Posts Tagged ‘health’

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.


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 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.

Dance classes in London at Pineapple and Danceworks

Wednesday, September 2nd, 2009

The Mission

Review a selection of dance classes that take place in London’s Pineapple dance studios, and Danceworks dance studios. I’ve done a few dance classes in the past but I would still consider myself a beginner.

I packed my trainers, top, tracksuit bottoms and headed off into London not quite sure of what awaited me.

Note: This article on London’s Pineapple and Danceworks classes was first published on in 2007. I’ve moved it over to here as I’m not maintaining that site any more. I’ve updated the class times where necessary, but the main text (with minor edits) is from the original 2007 article.

Pineapple Dance Studios

pineapple dance studios covent gardenPineapple is the UK’s most famous dance studios. It is so named (legend has it) as it used to be a warehouse which stored pineapples. There are over 10 different studios of various sizes on four floors. They do everything from Ballet to Jazz to Egyptian to Hip Hop. If you can dance it, they do it. You can just turn up and do a class. If you turn up on a weekday evening then you have to pay £4 for day membership at the door and then you have to pay the teacher for the class. Some teachers collect payment at the beginning, others after the warm up and some at the end. Most classes cost around £6 for the hour. It is certainly not cheap but then this is London.

I arrived at Pineapple, checked that the classes I wanted were on (class updates are shown on a LCD TV outside reception) and headed downstairs to the changing rooms. I got changed and then headed up to the first floor where I awaited the start of my first class.

Links: Pineapple

Class 1. Nicky Bentley – Street Jazz
Monday – 7pm – Beginner – Pineapple

Nicky’s class is the class that you get pointed to if you are a beginner and want to learn some pop moves. Her classes are hugely popular and she has even stared in the Street Jazz DVD, one of a growing number of DVD dance classes that Pineapple have produced.

I decided to do the beginner class but there is also an intermediate class available if you are feeling more confident. The studio is very big and it needs to be. I counted over 50 people in this class! I went and took a position in the middle of the class. In a class of this size standing right at the back is not recommended as you won’t be able to see anything.

Nicky starts the class with a relaxed warm up which is Jazz influenced. There are cardio-vascular moves to get the blood flowing and stretches to get you ready to dance. Some of them can be a bit painful if you are not used to them so don’t push yourself too much on your first class.

Once the warm up was out of the way it was onto the class. Nicky teaches a routine of around 4 lots of 8 in length. This seems to be the typical routine length for beginner classes. It is enough to do a good routine but without being too long to remember. Nicky’s choice of music is straight out of this weeks top 20. Expect Beyonce, Jamelia, Blu Cantrell or whoever else is in the chart this week. After leaning the routine she splits the room into two groups so you can have a chance to dance without having people treading on your toes all the time.

Verdict: A good fun class and ideal for beginners which is really good exercise. It does get very crowded so don’t stand right at the back or you’ll never get the routine.
2010 update: Sadly Nicky died of breast cancer in 2009. Her classes and style do however live on – now taught by her assistant choreographer Mark James. Same time, same place.

Links: Street Jazz – Dance Masterclass DVD

Class 2. Jimmy Williams – Street Locking
Monday – 8pm – Beginner – Pineapple

No sooner had I finished Nicky’s class then it was straight into Jimmy’s street locking class. Luckily going from one to the other is easy as they happen to be in the same studio.

Street Locking is somewhat harder to explain for people not familiar with the style. It is a really funky dance style where you ‘lock’ one part of your body whilst another moves. It may sound odd but it makes sense when you do it. Jimmy includes both locking and popping moves in his routines.

Whereas Nicky’s class was full of beginners it is clear that Jimmy gets a slightly different crowd. It is still a beginners class but it does attract some people who have been putting in a lot of practice. Jimmy doesn’t bother with a traditional warm up. There are no stretches. He goes straight into popping and locking exercises. These are difficult to do right. When Jimmy demonstrates them they look amazing, when I look at myself in the mirror they aren’t quite so good.

Then it is onto the routine. The actual routing is fairly simple but it is great fun. The more talented dancers really get into the routine which pulls the atmosphere of the class up. The music is as funky as it
can get, making a very enjoyable class.

