Friday, 28 February 2014

Where there's one, many follow?

For those of you who follow me on Twitter, you may have seen a number of tweets around my recent visit to Northern General Hospital recently. The visit wasn't to see my usual diabetes team, but to see a new consultant at the metabolic bone centre.

When I last saw my diabetes consultant we had a conversation about a variety of issues I was facing and it was decided that an Antinuclear Antibody (or ANA test) would be appropriate. The test came back positive and, in light of this, I was to referred to rheumatology. I had to wait for the referral request to go via my GP, because my diabetes consultant wasn't allowed to refer me directly.

Without discussion, my GP set up three choices on the NHS Choose and Book system, all of them where located in the Rutland area. Since my diabetes care is handled in Sheffield, I wanted my rheumatology care to be provided there too. I rang the GP surgery asking for a referral option to Sheffield, only to be told the system wouldn't allow it. After further pushing by me, they said they would try a paper referral, but they didn't believe it would be successful.

It was successful and on Tuesday I had my first consultation. I was asked to bring a list of my current medication and a urine sample. As usual my urine sample wasn't required - sometimes I wonder why I bother and why they always ask for it in the letters they send... my theory is that they just like to take the ....!

Welcome to the Metabolic Bone Centre!
Anyway, on arrival I checked in at reception and it was a short wait before the consultant came into the reception area and called me to his consulting room.

We had a good chat, not just about the symptoms experienced but about other things too. I like it when that happens because I feel I am being treated as a person and not a set of conditions that need to be resolved - it's these small things that make a huge difference because, if being truthful, these times are stressful experiences.

After lots of questions, discussion and examining my fingernails (amongst other things), a diagnosis of Raynauds was made. Since before Christmas I've suspected this diagnosis would be made and today was the day my suspicions were confirmed.

My consultant took time to explain the condition, how it manifests itself, talked about coping strategies and informed me that he'd write to my GP to recommend drug therapy to minimise the impact. He also talked about the different types of drugs available, both short and fast acting versions and what his recommendation was.

Bloods Request
As part of that conversation he asked me a really interesting question: "Why do we clean our teeth in cold water?". I promise there was a reason (related to my newly diagnosed condition) behind the question, but I'll leave you to ponder the question for yourself - after all every other washing activity makes use of warm water.

I'd already done a bit of research around the condition, but I hadn't realised I'd require an x-ray to be taken to determine if an extra rib (or to be more precise a cervical rib) was the cause. A number of blood tests (ANF or AntiNuclear Factor which I believe is another way of asking for an ANA test, ENA, C3 C4 and dsDNA) were also requested to provide further analysis and to check I don't have a more serious condition.

After a number of failed attempts to get blood I was sent to the x-ray department (following the blue line on the floor!). I (foolishly?) suggested I'd come back once the x-ray was complete, fully hydrated for another attempt or two - I expected to be in the x-ray department for some time!

X-Ray request
Surprisingly the wait was fairly short. I was taken into an x-ray room, asked to leave my belongings on the bed (including my glasses), stand in front of the x-ray machine, shirt collar up and head back whilst the x-ray was taken. Within seconds the procedure was done and I was free to go back for another attempt at bloods.

Blood taking was a disaster, after five attempts between three different members of staff it was decided it would be better if I came back the following day for further attempts. Thankfully the following morning blood samples were obtain at the first attempt!

Interestingly over the two days I saw three receptionists, four people for bloods, one for x-ray and one consultant. Only one person told me their name - the consultant.

So now I wait and wonder what the results will show, do my usual digging around journals and websites to understand the detail of possibilities and (of course) decide whether to accept the drugs offered or to try and manage the condition without their assistance.

I'm not sure what my decision will be about the drugs (maybe I'm in denial that I need them), but I do know that now I have more than one condition, more than one consultant and a lot more visits to hospital on the cards!

How many more will I manage to collect on this journey?