Why did my Post Covid Knee take me to A&E in a purple Sarong?
27th April 2023 – Quick Update:
At last, after months of waiting, I got to see the Consultant at the prestigious Royal Orthopaedic Hospital, Birmingham.
What’s the precise problem?
I have a 14 x 10 mm “defect” (missing cartilage) and a “flap” on the inside section of my right knee. It needs surgery.
There is no blood supply to connective tissue so with the exception of children (still growing) this is very unlikely to auto-regenerate.
Although the surgery is routine, recovery will be slow due to the reason above. No walking for two months minimum to allow the cartilage to regenerate. Then, rehab can begin. Chances of success for an active person like myself are not guaranteed – in fact it could end up worse than it is now. Oh…
If the joint is painful the consultant offer a cortico-steroid injection right there an then. But it’s not painful as a general rule. And as these injections can also cause problems, we agreed that it’s best to “save them up” for when needed…
What should / shouldn’t I do now?
The consultant suggested that I start running again and just see how it goes. BUT it could hasten the degeneration of the cartilage. When I mentioned cycling, he said that’s the best thing to be doing – cycling and swimming and of course, a cr*pton of Pilates.
So, it looks like it’s goodbye running and hello cycling. I’m moving over to the “dark side” – cycling :)…
How do I feel about this?
Overall, good. I now know the ins and the outs of everything AND although this info took a long time in coming – I feel that I have a plan whereas before everything was all in the air ad conjecture…
A bit gutted that I won’t be doing a full Ironman Triathlon ever nor any more of those crazy long Ultra Marathons… but I CAN ride Century Rides (100 miles – 160 kms) each weekend when I get bike fit enough 🙂
The story – this part is more fun 🙂
In July 2022 my first encounter with COVID really knocked me about although I didn’t once think I might need to go to hospital. After 11 days from my first positive test, which took four days, NHS recommendations were that, from the perspective of infecting others, it would now be safe to go outdoors.
So I went to the shop for some much needed supplies and then for a short walk: less than 2000 steps. The next day my right knee was in complete agony making walking impossible. Because of the pain, I lay on the sofa for another two days.
… oh yeah!
“La Colmena” by Camilo José Cela, (The Hive in English) is a novel (wiki link here) that covers three days of life of almost 300 characters. Set in 1943 it deals with the misery, poverty and general unhappiness of those same characters in post Civil War Spain. There are few heroes.
Back to Here and Now
Unlike “La Colmena”, this story is true and covers less than 24 hours. There many characters, but far fewer than in Cela’s novel. As a bonus, it’s much shorter. Also, it centres around my experience whilst La Colmena circles around people without a defining centre. This story is also far less well written!
In addition, this is a happy story full of Super Heroes masquerading as normal people. This is Hollywood in reverse: the Superheroes are the Normal People – and most especially The Sandwich Lady.
Read on …
Here begins our prologue:
… we go from pillar to post
This is where the story begins. Four weeks of visits, calls, trips and waiting trying to find out what was wrong and get help!
Though important to me, this was not a medical emergency, nor had there been an accident, so a trip to Accident and Emergency (GP suggested I call 111 and 111 suggested Accident and Emergencies) resulted in the Nurse directing me to Out Patient Department.
The Doctor at Outpatients told me she could do nothing and I needed to see my General Practitioner. She recognised my frustration at going round in circles… Poor her and poor me.
– it’s not a good look!
Meanwhile, I was becoming frantic: a Pilates teacher with a serious limp was not a good look! Fortunately, I could still cycle short distances enabling me to get back and forth to the ZELLIG and our Pilates Studio. I could still teach and I experimented with what exercise I could and could not manage. Over the days, I was able to significantly increase the range of movement of my knee.
Four weeks in:
Lights, Camera and Action!
One Friday in early evening, after four weeks of to-ing and fro-ing with little success, and after returning from an X-ray at City Hospital, the swelling in my knee spreads upwards to my hip and all the way down into my feet.
a suggestion, a confirmation and an ambulance?
This suddenly feels more serious and more urgent! I’m getting worried. I really want to put a tourniquet around my thigh to stop the swelling going higher up into my hip!
I text a client, who is a Doctor (you know who you are 🙏🏽), and she suggests to go Accident and Emergency. I call 111 to double check: I don’t want to be turned away again. After lots of questions and suggestions like the idiotically stupidly obvious: “take off that tourniquet” and consultations between themselves and Doctors, they tell me to go immediately to A&E.
They even search for the most appropriate and least busy hospital: The Queen Elizabeth University Hospital – not the closest, but the least busy. They offer to send an ambulance 🚑, but I decline, saying I’d just as easily get an Uber, saving valuable resources for someone who might be in far more imminent danger than I was. People die, you know.
Arrange “tomorrow”: aka put your affairs in order
& thank you Michelle and Yousuf
Not knowing what was going to happen I call all my 1:1 clients to postpone our lessons for Saturday (again, thank you 🙏🏽 to Jo and you Niharika).
