Where are you headed?

 Every year I tend to post a link to a previous blog- Go outside, sit down. Wait. It's a decent read, even if you've read it before. 

The reason why I'm writing a kind of new/semi-update is because this kind of happened over the weekend and it was simple fortune that the casualty happened to be in a place with some kind of phone signal. 

Backstory: Snow over night. Icy on the ground. A barmy -5 air temp, clear blue skies. A bloke goes out running in the morning on a route he knows well. Tells his wife "where he is going"- and what time he should be back- in about 2 hours. 

40 mins later, the police get a call from the runner with a suspected fractured leg with a short description of what he has run past- though not his exact location, and pass the information on to Mountain Rescue. There is a further vague message, potentially from his wife that he might be on one of the lower level footpaths around here- but that doesn't match the description given by the casualty on the phone.... 

By the time the Mountain Rescue team get a team out of base, he has been sat in the snow (albeit with a foil blanket) for more than an hour. Although it is a bright, clear day, he is not in the sun and is slowly making less and less sense on the phone as he becomes gradually more hypothermic. 

He can answer the phone- but he can't use it to give us a direct location as he doesn't have his glasses with him. Why would he? He's going on a run.

Due to the information passed to us on the phone by the casualty himself, a team was on the hill and with him within 1.5 hours as he was going pretty hypothermic - with a very messed up leg. That's well within the time (2 hours) that his wife would have happily expected him to still be enjoying his run. 

What if he had just gone a bit further up onto the moor before this happened- and then snapped his leg in an area with no signal? 

When does the wife get worried enough to callout mountain rescue if he isn't home in the allotted 2 hours? Immediately? After 2.5? 3?- 

and when she DOES eventually call through- what information do we have? 

That he has gone for a run, potentially along a low level footpath that he wasn't on at all. (mixed messages? misunderstanding of potential route?- who knows)- but by that time, he'll have been in the snow with a snapped leg for 2-4 hours going severely hypothermic in an as yet unknown location.

And if you didn't know already, trauma and hypothermia as a double act are not a good combination. 

Now- I know that sometimes when you head out, you don't know exactly where you are going. Equally, it might be nice to know that people DON'T know exactly where you'll be. 

However, as one of the people that might have to put together a series of vague (sometimes incorrect) clues as to where you might be when you're ovedue/have fallen down a hole that is out of signal and snapped your leg etc. it would be really handy if someone knew at least where you were vaguely intending on going, and when you were planning on being back. 

Note- this is not just for runners- walkers are in the same bracket, and just because you *think* you're carrying more than an average runner in your rucksack, it doesn't make Mountain Rescue come any faster... in fact, you might have told someone you'll be 5-7 hours on the hill... that is a LONG time to wait before being certain that MR have been called.

Where exactly are you planning on going again?!

Whenever I go out I give Lynne a rough plan of where I'm going, what time I'm planning on being back, and a "pull the cord" time- when if she hasn't heard from me- call 999. Chances are, if I'm ok, then I'll have signal *somewhere* and should be able to tell her that I'm ok. If I'm not- then I know that there is a specific time when I *know* that MR have been called. 

If you don't know how to call Mountain Rescue in the UK- it's 999, and ask for Mountain Rescue through the Police. 

It's glorious out there. Enjoy the hills, be safe, have an escape plan, and know when you need to call it in.

Hill and Fell relays 2023- Leg2

 Originally I wasn't going to be running this. Generally speaking each person in the club apparently gets "1 relay run a year", though I wasn't aware of this. However, due to various people deciding to run, then not run, and teams being shuffled and reshuffled (as is always the case to the frustation and stress levels of those organising the teams) I ended up being partnered with Ben Tetler on Leg 2. 

Ben is a faster runner than me- kind of in the same league as how Chris is a faster runner than me, so I was under no illusions that this was going to be a fairly challenging day out. None the less, it was most likely to be a fun day out as well. It was useful to be on Leg2 as I had to leave early to get back for an MRT exercise- so that fell into place nicely. 

The Relays were held by Keswick this year, and so started in Braithwate, which brought  back memories of a hiking holiday I went on with Rob back in oooh- 2006 which is mainly remembered for waking up every morning with ice on the inside of the tent, seeing footprints in the snow of fellrunning shoes and thinking "wow- imagine living somewhere that you own a pair of shoes with spikes in *specifically* for days like this, and, on the last day, walking down off Grisedale Pike, being overtaken by a fellrunner and thinking "that's amazing. I wish I could do that- no chance living in London". 