Verdict: Really good fun. Slightly different to the average dance class.
2010 update: Same time, same place.


danceworks dance studios balderton streetThe slave drivers at reviewmylife allowed me a nights rest after my first two classes but on Tuesday I was to do two more. My first one was to be at Danceworks studio near Bond Street underground underground station. It is in a side road opposite the Selfridges clock.

Danceworks is a similar place to Pineapple but on a slightly smaller scale. It has 5 studios in an attractive building – a more modern studio than Pineapple. There is definitely a different atmosphere here. People come here for fun and to get fit. They also do that at Pineapple but Pineapple has a definite core of people who really want to ‘make it’ as dancers. Danceworks is more relaxed.

Again to take a class you need to be a member. £5 for a day membership and then around £6 for the class. In most cases you pay for the membership and the class at reception. In a few cases you pay the teacher direct, just ask at reception so you know who to pay. One major difference with Pineapple is that the numbers to the classes are controlled.

Each class has a quota and once it is full you can’t get in. For some classes such as Xpress Yo’self and Dancemania it is worth getting there at least 20 minutes before the class to make sure you get in.

Links: Danceworks

Class 3. Hakeem Onibudo – Xpress Yo’self
Tuesday – 6pm – General – Danceworks

I don’t know what Hakeem has for breakfast but if we all had it then life would be more fun. He comes across as a powerhouse of energy confidently launching the class into a funky warm up. He adds in some stretching and then it is onto the routine. This is apparently a ‘level 2’ class. He does other easier classes which are level 1 and an intermediate class which he calls level 3. So if you find this class too easy you can move up, if it is too hard you can try the beginners class.

Hakeem does street style choreography. His movements can be very physical so this is a good work out. His choreography is quite unique, somewhat different to most other hip hop classes. You have to try it to understand.

Hakeem is full of enthusiasm and pushes us to do our best. I really enjoyed this one.

Verdict: Very enjoyable class with a good atmosphere thanks to Hakeem.
2010 update: He no longer does a class at this level on Tuesday. The intermediate class is on Tuesday instead and a beginners on Monday. Check with the Danceworks website for the latest class times.

Links Impact Dance

Class 4. Stuart Bishop – Rudeye ‘Fusion Funk’
Tuesday – 8pm – All – Pineapple

I now had to walk half an hour from Danceworks to Pineapple for my second class of the day. The walk allowed me to cool off after a tiring class.

Stuart’s class has a definite buzz about it. The dancers who attend are the most dressed up of the classes I’ve been to so far. The regulars are easy to spot, they look like ‘dancers’. At the back are some beginners like me.

He starts with a really fun choreographed warm up to the tune of Michael Jackson’s ‘You Rock My World’. It is the regular warm up which is quite complicated if you are doing it for the first time. The regulars at the front made it look easy. The high standard of the people there could be intimidating to a newbie but fortunately Stuart makes it clear that he is very happy to have beginners in the class. He says that we should just get as much of the routine as we can.

A number of people in the class are professional. Having them in the class is good because 1) their performance pulls up the level and energy of the class and 2) it allows us beginners to see exactly how the routine should be done.

The routine itself is amazing. It is hip hop based with plenty of locking and popping moves. It is the longest routine I’ve done so far, and I have a lot of trouble remembering it but it is still really good fun. Many people in the class pull off a flawless performance of it at the end when we are split into two groups – girls vs boys. Luckily Stuart does each routine for two weeks so we have a chance to improve next week.

I guess if you are feeling really keen you could even practice at home.

Verdict: Brilliant choreography and a good atmosphere in the class. The routines are difficult so you’ll have to persevere to get the most out of them.
2010 update: Same time, same place.

Links: Rudeye Ultimate Street – Dance Masterclass DVD | Rudeye Website

Class 5. Maria Yacoob – Jazz
Wednesday – 6pm – Beginner – Pineapple

Jazz is one of the most popular styles at Pineapple. There are many kinds on offer – street, latin, LA, modern – but Maria just calls her class ‘Jazz’.

