Greetings to all of You Lot who, for better or worse, follow my Ramblings (and occasional Rantings) here. As usual, all I can say is: haven't you got better things to do?
Anyway, I'll get to the point. Some of you might remember one of my recent Posts complaining about Dizziness when getting out of bed (usually in the mornings), looking upwards (e.g. for inspiration from the Heavens), changing light bulbs on the marble chandeliers at the Mansions etc.
Thanks to a few of you for suggesting that it might be BPPV (Benign Paroxysmal Positional Vertigo - i.e. you get dizzy when you move your head in a certain way). Yep, you were right. And so followed tortuous efforts to get an appointment with my local WSM GP surgery to get it sorted via the Epley Manoeuvre - a precise procedure to confirm and resolve the condition.
After 2 weeks of mainly telephone contact with my local (UK) GP Surgery (Practice name not mentioned for obvious reasons..), various GPs scratching their heads and telling me 'they didn't really know how to perform 'Epley' / unsure that any Practice Nurses there could either / it would take a week to refer me to the local hospital ENT Department' etc, I lost-the-will to pursue things and decided to escape to my sister's place in Dorset for a break and to do some DIY projects - but with the dizziness still hanging around. Ladders..? Working at Heights...? Ohh Nooo..!
Whilst in Dorset, Sis suggested popping in to her local Medical Practice on the off-chance that someone there could advise. We 'rocked-up' there (whatever that means)with no appointment, and also my NOT being a registered patient there. Prospect of Result? Mmmm... sceptical to say the least.
Now, what do you make of this..?
On presenting myself / my symptoms and asking if anyone there knew about BPPV / Epley, the friendly and helpful receptionist immediately networked it out vie e.mail to the various GPs on duty and asked me to wait 5 minutes. Literally 5 minutes later, I was given a consultation with a truly brilliant, young male (not that that matters) Dr W. who greeted me with a smile (and even stood-up to shake my hand!), made welcoming comments, had an attentive style, and asked me for a brief run-down on my medical history (since he didn't know me from Adam) as a pre-cursor to the consultation. I summarised my health story, mentioned my PMR / current progress, and more important, the BPPV - and my prior knowledge of it due to my involvement here. He wasn't phased by this at all.
Dr W. immediately explained BPPV in Plain English and said "Let's do the Epley Manoeuvre and see which side of your head / ear is causing the problem". 15 minutes later after an expertly performed Epley sequence of head positioning, lying on my side, inducing SCARY(Woooo-hooo!) Dizziness etc, and with some laughs in between (e.g. "try not to fall-off the bench, Mr Benjamin, you'll be ok"), he conclusively diagnosed BPPV - and gave me advice about what would follow (i.e. let it settle down, don't drive immediately etc). He also recommended a referral from my usual GP for a Head Scan on the hopefully miniscule chance that the cause might be something less benign. With that, a smile, handshake and Goodbye.
Result?
If I could give a GP and their Practice a Client / Patient Satisfaction rating for the usual criteria like Speed of Response, Friendliness, Expertise, Patient-Care etc. this one would rate 11/10 on all counts. A very Satisfied (and relieved) MB after many Hassles, Disappointments and Vagaries in dealing with my local GP Practice over the years.
My Conclusion(s)?
1. GP Surgeries vary immensely in terms of their resources to handle non-urgent Patient presentations and allocate appointments. Some poor, some excellent, and everything in between. But we probably know the reasons why.
2. A 'good' or 'poor' GP in terms of Expertise and / or a Patient-Centred approach can be regardless of age, gender, nationality or experience.
3. There are some Brilliant GPs (and Rheumies) out there. If you are struggling with yours (for whatever reason) it's worth shopping around to find one - as I did by accident today.
That's it.. only to say that my Faith in the NHS was more-than restored today after a truly exceptional Patient Experience in more ways than one.
Hope this helps some of You Lot in the UK who have the same dilemma around GPs / GP Practices and the often elusive concept of Patient Service Quality.
