Stable... Not great

I've been quiet recently. I guess this means that things are stable. I'm not sure stable is necessarily a good thing though. I definitely have a lot of room for improvement.

I've now been taking methotrexate for a couple of months. This is a real mixed blessing. I'm pretty sure that I'm getting some positive effects but for the first few weeks the pills made me feel terrible; they would wipe me out much harder than the arthritis ever have. I think I'm now coping with the side effects but the dose isn't strong enough to cope with all my psoriasis symptoms. I should be having regular reviews but it seems like they've made a mess of this a bit.
I guess I could be chasing the hospital harder. To be honest the last couple of appointments I've had to wait over an hour after the scheduled time. What should be a quick late lunchtime appointment turns into a whole afternoon off work. This isn't making me that keen to go back, especially when you're seeing a doctor that has barely skimmed your notes and provides no useful insight.

Dactylitis Again

Thursday morning saw me being squeezed in with an unscheduled rheumatologist appointment. It turns out that when you do cancel a 6 week appointment and turn it into a 20 week appointment then things are liable to deteriorate. Currently it's dactylitis of the index finger on my left hand.

In my pre NHS days I would have had to pay about £200 to get the finger injected with steroids. I would definitely be sorted pretty quickly but I could never afford to have any more investigation done. With the NHS I've had to wait a bit longer but not only will I get my inflammation sites injected but they are also going to investigate with ultrasound (would costs thousands to do privately) and speed up my change of medication.

I definitely couldn't afford the treatment I need privately but there appear to be a big caveat with NHS care. They will only treat you once it's become the last option. I just can't believe that it's cost effective. Had they changed my treatment earlier I wouldn't need thousands of pounds worth of investigations.

See you in 6 weeks... er... make that 5 months

When you leave a hospital appointment with them requesting to see you again in 6 weeks you somehow imagine that is what will happen. Apparently not if somebody goes on holiday/resigns/gets fired. They are seemingly incapable of redistributing the workload amongst the remaining staff or hiring a replacement.

My original appointment was for July 18^th. The rescheduled appointment is for October 24^th and apparently there isn't anything free at all between those dates. My only alternative is to ring up once a week to see if there are any cancellations; they don't have a standby system at all.

I'm not that fussed that I can't have an appointment in 6 weeks. That's not a long period of time and as long as my medication is vaguely stable I've got no concerns about stretching that a bit. 20 weeks, however, was more than enough time for me to develop the condition, have to give up my career and start a new career. My hope is that this medical trial is going to start soon as that's the only way of getting timely treatment.

Inhibiting COX

They've got me on a great new medication now. It's called Etoricoxib and is another anti-inflammatory drug. I had to switch medication because I developed some pretty crippling inflammatory back pain and Diclofenac is pretty rubbish at tackling that.

Etoricoxib / Arcoxia

Etoricoxib, better known as Arcoxia, is a COX-2 inhibitor. Most standard anti-inflammatories inhibit both COX-1 and COX-2. This is a bad thing. COX-2 is the cause of inflammation around the body but COX-1 is responsible for the proper functioning of the stomach. In fact, stopping COX-1 from doing it's job makes you pretty much dependent on pills to protect your stomach and prevent ulcers. Etoricoxib is in theory much safer as your stomach is left pretty intact.

Why in theory?


Arcoxia is a pretty new drug and the evidence behind it isn't perhaps as good as it should be. Because of this it's not licensed for use in America at all. Here in the UK you can get it prescribed on the NHS but it's not as easy as it could be. Only certain hospitals stock it due to the cost. It is possible to get though.

Magic!!!!


The Arcoxia has really transformed me again. Just as I was starting to get angry and miserable it's cleared up a lot of the pain again. It also means that I only have to take pills once a day, which I can normally remember, rather than twice a day, which I frequently screw up.

From The Pharmacy

How long?

Yep. Average waiting time at Guys Hospital Pharmacy is apparently 144 hours. Luckily, with a bit of charm I managed to get my pills in just 1 hour.

From the waiting room

I'm sitting here waiting for my appointment. Apparently Holocaust documentaries are where it's at. I guess most of the patients here remember it the first time.

Sleep Does Good

I've been trying to cut down the medication that I've been taking. I'm convinced it's not doing me much good. I think it's pretty much turned me into a burping and farting machine. I'm still stiff most days that I don't take it but there is a definite pattern. Rather than being particularly stiff in the mornings, which I am a little bit, I am now most stiff when I am tired. If, however, I stay in bed for 15 hours in a day, most of it asleep, I can pretty much enjoy the rest of the day with no signs of inflammation. If only I could schedule my life around sleeping 15 hours.