She adopts a traditional jazz approach to her class. The warm up takes over half the class and includes a variety of different jazz positions and stretches. The warm up is quite gentle but you have to put effort in and ensure that you do the positions correctly to make the most of it. Maria comes access as very personable. She makes an effort to remember peoples name’s – she seemed to know pretty much everyone in the class by first name. She extends this thoughtful approach to making sure that people are doing the warm up exercises correctly. Whereas some teachers will just leave you to make mistakes she will help you to do them correctly.

Once the warm up is done we move onto the routine. Her choice of tunes is very pop. On the day I went there it was Britney. The routine incorporated jazz kicks, poses and a pirouette.

Verdict: If you are looking for a traditional jazz class then this one is for you. Maria makes sure you understand the theory of the positions as well as giving you a fun routine.
2010 update: This class is now on Thursday at 7pm, but check the Pineapple website for any updates.

Class 6. Mark Battershall – LA Jazz
Thursday – 6pm – General – Pineapple

Time for another jazz class. This time my teacher is the fabulous Mark Battershall. He calls his jazz ‘LA’. I don’t really know why but it sure is good. Be warned that his warm up is tough! Sit ups to make your abs burn, jazz moves and stretches. I was ready to collapse after completing it.

Mark is a very cheery teacher and carries his enthusiasm from the warm up to the routine. Plenty of shaking, and touching are the order of the day. If you are very shy this may not be the class for you. If you are willing to give it a go then this class will make you feel really good.

The music is mostly chart based pop. Once the routine is learnt Mark makes half the class sit at the front of the studio and watch the other half give their performance. Then it is time to swap.

Verdict: Fun.
2010 update: Mark no longer does beginners classes, but does do more advanced level ones. Check Pineapple’s website for details.

Class 7. Lil J – Street Hip Hop
Thursday – 7pm – Beginner – Pineapple

Lil J is so called as she is ‘Lil’. This she may be but she has plenty of energy in her small frame. The first thing I notice about this class is that the attendees are somewhat younger than many of the other classes. The average age must be around 18. I felt a little old but I stepped in and took my place.

After a very quick warm up, it can’t have been more than two minutes, we got straight into the routine.

The style is Hip Hop and incorporates plenty of ‘tick tock’ moves. These are so called as they involve many short fast movements like a clock ticking. It is difficult to do right but looks good when done by the regulars.

Unlike most other classes Lil J doesn’t stick to one song for the whole class. She plays a large selection of Hip Hop through the class. Some of the earlier tunes are slow but she brings faster tunes in as we get better.

Verdict: Young crowd and lots of tick tocking!
2010 update: Same time, same place.

Links: Lil J Website

Class 8. Xavi Monreal – Hip-Hop/Street Jazz
Saturday – 2:15pm – Beginner – Danceworks

Off to Danceworks on Saturday. My teacher today is Xavi. He starts with a funky warm up before moving onto the routine. His class is hip hop based but with definite hints of jazz. As opposed to other hip hop classes whose moves can be somewhat jerky his movements are very smooth. The routine flows from one section to the next which feels very good to do.

As well as showing us the routine he explains that we have to really give it our all each time we practice. He says that if we just keep ‘marking’ the routine we won’t get the most out of. All sensible stuff if you want to dance well.

He comes across as a really friendly guy – I think he is Spanish in origin. He has a lot of enthusiasm and pushes us hard until the end when we split into two groups.

Verdict: Be prepared to dance hard and you’ll enjoy this one.
2010 update: Xavi no longer teaches at Danceworks, but has classes at Pineapple. Check their website for the latest class times.

Week 2

After my week of classes I was somewhat shattered, but there were a few more that I wanted to try out. I hadn’t been able to do these in my first week as they clashed with the previous classes.

Class 9. Dennis Wonder – Dancemania
Thursday – 6pm – Beginner – Danceworks

Dennis runs a very popular beginners class at Danceworks. Out of all the classes I’ve been to this turns out to be the easiest. The moves are pretty simple and certain sequences appear from one week to the next. After warming up and stretching he starts teaching us the routine. His technique is very much to show us and we follow. There is very minimal explanation but then the moves are simple so it is not needed. I hardly hear Dennis utter a single word throughout the class.

