That shoulder thing

My left shoulder started causing me trouble quite a while ago now… about three years ago I guess… and intermittently I try to do something about it.

About Aug/Sept last year I got myself another referral to physio (my 3rd I think) and a promise of some more attention. The local policy appears to be approximately 6 sessions of physiotherapy before they need something new.

This time we were able to make some progress on the underlying issues – above and beyond any basic hypermobility (which was not discussed) the possibility of impingement was raised for the first time (not sure why it wasn’t considered before).
Although I did have a course of acupuncture again, I found that the deep tissue massage and heat treatment were more effective for pain relief and for the first time the suggested strengthening exercises seemed to make a difference – although it was only at the end of the course of physio that they suggested a resistance band to work with.
I was pleased then that I was taking less painkillers and feeling less stiff but determined that this time I would not simply wait another year for another course of physio to prescribed when inevitably all my coping mechanisms broke down and delighted that the physiotherapist was in a position to refer me to a shoulder consultant.
Yup after 3 years I actually went to see someone who specialises in shoulders!

The clinic was clearly quite full of people; some having the rehabilitation after breakages examined, some with sports injuries and a few who probably had arthritis but all cranky and bemused by the self-assessment forms we had to fill in and all sat waiting in the over-hot, loud seating by a hospital cafe.
They sent me (and I think everyone) for an x-ray before letting us see the consultant. The only other time I have had an x-ray that hurt was when I broke my collarbone aged 12 & everything hurt – but putting my arm in that position hurts that is one of the reasons I was there! Then after a series of mobility and strength tests they also did an ultrasound and I was offered something approaching diagnosis.
I was rather troubled by the mobility tests – my range of motion is quite good (its not like the knee that just wouldn’t straighten) but a) that is largely down to extensive physiotherapy and regular exercise and b) it hurts.
I understand that they need to check whether there appears to be some kind of blockage etc but I wonder at what point I am supposed to say ‘please the more of these we do the worse it gets’, I didn’t get the impression that he heard me when I said yes I can get my arm into this position but in my daily life I would avoid it wholeheartedly because it really hurts. And yes, I know it was excruciatingly hot in there, but some of that sweat was from tension and pain.

Still, there was something visible in the ultrasound – I liked the ultrasound; the gel was cooling, the process was not painful and the machine looked pretty nifty. I would really have like to have seen the pictures though.
But, what the consultants could see were lesions from an impingement (which sounds like they are infectious – they aren’t) and what it means is that the bones are essentially rubbing together – hence physio is supposed to strengthen the muscles which hold them apart. They sent me a letter with the technical details which in theory tell a Dr which bits are causing the trouble but didn’t entirely help me work out quite what my shoulder was doing to itself even with the wonders of Google.

So after several hours of waiting and prodding and poking I was offered some ways forward. The plan went as follows: a steroid injection, more physio, a check-up a couple of months down the line, and then possibly another steroid injection and possibly surgery or both…

Steroid injections hurt!

Actually I might stress that some more they really really hurt! According to my letter, there was anaesthetic in the mix as well as the steroids which might explain why I was able to walk home but were definitely not noticeable enough.  [Warning: do not read this next paragraph if you are squeamish about needles]
Part of the problem is that when you stick a needle into a joint you can feel it go in and then you can feel it move around. It honestly felt like it was grinding. I am not a wimp, I am ok with giving blood and getting injections generally, I am used to being in pain but this pain was enough to make me think I was going to pass out. The nurse brought me water and I sat with my head down for ten minutes or so – waiting I guess for the anaesthetic to kick in – at which point the consultant checked I could move my arm (and yes moving it over my shoulder was at that point easier) and sent me home.
Gradually, the stiffness set in. I definitely had a steroid flare up and co-codamol was not touching it. By the following morning I couldn’t raise my arm at all, I could only dress myself in small stages to recover from the intense pain, I couldn’t carry anything, I couldn’t even sit quietly without pain. I was a mess.
Still this too passed and two days later the pain had subsided enough for me to feel normal again. I’d like to think that the following two weeks were noticeably better in terms of ease of pain-free movement but I’m not convinced. To be brutally honest they are going to have to offer me some better improvement than that to make the injection worth going through again… As I type the shoulder is aching and complaining and I am still waiting for the referral for more physio to be acted on.


ACT or analysis

Quick thoughts on therapy:
My current counsellor has proposed two routes for me to take with regard to fighting the blues. One is Exploratory Psychotherapy (think Freud & Jung but with less sex) and the second is Acceptance and Commitment Therapy (think value-oriented mindful action).

The first I apporach with the basic fear of being caught in a blame game and never-ending sessions of attempting to root out a subconscious desire that can’t be proven one way or another. Add to that the basic weirdness of such ‘intimacy’ with a stranger and the horror of opening the broiling wounds of my psyche and the underlying fears and pain that I have spent years learning how to control and it seems a ridiculously frightening and uncomfortable prospect.
On the other hand perhaps some dark recesses would be less shadowy if I faced them, perhaps there is something lurking that a stranger is perfectly positioned to uncover and I would be able to fight my own demons more effectively and just don’t know it yet. Perhaps I secretly yearn to express myself…

The second option has the obvious advantage of a slightly buddhist feel with a smidgen of humanist philosophy and some dialetical language theory thrown in for good measure. I enjoyed mindfulness even if I never had the self discipline to follow through the practice and since ACT can also be used to help manage chronic pain it seems an obvious choice.
What if, however, I am merely throwing another coat of paint over the rust? What if I can’t muster the motivation? What if I don’t put the effort in because I am too comfortable being “ill” even though I’m actually just a malingerer? What if there just isn’t a therapist inside 30 miles?

A huge part of me just wants someone to tell me what to do; to say this is the right thing in your life and you can make it work; to tell me that I’m ok.
Trouble is it doesn’t matter if they do cos I don’t know how to believe them.

Community Mental Health Team

So Sleepy has been allowed home..
He is officially deemed well enough to take care of himself, told to take his meds, and been offered (or possibly given the condition that he take) care from the local community mental health team. So what does this actually mean?

Well the Royal College of Psychiatrists produces a handy leaflet to explain the role of the team and the people involved (which is much more helpful than the info provided by our local council!).
But as far as Sleepy is concerned – he is expecting a couple of weeks of hospital meetings to check on his progress and maybe a phonecall once a month from a Nurse.

Now its good to see him brighter, socialising, planning for the future and generally making progress but forgive me for thinking that a couple of psychologist meetings post-psych ward and nurse giving you a quick ring once in a while isn’t really after-care or learning skills to help you prevent psychotic break-down.
The theory is good but if this is looking after people I want better, we are told thats what we can and should get but it is still easier to hand out the pills and hope it all goes away.

Where are the back-to-work teams that the government promised? Where is the increased access to talking therapies?