Posts Tagged ‘BUPA’

Wrist and arm pain when using a computer

Monday, April 12th, 2010

Like many people who have to use a computer all day, every day, as part of their job, I find that I regularly get a painful or numb feeling in my wrists and arms.

This is my story of what I’ve done to try to make that numbness and pain go away. I’ll add a usual disclaimer, pointing out that I’m not a medical expert, this is just personal account, and that you should get advice from a professional if you have any kind of pain.

Office work is dangerous

It all started when I began my first job in an office. People may think that working in an office is safe for your health. My experience is that it is not!

Over the first weeks and months that I was there I started getting a feeling of numbness in my wrists when I was sat at my desk using the keyboard and mouse. I also started getting knee pain, which is something I have previously written about.

DSE assessment

After this had been going on a while I decided to request a DSE (display screen equipment) assessment. Fortunately this easy to do at my company. Within a week I was visited by someone from a DSE company who looked at how I was sitting, and how I was using the keyboard, mouse, and monitor.

He made adjustments to a few aspects of the way I sat at my desk, including raising the height of my monitor, and making a few adjustments to my chair.

He raised my chair to make sure that I didn’t have to tilt my arms up to use the mouse and keyboard. Because of my raised chair, I had to get a foot rest as well to keep my legs comfortable.

He also gave basic advice such as telling me to take regular breaks from the computer.

To help me remember to take regular breaks I installed the free SCIROCCO Take a Break software which I configured to pop up a reminder every half an hour.

scirocco take a break

Learning to live with the numbness

I got the numb feeling in my wrists and arms every day I worked at the office, but I learnt to live with it. The severity of the problem wasn’t improving, but it wasn’t getting any worse either.

I’d found that the problem was always much worse if I worked with bare arms. If I had the sleeves of a jumper covering my arms the pain or numbness wouldn’t be as severe or as noticeable.

uniqlo jumper

One theory I have for this is that when wearing a jumper, the extra fabric around my arms acts like a cushion, preventing me from constricting any of the nerves in my arm as severely as when they rest on my desk. This is just my personal theory, and I can’t give any scientific proof that it would work for anyone else.

You don’t always want to wear a jumper when it is hot so I discovered that I got the same improvement if I just wore fabric wristbands. You’ll find these in clothes shops that sell accessories.

fabric wristbands

Wrist braces, pill popping, and exercisers

During this time I tried a number of other things to try to reduce the pain. I gave wrist braces a go, but I found them to be very restrictive for my wrist and arm movements. I much preferred using simple fabric wristbands as I spoke about above.

wrist support for wrist pain

I tried using a number of different pills. I tried multi-vitamin tablets, cod liver oil, and glucosamine sulphate. It is possible that they helped with my general health, or even helped with my specific wrist problems, but to be honest I didn’t notice any difference when I was using them.

vitamins glucosamine sulphate cod liver oil

I also tried using wrist exercisers, but I didn’t find they improved anything. If anything I found that my wrists felt worse after using these.

wrist exerciser

Electric conduction tests

After many years of putting up with my wrist problems I decided that I really should see my doctor. When I went to see him he asked me some questions, took a look at my arm, and then said he would refer me to the hospital to have some electrical conduction tests done on my right arm (the right was worse than the left). He said that I might have a mild form of carpel tunnel syndrome.

At the hospital they attached an electrode to one finger at a time, put some salt gel on my arm, and then measured how easily electricity conducted through the nerves. They also did tests that caused my fingers and arm to twitch as a result of the electricity.

I got the results a week later which said that my nerves were fine, and if anything was wrong with them it was very mild.

Physiotherapy for my wrist pain

I had private health insurance with Cigna from my employer, so I called them up to ask if I could see a physio about my wrist and arm pain.

They agreed, and authorised six physio sessions for me.

The physiotherapist started by asking about my problem, and then doing basic manipulations on my arms to judge what the problem was. She though the problem was caused by tightness in my muscles, not just around my arm and wrist, but also in my shoulders, neck, and back.

She explained how the nerves are connected, and how problems in your back can also affect your arm and wrist.

Over the weeks she did deep tissue massage on my arm to loosen up the tissue structures. This was quite painful, and would leave me with red and purple bruises.

She also did massage on my shoulder and back areas to loosen any tissue structures that might be constricting the nerves which lead to my hands.

As well as the deep tissue massage she showed me a variety of stretches. These weren’t just hand stretches, there were stretches for my back, arm and neck as well. She was trying to work on the whole length of where the problem might be coming from.