At regular intervals he rotates the people from the back to the front. Everyone should therefore have a chance of being near the front (if you’re brave enough that is). The music is a mixture of pop and hip-hop designed to please the crowd.

Verdict: A good class for beginners.
2011 update: He now teaches at the Marshall Street leisure centre, W1

Links: Facebook Group

Class 10. Kate Prince – Zoonation
Saturday – 3pm – Beginner – Pineapple

Like many dance teachers Kate runs a dance troupe. In her case they are called Zoonation. In this class she teaches her ‘Zoonation’ style. The crowd are definitely of an intermediate level. There are few beginners here so Ifeel somewhat out of place.

After a quick warm-up she gets into the routine. The routine is funky and smooth, the moves make sense with the song’s lyrics. It does however prove too difficult for me. Many people in the class manage to execute the routine brilliantly so I’m obviously out of my depth. This is a good one to watch if you want to see how good dancers do their moves. If you are brave enough take part!

Verdict: Good choreography. But hard!
2010 update: Zoonation don’t appear to do classes at Pineapple anymore, but they do classes elsewhere. Look at their website for details.

Links: Funk Fusion – Dance Masterclass DVD | Zoonation Website


There are a lot of very good dance classes out there in London. They are very varied so don’t give up if you don’t like the first one you try. Keep trying lots of different classes until you find a style that you enjoy. Theses dance classes are really good exercise and much more fun than going down the gym. I can also recommend them if you suffer from knee pain, or wrist pain. Exercise as long as you are careful can help to reduce aches and pains that you may have.

Dance class times

Please note that although the class times were correct at the time of publication you should confirm the class days and times with the dance studio website as they do change from time to time.

Lipoma and cyst removal surgery

Monday, August 3rd, 2009

About 5 years ago I started developing a lump on my leg – on my thigh. It grew to the size of a small marble. It was below the surface of the skin and seemed fairly firm and quite spherical.

lipoma cyst on leg

Lumps growing under your skin can be bad news so I went to see my doctor. He told me it was a lipoma – a harmless build up of fat under the skin. He said I could have it removed if I wanted to but that it would do no harm if I left it.

I lived with this odd lump for 5 years and it didn’t cause me any trouble. A year ago I spotted that it had grown larger. It had now reached the size of a large marble under my skin. I went back to the doctor and this time we decided to get it removed. He wrote me a referral and told me that I should expect an appointment letter from the St. Mary’s hospital in about 6 weeks.

My appointment letter arrived. It told me that I would be a day patient – i.e. no need for an overnight stay – and that the surgery would be carried out under local anaesthetic. I was told the date and time to report to the small surgery unit. Apart from that there were no special instructions.

The surgery

On the day I reported to the St. Mary’s Hospital small surgery unit’s reception and had a simple form to fill in. A little later a nurse came in and told me to change into the hospital robes. I did this and waited some more.

Another nurse arrived and took me upstairs to another waiting area. This waiting area was full of other people in surgical robes – either waiting for their surgery to begin, or sitting there under observation after their surgery was complete.

More waiting was involved, until the surgeon appeared and lead me to another room. This room was like a doctor’s room. It had a movable bed (plastic, not fabric covered), and lots of cupboards. Another nurse was in the room as well preparing some equipment.

The surgeon asked some questions and took a look at my lump. She explained what she was going to do. Seemed simple enough, give me the aesthetic, cut a slit in the leg, remove the lipoma and then stitch the leg back up.

I had to sign a form saying that I understood what was going to happen and that I understood that I would be left with a scar.

She had me lie on the bed and positioned my leg. She shaved the area and then using a marker pen drew a few lines onto the lump where she was going to cut. She then swabbed some liquid (I’m guessing it was iodine) onto the area to sterilise it.

Next was the anaesthetic. I had assumed that this would involve a single injection to the area – wrong! She told me that the injections were usually the worst bit of the surgery. She would inject into the surrounding area multiple times. She warned that the injections would feel like bee stings.

The injections did definitely sting. She started out with about 4-5 injections around where the lump was. She then poked the area and asked if I could feel anything. I could. She then gave me another 4-5 injections – I wasn’t watching but I think that as well as them being around the lump they were also at different depths into the skin. Clearly each injection only numbs a very small area. More injections followed until finally she was satisfied that the area of my leg would not feel anything.

