Category: Medicine and Health

Migraine’s silver linings

~ Jennifer Barraclough ~ 1 Comment

This is another draft extract from the book based on my personal experience of migraine which I am currently writing and hope to publish in the next few months. I would like to include some short contributions from other people too, so if you have anything you would like to share in relation to this post or any other aspect of migraine, please leave a comment below or write to me through the contact page of my website jenniferbarraclough.com.

I am rather sceptical about claims that illness is a “gift” or a “lesson from the universe”. I think my life would have been much happier if I hadn’t had migraine. But no experience is entirely bad, so this post is my attempt to find some positive things to set against the hardships.

Having migraine provides a strong incentive to lead a “healthy lifestyle” – a nutritious diet, enough exercise, enough sleep, managing stress. For migraineurs it is especially important not to go too long without eating, not to over-indulge in food and drink, to avoid known triggers, and to maintain a reasonably regular daily routine. The self-discipline needed to stick to these guidelines can be tedious. But it will hopefully be rewarded not only by having fewer and less severe migraine attacks, but also by a reduced risk of many other medical disorders and of accidents, and an improvement in general wellbeing.

Activities which disrupt the daily routine too much are quite likely to bring on a migraine, spoiling the occasion for oneself and others, so it can be prudent to avoid them. Sometimes this is disappointing, for example when I decided not to accompany my husband on a trip to a beautiful island because it would involve an early morning start, a choppy sea voyage, and a strenuous walk before lunch. On the other hand migraine provides a good reason to be selective about how to use time and energy, rather than waste them on things which are neither enjoyable nor worthwhile. The temptation to cite migraine as an excuse to shirk unwelcome obligations should of course be resisted ….

While being less active in the outside world, there is more time to spend quietly at home, giving opportunities for rest and relaxation and creative activities. As discussed in another chapter of my forthcoming book, the migraine experience can inspire creativity, especially for painting but also in music, fiction and poetry. I haven’t made much use of my own migraine experience in my writing, except once in a short novel called Fatal Feverfew, which would seem quaintly old-fashioned today.

Over the years, outside of my career in orthodox medicine I’ve explored many systems of personal development, psychotherapy, natural healing, religion and philosophy. This has been mainly out of general interest but partly motivated, consciously or not, by the futile hope of finding “the answer” to my migraines. I’m not sure how much anything helped with the attacks themselves, but I have learned to cope with them better and to become more skilled in dealing with other people’s reactions. Hopefully all these studies have also made me a better-informed and more tolerant person. 

As a final comment it is reassuring to know that, except in very rare cases of stroke during an attack, migraine does not cause permanent brain damage or cognitive impairment. And although migraine carries a raised risk of cardiovascular disease, the risk of developing diabetes or cancer is reduced, and the overall death rate is not increased. Most migraineurs therefore have a normal life expectancy, and maybe the best thing that can be said about migraine is that after the age of 70 it often goes away.

If you have found any positive aspects in your own experience of migraine I would be interested to know about them.

Stress, migraine and me

~ Jennifer Barraclough ~ 8 Comments

This is another draft extract from a book based on my personal experience of migraine which I am currently writing and hope to publish next year. I would like to include some short contributions from other people too, so if you have anything you would like to share about this or any other aspect of migraine, please leave a comment below or write to me through the contact page of my website jenniferbarraclough.com.

Stress is known to contribute to many medical disorders, presumably because of the impact of hormones such as adrenaline and cortisol, generated through the sympathetic nervous system, upon the body and brain. Many migraineurs cite stress as their top trigger factor, while others vehemently deny that stress has anything to do with it at all. Some of my own attacks have clearly been induced by stress, whereas others have apparently come out of the blue. Many people talk of stress without really thinking what they mean, and it is too easy to say of migraine or any other condition “It’s due to stress” or worse “It’s just due to stress”, when this may not be the case at all and is certainly not the whole story.

Feelings of stress are usually blamed on outside circumstances, the negative events and ongoing difficulties which are an inevitable part of life. But it is individual responses which determine how stressful these experiences are perceived to be. Responses depend both on mental attitudes and physical constitution. There is evidence that the sympathetic nervous system tends to be overactive in migraineurs even between attacks, causing them to live in a state of chronic low-grade physiological stress, perhaps without knowing it. This would explain why therapies which promote relaxation, such as biofeedback, are effective for migraine prevention.