Still no new on the trial. I'm starting to doubt whether it is the right thing to do. My symptoms seem to be largely manageable with enormous periods of rest. I just have to sacrifice my weekends to sleeping.

Wave Goodbye To The Gear

Last night, for the first time in months, I had all my music gear laid out in one room. I pretty much haven't touched any of it since I was diagnosed with arthritis. It was quite emotional seeing the culmination of 5 years work all laid out, including a brand new never gigged amp.

My room full of gear

I don't want to get rid of all my gear; there are far too many happy memories associated with it. Realistically though there's no point keeping everything. Some of it I was planning on selling anyway. There's now going to be a slow process of putting things on ebay and waving goodbye to them and finally deciding which instruments mean something to me.

I tried picking up one of my guitars last night as well - just to see what would happen. There's still pain there. As I'm still waiting to hear about the next treatment plan my body is slowly seizing up. If I forget to take just one pill I'm reduced to a kind of limp/hobble that looks like I'm about to soil myself. Driving is also starting to become a bit of an issue if I miss my pills. I could, of course, just remember to take them but somehow my day just never pans out that way.

Efficacy of Methotrexate - Who Knows?

Methotrexate wasn't initially intended for treating arthritis. In fact, it's first use was in treating leukemia and was used a chemotherapy drug for a long time. It is certified for use in treating auto-immune disorders, such as psoriatic arthritis, but nobody really knows how effective it is.

Psoriatic arthritis tends to manifest itself in 3 main ways:

1. Inflammation of the synovial bursa - This is inflammation of the joint itself, the stereotypical symptom of an arthritis.
2. Inflammation of the tendon sheath - The tendon sheath is similar to the membrane surrounding the joint and can become inflamed in the same way. This is what causes tendinitis and the dactylitis that's so typical of PsA.
3. Inflammation of the entheses - Enthesitis is inflammation at the point where the tendon meets the bone. It's different in nature to the synovial inflammations.

Rheumatologists are pretty confident prescribing methotrexate for arthropathies that involve synovial and tendon issues. It works. They have the evidence. What nobody has conclusively tested is whether methotrexate can improve the condition of enthesitis.

In two weeks time I should hopefully be part of a trial that hopes to discover whether methotrexate is effective, and exactly how effective it is. The trial is based purely on taking accurate measurements and adjusting treatment according to those measurements rather than just following best practice guidelines. This is what evidence based medicine should really be.

Methotrexate on Monday

One of the biggest factors in the amount of pain and stiffness I have appears to be tiredness. Unfortunately the amount of sleep that I need in order to have significantly reduced pain is too much to be sustainable. In fact, the best plan that I seem to have found at the moment is to have a long sleep on Saturday mornings in order to reset my system.

On Monday I'm hoping to start on methotrexate. This is a pretty big step in my treatment and also initially a bit risky. There is a danger of liver damage and so for the first few weeks you have to have weekly blood tests, my favourite. At least Guy's Hospital has a dedicated nurse for the rheumatology department. I reckon I should be able to make it there and back in my lunch break. There is also a chance that I could be given the proper hardcore drugs fairly soon. Normally they're out of reach of most patients but the advantage of going to Guy's is that they run trials. It's not a trial of the drug but the method of treating. This means that it's pretty much totally safe and puts my further in the queue.

Here's hoping for methotrexate.

Finally In The NHS

It's finally happened. I've had my first appointment with the consultant at Guy's Hospital and he actually seemed to know what he's talking about. In fact, in the 3 hours I was there he confirmed my diagnosis, I had a blood test and a chest x-ray and he prescribed me pills to protect my stomach that I really should have been taking all along. Best of all I'm back there in two weeks for the results and to really consider whether to start on Methotrexate. Larry would definitely be jealous of how happy I am.

Shawn Lane - Playing guitar with psoriatic arthritis

Just a warning first - this will only interest guitarists!

There have been very few professional guitarists with psoriatic arthritis, or at least that have admitted it. In fact, I suspect that there aren't any working as freelance musicians. The demands of turning up every day ready to play something completely unprepared just don't work with a condition that leaves you not knowing how you will feel when you wake up the following morning. There has been one artist though that famously had it, and it doesn't exactly give a lot of hope.