As I was lying down I fortunately couldn’t see exactly what she was doing. I saw her holding a scalpel blade. I don’t know exactly when she started cutting into my leg. This is obviously a good thing and meant that the injections were working!

She spent some time doing what I assume was cutting. It is a very odd feeling to be lying down whilst someone uses a scalpel and surgical scissors to cut into your skin. Every so often she’d ask the nurse for some help of a new piece of equipment. A few times she needed a new scalpel.

After what was about 10 minutes she told me that she could see the lump and said that it wasn’t actually a lipoma which is what my doctor had diagnosed it as. It was a harmless benign cyst. The surgeon said that this made it a bit more tricky as she needed to remove it in one piece. If she couldn’t get it out intact then there was a risk that a piece could get left behind which would start growing again.

She also told me that it was quite firmly attached at the bottom so it would require a lot of cutting to remove. She continued cutting and snipping for another 15 minutes. I didn’t feel any of it. All I could feel from my leg was a numb feeling caused by the anaesthetic. Similar to the numb feeling you might get from a dentist anaesthetic.

Finally she announced that it had been removed!

She checked that there were no pieces left and then got ready to sew me back up. Doing the stitches (or sutures as medical people call them) seemed to be straightforward. She used 6 stitches in the area. She told me that they usually have the ends cut short but in my case she’d leave them long so they didn’t come undone. There was a risk as the incision was in a mobile part of my leg.

On top of the main stitches she stuck some paper stitches down – so the main stitches wouldn’t move about. I had a look at the wound at this point and the sight was not great. It was as if someone had cut a one inch hole into my leg and then sewn it back up – which of course is what had happened.

She then put a giant plaster over the stitches and finally wrapped a bandage tightly round my leg.

She told me that I should take it easy today, and warned that my leg could be very painful once the anaesthetic wore off. I could take some standard pain killers if I needed them. I was to take it easy for the next few weeks but there was no need for me to avoid walking. No running, sports or anything stressful for my leg, but normal walking would be fine. In two weeks I should go to a nurse at my doctor’s practice to get the stitches removed. I was also told not to get the wound wet. I could shower if I kept my leg away from the water, but definitely no baths.

It all sounded like it had gone very smoothly. Little did I know that the surgery was only the start!

Before I left the operating room she showed me the cyst in a bottle. It was white, quite spherical and the size of a large marble. It looked a bit like an eyeball!

Afternoon recovery

After the surgery I was told to sit down in the waiting area and have a drink and a biscuit. 10 minutes later I was allowed to leave.

It was quickly apparent that walking with an anaesthetised, stitched up leg was to be a slow affair. I made it to be bus and managed to get home.

Once home I sat with my leg up and tried to rest it as much as I could manage. For several hours the area of my leg that had been operated on remained very numb. Slowly the numbness started wearing off, to be replaced with a sharp painful stinging sensation.

I’d been told that I could take painkillers if I needed them. The problem is that you don’t know how much the pain is going to increase by. I decided not to take any pain killers unless the pain got really bad.

For another few hours the anaesthetic wore off. The pain did increase but it was manageable. It was most noticeable when trying to move or walk.

I had to sleep on my back that night as my leg was too painful (and too fragile given that it had new stitches in it) for me to put any pressure on that leg.

The next day

The next morning the pain had died down considerably. I was able to hobble around, but my limp was obvious.

I continued to rest my leg as much as possible as I knew that I needed to give my wound a chance to heal.


Over the next two weeks the pain reduced more. I was able to take the bandage off in the first week but the large plaster remained covering my wound. I had no idea what was happening underneath, but I was hoping that the hole was closing up.

after cyst lipoma removal surgery

It was no longer painful when sitting or walking, but the pain was there if any pressure was applied to the area. I still couldn’t sleep on my side.

As the days wore on I could walk more and more normally. I thought it must be getting better.