One common source of stress is an accumulation of the hassles and demands of everyday life in the modern world – juggling work, household and family responsibilities, financial strain, discord in relationships, transport delays, a deluge of emails and media posts. Pressure can intensify at times which are supposed to be enjoyable, such as holidays or Christmas, when organising the preparations is combined with changes to routine and possibly physical stress from lack of sleep, unfamiliar foods or missed meals, and excessive exertion.

Even when there is no external cause, people can generate stress for themselves by setting unrealistically tight deadlines or high standards, mulling over regrets about the past or anxieties about the future.

Migraine itself is a potent source of stress, and vicious circles can develop, as in the case of someone who is worn out after a busy period at work, gets a severe migraine and has to take a few days off. There is nobody else to cover for them, so on returning they find a backlog of tasks has built up so that the workload intensifies, and leads to another attack. After this scenario has been repeated a few times they either lose their job because of being unreliable, or feel compelled to resign, and then experience the stress of unemployment and financial hardship. 

The relationship between stress and migraine is not straightforward. It is recognised that some migraineurs manage to cope with intense pressure during the week, but get an attack at the weekend when in theory they have time to relax. Not all stress is bad. In the days when I was prone to severe migraines, I found that working very hard on a project that was important to me did not bring on an attack. Situations in which I felt frustrated and not in control, for example having to attend long meetings of little interest or wait hours in airports for delayed flights, often did.

I may be wrong but I have the impression that major crises, stressful though they are, do not necessarily trigger migraines and might even protect against them. A woman once told me that her severe and frequent attacks had stopped for several months following the sudden death of her child. I experienced something similar a few years ago when my husband was critically ill at the same time as my mother was dying. Although I became unwell myself with other mental and physical symptoms during this period, I did not get any migraines. I have never seen this phenomenon described in the literature and would be interested to know if others have experienced it.

Don’t pat strange dogs – Updated

~ Jennifer Barraclough ~ 8 Comments

While out and about I always say hello to the dogs I meet, and most of them want to be friendly. I have patted hundreds of them over the years, and never been bitten – until last week. I was walking past a cafe where a medium sized black dog was sitting with his family at an outside table. Our eyes met. I began to approach him, assuming he wanted a pat, but he suddenly lunged forward and sank his teeth into my hand. It was a deep bite and very painful. I went into shock and almost fainted. The dog’s devastated owner and the cafe staff were very helpful, bringing me water and putting iodine and a plaster on the wound. After a while I felt well enough to continue on my way.

The pain continued all day, and by next morning my whole hand was red and swollen. My husband came with me to the emergency department of our local hospital. I was seen by a specialist nurse who gave me a tetanus booster and some blood tests, arranged for a hand X-Ray and admission to the orthopaedic ward.

The ward was full, so I spent the first day receiving my intravenous antibiotics in the corridor of a crowded and noisy medical assessment unit. I was transferred to a spare bed in a gynaecology assessment unit overnight, and finally reached the orthopaedic ward before lunchtime next day. This was not ideal but the important thing was having been promptly started on treatment, without which I realise I could have lost an arm or even died.

Being in hospital was a new experience for me and not nearly so bad as I expected. All the staff I encountered were skilled, efficient and kind. It was interesting to chat to other patients, and good to receive visits and messages from family and friends. I felt surprisingly well during my stay but it was a while before the cellulitis began to resolve. I was scheduled for surgical drainage on the third day, but by then the operation was judged to be unnecessary and I was discharged home to continue on oral medication for another week.

Dogs usually bite because they feel threatened, and it is those who have been abused as puppies who are more likely to become aggressive in later life. The owner has kept in touch and I hope to meet him again to find out something about the culprit’s background and character, and try to understand why I provoked him. I will be more cautious in future about patting strange dogs.

Update March 2024

Three months after the events described above, I arranged to have coffee – in a different café – with the family of the dog that bit me. As I suspected, Baxter (not his real name) had been cruelly treated in early life, during that vital period from about 8-16 weeks which can make or mar a dog’s temperament. He was born overseas in a puppy mill, transported long distances, and surrendered to a rescue centre before being adopted by his present owners. Even after some years in a loving forever home, he still has some behaviour problems, and is now having professional therapy. When I saw him at a distance he regarded me suspiciously. I have let go of any fantasies about making friends with Baxter, but seeing him and his family again gave me a worthwhile sense of “closure”, and I wish them well on the long journey of rehabilitation for a dog who has been so damaged by early abuse. By the way my hand wounds have healed well, leaving just a tiny scar to remind me of what happened. 