So here we are. Vet40 team for Glossopdale. A pretty crisp day, but with a fair amount of rolling clag across the tops. Neither Ben nor I had had any time to get up to recce the leg, so we were just going to go with the safest lines, which were the ones on the map. Leg 2 is about 12.5k with 1000m of ascent (unless you recce it, take some sneaky lines, and then its only about 950). Jamie Helmer was on the first leg and set off circumspectly, gaining places over the course as other, more enthusiastic starters began to regret their decision to go out hard. Ben and I got through kit check and warmed up- reccying the first 300m of the course (oh how detailed), and went back to the start pen waiting for Jamie to come in. 

 

The general plan for the day was for me to go as fast as I could, and for Ben to be nice to me and not blast off up the hills at a pace I couldn't follow. Now- if you read the last blog about the HBMR relays, you'll know that I ended up with a bit of achilles tendonopathy after that, so for the last 3 weeks I've been concentrating on rehab and very much *not* running, in the hope that it would be ok for today. It had been getting better and better, but I figured that it might hurt today, but as I don't really have any more races after this, it didn't matter too much if it flared. So this could be interesting.

We saw Jamie on the last little slog up the hill to the final downhill blast and got ready in the start pen along with a number of other teams, and once tagged, we were off. The initial climb wasn't too bad- and was generally fairly runnable. Ahead of us we could see (amongst many others) the Dark Peak V50's and the Pennine V40s, both of whome seemed to be making pretty decent headway. Dark Peak were closer and we overhauled them just as we got to Barrow Gill, but Pennine remained stubbornly ahead. 

I was trying not to go too deep too soon, especially as I saw Outerside, the first actual peak, and was thinking- "well, thats maybe a quarter of the way in... don't go too silly- hold something back for the harder climbs". The initial running was very much Mudclaw territory. Plenty of sloppy bog and mud to sink the studs into, and you could see the people that weren't wearing shoes with that amount of grip as we passed team after team. However, on the climb up to Outerside, the bog gave way to stone where anyone with any kind of inov8 was immediately swearing at the ridiculous lack of anything resembling friction under their feet. This was going to be an interesting leg. Maybe I should have been wearing a mudclaw on one foot and a VJ on the other?

We bust up Outerside as fast as I was able, mainly trying to keep to the vegetation parts of the climb, avoiding people sliding across slippy wet rock, and managed to catch and pass Pennine V40's just prior to the top. Although the tops were still clagged in, I looked down and across from the Checkpoint and thought "this is pretty much the Teenager with Altitude line- I know this"- and off we clattered down towards Birkwith Beck overtaking another team, and seeing several others in our sights, who we caught up with, and then overtook along the rough traverse and down the steep descent to the main path up to Coledale hause. 

Yes- me on a descent- but not the one down to the beck (there was no-one there taking photos)

I'm not going to lie- this was not a high point. Ben seemed very in his element driving hard up the moor across the bends of the path- while I chugged a gel and held on for dear life. Taking the main path would have been less efficient, and at this stage I would have been going at the same speed over a zigzag terrain as direct up a moor, so in fact we gained on the teams in front. Ben had his eyes on the Bingley Vet team- the only way we could pass them was if they slowed down- I wasn't about to get any faster!

As we climbed to the Checkpoint at Coledale Hause I looked across and 99% of the teams ahead of us were climbing the main scramble up Eel Crag. There was a sole Keswick team traversing across the bottom of the crag- which looked like a decent line, but one that you'd only really want to take if you'd previously reccyed it (which, presumably being the host team, they had). It would have been great to take a sneaky line there, but considering the clag was still a bit down, and this was around an area characterised by places such as "Eel Crag", "Scott Crag" and "Scar Crag", it didn't seem like a good idea to start going off piste. 

Dibbed at the Hause, and then a scramble up Eel crag. Again, anyone in inov8s was cursing the lack of any kind of grip on stone. If you put your foot on any kind of rock you could guarantee that you'd slip. It was genuinely ridiculous. I might have slightly rose tinted specs on here, but about 10 years ago you could get a pair of shoes that gripped on mud AND rock, these days, it seems like that ability has been lost- which is really weird. Anyhow, a slog to the top of Eel crag, and by now, my legs and lungs are really starting to feel it. A Keswick team (not the one we'd seen earlier) came past us, and a Helm Hill team that we had just overtaken, and so at least we had someone to follow a little way to the top of Eel Crag in the mist. 