Visit to to the nurse

Two weeks after my surgery I visited the nurse to have the stitches removed. I couldn’t visit the nurse at my doctor’s practice as they were dealing with a mice infestation, so I went to the Soho Walk-In Centre. You don’t need an appointment to go here, but you do have to be prepared to wait. On this visit I arrived after work and after filling in the form they gave me, I had to wait nearly two hours before I was seen.

The nurse was very friendly and after questioning me asked me to sit on the bed. First she removed the giant plaster and then started removing the paper stitches. I was watching as she did this.

The paper stitches are stuck onto the skin (like match stick wide pieces of masking tape). The adhesion is fairly strong so a bit of ‘pull’ is needed to remove them. As she took them off it became very obvious that my wound was still completely open. Only the main stitches were holding each side of my skin together.

She spotted that one of the longs ends of one of the stitches was sticking inside my leg. Perhaps this was making it harder for the wound to heal. She re-positioned the end part of the stitch and told me that it was clearly too early for the stitches to be taken out. She put some new paper stitches in place, and put another giant plaster over the wound. She told me to come back in a week.

Before I left I did find out that in order to avoid a two hour wait it would be a good idea to get there just before 8am when it opened.

A week later

A week later I went back to the Soho Walk-In Centre. As suggested I got there before 8am. There were already a few people waiting. At 8am the door was opened and we were let in. I filled in the form and after about 10 minutes was collected by another nurse.

She removed the giant plaster, and then the paper stitches. The wound looked pretty similar to a week ago. It still wasn’t closing up.

The nurse told me that she would have to remove the stitches anyway. She said that there was a limit to how long they could be left in. She removed the stitches – which is very quick and painless by the way – and then cleaned up the wound.

She put new paper stitches on to try to hold the two edges of skin together and then put another giant plaster over the top. She gave me some giant plasters so I could replace the plaster a few times and told me to come back a week later.

lipoma cyst removal scar 2

The next two weeks

Over the next two weeks I visited the Soho Walk-In Centre three more times. Each time my wound would be examined, cleaned and be re-dressed. Each time when I saw the wound again it didn’t appear to be much better. Each time I was told to come back in 3-5 days.

One one occasion to save me a visit one of the nurses gave me a dressing kit so that I could re-dress the wound myself the next time. And I was given a supply of the Mepore giant plasters so I could change them every few days.

dressing pack

mepore giant plaster

On another of the visits a gel was squeezed into the wound which was supposed to encourage the healing process.

intrasite gel

A breakthrough

It was now four weeks since my surgery and the wound was still not closing. I was wondering if the wound could be infected. In fact one of the nurses had wondered this but after getting a second opinion had decided it wasn’t.

On visit number 6 to the Walk-In Centre the nurse I saw told me she believed the wound was infected. She explained that this was why it wasn’t healing up. She cleaned and re-dressed the wound. Over the actual wound she put an inadine sheet. This is a small piece of fabric which is soaked in iodine. Iodine helps to kill bacteria. She also gave me a prescription for Flucloxacillin – an anti-biotic which is similar to penicillin. I was to take this three times a day for the next week.


The Flucloxacillin caused me no problems apart from one day when I had a lot of chest tightness. On my 7th visit to the nurse I mentioned this side-effect but was just told to keep taking it.

On my 8th visit I saw real improvement to the wound. It looked like the anti-biotic had killed the infection and allowed my wound to heal. The wound had almost closed up. Rather than putting a giant plaster over the wound the nurse put a thin see-though skin-like layer over the top of it. She said this would help the scab that was over the wound to break down and would speed up the healing process.

duoderm layer

The end

Six weeks after my surgery I made my 9th visit to the Soho Walk-In Centre. My wound was now fully closed up. The nurse took off the skin-like layer, cleaned the wound and put another one of the skin-like layers over the top. She told me to leave this layer on for another week. She told me that there should be no need to come back!

Indeed this was my last visit to the nurse, after taking the final skin-like layer off I was able to leave the wound exposed. It still had a large scar over the area, and there was a indent where the cyst had been but at least I could have normal baths, and showers again.

Over the next 6 months the scar did reduce. It still hasn’t disappeared and the indentation is still there but it is good to have got rid of the lump – even though the whole experience was a lot more hassle than it should have been.

lipoma cyst removal scar 3

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.