And, as always, try to keep smiling on the PMR / GCA Journey
MB
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markbenjamin57
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Get on google Mark - there are YouTube videos of "How to do the Epley" . A PMR friend and her daughter found one, the daughter studied it carefully and did the necessary. To be fair, she is an anaesthetist...
Many doctors will refuse to do it in their surgery/office because patients frequently puke - they don't want the mess so try to pass the buck. Provide your practice with a copy/link to the video and suggest they do some CPD. It isn't rocket science - or maybe it is for your practice?
I know PMRpro. But having done the DIY Home version (clearly, as an amateur, with no effect) and then experienced it done by an expert (with dramatic effect), I think Epley is best done under supervision - for the first time at least. Mmm... as for educating my GP Practice in Epley?! Maybe move on... to another Practice.
Yep, sometimes best to chuck-in the towel and move on. On reflection, I've had many similar experiences with my local GP Surgery over the years, including prior to my M.I. in 2004. But won't go into them now...
So glad you're feeling better,what a great Gp surgery😊I thought I saw you on a jet ski today on the marine lake! But it may of been Tedski on the jet ski.Have spent a lovely 5days at WSM obviously living life to the full as usual.I know how to party (my new favourite saying)😁
Thanks S - glad you had a good time at WSM. Sorry I wasn't around to wave at you from Floor 17 at the Mansions! 'Jetski / Tedski' - there must be a joke in there somewhere?
Yep Jane, Epley is quite a precise procedure and, although it doesn't hurt exactly, it is designed to induce the dizziness so that you can tell which ear is most affected. Dr. W observed my eye movements at the same time - he could see them rolling and laughed. He's obviously an expert at it! Of course, Epley also tries to relocate the crystals back into the right bit of the ear canal. Fingers crossed it's done the trick...
Mark I am delighted. This is so happy and so cheering. What brilliant luck and how easy it is to make a patient feel better in so many ways, not just clinically. I know what you mean. When I last visited the uk I had two separate occasions when I needed medical help from a practice based clinic. One experience was similar to yours with polite staff who used initiative and trouble shooting. A well mannered and efficient doctor who made me feel fabulous. The other experience was the polar opposite with staff who seemed to not want to help and would actually love me to feel worse. A gp who had no hygiene habits or bedside manner whatsoever. I am delighted for you. Linda xxxx
Mark, If you actually have Vertigo it is reportable to the DVLA Medical section. I sent form DIZ1 (I kid you not), result -licence revoked, can re-pply in 3 months! Getting to know the (few) local bus routes.
Thanks Vanner. Well, the GP just said not to drive for a couple of days - no more than that. In the NHS notes about BPPV it says to tell the DVLA if the symptoms are 'sudden, unexpected and disabling'. Fortunately, no symptoms at all whilst driving so I'll hold back on reporting them since I think the Epley has done the trick. Fingers crossed.. but it does remind you how much you take for granted re. driving and mobility...
When I lost the sight in my right eye GCA - about 10 months ago, The hospital said that I should report it to the DVLA. My ophthalmologist optician said "Do not do that! They will probably rescind your licence and make you jump through hoops for the next couple of years" "If you pass a couple of eye tests, you are not obliged to talk to the DVLA at all." One is the field of vision test and the other is a bit like the reading of a number plate at 20 metres - I can't recall it's name. The fine print on the DVLA's website confirmed this - So I took the tests -and passed. So that's that.
Thanks Arthur, good to know. Although I notice in the news that the Old Bill (UK Police) are introducing eye tests for all drivers who are stopped, for whatever reason. So, as you say, an optician's opinion is probably best - and using sound judgement of course. Just be careful with your motor insurers though, you should really notify them of any 'changes in circumstances' which might affect the validity of your policy. A tough one, I know...
I did contact my insurer to advise them of my sight loss - somewhat nervously! When I told them that I had subsequently passed the two sight tests that the DVLA specify, they told me that I need not have informed them, and that all was well.
I do drive less often and more slowly now though. It's not so much fun anymore.