Shawn Lane developed psoriatic arthritis at the age of 13. He still went on to become one of the most technically accomplished electric guitar players around. Fortunately for him as a guitarist, the illness seemed to mainly attack his legs; whilst he could play fantastically he had trouble walking around.

I'm not sure what treatment options were open to Shawn, and there's very little written about what medication he was on, but he certainly wouldn't have had the option of the newer biologic drugs. Methotrexate may have been an option to him but it's not  talked about and there's plenty of reasons why somebody can't take that. What we can be certain of is that he basically survived on steroids.

My experience of steroids is that they can completely clear your system of inflammation. They can pretty much make you fully functional. They're great - in the short term. Unfortunately they have some nasty side effects. After years of steroid treatment Shawn ended up incredibly fat. He also developed another condition that often goes along with inflammatory arthropathies - pulmonary fibrosis. Ultimately it was the pulmonary fibrosis and long term steroids that killed him. Ultimately though, I suspect the reason he was so dedicated to the guitar was his psoriasis at a young age.

Haircut in a Snowstorm

One of thee curses of psoriasis is that it can sometimes make everyday tasks stressful and embarrassing. I have undiagnosed scalp psoriasis. I say undiagnosed because at various times it has been diagnosed by GPs as eczema and seborrheic dermatitis, although they refuse to refer me to a dermatologist despite it being clinically relevant. The way that it responded to steroids and the pattern of flare-ups in combination with my psoriatic arthritis tells me that it is almost certainly psoriasis.

One of the cruel things, and something confirmed by psoriasis blogger Howard H Chang, is that there appears to be a relationship between scalp psoriasis and length of hair. In other words, just as it's time to have somebody get as close to my head as I ever let anyone my scalp decides to start shedding skin. To make it worse, the gowns that my barber uses are black. Every little (or big) flake of skin that falls out of my head is clearly visible for all to see. I have to sit there surrounded by my own skin in the full knowledge that everyone else can see it too. When it's just on my shoulders I can forget about it; I can't see it and people are too polite to mention it. At the barber it's there on full show.

On the other hand, though, I know when I sit in the barber's chair that he's about to give me 4-5 weeks relief from itching just by cutting my hair. And believe me it itches. It itches all day. It itches so much I'll pick at it and scratch it until it bleeds.

Days To Remember

There are certain days in your life that are worth remembering. I remember my first ever band call for a panto. I remember doing my first West End press night and nearly hitting Will Young with my phone as I dropped it through nerves. Friday 11th February is one of the days that will be ingrained on my memory forever. The start and end of an era.

I guess a career change isn't particularly unusual, but to attempt one based on no relevant experience and no relevant qualifications in this economic climate is probably nothing short of madness. Fair enough, I had very good reasons to be looking for a real job for the first time in my life. The psoriatic arthritis was making my position as a freelance musician completely untenable. All the same, the prospects for somebody with my employment history getting a job in another field were slim. It was hard enough getting a job as a musician.

That Friday I attended an aptitude test. It was for the only job that I had really been drawn to as I typed cover letter after cover letter. It was also the only job to come back with a positive response, and 1 of only 3 to respond at all. Apparently I did well in the tests and was asked for an interview the following week and finally offered the job yesterday.

What really made the day momentous though? Well straight after the aptitude test I left to do two shows at the Shaw Theatre in Euston. These shows were my last engagements as a professional musician. I was on this show that I confirmed to myself that it was time to move on. I wasn't expecting the move to be quite that instant.

In fact, the day serves to remind me how lucky I've been in life. Almost every job that I've really wanted has been offered to me. Just when I need it most I get the job that I wanted from my first ever job interview against people that I'm sure had better CVs for the role. I'm definitely not a religious man, never will be, but sometimes I do wonder, when things really go this well, if somebody is looking out for me.

More hand pictures

Today I'm feeling incredibly stiff. It was a struggle walking upstairs for a while and this knot in my back just won't go away. The steroids have definitely given up on me now, and far too quickly with 4 weeks to go before I see the rheumatologist.

When I'm feeling this stiff it's nice to remind myself how much progress I have made. Whilst new things keep popping up I'm confident that with the correct treatment they can be helped.

My hand at its worst

This picture shows how little I could bend my middle finger at it's worst. I could not use it to grip anything at all. In fact it put me back to pre-beginner guitar playing. Open position chords were perhaps the hardest thing to do, and not managing them was what made me finally concede that I had to stop playing.