Food, drink, migraine and me

~ Jennifer Barraclough ~ 9 Comments
Photo by Chelsea Pridham on Unsplash

This is a draft extract from a book, based on my personal experience of migraine, which I am currently writing and hope to publish next year. I would like to include some short contributions from other people too, so if you have anything you would like to share about this or any other aspect of migraine, please leave a comment below or write to me through the contact page of my website jenniferbarraclough.com.

People who are vulnerable to migraine often report that dietary factors – foods, drinks, and meal patterns – can trigger their attacks, and this is certainly true in my case. Eating cheese is the worst thing for me. It took many years to recognise this, which now seems strange, but because it was something I used to eat almost every day when I was younger I didn’t notice a connection. Also, this was years before it was possible to look up health information on the internet, and we were not taught much in medical school about relationships between diet and disease. Cheese, especially strong aged ones, is implicated for other migraineurs too and this is believed to be because it contains high levels of a biogenic amine called tyramine. This substance gets metabolised in the gut by an enzyme called monoamine oxidase, but people who only have low levels of this enzyme cannot process it fast enough, so that it builds up in the body and can cause not only migraine attacks but also increases in blood pressure and symptoms such as nausea, sweating and anxiety. Other high tyramine foods which are sometimes implicated in migraine include chocolate, processed meats such as bacon and salami, smoked fish, raw onions, fermented or pickled vegetables, broad and fava beans, oranges and other citrus fruits, ripe bananas, pineapples and avocados. None of these disagree with me like cheese does, so I suspect that the combination of chemicals besides tyramine found in different items of food is involved in individual sensitivities. While some migraineurs benefit from a low tyramine diet, others have reported benefit from gluten-free, dairy-free or ketogenic diets, or from giving up all forms of sugar.

While some foods may be best avoided, the good news is that others – those containing high levels of omega-3 fatty acids – have been found to reduce the frequency and severity of attacks. They include oily oily fish, dark leafy greens, chia seeds, flaxseed, tofu, walnuts, and eggs. 

Alcoholic drinks are often blamed for precipitating migraine attacks. This may not be due so much to the alcohol itself, as to the fact that they contain various other chemicals, again including tyramine. I love wine, so am glad to say that white or rose in moderation is not a problem for me, in fact it is probably helpful because of its relaxing effect. Red wine is more risky, and is notorious for provoking headaches even in people without migraine, probably because of its quercetin content. I seldom drink more than one glass of anything nowadays, having found in the past that just a slight excess can be followed by a whole day of feeling very ill with a ghastly mixture of migraine and hangover symptoms. When cheese and wine parties were fashionable they often proved a disaster for me.

Coffee, and other caffeinated drinks, are migraine triggers for some people. I am fine with one double shot flat white or Americano mid-morning, but not more. Sudden withdrawal of caffeine can also lead to an attack, so it is best to keep a fairly constant intake. A few years ago I spent a week at a health resort where coffee was forbidden. I had cut down on it the week before but still had a nasty headache for the first three days, though this did not develop into a full-blown migraine. Paradoxically, caffeine is present in some over-the-counter medicines for migraine, and black coffee has been found helpful during attacks as a treatment for people who do not usually drink coffee at all.

The timing and size of meals is important, as well as the type of food and drink they contain. Going too long without food or water can precipitate a migraine attack, but so can eating too much at one time, so it is important to maintain a reasonably regular meal schedule and to avoid dehydration.

Food triggers may be hard to identify because there can be a delay of hours or even days before their effects develop. If someone gets a migraine soon after eating a certain type of food they may develop a fear of that item and avoid it in future, although the attack may actually have been caused by something else. There may be a psychological element involved – for example if I have given in to the temptation of eating a piece of cheese, I usually worry about it afterwards and my anxiety may increase the likelihood of an attack. 

Avoiding alcohol, caffeine and all suspected food triggers requires a lot of will power, is awkward in social situations, and makes for a somewhat joyless existence for those who enjoy eating and drinking. Some of the “migraine diets” to be found on the internet appear impossibly restrictive and might even cause nutritional deficiencies in the long term. Dietary triggers are not the same as allergies in which eating even a tiny amount of a certain food, peanuts for example, is quickly followed by a severe reaction or even death. Many migraineurs can get away with eating their trigger foods in small amounts now and then provided they are not exposed to other risk factors at the same time.    

