Mésothérapie

I’ve just taken another jump into the unknown: I’ve had a dose of mésothérapie in my back.

This follows discussions between my physio and the various doctors about my sleeping problems. One of the main causes is the discomfort in my back which makes me want to move my left leg  all the time so I end up sitting in a chair.

This afternoon I was referred to a doctor I had not met so far. Luckily I always scan my x-rays and was able to show her the most recent ones of my spine and hips.  She looked at these and immediately said my spine was in very bad shape. Something I knew already of course, but it saves me having to recount a long medical history .

She  asked me if I had ever heard of  Mésothérapie-which I hadn’t-  and explained it was a series of superficial injections just under the skin, spreading anti-inflammatories and other medication into the problem area .  I gave her the go ahead and so, given I couldn’t lie on my tummy, stood Leaning over the couch while the doctor used some sort of injection gun to administer a dozen or so pricks in my back. Not really painful, so now I will see if they work. If they do, she will repeat the treatment next week.

So  then I went back to my room and of course googled the treatment under I ts English name ‘mesotherapy’.  I’m quite glad I didn’t do that before as I might have been scared off trying out the treatment!   In the English speaking medical world it does not meet with much approval  and seems to be a procedure used predominantly by cosmetic surgeons. Mésotherapie seems more widespread on the continent – as are other alternative medicines – and has its place dealing with localized pain caused by arthritis, for example.

Postscript. 7am the following morning.

It didn’t work – at least not yet. Slept worse than ever.

Fighting fatigue

I’m not writing much at present because when I’m not having meals or treatment I’m tempted to lie down for a quick snooze.

I’m continuing to have very poor nights with about three to four hours sleep. I go to sleep at about 11, once the noise of staff changes and people going to bed has ended, but I invariably wake up one and a half hours later. Then a mixture of mild shoulder pain and back discomfort prevent me going back to sleep. Last night I spent a few hours reading or half dozing in the comfy armchair in the area at the end of our corridor. That’s where I am now–much the comfiest place with support for my back and shoulder.

The nurses and physio are concerned but so far at a loss as to what to do. Today the physio took notes about how I felt in the night and I think the doctor will be reviewing my treatment again.

Meanwhile, reasonable progress on the convalescence front: the 20 odd staples were removed from my shoulder a couple of days ago and the wound is healing well, which means I may be able to start treatment in the pool next week. The physio measured how far she could move my arm today and says the vertical movement has improved since last week.

One of the salutary things about being in a clinic like this is seeing people coping with much worse crises in their lives. I only see the various people with major handicaps like amputations from afar, but I have got to know three women whose lives are not at all easy.

One is a young, good looking woman of about 40 who sits at my table. She has had a back operation and is clearly still in some pain, But more serious, I think she suffers from psychological problems, eats poorly, sleeps badly and is permanently tired and depressed. This afternoon she says she fell in the gym and nobody showed any concern and the doctors reaction was that it is up to her to get better. This may be true, but my mealtime neighbour and I are very concerned that they are discharging her at the weekend. She lives on her own and is in no mental or physical state to be at home. Our view is that she should be sent to a convalescent home, Preferably where there is some form of counselling service.

I think I have already mentioned the woman who sits opposite me at lunch who had a couple of back operations and in the course of one an epidural which went wrong and has left her with one leg paralysed and the other not working well. She faces a future in a wheelchair but is tackling her physiotherapy with great courage and cheerfulness. I’m glad to say there seems to be a very small improvement this week.

The third patient facing a difficult future is my friend the maths teacher whom I now know is called Catherine. She had major injuries from a car accident–she now recognises that a Renault Clio is no match for a hefty 4 x 4! Her problem is that her injured leg keeps developing infections, preventing further surgery. If the next attempt at the surgery doesn’t take place she faces the possibility of amputation. She is only 50 and for the past two years has had to put her life as a teacher on hold.

