Back to it!

So last week I went back to work after finishing my course of steroids, luckily they worked within 3 weeks! So the plan now is to take them the next time I have a flare… meaning I could be off again during this pandemic. Seeing as I’m only just off pred, I’m taking even further precautions in work, extra PPE and avoiding covid + patients where possible.

Back to work for me is back to working on the front line, numbers are now starting to decrease and plans are in formation about how we can start seeing outpatients and elective surgeries again, which is great! But going food shopping again and seeing how some members of the public still aren’t taking this seriously, having to tell someone to move a safe distance away from me, is worrying.

PPE life!

Also celebrated my 25th the other day! My partner made it super special decorating the house and making me my favourite food (a full English) and buying me a weighted blanket which let me say is a game changer!!! I had a mini flare of my hips, had the weighted blanket on top of me and it helped so much, didn’t need pain killers at all and managed to sleep, miracle!!!

This weekend we had my partners little one to stay for the first time in a few weeks, due to me being high risk. It was super fun! We ate a lot of birthday cake, went for walks to collect bugs and in the fields around us! We are lucky where we live as we have bats, deer, foxes and horses all visible from our home.

Today was supposed to be the start of our holiday in Greece, instead I’ve spent it re-potting my plant babies and watching my little Opal nest!

Some serious roots on the sweet peas!
Opal gathering hay for her nest ❤️

Lockdown bundates

The last few days have consisted of a lot of Mario gaming, re potting my seedlings and gardening and general round the house sorting. Me and my partner have taken to posting insta stories every day called ‘bundates’ to help with the boredom. Here are pictures of said bunnies!

My flare up has gone which is amazing, slowly reducing my steroid dose and hoping these side effects soon go away! I feel absolutely nuts most days, going from dancing round the living room to Grease, to hysterically laughing at nothing, to crying at not having my favourite cheese in the fridge. It’s like being hormonal x 1000. Super keen to get back to work and have some sort of routine and normality back, it’s starting to play havoc with my mental health.

Have any of you guys had experience with steroids? How did they make you feel?

“But, you look ok?”

Maybe I look ok because I’ve been sleeping this flare up off all day, or I feel worse at night, or I’ve taken a lot of anti-inflammatories?

I used to get this a lot, I still do, especially as I manage to work a full time post in a hospital with shift work. Awareness of invisible illnesses have come a long way since I was diagnosed and that’s so great, but it’s still a very lonely world out there for a sufferer when you cannot find anyone to relate to. This is part of the reason why I’ve started writing again, I want to be able to help people more than what I do physically in work, talk to people online who are mid flare and need someone to vent to about not being able to pick up a plate or open a jar!

Whenever someone finds out what’s wrong with me and that I’m in pain daily are so surprised and I always get the comment now “but you’re so happy all the time” “you’re always smiling and just get on with things?!”

Chronic recurrent multifocal osteomylelitis is a paediatric condition that I should have grown out of by now, unfortunately I’m one of few who haven’t been so lucky! To have my condition you have to be one in a million  (hence the blog name) so aren’t I even luckier to still be having flares?!

I have the most amazingly supportive family, friends and colleagues but it has taken a lot of years and some therapy to understand that it isn’t my fault I’m ill, it doesn’t mean I’m not good enough or don’t deserve to be believed…. (again, the title, but you look ok). At some points before diagnosis, I wasn’t believed, neither was my mum when she took me to the Doctor and was repeatedly told I had growing pains, so good on her for being that persistent for 4 years! I’m sure many of you can relate! During that time, I carried on with school and life however it was massively hindered by wedge fractures in the entirety of my thoracic spine, 3 levels in my cervical spine and swelling and pain of almost all extremities.

Anyway, 12 years later and multiple treatments tried, I’m still trying to find the one! I am currently on steroids for a flare and unable to work at my hospital due to Covid-19 and being immunosuppressed. Anyone in the same boat?!

I hope you’ve liked this little intro to my life… the funny stuff is to come I promise (I gave my boyfriend a bowl cut lockdown hair cut today) also woke up at 5:30am to feeling like I haven’t ate for 1000 days.

#thesteroidcravingsarereal

First Placement Blog – Case Study Idea

First Month Placement Blog

This blog will aim to reflect on my first month of second year placement, looking at what I have so far seen and experienced and also if I have found an appropriate patient for my IDIS case study.

