old chestnut - private cf public; options

Feel a bit silly writing this blog, but I guess it logs my thoughts for myself – though the reason I make it publicly available is I hope it will help others in various areas of health learn something – other people with broken clavicles, or more general principles on health; and health practitioners who may forget or not know about the service user/ client/ patient experience.

1.  private cf public medicine.

so, a first thing I asked the consultant when he told me my clavicle had not joined up after 10 weeks was whether it would be any advantage to go privately – absolutely none, he said.

However, now a few weeks on I don’t think I agree with him.  Potential advantages of ‘going private’ I realise include:

1.  choosing a specialist for ones problem – in my case, a ‘shoulder guy’ rather than a ‘hand guy’.  In the NHS, my issue comes under general surgery, so I may have lucky if you like to get someone in the right general physical area!

2.  if surgery is indicated, a more choicey process – seemingly more choice of date, a private room, staying overnight afterwards; from my point of view, not feeling useless if I don’t have someone immediately obvious to look after me in the initial post-surgery time.

and, of course, on the down side:

1.  considerable amounts of money...

2.  possibly time spent trying to figure out the process, and who to visit.

 

2.  options:

Last week I found myself moving toward immediate surgery (that is to say a plate – meaning eek my shoulder opened up, and bone graft meaning taking something out of my pelvis – very scary – and presumably painful).  I felt very uncomfortable with this – and although it sounded like the most sensible option, I was really stressed at the thought of having to be ready for surgery any of the next four Wednesdays to include rearranging commitment on and after that day, and managing the painful process of surgery and post-surgery.

now, having visited another practitioner, I find myself more drawn to a slower approach.  He didn’t seem to think that if I had the surgery in a few months time that would make that much difference.  There seems a possibility that actually finding a way to live with a broken clavicle may be the better option for me, and this gives time to explore that.  It also means I can explore some private options so if I have the surgery I can feel I have the person with the best experience for the job, and to allow myself the most comfortable experience (private room, overnight stay post-op) – if I feel I can afford it – which I may feel able to, and to prioritise this.

allfornow – any thoughts yourself, anyone out there?

c

Seamless... to CT

so, I was regretfully shocked recently when I discovered at my ‘discharge’ appointment that my clavicle had NOT JOINED UP AT ALL, and the consultant recommending surgery (which arguably should have been done right at the start of the injury).  Internet searching (which the consultant criticised me for doing) suggests that pinning is more likely to take if done at the start with the initial wound, rather than creating a new/artificial one, which is what is needed when the pinning is done at a later stage.

I have been for a CT scan as a next stage in this process.  I thought I would just note a bit about it, since I realised I was unclear what it was, and a friend of mine asked.  A CT scan seems to be a lot of X rays done to give a 3D picture of a body situation – eg in my case, where the two ends of the clavicle now are, and whether they are joined in any place at all.  The hospital said it was considered potentially damaging to a foetus, since it was a ‘high dose of radiation’ [alarming].  The machine is like a giant polo mint, and you lie down with the particular area to be scanned in the middle of a bed.  The [polo mint] machine then (with others outside the room) moves to and fro [around the body - clavicle/shoulders in my case]; I was asked a few times to breathe in and hold my breath for a few seconds, presumably to be still.  I wasn’t clear when the rays were doing their thing – throughout? just when I was breathing in?  The whole process took maximum 15 minutes.  I would have found more explanation helpful, though the process was conveniently timed for me in the evening, and the hospital was not busy at all, and having arrived early I was out before my actual appointment time.

Moving on to my point about ‘seamlessness’, what has shocked me is how there has been (from my point of view) no acknowledgement of my transition from a break due to have healed up within 10 weeks, and no hint that it might not, to the situation of it having joined up at all.  I have also missed out on an understanding of why this has happened – very unusual? to be expected for this kind of break? – [when shown the Xray in my fracture clinic appointment 2 weeks after the break, I couldn’t believe it could join up by itself, but was assured both by orthodox and complementary practitioners that it would, and the new bone cells would seek out the other half so to speak.]