I call Michelle who happened to be in Ireland visiting family (a big 🙏🏽 to Michelle @ZELLIG) to arrange for the studio key to be available for all those students doing their Personal Pilates Practice: the very capable Thinkers and Doers: Jessie and Andreea!
And that’s the great thing about learning Pilates (as opposed to doing it in a class): it gives you the independence to practice without your teacher!
Stage Left: enter Purple Sarong
I suddenly realise that I need to get dressed. BUT I can NOT get shorts on: the range of movement was so limited at my knee and there was pain.
Solution found: a sarong that someone gave me as present in Kuwait some fifteen or more years ago. I was going to hospital in a sarong!
At the time, I didn’t care, this was an emergency and it was nighttime. But I didn’t think about The Leaving in the bright sun 17-18 hours later. But guess what? No-one gave me a second glance – how interesting… Perhaps I should wear a sarong more often 🙂
Accident & Emergency
and waiting, and waiting and yet more waiting…
Reception had got the advance warning of my imminent arrival and knew who I was. They rushed into the department in a wheelchair.
After that, for a full 17-18 hours, mostly, I was waiting. The Doctors and Nurses we super professional making me feel in safe, in very capable and expert hands despite my own personal worry!
There were long periods of waiting …
… and I’m a bit of a worrier.
The Doctor who stroked his chin
But the Doctors were puzzled, surprised and interested: “I like your knee, this is very, very interesting” said the senior orthopaedic Doctor, stroking his chin thoughtfully. And yet no injury. That was the second Doctor to see me on a busy Friday night in Accident & Emergency. By this time, the inflammation had grown that the shape of my knee was almost indistinguishable from my thigh and calf, my toes were all squashed together and immobile due to the swelling. The range of movement in my knee was, well, just about zero!
The Thought Crossed my Mind
that People DO lose Legs…
I wasn’t scared, but I was definitely worried for sure! I have a friend and colleague that nearly lost her leg after a skiing accident caused compartment syndrome… and when you’re waiting long periods, the mind works overtime. I need felt I might lose my leg, but the thought crossed my mind, thank God for those wonderful people surrounding me!
The Doctors called around and found
The Best Possible Outcome …
They really pulled out all the plugs to get other Doctors to collaborate and liaise, and eventually we got the “best outcome” as the Doctor in charge of my case described it: the senior orthopaedic consultant agreed to see me after her regular morning ward rounds. They must have called her at 2-3 o’clock in the morning 🙏🏽! I didn’t really notice at first, but the pressure inside my leg decreased and very the swelling started to reduce. I called the Doctor as he was passing (busy with someone else) and he cam to take a look. He told me: “the swelling might come and go, but the issue remains the knee – the underlying cause”.
The Nice New Doctor,
the Angry Nurse and the soothing Head Nurse
It was late morning by this time. The Emergency Doctors had warned me it would take time. I’d not eaten a thing and had passed through the other end of hunger pangs by this time! I was transferred to an Acute Ward and quickly examined by a junior Doctor who would report to the consultant. Fortunately (for me) she was new to the hospital and left me on a wonderfully comfortable and private examination table where I could get a good hour’s sleep 😴 . But, unfortunately for me a rather angry Nurse found me in a place where I shouldn’t have been and unfortunately for the young Doctor, was pretty darn furious: “that Doctor has really messed up. big time! She should have left him there!” she told the head Nurse in strident tones… alas! The Head Nurse did her best to deflect her anger by acknowledging it and find me my place to be…
The Acute Medicine Ward with the BBC News
in the quiet before their storm
So finally, I ended up where I should have been all along: in the Acute Medicine Ward.
It was a huge room with dozens of upright but very comfortable chairs (at last) in the middle with curtained examination areas round two walls of the room. There was a massive Nurses’ station with dozens of computers on lines of desks.
I saw some very arrogant but very handsome looking young guys with flat stomachs and good hair coming in and out with stethoscopes around their neck.
The High Blood Pressure Nurse
This was clearly a very busy place. But right now there were just the three of us. And it was here I discovered that I had high blood pressure! The Nurse told me that the Doctor would want to talk to me about that.
The High Blood Pressure Nurse told me that this was the quiet part of the day. Later, all those empty seats would be filled: I imagined very controlled chaos!
The Disgruntled Guy with DVT
Moments later I watched her deal with a poor guy who was rather disgruntled a being told he needed to come in for further preparation for a test to detect further DVT: Deep Vein Thrombosis… Though she was patient and courteous, I felt that she was frustrated at telling different people the same things day in and day out. Dear High Bllod Pressure Nurse, you don’t know it, but you’re my Secret Guardian Angel: message heard and message understood: thank you – I’ll get my own blood pressure under control.