I would like to wear an eye patch when driving, since there is a tiny bit of remanent awareness of light in my right eye which slightly confuses the left one sometimes. I can still see everything, but it's annoying. However - imagine me being involved in an accident, and the Old Bill appearing on the scene - " 'Ello 'Ello! " - and "Aha!" would be the likely introduction I fear.
That's good on the part of your insurers - they usually look for any excuse to increase the premiums. When I was working with the Old Bill (traffic division) delivering Speed Awareness courses for 'Naughty Speeders', there were lots of drivers with perfectly good eyesight who STILL managed to miss speed limit signs, enforcement cameras etc! We would do a fun activity with them around 'observation skills' - a PP slide to count how many pens on a cluttered desk in 5 seconds - it usually made the point!
You are correct - my insurers prided themselves in not giving me a silly bad time. Some do apparently, as you say.
I am aware of your murky past Lord B. I was a "Client" a couple of year ago. 38 mph. - running late for a hospital appointment. Yes, I know there are no excuses! - They told me so. Still - my "Previous" was not halting at a Halt sign on a motorbike in 1958, in the days of "Speed cops" - So not too bad.
I daresay my next conviction will be for 5 mph on a mobility scooter - in Sainsbury's.
Careful now Arthur, 3 convictions in 30-ish years is pushing things a bit. On the positive side, I don't think Old Bill do courses for speeding on a mobility scooter in Sainsbury's.. yet
Pleased you got a diagnosis. It always seems better when one can put a name or in this case an acronym to something. Not sure why though. Perhaps it makes it more believable?
Can’t wait to get enough energy to storm a charity shop, to be able to stretch my arms again. They seem to have contracted by a foot (12”) Can’t bend down enough either.!!!
Probably as well, as I have still clutter (priceless artefacts) left after my last move.
Thanks Mark, so pleased for you right place right time.... I hope things settle in readiness for the weekend and your dizzy heights on that podium, who will be ready to catch you I wonder....perhaps give the audience the heads up that if it should happen you are not drunk!!
Seriously ATB for Saturday, I don't know who's more nervous Us Lot or you!
Thanks Telian. Yep, feeling ok for the weekend but if I start to 'wobble' on stage I might have to ask a few of You Lot to come and prop me up. Can you imagine..?!
I think not - there was a request for £15 last time I looked. And I resent being asked to pay for something that probably won't have anything I can eat! Sandwiches as far as the eye can see usually!
I did request gluten and dairy free and they said not a problem, apparently the caterers cater for all needs - we shall see. I usually find that the gluten and dairy free foods get eaten by everyone as they look so delicious, or people just want to try - slapped dannies keep off - hope that's the case - looking delicious I mean, I usually prepare by eating before I go anywhere just in case....
Yes - I had my plate of "safe" food sitting next to me on the bar at an evening event at a meeting and some cheeky sod helped themselves! I thought what a cheek! And it was because mine was different and looked superb. I really hate UK buffets though - I usually eat the fillings and leave the bread in a pile... I have been to so many events where I have requested wheat/gluten-free and there is no indication of what I can eat and what I can't. Nor have the caterers much idea either.
The best I have ever had was in Japan - evening do at a brewery in Sapparo. A member of staff took me round pointing to each plate tellng me what was OK and what wasn't. And at lunchtime on the first day I had asked what was what of the desserts - for the next day the head chef had been to the very upmarket confisserie and fetched me a whole gateau box of gluten-free cakes!
Exactly my point, I get so annoyed - bit like when someone parks in a disabled bay that clearly isn't, as they run in the store 'cos they know they're wrong, If I could catch them I'd say take a disabled place, take the disability too...after all of that I don't have a disable badge but OH does. I'll wait until I really need it.
Forgot to say the gluten free cakes sound delicious, reminds me of the cruise we went on last year, they were out of this world, just bite size so could try a few. I noticed folks saying oh lets try these - I once said 'they are gluten free if you need it?' reply was 'no but they look so nice' grrrrrr!
