheotomy for this gentleman might be warranted. Stabbie will lend the doctor his knife for the occasion.

Monday dawned, and Stabbie was denied breakfast. Hours passed—Stabbie was then denied lunch. However, Stabbie could smell the food odours wafting their way from the adjoining cubicles. Fasting makes hospital food seem to be pure ambrosia, but it was an ambrosia that Stabbie was denied.

Finally the nurse came over (quite a cute male nurse—Stabbie was quite smitten) and said that he'd be taken down to the angioplasty lab at around 4pm. He was still connected to the glucose/insulin pump.

The angioplasty was interesting—Stabbie could see his arteries coloured on the X-ray picture as the surgeon threaded the wire down there. When the balloon was inflated, Stabbie could not only see it on the monitor, but feel it in his calf. It was like an electric shock. The operation took around 3/4 hour, and Stabbie was then returned to Vlad Dracula ward.

Of course, by this time the hot dinner was over, so Stabbie was forced to eat a sandwich. Quite inadequate. And Stabbie was also forced to lie flat for two hours to keep strain off the wound. Kings does not suture the arterial hole they use to feed in the wire and balloon, so the surgeon applies a complicated plaster and then pressed down on Stabbie's groin for ten minutes. You may believe Stabbie when he says that it was not as erotic as the words would lead one to believe.

The end result was that 1 out of 3 of Stabbie's leg arteries could be cleared. The other two are irretrievably calcified. Stabbie may have an arterial bypass if the quacks think that more blood is necessary. However, he noticed that his foot is pinker now.

After lying in bed for two hours, Stabbie wished to "spend a penny", in the old English parlance. The nurse refused to let Stabbie walk the 20 or so steps to the loo; she brought in a commode and closed the curtain. Stabbie was not happy. We too shall draw the curtain over Stabbie's Monday evening. Suffice it to say that Mr. Buzz-Saw in the next cubicle was in fine voice that evening and Stabbie did not get a whole lot of sleep then either.

Tuesday morning dawns! Stabbie is to be discharged today! Hurray! But first, Stabbie's leg and foot have to be seen by the vascular surgical team to ensure that everything was working as it ought. Stabbie had originally had an appointment at the foot clinic for the Monday. However, then he got the letter, he called the clinic and tried to arrange it for the next Thursday, as he would be otherwise engaged on the Monday getting wires shoved down his groin and balloons inflated inside his arteries. The receptionist offered a Tuesday appointment. Stabbie thought, "Oh, I'll be right here so Tuesday will be fine; I'll just have to walk downstairs." and took the appointment.

At around 10:30am Stabbie left Vlad Dracula ward, telling the staff that he was going to the Foot Clinic and would be back as soon as possible. When he got down to the clinic, the receptionist could not find his notes, and much running around ensued. Stabbie, meanwhile, waited in the clinic for 2-1/2 hours while everything was sorted out.

It transpires, when Stabbie is finally seated in an examining chair in the clinic, that the vascular team had tried to visit him in Vlad Dracula ward, was told that he had gone to the foot clinic, and decided not to call Stabbie back but to see him when they got down to the clinic.

The head vascular surgeon has a really good bedside manner and pronounced Stabbie's operation a qualified success, as his foot is pinker and the pulse better. The podiatrist then poked around Stabbie's foot with his scalpel at the ready, and said, "Oh, your ulcer's healed now; there's just a scab over it."

So that was good news. However, worse news was to come. The nurse at the clinic couldn't administer my antibiotic (IV) because he was off sick that day. The podiatrist told Stabbie to go back to Vlad Dracula ward and tell them to administer it. He also told Stabbie to return in 3 weeks. That's almost a record. But the good news ends here.

When Stabbie got back to Vlad Dracula ward, he discovered that his hot lunch had been removed and the only thing he could eat was a ham sandwich with English mustard. On white. Oh, joy!