I'm almost certain now that I am going to end up on methotrexate it's just a matter of when. I can't get it privately as it's ridiculously expensive. I just hope Dr Kirkham won't  have to rerun a barrage of tests that have already been done. I have all the evidence but I suspect the NHS won't care.

Yay! Guys Hospital Appointment date

I've finally got my appointment date through. I'm seeing Dr. B Kirkham's team at Guy's Hospital on March 21st. I would have known this yesterday had I realised that there was post waiting for me. It was quite nice it  happening today though as it helped to set me at ease before my job interview.

I guess a job interview with me at the moment is slightly unusual. The first thing that I have to do is explain my condition. It essentially explains my entire reason for seeking a career change. There is the danger that it is off putting so the explanation comes with reassurances that it really only affects my guitar playing. Anyway, I'm really hopeful after the interview. I should find out by the end of next week. As the MD said, last Friday could very well have been the end of one period of my life and the start of another, a quite beautiful transition.

5 weeks or 5 days

The original prognosis with the steroid injection that I was given was that I could expect to be inflammation free for about 5 weeks. This was great news and should have kept me happy until I could get to see the NHS rheumatologist. Now 10 days later I can definitely feel inflammation coming back. Today it's a stiff back and a sore knee with a little bit of shoulder pain as well. It's quite deflating when reality is so far from what expectations you were given. It's back on the pills and back to grinning and bearing it.

Pain in my knee

Today has definitely been the day where I've decided things aren't quite as rosy as I had been making out to myself. My right knee has been causing me spontaneous pain throughout the day. I don't think I've done anything to damage it; my knee has just decided to be angry.

I've also been playing with niece a lot today. She's four years old and playing with her generally means a lot of lifting her up and throwing her round. Honestly she enjoys it, no need for social services. The problem is it keeps reminding me that there is something wrong with my index finger. If I lift her the wrong way the finger hurts, not excruciatingly but there definitely is something going on. I also completely ran out of energy at about 4pm, a pattern that I hope doesn't continue.

My first job hunt

Now my career as a musician is over, maybe for good, it's time for me to start looking for a job. I've never really had to do it before. Every job that I had as a musician came through word of mouth. Even with the Mary Poppins tour, where nearly every other member of the band had an interview, I was let in on the word of the Musical Supervisor Steve Brooker.

At the moment I'm really applying for a bit of anything. I know I definitely don't want to do sales or recruitment but beyond that pretty much anything is open. Marketing seems to be an area that I keep being drawn to - largely because it doesn't necessarily require previous experience.

I had an aptitude test for a company involved in online marketing yesterday. It genuinely felt a bit like being back at school doing exams again, except this time I was completely unprepared. The test was very specific for that company and I think I acquitted myself as best I could but I'm really not expecting anything from my first experience of the real world of work. It's a shame that they're the first people that I've got anywhere with. I think I would probably quite enjoy doing the job and working for that company but my lack of interview experience as much as anything else will probably be a big hinderence.

How things are.

Just to give you some perspective of how bad my fingers got I've taken a picture of how they look today. I have a nice healthy dose of steroids in my system keeping the inflammation at bay right now. This is probably as good a condition as my fingers will ever be again.

I have noticed in the past day or so that the steroids haven't been quite as effective as I hoped they would be. They've certainly cleared a lot of inflammation and I an currently clear of enthesitis (inflammation of the where the tendon meets the bone). This had been really attacking my hips and shoulders and severely reducing my mobility. Now I can sprint for a bus or cough and not have to worry about pain. Unfortunately, just about the only site where pain has remained in any fashion is in my hands.

There is a sore point still in my right hand palm, not really an issue day to day but it's still there. On my left hand the two most recent points of pain have certainly reduced a lot but there is still signs of the arthritis. The swelling might not be there but they feel funny - tender is probably the wrong word but just weird. I think everything is just confirmation that I'm doing the right thing changing career.

How things were.

At the moment my hands are feeling pretty good, although not without issue. There's another post coming on that soon I suspect. I think it is quite useful to look back at what state my hands had reached. This is the worst that my right hand got, my left hand having been worse before. This was actually the day that I had the steroids injected into the tendon sheath, hence the round plaster. The finger is discoloured and very swollen. In fact, the circumference (based on the state my left hand got into) is probably about 1cm greater than it should be. We're talking a jump from 5.5cm to about 6.5cm, pretty significant. I was actually told to take this photo by my private rheumatologist to show to the NHS just to make sure that they believe me when I tell them how it was.