During my first month I have been situated in multiple departments and hospitals including a private hospital and a paediatric department. Whilst in these various areas I have completed one appraisal (adaptive technique) and have been practising mobile radiography for a future appraisal. I have also spent a lot of time in theatre and in MRI which has been interesting to learn about as I didn’t spend much time there in my first year placement. Throughout my placement so far I have been commended on my communication skills and with my enthusiasm to learn, my aim for the rest of the placement is to continue to be enthusiastic about learning different things and also to gain as much experience in theatre as possible for next years appraisal.

Concerning finding an appropriate patient for my case study I am yet to find someone as I have only been situated in my allocated placement for one week in which I was in the A&E department, due to my case study aiming to be on a patient with Rheumatoid Arthritis I feel that I would liaise more with people who may have this condition during my time in the General Radiography department, where there will be more GP patients who come in for routine imaging.

My week in the general department is the last week of placement so I may have to look on the system and choose someone off there instead of actually imaging the patient and then looking at their details from that so that I can get started with the case study much sooner.

Any feedback on this idea would be much appreciated.

Manual handling of a patient with Rheumatoid Arthritis

Manual handling of a patient with Rheumatoid Arthritis and other joint conditions

As stated in my previous blogs my preferred patient for our IDIS case study will focus on a patient with Rheumatoid Arthritis. I have gone through the diagnosis, monitoring and the advantages of MRI and Ultrasound imaging in a patient presenting this condition. For my last blog I wanted to continue along this illness, due to our manual handling session this week I thought it would be quite useful to look into the manual handling of an arthritic patient as depending on severity some may be in wheelchairs and be unable to support themselves.

The law concerning manual handling consist of acts of parliament, regulations and codes of practice. The statutory instrument (The Manual Handling Operations Regulations, 1992) states that so far as reasonably practicable, to avoid employees of taking part in any manual handling that could cause injury, it also defines manual handling as ‘the transporting or supporting of any load by hand or bodily force’. Another manual handling act (Health and Safety at Work Act, 1974) sets out the duties of the employer and employee in a working environment, it includes duties such as attending any manual handling training sessions, providing equipment and carrying out risk assessments. These acts have validity as they are statutory instruments, although they may be considered old they are still followed as all the information in them concerning manual handling is still relevant.

A patient with Rheumatoid Arthritis is going to be in pain and therefore we have to be careful when we’re either transporting them from a wheelchair to the x-ray table or if we’re supporting them by doing it correctly. Risk assessment is needed before moving or supporting a load, an assessment tool used to do this is TILE (task, individual, load, environment) (Healthy Working Lives, 2013), however an issue is that it doesn’t fully support individual needs, every person has a different pain threshold therefore although someone may have a similar severity of RA they may have completely different pain management and therefore we cannot support them in the same way.

Swelling can reduce mobility in a patient due to pain and stiffness, if there is inflammation the patient will not want to put any pressure on that area for example lifting themselves out of a wheelchair if their wrists are inflamed. As RA is an inflammatory disease it’s vital that we do everything we can to protect the patients joints whilst moving them, we can do this by instead of gripping the patients joint using the palms of our hands so that our weight is distributed over a larger surface area. (Finney, A et al, 2006). This article has two authors with background experience, one being a Rheumatology Nurse however I realise this doesn’t necessarily mean the article is good. It has a good use of references included to back up every point they’ve made, however, they haven’t included a reference list at the bottom of the article so the reader cannot check where they got their information from and it therefore lacks validity. If the risk assessment shows that the risk is too great for us and the patient when moving them we can use assistive equipment such as hoists, walking and standing aids, slide sheets and many others (Health and Safety Executive, 2001). This article has reliability and validity in that we were taught how to use these pieces of equipment in our manual handling sessions and also on placement so although it was published in 2001 and equipment may improve the essential pieces are still used frequently in practice.

Overall from this research and my intermediate manual handling session this week I have learnt about the appropriate ways to support a patient if they’re in pain and to reduce the risk of further injury to them and also injury to ourselves. This blog further reinforces my learning of the legislation behind manual handling.

Reference List:

Finney, A and Thwaites, C. (2006) Nursing Times.net: Handling safety for patients with inflammatory arthritis. [online] 102 (21). pp. 26. [Accessed 12th December 2014]

Health and Safety Executive (2001) Handling home care: achieving safe, efficient and positive outcomes for care workers and clients. Available from: http://www.wlga.gov.uk/download.php?id=4761&l=1 [Accessed 12th December 2014]

Health and Safety (The Manual Handling Operations Regulations) 1992 (SI: 2793)

Health and Safety at Work Act 1974 [online]. Chapter 37. (1974) Legislation.gov.uk. Available from: http://www.legislation.gov.uk/ukpga/1974/37/contents [Accessed 12th December 2014]

Healthy Working Lives (2013) Manual Handling. Available from: http://www.healthyworkinglives.com/advice/work-equipment/manual-handling [Accessed 12th December 2014]

Note: 1st time referencing a statutory instrument, feedback would be great on whether this is correct.