Memoirs of an Oxford medical student 1967-70

~ Jennifer Barraclough ~ 2 Comments
Osler House, Woodstock Rd

More than 50 years after graduating from Oxford University Medical School, I found a boxful of letters and diaries which I had written during my clinical course. To a naive 20-year-old from a rather sheltered home background, whose first degree at Leeds University had involved more work than play, life in Oxford was a revelation – intellectually, socially and emotionally. My memory for the past is fairly patchy and though I clearly recall some of the people, places and events described, I have forgotten many others which were obviously significant at the time. I was known by my maiden name, Jenny Collins.

The course was mainly based at the old Radcliffe Infirmary in Woodstock Rd. For some attachments we visited the Churchill Hospital, where I would later become a junior doctor and eventually a consultant, Cowley Road Hospital, and the Nuffield Orthopaedic Centre. The Radcliffe Infirmary was closed in 2007 and its site is now occupied by university offices. The hub of student life was Osler House (not to be confused with the present clubhouse of the same name on the John Radcliffe site) an 18th century listed building in the hospital grounds. Downstairs was a lounge, bar and kitchen. Morning coffee and afternoon tea were provided free. Upstairs were bedrooms for use when on call. There was an attractive garden with a croquet lawn. Each student also had an attachment to an Oxford college – mine was Somerville – but being postgraduate did not live in. My first few months were spent lodging in Summertown with the mother of a family friend, the widow of a bishop and a keen supporter of Moral Rearmament. After I had moved into my own flat, my former landlady continued to invite me for dinner on Sunday evenings.

Our intake contained only 18 or 20 students. Being divided into even smaller groups for clinical attachments, we got a great deal of individual attention from our teachers. For me, as one of the few women in a male-dominated environment, this was often of a kind which would not be tolerated nowadays. As well as clerking patients we were given considerable responsibility for practical procedures such as taking blood, putting up drips, lumbar punctures, delivering babies, and assisting with surgical operations.

There were periods of intense activity – on take for medicine and surgery, night deliveries in obstetrics, preparing for exams. But otherwise the pace of work was fairly leisurely and allowed time for a vibrant social life. Lunches, dinners, parties and outings were frequent and usually involved vast quantities of food and drink. I sang in the hospital choir and in my final year played a good fairy in the students’ pantomime, Tingewick. I must have done a certain amount of studying but most of my free time seems to have been spent entertaining friends for supper or afternoon tea, making my own dresses, listening to pop music, or walking around Oxford which was then a peaceful place with few cars. Several of my friends did have cars, and when they were driving north would give me lifts home at weekends. It was a privileged and mostly hugely enjoyable life which, I imagine, was far more relaxed and informal than for clinical students today.

Much of what I wrote is too trivial, personal or libellous to publish, but maybe I will adapt some extracts for a series of blog posts, a memoir of a novel. Meanwhile I’d be pleased to hear from anyone who remembers those times.

On the other side of the (medical) fence

~ Jennifer Barraclough ~ Leave a comment

Since retiring from medical practice I’ve exchanged the role of doctor for those of patient and of patient’s wife, and being on the other side of the fence has been an interesting experience. Between the two of us, my husband and I have needed to see a good many different healthcare professionals from various specialties in recent years. Most of them were excellent, but a few were unsatisfactory and this was usually because of their poor “communication skills”.

Following the retirement of the family doctor we had known and trusted for a long time, I saw a GP whose failings included a rude manner, ordering me to take a long-term prescription for a new drug without any discussion of its efficacy and side-effects, and – as I discovered later – referring me to a hospital clinic without telling me. After that I changed to a different practice and am very happy with my doctor there, but my experience with the previous one distressed me for a long time, illustrating the importance of a good therapeutic relationship not only for improving patients’ emotional well-being, but for influencing their compliance with treatment and the outcome of their disease.

I don’t remember having any guidance about how to relate to patients when I was at medical school in the 1960s, nor during my junior doctor posts. Senior role models varied greatly in their approach, ranging from the caring and compassionate to the arrogant and disrespectful. In the later years of my career this aspect of clinical practice began to be taken more seriously, led by specialties such as general practice, oncology and palliative care. Communication skills training is now included in the education of doctors, nurses and other healthcare professionals, though its long-term impact must be difficult to measure, and depend on the student’s personality. The skills may come naturally to those who have chosen their career for humanitarian reasons. Those who are mainly interested in the scientific and technical side, or whose prime objective is making money, may pay little attention to such “soft” subjects in the curriculum.