Then came a fairly technical descent down and across to the ascent to Sail. Ben was wearing Walshes, and so had a totally different grip to mine. Stepping where he stepped didn't necessarily mean I was going to get the same stability as him, so it was quite interesting to notice how we descended differently according to what gripped and what didn't.

Up to Sail- a dib, and then down to Sail pass in the cloud that slowly cleared as we descended. My legs were shot, and this was amply demonstrated by Ben quite happily skipping down the hill where I would have normally followed without a second thought. Having been on the edge for 40?50? mins or so, I just couldn't keep the power down, so got to the bottom about 10 seconds after him. On the climb to Scar crags the Keswick and Helm hill teams slowed a little, and we passed them both at the top and had a beautiful ridge run down- looking ahead to the next gaggle of teams who were just dropping down off Causey Pike- a fair distance ahead. Gotta keep running....

Dib at the path junction and a hard left down what would be, in a lesser state of fatigue and cardiovascular stress, a beautiful descent. Still, despite my legs not working quite as well as they should, we were making time on the teams ahead. Over Stonycroft Gill and onto the main path where I got a little respite before heading to Barrow Door where, just before the final climb, I turned my right ankle. Dammit. Not something I wanted to do right now. It wasn't desperate, but it still hurt a fair amount. 

The final climb to Barrow *should* have been utterly runnable, but along with that recently twisted ankle, there were times where I was having to power walk- slightly annoying as Ben could certainly have gone faster. Final dib at the top of Barrow, and the final descent. Again one made for Mudclaws. A couple of teams were ahead of us, and I was confident we would catch them before the end. Ben, who was running at seemingly a lower level of intensity than me was still able to barrel down hills at a speed that I should have been able to keep up with, but I was losing ground due to fatigue and the ankle. 

The final sprint down to the finish

 

We passed a team at the bottom of the hill- just as we climbed to the final descent to the event field, and then passed another team, despite me having to walk at the top- with a final ripping downhill to finish, barely slowing for the fence where we tagged Rick and Neal who headed off on the Nav leg. 

Tagging

 

What a great route! I'm certainly going to go back and run it at leisure at some point, but crikey- at the end of this EVERYTHING was just tired and battered. 

Looking at the results now, we finished in 1:31, which put us 35th fastest overall, and 8th in the V40 category. Our run brought the team into the top 10 V40 teams, which Rick and Neal on Leg 3 and Steve Brown on Leg 4 managed to hold on to until the end- 9th V40, which was pretty decent. 

Thanks to Keswick for putting on such a fantastic event, truly a great day out. Thanks to Ian and Neal for herding cats getting the Glossopdale teams together. It really is a monumental task of management- though it really shouldn't be. Congrats to our other teams- 2 Open and a Supervets team for getting out there and running some pretty tough legs. Impressive, big hearted running. Thanks also to Clare and Sean for the use of their photos and video- much appreciated.

And yes, I got back home with enough time to spare for a shower, some food, got changed and went straight back out for the Exercise. Great fun. 

Oh- and the achilles feels fine. It'll still need a bit of rehab and tender care over the next few weeks, but the running didn't seem to affect it adversely. Happy days. 

"Out of our control"- dermatology nightmare

I should be in the Pyrenees, cycling from one end to the other, right now. I get updates from the guys who are doing it, and they're having a blast. 

Why am I not there? I hear you ask. 

Well, when we were in the planning stage, my ecsema was so bad that I couldn't even contemplate being away from medications for a couple of days, let alond a couple of weeks, especially if it was going to be a lightweight trip, with consecutive long days in the saddle. The thought of how bad it would be in terms of skin loss, bleeding and itchiness didn't even bear thinking about. 

In the meantime, I've been trying to get onto another, potentially life-changing medication- in fact. I've been trying since June and lets say, it hasn't been plain sailing in any way shape or form. 

You may know that I've been on Methatrexate for a year now. It's an immunosuppresant that is (amongst many other things) meant to reduce the build up of excessive skin cells, which should reduce the itchiness, scaliness and general nastiness of escema. It kind of worked for a bit, but in the last year I have had to be on actual steroids to reduce big flare ups, despite being on Methatrexate. In medical parliance, I have "failed treatment". 