The nurse prepared Stabbie's antibiotic (it's a powder that must be diluted in water then injected into a drip bag to be dripped into Stabbie's PICC line. Then she came back and informed Stabbie, "I can't administer your antibiotic although I've prepared it; your drug chart is missing." Stabbie suggested that the nurse find a doctor (it's surprising how difficult it is to find a doctor in a hospital, but Stabbie digresses…) but she said that was totally impossible and Stabbie couldn't have his antibiotic Tuesday.

After a bit of searching they found Stabbie's drug chart tucked into the folder of the patient to Stabbie's left. The nurse could then start the IV. But Stabbie's got a little list, and the numpty who filed his drug chart in the folder for the next bed is on that list. Stabbie will content himself with taking that person's medical diploma and slicing it into confetti with Stabbie's dagger. That person obviously needs a refresher course in filing, and having to prove his qualifications again may make him think carefully before taking someone else's drug chart.

The IV drip ended, and meanwhile the staff on Vlad Dracula ward were responsible for getting Stabbie's repeat prescription for antibiotics. A jobsworth from the Pharmacy department hectored Stabbie to tell her how much insulin he takes and when. Stabbie protested that everyone who needed to know this information already did. "We need it for our records." she responded coldly, and wouldn't go away until Stabbie gave her the information. It went on a letter that no one will read.

Somehow Stabbie thinks that using his blade on jobsworths is unworthy of the blade. In a way, it stains it with blood that it should never touch. So Stabbie will not physically hurt the jobsworth. However, Stabbie would be pleased if the jobsworths in the Pharmacy Department were classed with the telephone sanitisers and telemarketers of the Hitchhiker's Guide to the Galaxy when the revolution comes.

The jobsworth left Stabbie at 3 pm, saying that his antibiotics would be up at Vlad Dracula ward in an hour. Stabbie settled down to a book by Alfred Bester, and finished it by 5 pm as it was an interesting but easy read. No antibiotics. The nurses studiously avoided looking at Stabbie, all packed in his cubicle and ready to go home. So Stabbie went to the nurses' desk and enquired, politely, when the prescription would be ready so that he could go home. They said that it was coming up right that second. Stabbie went back to his cubicle and fumed.

At 6 pm one of the charge nurses (who was quite cute) came to Stabbie's cubicle and said, "You have a PICC line?" Stabbie's short-sleeved shirt revealed the PICC line better than anything, and he just showed his arm to the nurse. Then the nurse said, "We will have to send a fax to the District Nurse to tell her that she has to visit you and after that we'll give you the antibiotics."

Stabbie nearly lost his temper. He said, "I have been taking these antibiotics for a month and a half now. I have a good working relationship with the District Nurses and had already arranged for them to start coming again from Wednesday. You do not need to send them a fax; it's been taken care of. I have been sitting here for three hours. All I want IS MY ANTIBIOTICS and to GO HOME NOW!" Stabbie's last nerve had been plucked.

The nurse, alarmed at Stabbie's reaction, brought the bag of antibiotics and other supplies over and quickly went over the paperwork. Stabbie thanked him coldly and started down the corridor leading away from Vlad Dracula ward. The nurse charged after him and asked, "I almost forgot; do you have syringes?" Stabbie fixed him with a stare and said, "All I need is the antibiotics and the saline bags; everything else is provided. Good bye!"

Now Stabbie would normally have thought of eviscerating the poor nursing staff for treating him like this, as well as the pharmacist who lied to him about the timing. But, Stabbie is a forgiving kind of chap, and the nurse (did Stabbie mention he was a Hispanic male nurse?) was very cute. So Stabbie would probably content himself with cutting the shirt, trousers and boxers off the guy and ensuring that pictures were taken for later, private, consumption.

All in all, while the angioplasty did some good and Stabbie's foot ulcer is nearly healed, Stabbie's blood pressure probably soared through the top of his head and all his nerves were plucked so hard that they played Dies Irae. Stabbie got home, dropped his bags, and had the first hot meal he'd had since Sunday lunch.

So Stabbie is grateful that the blood supply to his right foot has improved, and he is grateful that the right foot ulcer seems finally to be healing up. But every other part of the stay at Vlad Dracula ward was purest hell, and he hopes that he never has to stay there again, if for no other reason than that the staff will brand him as "difficult" and take every opportunity to ignore him.

