Ortho appointment

palo

Hi guys,

I have got an ortho appointment at my local hospital in a week's time and am keen to make the most of it. It is my first one so am not sure what to expect.

It is because my physio said I should get some support from my GP re managing my arthritis which was diagnosed in February (mild-moderate according to x-rays). My GP referred me for asessment who passed me on to ortho dept at local hospital.

Anyway I have to say since the arthritis was diagnosed, I am reasonably able to manage, but since June I have had 2 severe bouts of sciatica. I have had back problems for approx 20 years, normally involving one week of being unable to do anything due to lower back pain, have had to call the GP out once I think, and an ambulance another time etc etc.

I am now terrified of damaging my back more and want some professional advice. I have been seeing a chiropractor for the past few weeks as the wait for physio under the NHS was about 4 weeks and I couldn''t wait that long for some help/relief.

So. could I use this ortho appointment to ask about my back, which lets face it is far more critical to my functionality, or will they get the hump with me and do I need to go back to my GP and demand they do something other than just give me painkillers as they have done for the past 20+ years..

I was in so much pain, I couldn't do anything, I couldn't sleep, or weightbear and work was impossible.

Any advice is welcome.

stickywicket

Sorry things are so bad, palo. I don't really understand why the orthopaedic people should 'get the hump' if you ask about your back. Won't they need a full picture? Or, have you specifically been referred to eg a knee or hip specialist?

If you have been referred for one particular joint then they might or might not be interested in others. I went to a foot surgeon once because of dreadful pain in my ankle. He x-rayed both ankle and the TKR above it and showed me how perfectly the ankle had fused itself and what a mess my ancient TKR was in. This was at an excellent teaching hospital though. I'd say suck it and see. You can always ask for free.

I'm not sure what can be done for backs other than pain relief. I know some have had operations on their spines - fusions mainly, I think. Maybe you could try a search (above).

I do hope you feel satisfied with the appointment and they can do something to help.

palo

Thanks SW, I will give it a try.

I have no idea who I'm seeing just someone in orthopedics...

frogmorton

I don't know whether the ortho will be able to talk about your back....they all have specialisms and you may need to see a back surgeon.

I hope he/she refers you on if they can't help because my back was like yours for 20-odd years and when I finally had surgery some damage had already been done and I can't feel part of my foot/behind knee and bottom cheek :oops:

The surgeon said if he had been able to operate 2 years earlier he would have saved the nerve.

Best of luck

Toni xxx

hileena111

Hi Palo
When you go in I would let him do the talking to start with.

Before you go make a list of things you want to know, question you want answered etc,
You might not need to ask all of them. If he does the talking first he might answer the questions you want answers to without you saying anything

I think the main thing is your list......most of us will tell you that.
It's so easy to go in, know what you want to ask then come out and think " why didn't I ask him that?" :? :?

Will someone be going with you ?
That is handy because you might be so busy asking questions that when you get out you may have forgotten things that were said.

Things I'm saying .......like notes and someone with you are from experience
If there is no one to go with you I have known a few people who have taken their mobile, asked permission to record and the ortho has been very nice and agreed so you can listen back to it.

Good Luck, let us know what date you are going

Love
Hileena

daffy2

As the others have said, take your notes with you, but I would be inclined to wait and see how the appointment progresses rather than have any specific expectations of it. Depending what your GP referral letter said and how they do things in your part of the world this appointment may be more of a triage exercise, to see if you need to see ortho( ie whether they feel they can help)and if so who.
Do make a note of the name of the person you see. I am so glad I did this when I had to go through an ortho triage process a while back and was rejected for further referral. Discovering that I had been assessed by a 'GP with an interest in orthopaedics'(ie not an ortho professional) helped in the push to get(eventually) a proper assessment of my several spinal issues.
Hope you have a good outcome and can start making some progress in solving your difficulties.

palo

thank you all for replying.

I have seen other specialists, over the past 18 years, just not ortho. so I always go with hubby and a list of questions and full potted history of my medical issues (relevant depending on the speciality).

Hubby broke his leg and they took x-rays at every visit to check progress, so I guess I wondered if they would do that, and if they did, could I steer them to my back as well or instead of my hands?

I am getting to the point where I think the lines are blurred and I wonder if some of my issues are not more to do with the drugs I have been taking. I firmly believe the steriods are implicated in my back issues as I have been reducing them this year, and last time I did that or got down to these sorts of level the carpel tunnel was unmasked, so I guess I feel this is deja-vu again but with something else popping up...

I suspect what you say Daffy is the case here, I don't have a referral as such just verbal/self referral from ortho triage based on a phone conversation with them, however I am very determined this time and can always push the MG at them if they seem unwilling to take action (if I get stressed I risk going into crisis, which leads to hospital admission etc etc...)

I will play it by ear and see what happens, I have a neuro appt the following week and can push for a bone density scan if nothing else as I have not had one for years, and am meant to have them regularly because of the steriods....

What I really really want/need is a proper wholistic assessment taking all of my issues into account and sorting out what needs prioritising and what needs to be dealt with first. I have just muddled along and dealt with issues depending on how urgent they become or otherwise just bump along, just managing.... Unfortunately the GP doesn't have time and isn't qualified...