The guy in the wheelchair who constantly wants to talk English with me also has serious problems, But like most people here, I have learnt to try and keep out of his way. He too has psychological problems and is almost certainly also on drugs. A good reminder that it is wise to lock one’s door when leaving one’s room, something I was not able to do when in le vigan two years ago and where the corridors were full of lost souls.

Protocols

I  haven’t written because there is nothing much new to say. I continue to sleep very badly and my daily physio is still at the passive stage, that is  two daily sessions on the machine that raises my arm up and down (I have progressed from 50 to 85 and should aim at 180 degrees) and a massage with Audrey (pronounced O-dree) my physio.

I seem to have spent  much of my free time over the past three days trying to catch up on sleep! Tomorrow I am going to talk to the doctor about an injection in my back. Not having the [painless  but irritating) spasms would be one less thing to keep me awake.  I now have a routine: I collect a mug of hot chocolate from the machine Downstairs and sit with my Kindle or iPad in a comfy armchair in the sitting area at the end of our corridor.

I was sitting there this morning when the maths teacher, whom I like but still don’t know her name, came up in her wheelchair, bearing a copy of Le Monde Diplomatique.  This inevitably prompted another discussion about politics.

She then said she had seen me on my machine and asked how the rééducation  was going. I replied slowly, as I am still in the passive stage, and added that what worried me was that by the time I reached the stage of moving my arm myself  I could be nearing the end of my stay here, as the doctor had been talking of me leaving mid December.

We both agreed that there seemed to be more and more talk of protocols with regard to the recovery time allocated for the various replacement operations – knee, hip and shoulder.  Difficult to know how to translate protocols,  they seem to be half way between rules and norms. Fine if you live in a town, preferably with someone else, and with physio services nearby, as the idea is that you continue  daily sessions from home. My companion pointed out that even then there is the cost of travelling to the physio, which is not covered by the CPAM.

A visitor passing by overheard our conversation and put in a defense of the system, we think from the position of somebody in health administration, After he left, my companion said this  confirmed the reasons were economic rather than driven by the needs of the patient..

I know  there is abuse  of the splendid French health system, but it is alarming to see the signs that it is drifting in the direction of  The British system. It does need some grown-up planning to ensure that where possible people can continue the right treatment from home but recognise that for some this may not be possible. So for example financial help to get to the physio would be cheaper than paying for a hospital bed. And transferring to a lower cost place (like the maison de repos where I was last year) should be possible at a later stage. The current rules are that you cannot switch establishments after leaving hospital.

Having said that I do hope  I can stay here longer. It is a well run place. Apart from one surly woman at reception,  the staff are universally efficient and friendly and by hospital standards the food is really good.

Possibly out mid-December

it is two weeks since ny op, one week here. Yesterday I had a routine meeting with the orthopaedic doctor, whom I like – he is authoritative and yet listens to what you say.

So far things seem to be going OK though at this ‘passive’ stage it is too early to say really. We discussed the pain treatment and he has increased doses during the day as he considered these too low. He was also the first to pay attention to my moan that the spasms in my leg were one of the things keeping me awake.  If the additional sleeping drugs don’t work he will give an injection in my back, where the arthritis is the cause of the spasms.

The only thing I was not happy about was his projected date for leaving hospital in the middle of December. I have pointed out that I live alone, in the country, with inadequate local physiotherapy services.  I also mentioned that the surgeon had forecast a stay here until well after Christmas. We will see. I get the feeling that there is a standard amount of time for each type of operation – beginning to sound a bit like post operative care in Britain!  At the same time when I see so many people so much worse off than I am I think it is right that priority is given to these serious long-term cases

 

Getting to know other patients

I ended up sitting next to Francoise, my neighbor the first night, at meal times. I think she would like to spend more time with me than I would like, but continues to surprise me by being quite outspoken in her political views.