I may have mentioned a few weeks ago that I was measured for orthopedic shoes at the diabetic foot clinic. As I had to attend there today to have my walking boot repaired (the lining had come off and ruined a suit and nearly ruined my leg) I was happy to learn that the shoes had arrived. The lovely man who fits shoes put them on me and I walked around a bit. For the first time in years I am wearing a pair of shoes that do not rub or chafe and which do not cause me any pain. I was so happy I nearly cried.

They look a bit boxy, but I don't care. They are dress shoes (wing tips) and can be worn instead of my boot, as the insole has been designed so that it takes pressure off the ulcer on the sole of my left foot.

Once these shoes are judged a success they will make me a set of walking shoes to the same measurements. They will also give me extra room in them so that when I travel and my feet swell from being on the plane, I can remove one insole and have more room for a few days while my feet return to their proper size.

All of this is designed to keep my shoes from injuring my feet, thus keeping me away from the foot clinic. And, for those who are wondering, these shoes are free on the National Health Service. I am so grateful to my adopted country for having the humanity to allow me, and others in the same situation, to receive the medical help we need to keep ourselves in good shape and alive and ambulatory longer. As someone who is currently unemployed, in the United States and other places where health care is not provided to those who need it but cannot afford it, I would have to continue to wear shoes that chafe my feet and create calluses, blisters, and ultimately infections. These can lead to amputation or worse.

Thank you, NHS!

As most of you will be aware, I'm a diabetic and constantly have to go to the quack for this checkup or that checkup. For my foot I go to Kings College Hospital Diabetic Foot Clinic. For diabetes itself, I am currently attending the Diabetic Clinic at St. Thomas's Hospital. I go to my own GP for prescriptions and anything other than diabetes.

A couple of months ago I got a letter saying that I had an appointment with the lipid nurse at the Diabetic Clinic at St. Thomas's. OK, no problem. That's all the letter said. No instructions about what to bring (urine sample, perhaps) nor restrictions on whether I could eat before the appointment.

The rest of the background to this is that, while taking simvastatin my cholesterol has been normal to low (for a diabetic) and my ratio of good to bad cholesterol has also been very good. So seeing the lipid nurse or doctor isn't top-of-mind for me.

Yesterday I turned up at St. Thomas's at around 11:05 am, saw the receptionist, then went to wait. The nurse's assistant came out and took my blood pressure (127 /71!) and weight (not so good). To the waiting room again, where a few minutes later the lipid nurse emerged and called my name. Into her office we went. She is from a middle European country and had the accent to match.

She started by asking a few questions which others had asked me before in the clinic, and the answers to which were on her computer. Then she said, "You've been fasting, haven't you?" I said, "No, I haven't." "Why not?" "The letter I got didn't request me to fast and the time of the appointment (11:30am) wasn't conducive to fasting, anyway."

She looked at me: "You should have known when you made the appointment that you needed to fast." "Hold on," I said, "First, I didn't make the appointment—the clinic made it. Second, I'm diabetic, on insulin at night, so morning fasting could be dangerous for me." She was wearing my last nerve very thin indeed. She then ordered me to fast whenever I come to the lipid doctor or nurse.

Then she came to my record and asked me whether I had any family. I mentioned that I was married in a civil partnership. She said, "There's nothing here to allow for a civil partnership. I'll put you down as 'Cohabiting'." I replied, "No you won't! Civil partnership is equivalent to marriage, so you will put me down as married." Nerve is now even thinner.

She then said, "Do you have brothers and sisters?" I replied, "Yes, one of each." "We must make sure they know that they are at risk for diabetes and hypertension genetically." I looked at her and, as calmly as I could, said, "My brother had a heart attack at the very same age I did, with angioplasty and a stent, just as I had. He was at the same time diagnosed with diabetes. I think he knows already. My sister is well aware of my brother's and my situations, so I'm certain she knows of her own risk as well. In any case, they both live in America so the NHS won't be taking care of them anytime soon."