I do think they need to appoint multi-disciplinary specailists for people like me who end up going to lots of different specialists with no-one really getting a full picture of everything and whether or how they are connected and thereby assessing which drugs really should be prescribed...

dreamdaisy

I have only had one issue at a time when attending orthopaedics but I see no reason why you cannot raise your concerns about what is affecting you the most - any information they receive from you will help them gain the broadest picture of what is going on.

I think it almost impossible for one person to have expertise on everything that can go wrong with the human body. It's essential that those 'experts' dealing with us talk to each other but that is where the systems in place for that to happen can (and do) fail. DD

daffy2

Oh how I sympathise with your wish for an holistic view - seeing you as a complete person with conditions that may interact, rather than a set of conditions all looked at in isolation under the heading of 'patient A'.
Sadly that's not how the NHS works for the most part(due in large measure I think to the way things have changed since it was set up) .The piecemeal approach is not the best use of challenged resources though, nor the best way to improve patient outcomes.
I have 3 conditions affecting my spine, together and severally as they say,only one of which seems of any real interest to the medics - and that's the one I don't regard as so much of a priority - not least because it doesn't appear to be progressing at present and isn't having an impact on everyday life.However it's the one that they 'know' how to treat and so were not happy that they couldn't tick that box, even though it is something my GP does keep on her radar. I did eventually get past the triage rejection, but it took time, effort, and help from a medical charity. My GP also learned a useful lesson in the way that her efforts to help a patient could be stymied by the 'system' rather than any clinical consideration.
As has often been said on the forum it is sad that the times when we most could do with some help to try and sort out what is happening to us and how best to proceed are the very times when we may have to 'go it alone' and do the legwork ourselves.
I do hope something positive comes from the appointment for you.

stickywicket

I, too, empathise with the desire for a holistic view of the entire person but I fear it's just wishful thinking. Surely a 'multi-disciplinary specialist' is a contradiction in terms? We are all human. How can anyone specialise in 'many things'? And, even if they could, which things? Many of us on here have feet in several camps but they are different camps for each person.

Back in the day, I was referred to 'an orthopaedic surgeon'. Then we got knee men and hip men, foot men and hand men. The more we learn the more fragmented the specialisms.

(Semi)-seriously, once robots get to diagnose us, all this knowledge might reside in one place and different bits / conditions / diseases / meds might all be taken into consideration. Meanwhile, I just hope you come out of this appointment feeling satisfied that things might improve for you, Palo.

palo

I totally agree about the complexity and impossibility currently to adopt such an approach, but if I give my example.

It took 6 years for the doctors to get my MG stabilised. 6 years of numerous emergency hospital admissions, I stopped counting after 13 in the first 2 years..

I had IVIg on many occasions both as an inpatient and daycase. They spent 1000s of pounds on my care and treatment. I had to give up a great career in that time too.

All that time they knew I was anemic, and gave me iron tablets they never investigated why or prioritised it (why should they they were neurologists), eventually I became so anemic I was haemoraging practically, and was referred to Gynae and had to have an emergency hysterectomy due to fibriods. One time I was in hospital and they didnt know whether to give me white and red blood cells as I needed both!!

After that the MG became easier to manage - any condition on top of the MG sends the MG out of control, if they had adopted a joined up approach they could have saved 1000s of pounds and I may well have been stablised far earlier and been able to stay employed far longer.. I was stable within 6 months of the hysterectomy.

This is not a luxury but we are so far from it currently.

stickywicket

You have certainly been through the medical mill - several in fact - and it constantly amazes me how positive you manage to remain.

It would clearly make absolute sense for you if neurologist and rheumatologist could put their heads together. I guess that, unless one of them has a great interest in the other specialty, it won't happen as they're all far too busy with their patients.

As for non-joined-up medical thinking - I got my first stomach ulcer when in hospital recovering from my second TKR. Back then you had to take your pills when they came with them so there were times when I had to swallow my NSAIDS without food. I soon learned that, in hospital, you have one disease / condition and one only. Best to get home asap

I'm surprised your anaemia was never checked out though. I'm heartily sick of having 'oscopies' just because my haemoglobin levels are low. There's never anything wrong.

palo

stickywicket wrote:

You have certainly been through the medical mill - several in fact - and it constantly amazes me how positive you manage to remain.

It would clearly make absolute sense for you if neurologist and rheumatologist could put their heads together. I guess that, unless one of them has a great interest in the other specialty, it won't happen as they're all far too busy with their patients.

As for non-joined-up medical thinking - I got my first stomach ulcer when in hospital recovering from my second TKR. Back then you had to take your pills when they came with them so there were times when I had to swallow my NSAIDS without food. I soon learned that, in hospital, you have one disease / condition and one only. Best to get home asap

I'm surprised your anaemia was never checked out though. I'm heartily sick of having 'oscopies' just because my haemoglobin levels are low. There's never anything wrong.

Fortitude is something you learn when life consistently beats the crap out of you and you know that you have lost more than you can ever regain or measure - you cling to what you have left. There is always something more you could lose....

It is also my philosophy

rule 1 stay out of hospital - do everything I can - take meds, exercise, read, learn, evaluate, monitor, manage
rule 2 stay out of hospital - explore all other solutions or options with gp
rule 3 if I have to go in make it as quick as possible, co-operate and do everything to get out quickly. Nurses and doctors are too stretched so self-help is really necessary..I had meds missed, wrong meds offered, no food for 4 days - back when I could only manage a puree diet they kept sending me solid food I could neither pick up or cut up or chew or swallow etc etc