The basic principles should be obvious, simply involving courtesy, common sense and genuine concern for the patient. Giving a polite and friendly greeting. Meeting in a clean and tidy consulting room free of interruptions. Listening to the patient’s story with genuine interest and empathy. Taking account of the patient’s knowledge and preferences when discussing management of the problem.

Conducting the interview becomes more difficult in the case of a serious condition. The medical literature contains many studies about techniques of “breaking bad news”, usually in relation to a cancer diagnosis, and I won’t attempt to detail them all here. Key points include giving truthful information without destroying hope. And avoiding dogmatic statements about prognosis, because the outcome in individual cases can vary so much from the average. Negative predictions can be self-fulfilling as well as disheartening, whereas except in the most dire situations there is always some help to be offered, and some scope for improvement. Another point highlighted by our recent experiences is that illness can be just as stressful for relatives as for patients themselves.

Free speech?

~ Jennifer Barraclough ~ Leave a comment

“This may be offensive to your reader” warns Microsoft Word when it finds bitch in the text of my forthcoming novel. Considering that I was using the term to describe a female dog I find this quite amusing, but it makes me think about other less trivial ways that the use of language is becoming curtailed. One of my characters expresses racist views before being admonished by his wife, and I understand that a similar incident in one of Sally Rooney’s books led a journalist to accuse the author herself of racism. JK Rowling was “cancelled” for a comment that some interpreted as transphobic – fortunately my novel contains nothing about gender identity issues. It seems more acceptable to portray violence towards people and animals in fiction than to risk upsetting “woke” sensibilities.

Free speech is also limited in real life. Here in New Zealand, doctors who express valid concerns about the safety of Covid vaccination are being disciplined by the medical authorities. The rare but well authenticated cases of serious illness or death attributable to this vaccine are seldom reported in the media, and campaign materials designed to get everyone vaccinated make no mention of potential risks. I regard the vaccine as the lesser of two evils so have had my own two shots, but I respect the rights of those who have researched the pros and cons of this intervention and decided not to accept it.

Book review “Cured: the life-changing science of spontaneous healing” by Jeffrey Rediger

~ Jennifer Barraclough ~ 1 Comment

Cases of the phenomenon variously called “spontaneous healing” or “spontaneous remission” or “remarkable recovery” are sometimes reported in the medical literature, usually in relation to advanced cancer. They are probably not quite so rare as followup statistics suggest, either because sceptical doctors presume that the original diagnosis was wrong, or because the patients concerned have stopped attending hospital clinics. Jeffrey Rediger, a physician and psychiatrist who is on the faculty of Harvard Medical School, has spent fifteen years studying this topic by interviewing patients and visiting healing centres. In his book, case histories are interwoven with summaries of the latest research into the body’s defences against disease.

The library copy of Cured on which I based this review is subtitled “the life-changing science of spontaneous healing” by Jeffrey Rediger but the version on the Amazon page, presumably more recent, has “the power of our immune system and the mind-body connection” by Jeff Rediger. Although I don’t know why the subtitle was changed (or the author’s name shortened) it strikes me that the term “spontaneous” could be misleading. Most unexpected, apparently miraculous, recoveries from a disease that had been considered incurable do not happen out of the blue, but after the patients concerned have taken active steps to reclaim their health.

Early chapters focus mainly on physical aspects, with detailed discussion about how to optimise nutrition, and support the functioning of the immune and nervous systems. The later ones have a more obvious “mind-body” emphasis with topics such as the placebo response, faith healing and prayer, the power of love, and what he calls “healing your identity”.

This last aspect may be of crucial importance. It builds on the work of early researchers such as Lawrence Le Shan, whose book Cancer as a Turning Point influenced my own choice of psycho-oncology as a career, and echoes the message of more recent books such as Remarkable Recovery by Caryle Hirshberg and Marc Barasch. Many of the patients described in these books made a decision, consciously or not, to take control of their lives and “rewrite their stories”. This often involved leaving a toxic relationship or an unsatisfying job, reviving an undeveloped talent or ambition, and most importantly making “deep mental and spiritual changes”. An essential feature was being true to themselves rather than conforming to outside expectations, and following their own path. This might require courage and faith, and the discipline to “burn their boats” to prevent a lapse back to the previous way of life. Some became whole-heartedly committed to particular healing practices. These were very varied, ranging from a strict ketogenic diet to daily immersion in yoga or meditation, suggesting that faith in the chosen modality whatever it may be is the crucial factor in its effectiveness.