Monitoring Rheumatoid Arthritis

Monitoring Rheumatoid Arthritis

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My last blog investigated the use of Ultrasound as an imaging modality in the diagnosis of Rheumatoid Arthritis, this blog will focus on monitoring the condition concerning how often the patient is imaged and tested throughout drug treatment. As a patient pathway it will be useful to see and learn of the different routes that a patient can have in their diagnosis, monitoring and treatment.

Once a diagnosis of RA has been given the different treatment options are considered, the treatment given can either be DMARDS (Disease Modifying Anti Rheumatic Drugs) or biological agents. For the use of DMARDS there are guidelines set out that need to be considered and followed before a drug is administrated, this allows an appropriate dose to be given to the patient that will give greater benefit than risk (Chakravarty, K, et al 2008). These guidelines were produced by the British Society for Rheumatology who have in depth knowledge of the disease and carry out research on the effectiveness of different drugs on different severity levels of RA, therefore they can be said to have a high level of reliability and can set the UK guidelines.

Due to the drugs having potential side effects on the body regular checks are needed for example blood tests to check for anaemia which can be an indicator of inflammation activity, not only is it of value for the patient being able to say whether they’re in pain or not the fact that we can also monitor inflammation levels in the blood means we can look at how active the disease is. X-rays will also be taken with every visit to the Rheumatology clinic to monitor disease progression of the bones, this is why in placement if there was a request from Rheumatology with the clinical indication of ‘RA progression’ we would take an image of both hands and feet as the small bones are normally worst affected. DEXA scans can also be used due to the use of a steroid over a number of years can decrease bone density making bones more osteoporotic and therefore more susceptible to fractures, if the bones show as being osteoporotic the patients’ medication will be changed and they may be given treatment to re strengthen the bone (Health Talk, 2010). The information on this website is gained from a combination of patient experience and researchers in the field of Rheumatology. This website is credible due to the experienced researchers and due to it being an award winning charity, it’s also based at Oxford University which is one of the top universities in the UK. They also have a list of references containing recognised national societies that look into all areas of Rheumatoid Arthritis. The information is really useful not only for a newly diagnosed patient but also for the health care professional as we can improve our patient care by understanding the amount of pain they may be in or their experience of having to have regular checks.

Rheumatology clinics are held weekly and the patient will be seen every few months depending on the severity and pace of their progressing arthritis, during these clinics a member of the Rheumatology team will assess the patient to see how bad their pain has been effecting them since their last visit to the hospital. The Rheumatologist will deal with any problems concerning medication and arrange for blood tests to monitor any changes in the patient and also send the patient for x-rays which are generally on the hands and feet to see if there is any progression. Occasionally the patient may not need a follow up appointment with a Rheumatologist and will be referred back to their GP (Weston Area Health NHS, 2014).

Overall this research into the monitoring of a patient has allowed me to be more aware in my next placement of where the patient will next be seen and the next time they may receive a dose of radiation. On reflection I now also know why x-rays are taken of both hands and feet and why this is justified for a diagnosis of Rheumatoid Arthritis.

References:

Chakravarty, K., McDonald, H., Pullar, T., Taggart, A., Chalmers, R., Oliver, S., Mooney, J., Somerville, M., Bosworth, A and Kennedy, T. (2008) Rheumatology: BSR/BHPR guideline for disease-modifying anti-rheumatic drug (DMARD) therapy in consultation with the British Association of Dermatologists. [online] 16 (1) [Accessed 3rd December 2014]

Health Talk (2010) Rheumatoid Arthritis: Regular monitoring and other diagnostic tests. Available from: http://www.healthtalk.org/peoples-experiences/bones-joints/rheumatoid-arthritis/regular-monitoring-and-other-diagnostic-tests [Accessed 3rd December 2014]

Weston Area Health NHS (2014) Rheumatology. Available from: http://www.waht.nhs.uk/en-GB/Our-Services/Clinical-Services/Rheumatology/ [Accessed 3rd December 2014]

Ultrasounds use in Rheumatoid Arthritis

Ultrasound in diagnosing Rheumatoid Arthritis

I chose to do my last blog on looking at the patient pathway for someone with suspected Rheumatoid Arthritis, within this I found that Ultrasound imaging is a useful way to image Arthritis. From the comments on my last blog it sparked an interest to look further into comparing what is commonly known amongst Radiographers as a good imaging source (MRI) to another more ambiguous way of imaging (Ultrasound). This blog will look into the strengths and weaknesses of ultrasound through diagnosis of the condition, my next blog will investigate monitoring of rheumatoid.