She then proceeded to lecture me on the evils of bariatric surgery, telling me about the grim side effects and promoting the virtues of simply eating less and exercising more. I had really had enough, and told her that I had been lectured like this for the last 50 years or so, and none of it was helpful enough to help me to lose weight. I know all this. What I need is help to lose weight, and bariatric surgery is my last hope of outside help bar wiring my teeth shut; it has also been shown that certain types of bariatric surgery assist in fighting off insulin resistance in your body, even before weight loss has begun.

She ended the appointment by giving me a ticket to have blood drawn for lipid testing, saying that the fact that I hadn't fasted didn't matter, really. Some other tests would be run and when she got the results she would send them along to me. I told her: "I already get enough bumpf from the NHS—please don't send me the results unless I need to follow up on them in some way or other. She countered: "We like to keep our patients involved in their treatment." I had to be firm: "Let's save the NHS some money and not send results unless something or other needs to be done, please. Thank you." Reluctantly, she agreed.

Those who are familiar with the "Carry On..." movies will remember the Matron, Hattie Jacques, who was a blunt, no-nonsense head nurse in many of the films. The Lipid Nurse reminded me of the Matron, so sure of what she knew and imposing it on everyone else in the hospital. It goes to show you that a good "bedside manner" is vital when doctors or nurses are dealing with patients; how much brighter and useful would this appointment have been if the Lipid Nurse's manner had been helpful instead of confrontational.

I emerged, had my blood taken by a lovely nurse (all the nursing staff who do the routine vital signs in the Diabetic Clinic are a joy, especially the dishy young man who was also in the Cardiac Intensive Care unit when I was recovering from my heart attack) and then marched back to the bus for the trip home and to lunch in the church Drop-In. I was not best pleased.

My foot is still bothering me. When I went to the foot clinic the day I returned from the United States, the podiatrist helpfully not only took off my left big toenail (her comment was: "That was the easiest toenail removal I've ever done."—not that the comment made me feel any better) but also cut out a blood blister that was on the ball of my left foot. This was bandaged with a support pad and instructions to return in 2 weeks.

The wound has wept and bled continuously for the past two weeks plus. The podiatrist who saw me last Wednesday said that it was coming along fine, but I wonder. It's still weeping. There is no pain of course (I no longer have any meaningful feeling in my feet) but it's very inconvenient and is keeping me from moving around much. I am to see them again in two weeks (and continue taking the antibiotics, of course) but I will have to ask them then whether there is anything further they can do.

The kicker (appropriate for toes, I suppose) is that, strictly speaking, I don't believe that this needed to be done. I have in the past had blood blisters under my skin on the sole of my foot. What normally happens is that the fluid, after a couple of days, dries out and, a few weeks or months later, the "scab" comes to the surface and is worn away as normal as the skin on my foot renews itself. I wasn't even aware of this particular problem before they cut it out. So I'm wondering what I should do. In the future I might ask that they either don't cut such things out (if they find them), or explain to me why the normal course of events is not good enough.

When I got back from the US, there was a letter waiting for me that informed me that I had a meeting with a lipid specialist and a dietician on June 30th. I was puzzled as at my last diabetic clinic appointment no one had mentioned that this was to happen. However, as I am nothing but dutiful, I trotted along this morning.

The lipid guy (who saw me 15 minutes late) was nice, and we had a good conversation, but some things stood out for me:

• Even though they had measured my height when I first went to the Diabetic Clinic, they insisted on taking it again. I am not convinced that the likelihood of my height changing from then (last August) to now is very high—though non-zero.


• About three months ago I went to take a fasting blood test for cholesterol. Everything was good to super-good (bad cholesterol is low, good cholesterol is high, total cholesterol is low). My diet hasn't changed between then and now. He wanted to take another blood test (and this one non-fasting). I said that referring to the previous test in my records would be a good thing instead of sticking me again. Thyroid blood tests have been taken repeatedly in the past and found no problems. So why stick me again? He wanted to fool around with my feet, and I said that I had had enough fooling around with my feet in the past month for my own comfort.