Another DSE visit

The physio wanted to see how I used my computer equipment. As my employer wouldn’t pay for an onsite visit (it wasn’t covered by the insurance), they arranged for the DSE assessor to visit again.

He once again looked at how my desk was set up. He made an additional recommendation. He said that I should change from using a full size keyboard to a mini-keyboard. He thought that the amount of travel my right arm had to do from the mouse to the keyboard might be causing problems.

The extra travel distance is caused by the numeric keypad of a full sized keyboard. I’ve highlighted in red the amount of travel when you use a full sized and mini keyboard in the photo below.

amount of hand travel with mini keyboard

He took photos of me using my equipment which I was able to send to the physio.

Back at the physio

The physio was able to use the photos to make another suggestion. She thought that my mouse was causing me to twist my arm in an unnatural way. She recommended an ergonomic mouse.

She had a number of different ones which I was able to borrow, and after experimenting I settled on a vertical grip mouse like the one in the photo below. I bought it from Helashop (who don’t seem to exist anymore), but there are loads of other ergonomic mice available from Amazon as well. I’d advise you to try them before you buy, as they can feel quite strange at first.

ergonomic mouse

In the next photo you can see the difference one of these mice makes in the position and angle of my arm, as opposed to using a standard mouse.

wrist angle changes with ergonomic mouse

Two mice are better than one

I made a further change in my desk. I started using a second mouse. For the left hand I used a standard mouse, and I used the ergonomic mouse for my right hand. It does take a while to get used to using a mouse with your other arm, but you can do it if you practice for a few weeks.

two mice and mini keyboard

By using two mice rather than one you can spread the load more evenly over both arms, rather than having your dominant arm take most of the damage.

After 8 years, what worked, what didn’t

I’ve had knee and arm numbness for 8 years now, at varying degrees of severity. First of all these are the things that I found didn’t help me.

  • Wrist braces – I found these too tight, and constricting for my work.
  • Vitamins, Cod liver oil, Glucosamine – I didn’t notice any difference through using them.
  • Wrist exercisers – No help to me. They seemed to make things worse.

Here is what helped me.

  • DSE assessment – If you use a computer all day then make sure it is set up correctly. Any slight problems in the way you use them build up over time. Ask your employer if they can arrange for an assessment.
  • Physio – Physio was very helpful, both to help me understand the causes of the problem, and to help with the treatment. It was definitely worth treating the back and shoulders as well as the specific wrist area.
  • Stretching – I found the wrist, shoulder, neck, and back stretches reduced the severity of the problem. If you can’t motivate yourself to stretch regularly; a yoga, pilates, or dance class may help you.
  • Wearing a jumper or wrist band – This isn’t a recommendation you often hear, but I find that keeping my wrist covered by fabric helped a lot.
  • Ergonomic mouse – I did find my right arm was more comfortable when using the ergonomic mouse.
  • Using two mice, left and right – Two is better than one as the load can be spread between the two arms.
  • A mini keyboard – The reduced amount of travel of my arm between the mouse and mini keyboard help as well.
  • Computer timer – I recommend you have a timer on your computer to remind you to take regular breaks. It is very easy to lose track of time, and end up spending hours using the computer without a break.


Costs of surgical procedures and operations

Saturday, January 30th, 2010

If you are due to go into hospital to have surgery then you might be interested in how much it costs regardless of whether you are going NHS or private.

In can be hard to find out what your treatment actually costs but I’ve found out that many of the major health insurance companies publish lists of how much they will pay your hospital for your surgery.

As the health insurance companies have special deals with the hospitals the prices they list will be a lot cheaper that it would be if you paid for the surgery yourself, but it will give you an idea of how much your treatment actually costs the hospital.

You can even compare how much each insurer pays for your treatment. This is because a standard classification of procedures has been created by the Clinical Coding and Schedule Development (CCSD) group.

If you know the code of your procedure then you can compare prices using the insurers schedule of fees. However note that some of the schedules just list the surgeon / anaesthetist’s fees, whereas other include the total cost including hospital fees.

You can easily search for your surgery using either the CCSD code or just by typing in the procedure name.

For example W8520 is the code for a type of arthroscopy of the knee. Currently Cigna would pay up to £575 for the surgeon’s fee and £250 for the anaesthetist’s fee. This is a total of £850 for the surgery.

If you paid for this surgery privately then it could cost you around £3000 – but note that this price includes all your hospital fees as well (and of course some profit for the hospital!).