This psychological picture does not fit every case. Regression from cancer following an acute infection with high fever is well documented, and must have a biological basis rather than a psycho-spiritual one. Some cases of remarkable recovery do appear spontaneous, because no explanation at all can be found.

Dr Rediger provides plenty of information and guidance for those seeking to prevent disease, or to maximise their chances of recovery from an existing condition, and the case histories are inspiring. He rightly avoids recommending particular approaches, and he acknowledges that there are no guarantees. Plenty of patients “do all the right things” and still succumb to their disease; spontaneous healing remains to some extent a mystery. This is a valuable book, though perhaps rather too long and detailed to be easily digested by someone dealing with a serious illness. Future editions could be made more accessible by adding an index, and summaries at the end of each chapter.

***

Jennifer Barraclough, originally from England and now living in New Zealand, is a retired doctor and a writer of medical and fiction books. A list can be found on her author pages: https://www.amazon.com/Jennifer-Barraclough/e/B001HPXGZI (US) and https://www.amazon.co.uk/Jennifer-Barraclough/e/B001HPXGZI (UK).

Recovering from wrist fracture: six months on

~ Jennifer Barraclough ~ 1 Comment

Six months have passed since I broke my wrist. Having heard from various sources that recovery from this type of fracture should be largely complete by six months, I decided to write what will probably be my last update on the subject, and hope it may be useful for other people dealing with this common injury.

Six months is of course a ballpark figure based on an average of many cases. Healing is a gradual process and its rate varies greatly between individuals. My own recovery is not complete, but there has been a lot of progress. As well as all personal care and household tasks, I can now easily manage the main activities that are important to me: typing on the computer, driving the car and walking the dog. The exception is playing the piano, which continues to hurt. My wrist still looks misshapen and probably always will, but I hope the residual swelling will eventually subside.

At my recent outpatient review with Xray, the consultant orthopaedic surgeon said that the bones were “solidly healed” but that the alignment between radius and ulna was not quite right and therefore certain wrist movements are restricted. He offered an operation to correct the displacement but, considering that this would require another six weeks in plaster with consequent limitation of activity and loss of fitness, I decided not to accept it at present. Surgery can be reconsidered at a later stage, but I hope that my condition will continue to improve on its own.

Finding “silver linings” in an illness is not always easy. I hope this experience has made me more patient, more tolerant of others’ limitations and not in so much of a hurry myself. It has led indirectly to several positive changes: a new choir, a new GP, and attending Pilates and “Silver Swans” ballet classes each week to improve my strength and balance.

***

Jennifer Barraclough, originally from England and now living in New Zealand, is a retired doctor and a writer of medical and fiction books. A list can be found on her author pages: https://www.amazon.com/Jennifer-Barraclough/e/B001HPXGZI (US) and https://www.amazon.co.uk/Jennifer-Barraclough/e/B001HPXGZI (UK).

Recovering from wrist fracture: ten weeks on

~ Jennifer Barraclough ~ 2 Comments

Recovery demands a lot of patience, but there have been several positive changes since my last post five weeks ago. I hope writing these updates will help me to appreciate the progress made, and be useful to readers recovering from similar fractures.

My cast was removed about six weeks after the injury. I was anxious about seeing my wrist again, knowing that the two attempts to reset the displaced bones had been only partly successful and the final position would not be perfect. It did indeed look crooked and thickened compared to the other side, and still does, though I hope some of the swelling will go down in time. It was a relief to have the cast replaced by a removable lightweight splint.

I see a physiotherapist once a week, and carry out the prescribed exercises four times per day. I can’t manage the full range of movements but measurements have shown a slight improvement at each clinic visit. Gently massaging the skin with herbal or homeopathic creams, and essential oils, is comforting. I no longer feel any need to take analgesics, but the ulnar side of the wrist is still stiff and tender, and I understand this can be a persistent problem which might require surgery later on.

As regards daily activities the the most significant advances include being able to drive the car and cut my own nails, though I still can’t use a knife and fork. My general vitality, which was impaired for weeks after the injury, has recovered now and I hope to get back to creative writing soon.

On the negative side, the Dexa scan carried out as part of the follow-up showed reduced bone density. This was disappointing because I take plenty of outdoor exercise and eat the right foods. Before considering medication I shall try extra vitamins and sunbathing, and be more careful about avoiding falls.

All the aftercare is free of charge under New Zealand’s generous Accident Compensation scheme.