But that was the least of my concerns right then…
The Older Lady trying to escape the TV
A few people came and left, I felt a pang of envy that I was still here waiting listening to the cycles of BBC news from the TV screen. It was on constantly, really annoying one poor older woman, who tried to escape it by moving right to the back of the massive room. More about HER later.
The Optimistic Consultant Arrives
… with her black pen taken from her “black bag of doom”!
At last the Doctor came. I remember her name: Dr. Rankin (coincidentally, I’m a great fan of Rankin’ Roger :-)). Oh boy! She was ultra thorough, professional, self demeaning – she described her handbag as “the black bag of doom” – and extremely competent. Not only did she carry her “Back Bag of Doom” around with here but also sported in which she carried her equipment. Clearly this was a woman of substance and not to be trifled with! 🙂
From her Back Bag of Doom she took a Black Pen, and after using it to write copious notes she returns it she remarking: “I’ll be careful to replace this pen properly – it writes really well – I like this pen”.
She took a massive amount of time taking my history – no stone was left unturned: progression of COVID, the progression of the leg problems, family history, genetics, diet, physical activity levels, travel, sexual activity, urination and stool quality, every single other symptom that had appeared during COVID like the red birthmark type thing that had appeared on my chest.
But she was still mystified by my condition: there are many different things that it could be she said, but we’ll find out as we eliminate more and more things one by one. Thorough? She was wonderful!
The guy with the spontaneous fracture
I said that there had been no injury – I’ve been lying on the sofa for the best part of two weeks. “Not necessarily”, she replied, “just last week I was treating a guy that suffered a spontaneous fracture to his tibia – it just went and broke”. “OMG” I gasped, “we are fragile creatures”.
The Medical Procedure
and a surprise!
After a local anaesthetic and several freezing sprays, she drew the fluid out and was surprised: “oh! It shouldn’t look like that!”. “Like what?” I asked, intrigued at her surprise… she held up the syringe and showed me the fluid that had caused my swelling: it was a clear yellow fluid. She showed me how you could still see the graduations of the syringe through the liquid. “It should be opaque, full of white blood cells: so this is not inflammatory”, she patiently explained. Can you see how I liked this Doctor so much? The mystery becomes more mysterious.
The cortico-steroid went in with no problem. I’d had this treatment one before when I separated my shoulder from shoulder blade in a cycling accident. The effect was spontaneous, but Dr. Rankin warned me that sometimes it could take a few days to take full effect and that equally, it might not have the effect we wanted – and she explained about the side effects.
With a short discussion and talking around a few ideas about how much we really know about the human biology, she left to write everything up, arrange to get my X-rays from City Hospital and making sure that she had my phone number correctly down for a follow up. Yeah!
She was very much more optimistic that I am about science and medicine: “Look, in the ’80s we had AIDS and people were dying left right and centre with pustular sores draining down their legs. Now it’s just something that people can live with – almost like a difficult one, but an inconvenience nonetheless. We are a very ingenious species”.
I told her that I had been in the hospital since about 8:30 that previous evening (it was now about 1:30 pm the following day) but that I was so grateful for her taking the time, a good 90 minutes, and patience to see me and deal with me in such a way. Truly, I was grateful.
& Gratitude 🙂
People mention gratefulness often and I feel that there’s some virtue signalling, especially public displays on social media.
But the gratitude that I feel towards: my Doctor friend that suggested to go to A&E🙏🏽; A. Topping – my usual go to health advisor🙏🏽; my clients’ understanding – Niharika 🙏🏽 and Joanne 🙏🏽, Jesse 🙏🏽 and Andreea🙏🏽 who did their own workouts without me; Michelle from Zellig🙏🏽; Yousuf our wonderful Zellig Security Guard that does stand in weekend reception duties at Zellig🙏🏽; the operators and Doctors at 111🙏🏽; the Uber driver who drove me so smoothly through the huge crowds leaving the cricket match at Edgbaston🙏🏽; the “reception at A&E who let me through double-quick🙏🏽; the two Doctors 🙏🏽 & all the Nurses 🙏🏽 at A&E; the Young Doctor that left me to catch up on sleep where she shouldn’t have🙏🏽; the Dr Rankin 🙏🏽 and Nurses 🙏🏽 in the Acute ward – especially the Nurse 🙏🏽 who told me I had high blood pressure; the Uber driver who took me home 🙏🏽 and the staff in my corner shop!🙏🏽
Remember the older woman who was trying to escape the noise of the TV screen? A special thank you 🙏🏽 to you for telling me that there were sandwiches in the fridge at the back of ward with the tea & coffee. I hadn’t eaten for more than 20 hours! I hadn’t really been hungry before, but now it was all over, I could eat a sandwich. I chose egg and mayo – it tasted divine with a glass of water!
A very very special thank you to my friends, Sharon and Gary 🙏🏽 , for well, just being there. Without condition nor expectation.
And everyone that has sent me good wishes and offers of support.
And thank you to the NHS.
… to be continued