Knee pain, physio, MRI scans and lateral release surgery

Thursday, September 3rd, 2009

I’ve been having problems with my knees for many years. I get pain when I am in a seated position. I do a desk job which means I am in pain for much of the day. Sitting in a cinema, restaurant or car will cause me pain as well. I don’t have pain when I’m standing, walking, lying down or exercising. The pain is mostly in my right knee – coming from the area under the knee cap – but there is also some pain in my left knee.

Physiotherapy

I first had physio on the NHS about 7 years ago and have since had multiple courses of private physiotherapy as well. If you have read my nhs vs private physio post you’ll know what the differences are with between NHS and private treatment. In total I’ve seen four different physiotherapists.

My first physiotherapist diagnosed the problem as patellofemoral pain syndrome, and all the other physios I’ve seen have used the same name for the problem. Patellofemoral pain syndrome is not in fact a diagnosis at all. It is just a generic name that means ‘knee pain’. Pretty useless really! I know I have knee pain and giving it a fancy name does not help!

What is important for your physio to do is to properly diagnose why you have pain in your knee. There is a very good guide to patellofemoral pain on the KNEEguru website which also contains detailed information on all kinds of knee related issues. Before having a course of physiotherapy it is worth reading about the basic anatomy of the knee and the leg. If you know some of the names of the bones, muscles, and how the knee joint works you’ll be better placed to understand what you physiotherapist tells you.

In my case the physios have always believed that my knee cap (patella) is in the wrong position. It is not centred in the patellar groove which causes more pressure to be put on one side than the other. The pain comes on when I sit down because in this position the knee cap is pulled into the side of the patellar groove which puts pressure on it.

My treatment has consisted of four main part.

1. Stretching the outer muscles of my leg

In my case the outer muscles and connective tissues of my right leg are tight. This has the effect of pulling my knee cap away from the centre of the groove. By stretching these muscles the pull on the knee cap should slowly reduce.

2. Strengthening the inner muscles of my leg

I was given exercises to strengthen the inner quad muscles of the leg. By strengthening these muscles the knee cap should be pulled towards its correct position.

3. Deep tissue massage

A painful type of massage was carried out on my outer thigh to try to stretch out the muscles and other connective tissues. This helps to reduce the pulling forces on the knee cap.

4. Taping of the knee cap

The stretching and strengthening exercises slowly help to reposition the knee cap but a more direct re-positioning effect can be achieved by taping the knee. After assessing the position of my knee cap the physiotherapist showed me how to attach surgical tape over the knee to pull it into the correct position. For me the taping had an almost immediate effect on my knee pain.

Orthopaedic consultant

My knee pain went up and down over the years and I started new physio courses when my pain got worse. During my last course of physio my knee pain actually got worse which is when my physiotherapist recommended that I see an orthopaedic consultant.

Upon visiting the consultant he asked me a few questing and quickly looked at my knee. He said that my knee cap did look like it was further off centre than it should be. He gave two recommendations.

He could either have a look at what was going on inside my knee and possibly treat any problem by doing an arthroscopy. An arthroscopy is a keyhole surgery operation where a camera and light source is inserted into the knee through a very small incision. A liquid is pumped into the joint which helps to expand the joint so it easier to see and navigate around. Surgical tools can then be inserted through a second or third hole to probe or treat any problems.

The second option was to send me to have an MRI scan done of my knee after which I might need an arthroscopy to treat any problems found.

I picked the MRI scan as there wasn’t any disadvantage to having it done. It never hurts to have as much information as possible before considering surgery.

MRI scan

I was told to remove anything metallic from my person and put it in a locker outside the MRI room. I was then taken in and made to lie down on the machine’s bed. I have one metal crown in my mouth but this was not a problem.

The technician secured my leg into place and gave me some headphone to wear. She asked what kind of music I wanted to listed to. She suggested pop, and I was fine with that. I was given a button which I could press if I needed to contact her.

She then left the room and a few minutes later I heard her voice through the headphones. She said that they were going to start the machine. They started the music as well. It sounded like an old compilation of really bad pop songs.

The machine started up and rumbled into life. It was surprisingly noisy and seemed to vibrate intensely like a piece of industrial machinery. Even with the headphones on your can’t ignore the fact that this large machine is roaring around you!

The machines roared for about a minute and then stopped. After about 30 seconds it started roaring again. After a few minutes of this the technician’s voice came back on the headphones. She told me that I wasn’t keeping my knee completely still. This was annoying as I was keeping it as still as I could. It is hard to remain completely still for so long. If I’d known how long it would take I would have asked for my leg to be more securely fastened in place.

