Friday, February 5, 2010

Medical Adventures in South Africa

Well, I am in Johannesburg on medical leave to try to sort out my right shoulder. It has been troubling me for close to 6 months now, and I’d hoped to be able to delay treatment until the summer holidays. But the last 2 – 3 weeks has seen both the pain and the immobility get significantly worse – to the extent that I had to do something about it.

I went to the doctor in the SOS clinic in Luanda, and after 2 x-rays and an examination, he decided that I would need to be diagnosed in South Africa. He had hoped to send me for an MRI in the main SOS hospital in the Ilha, but the machine is broken, so he wasn’t able to do much more than refer me to SOS Johannesburg with a request for an appointment with an orthopaedic surgeon.

This happened about a week or so ago – I had to cancel the first appointment they made as it was so soon that I couldn’t get a flight. I arrived here on Tuesday (after another hellish airport experience – just as I was beginning to think they’d got it sorted) only 2 hours late. My appointment was for Wednesday morning, and that’s when things started to go badly wrong for me. The doctor I saw was convinced he knew what was wrong with me – after about 3 minutes of my walking in the door. He didn’t test the extent of the immobility of my arm, nor did he ask about location of pain. He already “knew” what was wrong anyway.

I tried to tell him about the surgery I’d had on my left shoulder almost exactly 5 years ago – I’d ignored all early warning signs back then and as a result had gone swimming one evening – to wake up the next morning with NO movement at all in my left arm. Panic time! I was in Kuala Lumpur at the time & the specialist I saw was excellent - & no problems with getting x-rays or a MRI. I had a sharp bone spur that had damaged the tendons in my shoulder joint – the photos he showed me after surgery are implanted on my brain – tendons all frayed & splayed around looking like they had been hacked apart with a blunt knife. About 50% of my tendon had been cut through - he removed the spur as well as stitching up my tendons during arthroscopic surgery.

Unfortunately, my copy of his surgery photos are in storage in KL along with most of the other stuff I couldn’t take to Luanda – so I couldn’t show him or any other doctor what I was talking about. I did bring the MRI x-rays to Angola (which I didn’t think were necessary to take to SA as it was the wrong shoulder) but had the MRI report with the diagnosis on it. I’d shown the same report to a specialist I’d seen in Manchester the day before we flew out to Thailand just last month, as well as the doctor in Luanda. Although both needed imaging to confirm diagnosis, they both thought it was probably a similar problem with my right shoulder.

But not the doctor I saw on Wednesday – he told me “I don’t believe it” & that it was impossible for a projection to damage tendons the way I’d described. He sent me off for x-rays and an ultrasound, neither of which seemed to be very helpful for a diagnosis. The ultrasound doctor said she couldn’t see signs of tendon damage & that it wasn’t something like tendonitis. My follow-up visit with the doctor after the tests didn’t go well at all. He still believed his initial diagnosis, even when I told him I felt he hadn’t examined me sufficiently or looked for other possible conditions. I explained how vulnerable I felt as I wouldn’t be able to return to Johannesburg in a month if he was wrong & that there was no possibility of proper care in Luanda itself. He ignored me – even though I was in tears by this time (I don’t handle confrontations well). He said all I needed was a cortisone injection & that I would regain instant mobility & lack of pain in my joint, followed up with some Physiotherapy and I had to never write on the whiteboard again and I had to get new pillows to sleep with.

What happened next is one of the worst things that has ever happened to me. I was still crying when he injected my shoulder from behind. It was incredibly painful. He instructed me to wave my lower arm around to move the solution in my joint & then asked me to raise my arm (the only thing he had asked me to do during the earlier consultation). I lifted it, and it was about 10% better, but I could still feel it catching. When I told him that, he grabbed my arm himself, shook it a bit & then lifted my arm for me. Maybe a total of 15 – 20% improvement, but nothing like the “total cure” he’d promised. When he let me go, I tried putting my arm up my back (something he hadn’t looked at) & it was still the same – no higher than waist high. He seemed shocked when I told him this. For the first time he touched my shoulder (other than to put the injection in) & asked where it hurt. I told him the pain was in the front of my joint – I had no pain at the back. The pain (as the other doctor’s I’d seen had realised) was located at the head of my biceps. It seemed to surprise this particular doctor – but he wasn’t fazed – he simply got another syringe & put more cortisone in – directly on the tendon (& left me with a nasty bruise). I was crying so hard by this time that I was actually shaking – but he never ever acknowledged how upset I was – to the extent that he didn’t even offer tissues!

He then wrote me a referral letter for a physiotherapist (saying I had tendonitis) & wrote a prescription for anti-inflammatory pills & painkillers (“to take only if I needed them”). That was that – said I should stick around until my scheduled flight on Tuesday in case I needed to see him again, but the impression I got was that he thought my problem was solved.

I was in such a mess when I came out of his office to pay the bill, that his secretary came round to give me a hug! I got the prescription filled, had lunch in the hospital cafeteria & tried to absorb what had happened. I was in tears again when I talked to Bill that evening – he was really mad. I went to bed, but couldn’t sleep & at midnight, got up to write out what had occurred & my concerns about it.

When I woke (after about 3 hours sleep) in the morning, I was horrified that my mobility behind my back was actually much worse than it had been the day before. I went to the physiotherapist that morning and she was wonderful. I told her what had happened & how scared I was. She recommended I get a second opinion & gave me the names of two shoulder specialists to try. She was able to improve the mobility of my arm and certainly made me feel much calmer & not so terribly alone. When I got back to my guest house, I wrote to SOS Johannesburg (who have been in contact with me every day asking how things have been going) and asked them to try to get an appointment for me with one of these doctors as soon as possible. I slept much better knowing that I would get a second opinion before going back.

Today I got a phone call from SOS at 8:10am to say I had an appointment at 9:00. I was out the gate 5 minutes later & fortunately the traffic wasn’t too bad so I arrived at the hospital in time. I’d had the forethought to pick up my x-rays and ultrasound on a CD the day before (what a wonderful technology), so I was able to show the new doctor those. I tried to briefly explain what had happened & he checked my arm mobility, did a confirmation ultrasound & diagnosed the same problem as my left shoulder! He said that I had a large amount of tissue swelling (which I think is a result of the injections I got) but he didn’t think the tendons were as badly damaged as they had been in my left shoulder when I had surgery then.

Everything happened very fast – he booked me for surgery on Monday morning & asked me to delay my flight back until Saturday. I had to cancel the appointment I had with the physiotherapist, but went to see her anyway to tell her what had happened. She said that if the tendon damage is less, I will probably recover much faster than last time. I left her to get in touch with school to contact the insurance company to try to organise payment for hospitalisation costs (this had been done earlier but of course for the hospital of the first doctor!) So, I’m going to have surgery in 3 days time but I feel 100% better than I did on Wednesday when the only thing wrong with me was that I was a teacher! I know now that I will get better – my recovery for my left arm was wonderful – full mobility in every direction & no problems with it ever since. So I am optimistic about this arm too – although the physiotherapy situation in Luanda isn’t good. I’m hoping that I will be able to do much of it myself.

The really sad thing about all of this is that I will miss Bill’s birthday on Sunday. I have some presents hidden for him, but can’t get what he really wants until we get back to the UK in June. I haven’t found anything great for him here either. I hope what I’ve managed to get will at least give him a bit of a birthday feeling (even though I don’t think it will last for long as they aren’t very exciting). I made the newspaper clipping at the beginning of this post to let him know that I was thinking of him. This is from the Newspaper Clipping image generator - a great site if you are more imaginative with words than I am. “Monster” was Bill’s band nickname when he was in KL.