The problem of diagnosing Psoriatic Arthritis

Diagnosing PsA

Psoriatic arthritis is apparently quite a hard illness to diagnose. With other similar forms of inflammatory arthropathy there are usually markers that show up in blood tests that can help in confirming a diagnosis. Psoriatic arthritis is generally diagnosed based on the experience of a rheumatologist and an observation of symptoms.

One of the most objective test that a physician can do in confirming the presence of symptoms of psoriatic arthritis is simple measurements of areas in which there is pain. Generally if there is pain then there will be associated swelling. In fact, my diagnosis was largely based on the dactylitis of three of my fingers. They were swollen to the point that it was easy to see that there was an issue. More recently I have had a swollen DIPJ. The pain is there but the swelling was only slight. In fact, the circumference of the joint was only 0.2 cm bigger than it's equivalent on the opposite side.

Another tool in the diagnostic arsenal is simply to start treating. If you treat with anti-inflammatories and the body reacts favourably then it's a pretty clear sign that there was inflammation present. In fact, the effectiveness of the anti-inflammatories on me revealed more specifically that I was suffering from inflammation more so than the specific blood tests for inflammation (erythrocyte sedimentation rate and C-reactive protein). The problem is, although there has clearly been a response from my body, there is no objective way to measure the level of the response.

Why is this a problem?

I'm shortly (hopefully!) about to change rheumatologist to an NHS one, or rather I'm going to augment my care plan with an NHS one. This is primarily because I have no medical insurance and it would be prohibitively expensive to be treated privately forever. Unfortunately, the NHS rheumatologist is unlikely to accept my private diagnosis on face value. I have some photos of the dactylitis at it's worst in my fingers, which may be the clincher, and my experience with the anti-inflammatories, which becomes less accurate as time goes on. What I intend to take is a full set of baseline measurements of joint circumferences on my hands, as well as a record of the measurements taken by my hand therapist. This is my proof of swelling and specific joint problems. Once I've proved that I'm hoping that they'll take my word for the more objective symptoms.

Feeling good

Oh steroids you marvellous drugs. It's only been 48 hours since I had the injection and the inflammation is all so much better. Gone? Not quite yet but at this current rate I would expect it to have disappeared within the next couple of days. I'm back to bounding up stairs and am alert in a way that I haven't been in ages.

When an illness develops over time it's quite easy to forget how you used to be. I've always considered myself to not be a morning person but recently I've been really struggling to get up. I just assumed that this was how I was. Now, with the steroids kicking in I'm back to waking up alert in the morning. This has easily taken me back several months.

Unfortunately you just cannot take steroids long term. These are a great diagnostic test for me but I really don't want to end up moon-faced and bloated. It's essentially the steroids that finally killed Shawn Lane as he battled to keep his Psoriatic Arthritis under control. That's not something I'm willing to do.

Day 1 of steroids

I don't think I've felt this awake or alert for at least 6 months. These steroids are a wonderful thing. My right buttock still feels massively bruised from where I was injected but the pain throughout my body seems to be diminishing. The newly developing pain in my toes seems to have totally receded.

I do have to keep reminding myself that this is probably only temporary. The Dr said he expected it to last approximately 6 weeks but that I should feel pretty much cured for that period. I know I'll get tempted to think everything's better and try to start working as a guitarist again but it won't do my reputation again if after the 6 weeks is up I suddenly have to start pulling out of work again. The 6 months I've planned to take off isn't to get better, it's to see how I can stabilise what's happening. The more I think about the whole ordeal the less I'm convinced that I will go back to full time playing.

New Career?

I'm definitely taking 6 months off from playing guitar. It has got a point where I just can't guarantee being consistent and I'm having to be incredibly wary of which jobs I choose to take. It has also got to the point that, with all the pain I'm getting from playing the guitar, it's just not a lot of fun any more. It has become a real chore, even more so because I'm very aware that I cannot play now as well as I used to. So 6 months to take stock of my situation and see where life takes me.

A shot in the bum

With my whole body seeming to be flaring up all over the place at the moment I have gone back to my private Rheumatologist to try the next level of treatment. It turns out that this is a shot of steroids into the buttock. Whereas my three previous injections have been into specific tendons to quench the dactylitis at the time, this is a much more general shot that should hopefully relieve symptoms all round my body, for approximately 6 weeks.