Ultrasound has been used in Rheumatology for around 30 years but with advances in equipment and our knowledge of the clinical signs of RA it is now used much more in diagnosis. Ultrasounds use in Rheumatology is either used in the clinical setting or for research purposes due to there being no use of radiation and its ability to image in multiple plains, giving us a high amount of information. One of the reasons why Ultrasound isn’t more regularly used in imaging RA is due to the skill needed to image the patient and also the knowledge of rheumatic diseases, in this article a way suggested to overcome this problem is either Rheumatology being trained in Ultrasound or Radiologists having a more in-depth knowledge of rheumatic disease (Wakefield, R, et al, 1999). This article picks up on the use of Ultrasound in Rheumatology and uses a number of reliable sources including the initial study on the first clinical use of Ultrasound in 1972 by McDonald and Leopald. Although this article and its’ references could be said to be outdated they are some of the first investigations into the uses of Ultrasound looking at MSK disorders and so are useful to look at. A more recent article has looked into the use of present day Ultrasound and states that there were guidelines produced in 2001 to set the standardisation of ultrasound use for Musculo-skeletal problems. In 2006 EULAR also introduced a new training program which had three different levels, this allowed Rheumatologists to be trained in Ultrasound (Kang, T, et al, 2012). This article is useful as it shows how we have improved our training and guidelines in the 21st century to not only improve inter-professional working but to also lessen the amount of time the patient will spend in hospital by having a scan done at the same time as seeing their Rheumatologist.

Concerning the diagnosis of RA with Ultrasound it’s important to use the correct transducer to get the best properties for the part of the body that’s being imaged e.g a high frequency transducer is of better use for less dense areas of the body due to poor penetration. “Hockey Stick” transducers are good for imaging MCP joints due to its’ small surface area and its ability to get the correct angles so that the joint can be viewed in 3D (Wakefield, R, et al, 2000). This study by Wakefield is useful in looking at the different transducers and equipment used for imaging in Ultrasound however the study itself lacks validity in not having patients with different severities of RA and only having 100 participants making it unrepresentative. Also, intra observer reliability was only looked at in 40 of the scans produced, for this to be more reliable they should have looked at at least 90% of images to reduce any errors in diagnosis.

Joint space widening is an indication of joint inflammation and Ultrasound is useful in distinguishing between these various types of inflammation, synovium is not normally seen in a patient with healthy joints. Synovium is the main target of inflammation and if not recognised can cause irreversible damage to cartilage and bone (Arthritis Research UK, 2011). Joint effusion is another indication of RA and shows up on an ultrasound as being hyperechoic, this is due to a change in the bone structure making it weaker and therefore giving off fewer reflective waves. This compares to the synovium becoming thicker and therefore more echogenic, reflecting more of the ultrasound waves. The comparison of these two pathological changes show the sonographer that there are changes in the structure of bone and synovium and can then begin to make an accurate diagnosis. Looking at the amount of false negatives and positives Ultrasound is good at early detection of RA but isn’t as good to differentiate between the different causes of thickened synovium or bone erosion (Tsou, I, 2014).

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References:

Kang,T., Lanni, S., Nam, J., Emery, P and Wakefield, R. (2012) The Evolution of ultrasound in rheumatology. [online] 4 (6). pp. 399-411. [Accessed 2nd December 2014]

Taggart, A., Benson, C and Kane, D. (2011) Arthritis Research UK: Ultrasound in Rheumatology. [online] 6 (9). pp. 1-16. [Accessed 2nd December 2014]

Tsou, I (2014) Rheumatoid Arthritis hand imaging. Available from: http://emedicine.medscape.com/article/401271-overview#a22 [Accessed 2nd December 2014]

Wakefield, R., Gibbon, W and Emery, P (1999) British Society for Rheumatology: The current status of ultrasonography in rheumatology. [online]. 38. pp. 195-201. [Accessed 2nd December 2014]

Wakefield, R., Gibbon, W., Conaghan, P., O’Connor, P., McGonagle, D., Pease, C., Green, M., Veale, I and Emery, P. (2000) Arthritis and Rheumatism: The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis. [online] 43 (12), pp. 2762-2770. [Accessed 2nd December 2014]