Last night we were sharing with the woman seated opposite me the usual disgust and incredulity over Brexit and Trump, and moved on to apprehension about the forthcoming French elections. Meanwhile the man opposite was saying nothing, finished his meal, wished us good afternoon and left. Oh, we said, could he have been a Front National supporter?  But if he was, why should we  be at all concerned about giving our views on the FN.

in fact as well as The woman opposite, a management coach before being smashed up in a car accident, there are two other interesting women at my table of eight.

Unlike the Centre Ster  three years ago, there are almost no other shoulder patients;  I should say that knee replacements represent the largest group with a Little smaller. number of hip replacements, at least at the moment.  There are also a significant number of people with back injuries, sometimes evidently serious, and also the usual sad Victims of road accidents, some with loss of limb, most still in wheelchairs.

I am quite glad Margaret had her back operation before I came here. Another woman at my table had two operations on her spine last month, one low down, the other near her shoulders. In one op the epidural went wrong, she had to have a third op, i think to remove a clot, but has ended up with her spine paralised. It is not clear how much movement she will regain.

The salle de rééducation is another place where  can slowly get to know people. I had an interesting discussion today together with a woman who had been maths  teacher. She  had taken pot in a few school exchanges to England and  had then observed mathematics lessons and make comparisons between the methodology and the two countries. She was 70 of the belief that the science  baccalaureate was no the most crucial,  opening doors in oh walks of life. She was pretty dismissive about the value of the bac littéraire

Finally, yesterday I made “friends” with a man in his 40s, you said in a wheelchair after major injuries caused by a hit and run  Driver. He was  Keen to practice his English, which was remarkably good for somebody who had never lived in Britain or the states, and to tell me how much he loved  English pop music.  In the course of three meetings I have learnt much of his life story: gay, with a past involving drink and drugs and apprehension about AIDS, he said that he had at least broken the drink and drugs habit here. Not an easy life, friendly and lonely,  nevertheless I declined the invitation to boire un aperitif in his room.

Downsides to my room

I shouldn’t complain – but I will.

My room may glisten with its new paint, but its location is far from ideal:  I am  bang in the centre of the first floor, where two corridors meet, opposite the lift and stairs and next to a room where people collect their ice packs (as well as use washing and drying machines) and beside it is the dirty laundry room. So, lots of people pass by, invariably conducting conversations down the echoing corridors.

My window looks out at the entrance way to the clinic, where the smokers congregate and chat.

all this adds to my sleeping problems, particularly  in the early evening. There is also    the irritating practice, shed by all of the hospitals, that the night stuff do a tour  at about 10, just as you have dozed off.

Luckily insomnia remains my only significant problem; the acute nausea I have had for over 10 days finally  magically and mysteriously disappeared about a day ago.  I’m beginning to wonder if any of the painkillers were responsible for me feeling so ill and that it was in fact some sort of post operative trauma.  I wonder this because of my bad experiences last year. I knew the situation was quite different, but it is quite a coincidence that in someway the digestive system – liver and intestines – should have been involved on both occasions.

Anyway the staff share my relief that I’m feeling better. Of course the shoulder still hurts  that’s normal, particularly after physio sessions. That’s normal  I know this will increase as the exercises become more active, but at least I have satisfactorily nearly passed the first fortnight hurdle.

 

Ouch

i’ve just experienced reassuring evidence that the health  services in this clinic function as they should.

Most of my rééducation at this stage is passive, that is to say the physio or machine does the movements rather then my shoulder moving  on its own. So I have two long sessions a day on a machine that moves my arm up and down for nearly an hour, the idea being that the  arm should bit by bit be able to move In a larger arc.  Then I have a shoulder massage which feels really good. But now they  are adding gentle movements which I do, never asking the right arm or shoulder to initiate the movement.

This afternoon the physio showed me how to use my good (in my case not so good) arm and hand to gently lift up the hand of the operated side. In one of the movements I suddenly had excruciating pain as I brought the two arms down. It was the end of the session and I somehow got back yo my room where I asked for an ice pack and painkiller (luckily acupuncture or nefopam gives me no side effects).