As with many of the other treatments that I've been having, this also has good diagnostic value. Many of my symptoms are quite subjective. I'm in pain, and the pain can be caused by doing specific things, but actually measuring any level of inflammation is quite hard. If I respond well to the steroid shot then they should be able to say a lot more confidently that my symptoms are being caused by inflammation, thus tying in with the original diagnosis.

Right now though, I'm stiff all over. I have to find a comfortable position to sit in and when I get up there's a few paces of hobbling until my body gets used to moving again. Last night was a real struggle to play the guitar. I'm pretty confident that if I had a show tonight then I wouldn't be able to make it all the way through it, at least not well. My back is also getting increasingly stiff. I suspect the 2 hour drive each way to work this past week hasn't helped me a lot.

Anyway, I'm off to try and enjoy some Chinese New Year this weekend hopefully with my girlfriend. If there's one thing guaranteed to take my mind off the pain it's spending a bit of time with her.

The difference between NHS and Private Healthcare

NHS: We'll put you on an 18 week waiting list. We don't really care that you can't work at all.

Private: I'll fit you in tomorrow before another patient. Let's do our best to get you back to work in a cost effective manner

Hanging up the guitar (for 6 months hopefully)

I've decided that I'm going to have to give up playing for 6 months. This is currently dragging on and I'm not able to plan any sort of a future whilst this is happening. Everybody keeps suggesting that I go into teaching the guitar. It's just not that easy. At the moment I really am not enjoying playing. Even the simplest things can be painful. I really just want to leave the guitar until I feel like I have a bit of control over this condition. Am I leaving it for good? I don't know. It depends what the next few months bring. If I can't be as good as I was, and improve beyond that then I don't really see much point picking the guitar up again. I won't enjoy it.

There has been new developments in my psoriatic arthritis. My index finger is new generally inflamed, causing pain when playing some simple chords. Not excruciating but certainly distracting. The furthest out joint on my middle finger (DIP joint) is also now swollen. This is as far as I know new. Bizarrely though, this isn't actually causing me pain when playing but is causing spontaneous aches and pains and is slightly stiff. My whole body, however, just doesn't seem to be reacting to the anti-inflammatories like it used to. My shoulders are now generally sore. I think swimming is still a no go, although I haven't tried it recently as I've been working pretty constantly since I had to abandon my last attempt.

I've now got confirmation of receipt of my referral from Guy's. Unfortunately, this means that I'm still potentially a long way off an appointment. There is no date or even mention of when the appointment may be. I'm hoping for mid-March but I fear that it may be as late as mid-May.

So all in all, until I can control my symptoms and be confident that I will wake up the next morning able to play as well as the previous day, I've decided to hang up the guitar. I've got work that I'll have to struggle through until the end of next week and then I'm done.

More NHS woes

It turns out that they've lost my referral for Guy's Hospital. Just as I'm starting to worry that the tendinitis might be returning in my fingers I discover that my referral hasn't gone through. My GP is faxing them the referral letter again but last time I checked it's about a 6 week wait there from referral to appointment. This would put it a 9 weeks from my initial time of referral. It just serves to remind me that I still have no diagnosis from the NHS. In fact, all they seem interested in doing is arguing with the diagnosis I got privately, from one of the most highly respected rheumatologists in the world.

While all this is going on I'm trying to tackle my tendinitis/enthesitis trouble spots as they start to hamper my work. It's costing me about £200 per go. Luckily I've only had to have 2 so far, but as I said above I'm worried that I could be setting up for some more finger problems right now. The steroid injections are fantastic. They take me from about 30% use of finger to being 90% pain free in a matter of a few days. They are an instant cure that in theory can keep me working. They should be available on the NHS but their laid back approach to diagnosis means I can't get them. In fact, if I hadn't sought any private treatment by this stage then I would have put myself at serious risk of doing permanent damage to either the nerves or joints in my fingers.

I've started swimming to see if building up a bit of fitness and muscle strength might help with the symptoms. All it seems to be doing at the moment is aggravating things. I had to cut short my last swimming session because I couldn't do breast stroke due to my hip adductors being sore and I couldn't swim front crawl because my left shoulder was getting more painful with each length.

I've got about 10 days worth of work coming in the next couple of weeks. It's a real test to see whether my fingers are going to be up to more serious work. The slightly galling thing is that the money that I'm earning for the work will barely cover the cost of the treatment that I've had up to this point.

Nightmares

I seem to have accidentally discovered a new facet of my condition. If I have a night without an anti-inflammatory and have a glass of alcoholic drink I will wake up 3 or 4 times with nightmares. I guess that's put an end to my drinking then.