Previously I’d only had X-Rays taken of my body and anyone who has them taken knows that they are very fast – like taking a photo. An MRI scan is more like a very slow exposure. This is because many images are being taken at slices across whatever it is they are scanning.

knee mri scan front

The machine could take 20 images slices through my leg. It can take the images in any direction as well. They took images from top to bottom, left to right, and along my leg. Each time the machine would rumble for about one minute and then stop for about 30 seconds before starting again.

knee mri scan patella

The whole process took about 20 minutes during which I had to endure music such as Cyndi Lauper’s Girls Just Wanna Have Fun. I was glad when it was all over!

Afterwards they told me to wait outside whilst they put my images on a CD. The CD ended up having around 100 images on it from various angles. Some scans had been done several times – probably because I hadn’t managed to keep as still as they wanted me to. After I’d been given the CD I was free to go. I’d see the consultant again in a week for him to discuss the MRI images and recommendations.

knee mri scan side

Consultant recommendations

A week later I went back to see the consultant. He told me that internally the knee looked healthy. The bones and ligaments seemed in good condition.

The only problems were that my knee cap was tilted as you can see from the below image, and that my knee cap was higher than it would usually be.

knee mri scan cross section

He gave two options. Either I could try some further physio – now with the extra knowledge of how my knee cap was positioned – or he could perform lateral release surgery on my knee.

The consultant told me that a lateral release of the patella was a very safe procedure. It would take 30-45 minutes, be done under general anaesthetic, and I’d be able to walk out of the hospital and go home a few hours later. I should be able to do exercise such as running after a month, I’d be able to do high impact exercise such as karate two months after the operation. He said that main risk was deep vein thrombosis but even that was extremely rare. This appointment lasted less than 15 minutes and this included the time where he was explaining the MRI scans.

I told the consultant that I’d prefer the surgical option as I’d been having physio for so long.

My own research into lateral release surgery

When I got home and thought about it more I felt that I didn’t really understand what it was the consultant wanted to do to me knee. This is probably not surprising given that I spent less than 15 minutes with him. I wanted to be able to do my own research to better understand the surgery.

I did some research on Google into arthroscopy surgery and lateral release surgery. I phoned up the consultant to confirm the name of the procedure, and that it was the lateral retinaculum which was going to be cut. This at least allowed me to find specific information on the surgery.

Lateral release surgery is an operation which is supposed to allow the knee to rest in the correct position by cutting through the tight lateral retinaculum. This lateral retinaculum is a type of tissue which hold the kneecap on the outer side of the leg. The procedure uses arthroscopy techniques rather than open knee surgery. There is a quick description of the surgery on about.com and there was a really excellent article on arthroscopy surgery on KNEEguru. You’ll still find lots of individual accounts of the surgery on KNEEguru and on Google by using the search boxes.

Obviously the internet does not provide a balanced view of the success of surgery. People with bad experiences are much more likely to share than people who have had no problems. Still I was very alarmed by the large number of accounts of people who have said that lateral release surgery has made their knees worse. In some cases people have been saying that this surgery has left them with permanently reduced mobility or in agony. Some people say it has ruined their life. Strong words indeed. Other people talk about the long recovery times to get mobility back up to normal. There are of course people who say it has greatly benefited them and who had no complications.

Even if the people who have had complications are just a minority it does show that the surgery can have real complications. I was worried that these complications hadn’t been properly explained to me by the consultant. An appointment lasting under 15 minutes is just not sufficient to explain the MRI results, the surgery and the risks. I got an explanation of the MRIs, a very brief description of the surgery and hardly any detail of the risks.

I decided to cancel the surgery. Even if the risks are small I didn’t consider it worth risking my mobility for the sake of pain – which although can be quite painful – is something that I can live with. Especially now that I know the internals of my knee (bones, ligaments) are healthy I didn’t want to risk the health of my knee by having surgery. I was also put off by my previous experience of surgery where a simple lipoma/cyst removal surgery turned into 6 weeks of pain and inconvenience.

Even if the surgery made my right knee better I’d still have some pain in my left knee.

I decided to continue with the physio. Previously there has always been an element of guess work with the physio as the physiotherapists have always been diagnosing the problems from the outside of the knee without any knowledge of what is going on inside. Now that I have the MRI scans of my knee, and can see more precisely what the problem is I hope that they physio can be better targeted at what the problem is.

