Hydro

Rachael had a very productive session with Dan. Dan did a thorough full body workout with Rachael. He spent an extra amount of time working on Rachael's feet and toes which has been of great benefit. Rachael could still feel the improvement the following day. 

Dan noted that Rachael's shoulders were both out of alignment but Rachael reported that she had become used to the discomfort and that it was her neck that caused the most trouble. Dan put Rachael's shoulders back and massaged her neck.

There was an incident at the end of the session where the staff lowered the chair into the pool for another patient whilst Rachael was floating on her back. A small wave from the chair went up Rachael's nose so Dan sat her up. However when Dan lay Rachael down again some water ran back down Rachael's throat but due to thick phlegm she had difficulty in swallowing or coughing up the water. She managed to clear the blockage after Dan sat her up straight again. Rachael did not feel endangered by the incident but the pool staff did seem to panic a little.

Due to a staff meeting at the hospital on the 30th July and her PA being on holiday on the 6th August Rachael will not be going to hydro for three weeks.

Orthotics

Rachael attended the Orthotics Department at B Hospital for a trial fitting of some new shoes to help with the curvature of her toes. Unfortunately the new shoes were far too small. Val noted that Rachael's feet had widened considerably since her last fitting.

After discussion it was agreed that Val would order some new wider shoes with a squarer toe and that they would be fleece lined for added warmth. An inner sole would be made for the shoes with a raised area which would sit under Rachael's toes and help to support them. Rachael's feet would be able to slide over the raised area, but if that didn't work, Val would find a way to attach the inner sole to Rachael's foot before sliding it into the shoe. Rachael is still dubious about whether this will work or be counter-productive.

Val also recommended purchasing some battery powered heated socks to help keep Rachael's feet warm.

Hydro

Rachael attended hydrotherapy with Dan as session supervisor. Rachael had no specific issues but due to recent problems Dan worked mainly on Rachael's shoulders, arms, hands and neck. He also did some work on her knees. 

Dan worked on a particularly effective exercise with Rachael lying on her back and doing a breaststroke motion whilst her hands were flat on her stomach. Rachael noticed a slight and occasional difficulty in breathing whilst lying on her back in the water. This was not enough to cause discomfort at present but is something to be aware of in the future.

The pool was noticeably cooler than usual and Rachael's jaw was locked on getting out and Rachael continued to feel the cold, shivering while getting dressed.

Hydro

Rachael attended her hydrotherapy session with Dan as her session supervisor. Rachael had no specific issues this week so Dan asked his trainee staff, Cheryl and Justin, to work on Rachael's feet, knees, hands and shoulders.

Cheryl worked on Rachael but she was totally ineffective. She caused some pain to Rachael's feet and Dan had to tell her to stop and to listen more carefully to what Rachael was saying to her. After this she just gently rubbed and massaged Rachael's muscles which had no useful effects on Rachael whatsoever.

Dan spent a couple of minutes with Rachael at the end of the session but Rachael only managed to walk about a width and a half as her muscles had not been worked on enough.

Podiatry at B Health Centre

Rachael attended the podiatry clinic. The podiatrist asked Rachael how her toes had been since the last visit and if she had required any antibiotics. He checked the circulation in Rachael's feet with an ultrasound system. He informed Rachael that the circulation around her bigger vessels was healthy but the microvascular vessels that bring blood to the skin are not working so well, which is the reason why she has cold feet.

The podiatrist asked Rachael about sensations within her feet. Rachael informed him that she can feel things but that she has no sense of whether it is a sharp or a dull touch.

He advised Rachael that the best thing would be for her PA to file her nails once or twice a week to a manageable level. This way the sides will grow a little bit longer than the top of the nail maintaining a straight edge which will stop them from further ingrowing. The podiatrist cut Rachael's nails and demonstrated how to file them.

He congratulated us on the general foot care regime, especially in attempting to keep Rachael's feet warm at all times by using heated slippers and socks etc. He also advised us to keep Rachael's shoes warm before wearing and ensure that her feet are warm before she goes to bed.

The podiatrist mentioned nail surgery again but did not feel that it was the best option at this stage.

The podiatrist offered Rachael the option of taking a referral application home to refer herself if required. An appointment with a referral would take one to two weeks whereas existing patients can expect to wait four to six weeks. Rachael said she would rather be a patient and use the drop in clinic if necessary. The podiatrist agreed and recommended to Rachael that if she books an appointment within twelve months he will be able to keep a check on her feet and her status will remain active on their system.

Hydro

Rachael attended a hydrotherapy session with Sharon. Sharon went through the full range of motion exercises with Rachael. Walking was largely unsuccessful but Sharon concentrated on Rachael's neck muscles which have become weak. There were no dislocations in evidence this week.