At the same time, I have been marking essays for my Open University teaching on health and social care, where for example, a model of transition is mentioned where the sequence of change may include initial anger, ultimately with being reconciled and adapting to the situation.  This also reminds me of the Kubler Ross model of bereavement.  I haven’t felt any knowledge of this kind of process really from any health professional that I have come in contact with, except a physio who observed that my confidence had been shaken.  Too right.                       

acupuncture and stroke at Westminster University: East medicine summer school

acupuncture and stroke at Westminster University:  East medicine summer school

This day was part of the Westminster University summer school on Chinese medicine – I noticed they had a day about a particular interest of mine – treating stroke, so I went along.

Key points that came out of the day for me were:

1.  I had thought it was ‘normal’ for Claudia Citkovitz to use acupuncture in her treatment of stroke at a hospital in New York.  However, I picked up that it was special and hard won – so even in the States which sometimes seems more liberal she still needs to tread carefully.  I was struck by Westminster physio / acupuncturist, Jane Wilson, saying how Claudia had achieved what Jane had wanted to achieve – giving acupuncture to people post stroke.

I was interested by the mention of not being able to use moxa in the preliminary information – this wasn’t developed really in the afternoon; but I did ask a question about it, and was told that it was just not an option – the constellation of reasons seemed to be around safety (no smoking, oxygen tanks around) and evidence (lack of it? (as usual...)).

2.  Acupuncture (and tuina) are appropriate once patient stabilised a bit, say from 2 days after the stroke.  I was interested that it isn’t used immediately, and not sure if that is a protection given that apparently some strokes continue on through the first week, having more strokes occurring.  There is something around it being helpful to keep the blood flow (and pressure) up initially – so perhaps that’s part of it.  I’m realising this is a big subject with already others working here, even if in a restricted way.

3.  I was interested that 2 shiatsu practitioners attended – the one I spoke to seemed very experienced at working with people post stroke, and has found these clients by recommendation from other clients, but has only worked privately with them, as opposed to within orthodox medicine.

any other key thoughts from the day?

I was interested in how focussed it was, and the use of particular points at various stages.  I was touched by Jane (and Claudia)’s consideration of the real absence of hope for some people, especially if without support from family and friends .... and money.  But of course on the other side, it is very exciting what it sounds like acupuncture may do, and presumably this is what Claudia’s doctorate is about.

somehow, the day didn’t really touch what I had been drawn to with thinking of shiatsu treatment for people post-stroke – though thinking about it, perhaps there were things – Jane saying how these treatments could fill the gap – Stroke people apparently feel their emotional needs are really not met; and also Jane commented that touch is really important – though done slowly and carefully since everything can feel quite overwhelming to people post stroke – almost like seeing things for the first time.

what about you – do you have any knowledge, experience, views on this kind of work?

all for now,

Catherine.

on tissue damage and transitions

I’m writing this really in case it’s of interest to others specifically with breaks (including clavicle), as well as to think how health care can better support people get better.

from bone break to tissue damage:

when I discovered I’d broken my clavicle, the impression I had was that it would get better, and within a period of time – initially I thought 3 weeks from my googling, and then 10 weeks after I’d visited the fracture clinic where I talked with a medical doctor, and discussion with my privately organised physio.

After a couple of weeks I did notice a different slant to my shoulders, but another very experienced complementary practitioner thought if anything the new position was better.  However, a recent consultation with a new physio revealed the opinion that my shoulder has ‘dropped’, as I understand it since the bone has re-joined in a slightly different position – this impacts on where I can put my arm – so, wriggling movements feel damaging, as well as something close to the tennis overarm serve (which I would like to get back to doing).

and so I am now considering the more real possibility of long-term/permanent damage, and it was an unpleasant shock. 

what really strikes me is the kind of seamless transition from ‘going to get better soon’ to ‘well, probably not’ – there feels to be no attention or space given to the, I guess, psychological effect of this on me. – apart from from me, and I realised I was going through a kind of Kubler Ross bereavement process, feeling anger and grief, as a start.