NHS vs private physiotherapy – and BUPA vs Cigna

Friday, July 24th, 2009

I have had multiple sessions of physiotherapy over the years for various joint problems. I’ve experienced both NHS and private physiotherapy. For my private physiotherapy I’ve dealt with both BUPA and Cigna.

NHS vs private physiotherapy

If you need physiotherapy you have two basic choices, you can either try to get it for free on the NHS or you can go private. If you go private you’ll either have to pay for it yourself or if your private medical cover it may be possible to get them to pay for it.

Referral letter

Getting NHS physio will in the first instance require a visit to your doctor / GP. You’ll need to get a referral from them for a course of treatment. If you are having NHS physio then the referral will generally dictate which physiotherapy practice you visit.

Sometimes you will need to be a bit assertive with your doctor if you want a physio referral. They may well fob you off by saying something like you should rest your leg, take some pain killers, lose some weight etc. They may be valid points but if your problem is long standing then seeing an expert is probably the best solution. Often the best way to get what you want from your GP is just to be clear – explain that you have a problem and ask if you can see an NHS physiotherapist.

If you want to see a physio via your private health insurance then the procedure is usually very similar – but will depend on how your private health insurance company operates. Many of them will require a doctor’s referral as well. In this case you’ll have to ask your doctor for a private referral letter. You can just ask them for this. As giving you a private referral doesn’t result in any cost for the NHS they should happily write the letter for you.

If you want to pay for private physio yourself then it is generally not necessary to see a doctor. You can book your appointment straight with the physio clinic.

Making the appointment.

With an NHS referral you’ll then have to make an appointment. Your referral letter should tell you who to call to do this. One of the disadvantages with NHS physio is that there will be a waiting list. It could be a number of weeks or even months before your appointment date.

Making a private appointment with health insurance will require you to get approval from your health insurance company before booking your physio appointment. However as your health insurance company may need the name of the physio company that you are using (to check that they deal with them), you should check with the physio company first to make sure they will treat you, and that they can charge your health insurance company for your treatment.

The policies that I’ve had with both BUPA and Cigna mandated calling them to get authorisation before booking the physio. On calling them they ask basic questions such as why you want physio. As long as they are happy with your answers they will approve a course of treatment.

The first time I used BUPA was several years ago for wrist and arm pain/numbness. BUPA authorised treatment up to a value of £1000. They gave me an authorisation code which they said was valid for six months. This authorisation is needed by your physiotherapist in order to claim back the costs of your treatment. When I used BUPA again several years later they gave me another code for treatment – but this time valid for treatment up to the value of £2000!

Cigna was quite different. My company was using a ‘managed health care’ plan. This meant that Cigna would keep a tight control over the amount of treatment they would give me. Again, once they were satisfied they gave me an authorisation code. With my Cigna plan it was only valid for 6 sessions. There didn’t seem to be any maximum cost associated with it but I checked that the amount that my physio was charging was acceptable.

After my initial 6 sessions were used up Cigna authorised a further 4. To get more physio would require seeing an orthopedic consultant which they would pay for. For the orthopedic consultant they would issue a code which would be valid for a single appointment. If an x-ray was required it would be covered if done in the same orthopedic consultant appointment, but I’d have to phone up again if they were booked in for a different appointment or if I needed an MRI scan.

As it turns out I did need an MRI scan – I called them up and they authorised the MRI scan and also authorised a follow up appointment with the consultant.

The treatment

The actual treatment was effectively the same whether I went with NHS or private physio.

Treatment consisted of an initial appointment where the physiotherapist asked lots of questions about my injury and manipulated my joints to try to make a diagnosis.

The time in other sessions was taken up with showing me exercises and stretches that I needed to do in my own time, and treatment – much of which was in the form of painful deep tissue massage. At some points they also used taping of the joints to hold them in the correct place, and ultrasound to stimulate blood flow.

Quick comparison

NHS – Go to doctor, get referral, book appointment and wait. Have a short amount of Physio.

BUPA – Go to doctor, get referral, get authorisation from BUPA, book appointment and see physio in next few days. Have as much physio as is covered by your policy. In my case £2000.

Cigna – Go to doctor, get referral, get authorisation from Cigna, book appointment and see physio in next few days. Have 6 sessions. Phone Cigna to authorise some more. Have 4 sessions. Phone Cigna to get authorisation to see orthopedic consultant. Consultant can then either recommend more physio or a different kind of treatment. Whichever is needed you’ll need to call Cigna at each stage to get authorisation.