• The dietician (a man, unusually, but his badge indicated "Head of Dietetics", so male privilege wins out—also possibly a Friend of Dorothy) discussed various things with me. After looking at my usual intake he was rather glum. He said, "Normally after talking to a patient I can put my finger on an easy win for weight loss—cut out the gallon of ice cream a week, for example. You don't have any easy wins in your diet. Portion control is the only way forward and, as you have said, sometimes that is very difficult when dealing with the kind of things you eat, such as pasta."


• When the question of bariatric surgery came up, it turns out that I am just a bit too thin to qualify for it on the NHS. They require a BMI of 35; mine is 34.2. We discussed some of the new insights into bariatric surgery and diabetes that have surfaced recently, including the duodenal stent and duodenal resection, both of which seem to also lessen the amount of insulin resistance the patient experiences and in the preponderance of cases actually bring the blood sugar down to normal before there is any significant weight loss. He wasn't too familiar with them (although he did mention the "duodenal stent" which is the technical name for the procedure I described to him) and, like all the other people I see, remains convinced that rather than try something of this nature it's better to make the gluttons pay for their past sins. Of course, he didn't put it that way, but there is a reluctance on the part of health professionals concerned with weight and eating to accept the fact that people who have had weight problems all their lives can greatly benefit from something more than a pat on the back and a kitchen scale.


• There was one piece of good news: my blood pressure, without having taken my diuretic this morning, was 127/73, which is almost totally normal. The doxyzosin that they started me on a month ago seems to have lowered my blood pressure significantly, even without the diuretic. This is good news, although I would prefer to have had it happen through weight loss.

So now I'm back home blogging about it. I'm relatively glum about all this, The fact that the NHS is not only not joined up between hospital trusts themselves and between hospitals and GP is bad enough: even within the same clinic they are not joined up between different health practitioners. This is worrying, because it's now up to me to "coordinate" all this stuff on my own and pipe up when a doctor or other health practitioner tells me something or asks me to do something or undergo a test. As I get older, doing this effectively will be more and more difficult.

The really infuriating thing about it is that the doctors and health practitioners accept it with a sigh. When you bring it up they are as indignant as you are about it, but do not seem to think there is anything to be done about it. Yes there is: ensure that stuff is online and print out or give access to this information to those who need it and those who are collecting it. The form that the nurse who took my height recorded it on should have been printed out anew with that information on it already. The lipid doctor should have been able to look at my cholesterol tests from a few months ago and note them. If he felt that it was worthwhile to take them again for some reason, he could then have cogently explained to me the reason for retaking them ("We normally feel that such tests should be done every 3 months." or "We think these tests are not accurate for [reason] and would like to do them again."). His only reaction was "Oh, if you don't want these tests that's OK." If he felt strongly about it he should have pressed a bit and given reasons. I suspect he always does these tests on people who see him with no regard to whether they had been done before.

The other example of this is the repeated appointments that they make for me to have my retinas photographed in order to ensure that I do not develop diabetic retinopathy. When I call (and get a recording) and explain to the recording that I'm already under the care of St. Thomas's for diabetic retinopathy and do not need to go for screening, they respond with a new appointment. Only when I get an actual human being, who needs two repetitions to understand that I have it already and do not need to be screened for it, can I get the appointment cancelled.

When I explained this to the doctor at the Diabetic Clinic last year, he told me that it was his fault (at last, someone takes responsibility!). Apparently, when some people go for screening and are cleared, they are dropped from the computer and can later develop it without knowing it. These appointments are sent to everyone on the Diabetic Clinic's patient list in order to ensure that anyone who was dropped is seen regularly. I think that there is probably also a government target for the number of retinopathy screenings that are done and, for every one they do, they get a certain amount of extra funding. Thus, they want everyone to have it done, whether they need it or not.

Now don't get me wrong: the NHS is a great institution and has always given me the greatest level of care that was necessary. However, like all institutions it could do better. Being joined up would be a big step toward getting better. Those patients who cannot keep track of their treatment or who do not ask questions may have repeated tests or slip through the cracks. Let's see how things develop.