A physio kindly sent me an article about clavicle / shoulder breaks, and this indicates that generally a bigger problem than the break is the damaged tissue – I hadn’t quite absorbed this before, and it gives me a new view – which feels relevant to other conditions of clients and friends/ relatives that I have observed.

present medical practice seems to virtually ignore this – and this may be a place where shiatsu and other forms of body work may be strong.

food for thought – do add any you have to this blog – I’d be interested.

regards, Catherine.

Diet – what to eat?

Last Sunday I joined some old mates for a regular strawberry barbecue fiesta – and met up with some friends who have got very committed to the ‘Palaeo’ diet, which is popular with many at the moment.  The idea is to remove farmed carbohydrates from our diet, since we evolved as hunter/ gatherers, and they argue that farming grain is where we went astray diet-wise – so, they seem to eat meat/ protein, and nuts and berries, and vege, I guess. 

Talking with a dietician I met at the very delicious dinner accompanying the recent Camstrand meeting located at University of Westminster this year, I asked her about this, and she said it was fine for short times to lose weight – much like the Atkins diet, but that when people went back to eating normally they tended to put the weight back on.  She reckoned that doing it long-term would damage someone’s liver.

Talking with a personal trainer recently, she said that many personal trainers are keen on the Palaeo diet, but she just favoured ‘eating normally but well’.  We also discussed the popular restrict yourself for 2 days, and eat what you want for 5, where she thought not enough attention is given to the ‘5 days off’.

So, what to do?  - not sure – I started off life eating normally with my parents; shocked my poor Mum when I became vegetarian at age 16 due to concern about killing chickens, for example.  Since then I have adopted other diets – vegan, macrobiotic, Chinese medicine; and heard of the food separation, and raw food diet.  Presently, my focus is on wholefood, organic, qi-filled food – but probably eat more of some things than I should (chocolate, wine...).

mmm, any thoughts on diet yourself?

experiential learning in health and social care – broken clavicle

So, I broke my right clavicle on a beach (horse) ride 6 weeks ago.  What a pain – meaning I have had to cancel my shiatsu treatments to give, as well as participating in tennis for at least 10 weeks during the summer season, just when it was getting going.  I am writing this piece, because as a patient/ client/ service user I gain new insights into the experience of health care, which can inform understanding for all – practitioners, whether orthodox or complementary and patients.  This is part of an attempt to consider what an integrated approach could mean.

1.  Initial orthodoxy – so, once it was worked out that I had injured myself, I was shipped off to A&E by ambulance, which all sounds pretty efficient.  (I don’t remember anything in fact from the beginning of the ride, to later in the day).  I seem to have received an X ray, which diagnosed the clavicle break, and a CT scan, which ascertained that my head/ brain was/ were broadly speaking OK, though the amnesia and odd behaviour indicated severe concussion.

I was kept in hospital overnight to observe for further problematic symptoms from the concussion, but discharged thankfully the following day.  I was told to go to the local fracture clinic, which I did two weeks later, but not especially advised to have any other treatment, such as physiotherapy.  I found myself intuitively adopting the ‘neutral’ Alexander position, with my eyes firmly closed, to allow the healing clavicle as much chance as possible to get back in the right position, and also to allow the shock to disperse.  I found myself yearning for some kind of healing compress, both for my head and for my shoulder, but was unable to manifest one; I had thought this might be something medical herbalists might do, but they seem keener to administer herbs as ?pills.

2.  As it happened, I had a physiotherapy treatment booked for the following week, and attended it.  I kept attending weekly (really from my own impetus rather than recommendation), and received very helpful treatment to help relieve muscle tension around the shoulder – by the spine, along the pectoral muscles and upper ribs, and perhaps other things that I don’t remember, or which weren’t explained to me.  I don’t feel like the physiotherapist gave me an overview of the recovery process, though they did help encourage me to reduce movement, such as not bicycling which might have jarred the healing bone.