This is where it gets fun. 

So I have to have regular blood tests to make sure that I am not becoming too immunosuppressed. These are taken at my local GP surgery, sent to the local hospital where they are checked, analysed, put onto a system which then gets pushed to my GP, whereupon it also gets pushed onto my NHS app on my phone, where I can check my bloods as well. All well and good. 

In June I was referred to that hospital to the dermatology clinic to try to get me on the new, fandagled medication as my GP is unable to put me on it. I was told there would be a wait of about 6-8 weeks before I'd get an appointment- ok, fine. 

I call up after 8 weeks to see if I had an appointment yet, or was still in the queue- and was told- goodness me, there is an appointment that had come free in 2 Saturdays time in the afternoon. Grand. So we went along to the hospital on the Saturday, having spent the last 2 weeks in increasing amounts of discomfort, to have my appointment.

Whereupon, I was told by the dermatologist "I don't have any letter about you, I don't have any of your bloot test results, it seems that you've been to a private dermatologist to get on methatrexate, and I don't know why you're here- if you're already on Methatrexate, I can't see why you need to be under two dermatologists to be on methatrexate". 

Gobsmacked would be a word I could use. Been waiting for 10 weeks from the referral- how on earth could she not have the referral letter, where on EARTH did the idea that I'd been to see a private dermatologist come from? and how could she not see my blood results? They'd been processed in THIS actual hospital! 

I did a very good job of controlling my temper, and, well, the upshot of it was that nothing happened and I was utterly utterly livid. She kept saying I had to "fail treatment" in order to be put onto the next medication, and when I asked what *that* meant- it was "use methatrexate for a year without improvement"... But- I've DONE that. Apparently not according to her records- so she booked me in for intial blood tests and a chest x-ray to get a "baseline"- which seemed kind of odd, considering I have at least a years worth of blood tests to show baseline and bloods on methatrexate.

Later that week I had an appointment with my GP, who not only showed me the referral letter, but also printed a copy out for me..... 

So- I go home and phone the dermatology secratery- of course you can't talk to an actual doctor- and asked about what had happened. The secratary seemed confused, saying that *she* could see my blood results on the system. What? Ok- how about the referral letter? No- apparently not. So I scanned and emailed the referral letter to her to attach to my profile- why and how it isn't there, I have NO idea. I then called about a week later to make sure it had actually been attached. Apparently it has. 

Great, next step- x-ray and blood tests. I go to the hospital (the same hospital, mind, that has been testing and reporting on my blood for the last year, that I have been getting on my NHS app), have my x-ray and full bloods done. Brilliant, all well and good. I wait a few days to be told about the results. Nothing. No email, no call, no message. Ok- check on my app- nothing. It's like they haven't been done. Ah man- I'd better check with the dermatology secratery - and leave a message. 

I get a call back the next day- oh, yes, my bloods and x-ray have indeed been done. Yes, they are on the system. 

So why can't I see them?

Sorry?!

Why can't I see them? I'd like to be able to compare them with the rest of the Blood tests I've had for the last year. 

Oh- no-one has ever asked that before. Um. You'll have to get your GP to ask us for them.

Again. Gobsmacked. All this information is linked to my NHS number. It's not like it changes from place to place. The information is relating to my health. If I wait another 8 weeks to see a dermatologist, that information is going to be out of date by- oh- 8 weeks. It would be really interesting to know what is going on with my actual health. Oh- and if my GP requests the results, it has to be by letter- which was the way the referral got sent- yes, the one that the dermatologist doesn't seem to have. 

So here we are in October. I've been waiting since June to see someone/anyone who has any idea about who I am, and has the ability to help put me on a new medication. It's SO hard to actually get hold of anyone. I didn't even know the doctors name that I eventually got to talk to. There is no-one to call, it all seems like a massive, faceless monolith, designed to make it as hard as possible to get any information about your health as possible. 

I *know* people in the NHS are working as hard as they can, but this disconnect, terrible communication, seeming inability to care about patients and complete lack of continuity of care makes it all seem like no-one really has a clue about what is going on anywhere. 

Yes, I'm still waiting to see someone. No, I still can't see my blood results. Yes, this has a massive effect on how I talk to and communicate with my patients as a physio- there are small blessings in everything.