Pleased that you are feeling better Mark,and the practice you visited in Dorset sounds wonderful.l needed an urgent appointment this morning and was very relieved to be given one,however it has not helped me at all.The doctor was a part time locum ,obviously well over retirement age who did not seem at all familiar with P M R and steroids.l have been having problems and not feeling at all well since l tried to reduce the Pred.,from 3mg to 2mg.l only tried to do this about three times during the last month,going back to the 3 mg. the rest of the time.l needed advice as to how much l should increase the steroid to suppress the bad flare l am now experiencing,as 3 mg just does not work for me anymore.l was told to stay on 3mg for l week as that is what it would take to start working ! Then book another appointment if there was no improvement. I mentioned this forum and the good advice and information it gives,and that usually a flare needs more preds.Then he said to increase the dose to 4 mg as that should be enough and as everyone is different the health forum is not always right.well at that point the time was up ,and l ended up asking the receptionist if l could speak ,via a phone call to a different doctor and l have to wait untill tomorrow morning to request ,around 8am,a call from another doctor.l apologise for this long ramble,but l just could not help but remember the wonderful Dorset practice .l am spending the rest of the day doing very little and l am tempted to go to A & E tomorrow if l do not feel any better and use their urgent GP service.Kindest regards to you and Tedski ....from Grants.
Top expert advice for a flare due to reducing too far is add 5mg to the dose at which the flare occurred. Once the symptoms have receded, providing it is under a week to 10 days, drop straight back to the level ABOVE where the flare happened. So try 8mg for a while and go back to 4mg. If it were me, I'd try 10mg and drop to 5mg - but I'm belt and braces and don't/won't compromise.
Following on from PMRpro's advice when things have settled, say back to 5mg, try reducing by only .5mg and stay there until the withdrawals have subsided before trying another drop, no matter how long it takes.... It's taken me 4 months to reduce by .5mg to 4.5. I've previously got to 3mg but don't seem to be able to get there this time. I'll stay put for now.
Just a quick reply as I'm getting myself ready for the big day on Saturday. Planning, preparing, conserving energy, relaxing, etc - as we should with PMR and GCA.
Sounds like your frustrating experience today is fairly typical of GP surgeries, unfortunately. All I can suggest is to keep push, push, PUSHING for a consultation with a more attentive GP and / or one who is better informed about PMR, Pred tapering etc. Hopefully you'll get a GP who has a more Patient-Friendly approach - and this alone will help you to feel better. But I agree - if you are really struggling and worried about your symptoms, either call 111 or just turn-up at A&E?
Yep, my experience with the Dorset GP / his Practice was exceptional - I only wish that it was the norm. Either way, please keep Us Lot posted on your progress?
The doctor l saw this morning insisted that more than 4mg.would be too much,that is why l felt he did not really understand much about PMR.l wish l had stayed on 3 mg.,l was OK with that as long as l did not overdo things,but my GP has added a note on my box of preds ,.to reduce dosage as directed.Read theprinted advice.l am well aware of all the information that comes with the steroids so l do not know if that was to warn me about all the side effects! My GP is away untill Sept. 17 th. lt was not just the problem with my legs that l was concerned about,my pulse was all over the place all night and l kept getting missed beats,l am made aware when this happens by tinnitus in my ear that is a constant pulse like noise that is linked exactly to my actual pulse,this has happened before and is very scary. Thank you both for your advice.
Dis you feel unwell with the irregular heart beats? If you do, whatever time it is, call 999 and tell the call handler what is happening. If theya re concerned they will send a paramedic with an ECG machine - which with a bit of luck will provide evidence of what is going on.
ThanksMark,The receptionist seemed to understand PMR when l asked for an appointment .l do find things are not as good as they used to be,they seem to be cutting down on blood tests,l have not had one for months.l hope the weekend goes well for you.
Thankyou for the expert advice dealing with a ‘flare’,the GP l saw obviously knew very little about PMR.The GP l saw recently at the hospital about a swelling on the side of my jaw was much more informed,l shall go there on Monday if things do not improve.
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