3.  I also had some shiatsu treatment.  I am a shiatsu practitioner, and my holidaying friend is too – having nobly driven me home, he gave me a brief treatment (just 10 minutes) to relieve shock (eg working on Heart 7 on the wrist – a well-known shock treatment point) – I felt my body shifting into a better space as he worked, and there was some hara movement, I think.  I was very impressed.

I asked my regular shiatsu practitioner if she would advise bringing my booked treatment forward, but she seemed to think I would benefit from healing by myself until the bruising went down.  I found myself craving a gentle shiatsu treatment to help settle down, but didn’t manage to manifest that.  When I did have shiatsu treatment, I was enormously impressed with the work.  Focus was given to the joints as each end of the clavicle; again, there was significant hara adjustment, and the shoulder felt more complete at the end of it; plus I felt shock had released in the process.

To conclude, I am enormously grateful to all these healers who have helped me in this process. I do think there could be more advice on how this kind of injury could be supported, because what I have received has beeen to some extent accidental, but so very helpful.

Feel free to add your thoughts to this blog.

Catherine.

stress and shiatsu

Do you get stressed ever?  Do you know anyone else who gets stressed?  When I get stressed, I can feel  like I have too much to do (which I may have).  I may feel  that I can’t make good decisions, or don’t have time to inform myself properly in order to make good decisions.  I may feel tension infusing my body, and affecting my weaker areas – down along my arms, up my neck, along my legs (mm, well, quite a lot of me).  I may feel a kind of buzzing in my head.  How about you?  Signs of stress may include physical symptoms like body tension, including tense shoulders – we have the expression ‘her shoulders were up by her ears’.  Other symptoms may include headache and sleeplessness and irritability. 

I remember attending a business course many years ago, and the trainer said that the ‘one thing you can say about shiatsu is that it relieves stress’.  Presently, I am having some coaching for my business, and my coach is emphatic that I need to find a niche.  I have decided to focus presently on stress because there is such a lot of it about – there are reports of high incidence of stress, people absent from work as a result, and money lost by businesses, countries and individuals as a result.

Stress is important – and reducing stress crucial to all our success.

Shiatsu treatment works physically on the body, and so stimulating muscles, skin, nerves, bone.  For muscles, it seems plausible that by holding the middle of a taut muscle, say the trapezius which runs between neck and shoulders, the areas of muscle imbetween that are working over-hard may get a chance to relax.  There is an acupressure point in this spot, which we use in shiatsu treatment, and is considered good for releasing pain in head and shoulders.

Shiatsu treatment also stimulates nerves.  There are energy lines running through the body, and the acupressure points follow these.  Each side of the spine, runs the so-called Bladder meridian (part of the Water Element) – these points are really important for all aspects of the body.  Physiologically this is also where nerves insert into the spine and spinal cord.  My sense is that nerves need to be stimulated, and sometimes this doesn’t happen so imbalance occurs.  I suggest that this work can enhance a sense of physical, and thus emotional and mental self.

Feeling stressed can also generate a feeling of having lost our way, or not knowing where to go for support.  A touch therapy like shiatsu allows the body to feel more present, and may enhance a feeling of being supported, and knowing where to find support.

There is quite a lot in the press at the moment about stress – I saw a full page article in the Guardian recently (Wednesday 3rd October, Time to talk about workplace stress by Debbie Andalo) where the problem of stress was discussed.  The writer reported running a workshop for stress, but said it had to be badged Keep your Edge in order for a high attendance.  So, stress can result in poor performance at work as well as home.  Keeping on top of things is more achievable if we feel relaxed and comfortable on all levels.

What do you think?  What are your experiences of stress, and how have you managed them?  Have you tried shiatsu?  Did it help?

please post comments on this blog.  I'd love to hear from you.
Catherine.