I was lying on my bed, slowly recovering, when the orthopaedic doctor came in. The physio had reported the incident to him and he wanted to check there had been no damage or displacement of the prothèse.  He was reassured by the various movements he did but said all the same I would get an X-ray to check.  He is also resuming the anti inflammatoires which had been stopped because of my nausea. ( no nausea for the last 15 hours. Fingers crossed!)

under the influence of ice, drugs and the feeling people are looking out for me, I feel much better. All I need now is to find a way to sleep at night.

New room – and nausea returns

Last night’s cocktail worked: I slept for 4-5 hours, albeit in intermittent  bouts. I would have slept longer but for spasms in my left leg/back (not helped by Only being able to lie on my back). Each time I woke I was aware of feeling pretty woozy and nauseous. But a price worth paying.

Then after the breakfast dose of pills I once again felt nauseous. I was completely baffled as to what could cause the problem. The only new drug  I had taken was codeine and I’ve taken that in the  past. Anyhow I asked the doctor on duty if it would be a good idea to drop the codeine at lunchtime and she agreed. In the afternoon, yet again, I felt really nauseous . The nurse on duty asked the GP Dr for her advice and she has removed Iboprufen rather than Codeine from the cocktail.  Again, i have never had problems with this before. We will see tonight.

Meanwhile i have moved to a single bed room. Downsides: it is opposite the lift and very noisy, and there is neither balcony nor view. Upside: it is spacious and newly painted and fitted out. Extraordinary what a difference that makes.

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On to rééducation

Yesterday passed in a blur. I left the Clinique St Roch soon after breakfast. (What was nice was how many staff came by to wish me well).  I crossed Montpellierc to the Centre Maguelone: another modern structure in a residential street in the suburb of Castelnau.

My first impressions were not good, I was greeted, if you can call an unsmiling grimace a greeting, by the secretary in the reception area. (My impressions of her have not improved with further meetings.)   How strange that so often reception staff seem to have new training in charm.

As usual I seem to have to start my stay by sharing a room, waiting for a single room to become available. My neighbour once  again called Francoise, it’s perfectly pleasant although she does tend to go on rather .

I was all set to start the physio sessions in the afternoon, instead I had to play the waiting game, waiting for doctors physios nurses administrators and others to come by and clock me into their systems.

Perhaps most impressive was the woman who acts as GP (as opposed to physio doctor). She spent nearly an hour taking down details of pretty well every medical event in my life. Would that GPs in France or England did the same thing, it would mean that there dossier started with a complete picture of your health to date.

We spent quite a lot of time discussing what painkillers  I should be offered. The picture is becoming somewhat problematic: Topalgic (tramadol) is off the list after the bad side effects I had last week, so is Lamaline (which we suspect  gave me the hallucinations three years ago with the other shoulder). Even paracetamol turns out to be a problem because my kidneys don’t function very well and the doctor has reduced the maximum I may take in 24 hours. I think  they have gone away to reflect on what are the other options – apart from morphine.  Meanwhile last night I was given Acupan (Nefopam), which worked well – for an hour.

Last night?……. not to be repeated  I slept for about an hour in all and all today have had a splitting headache.  It didn’t  Sharing a room and having to worry about disturbing Françoise every time I tossed and turned (would that I could turn…), But I think the real problem was General  muscular malaise  the physio today said it is common for all the surrounding area to compensate and be painful.  I spent much of the night in a sitting area near our room.

This afternoon the treatment started at last. I had the same session I had the previous time, with my arm in a machine that rises gently up and down for half an hour, and then a first class massage of my shoulder by a young physio, followed by an ice version of a hairdryer blown over the shoulder.

otherwise, all to report  is that the meals are not bad so far but the company leaves something to be desired. Early days yet but I hope that as in past years I find one or two people with whom I can have a reasonable chat.  Meanwhile Francoise who was a perfectly amiable companion (during our first evening together we managed to discuss Brexit, Trump and Le Pen!)  has now been given her own room. I hope to get mine tomorrow.