Arthritic flare up, in another country, what do I do?

May 21, 2016 8:37 PM

I am a Canadian visiting in London England, staying at an AirBnB near Baker Street Station. I have bone spurs/ osteoarthritis in both knees, usually very manageable. On Monday I suddenly developed crippling pain in the right knee. Rest and ice stopped it-- but normal walking soon triggered it again Since then I've been using ice, my knee brace, Naproxen and/or Voltaren and of course *long*periods of rest but in fact the pain is getting worse. It is more and more easily triggered. Yesterday I rested the entire day and did nothing but walk a few blocks in total to go for dinner, and tonight I woke myself just from the pain of a wrong movement

It is 4:00 am here and my knee hurts even though I am just sitting here typing this. I have had nothing as bad as this before. A flare-up should have passed by now and instead it is getting worse.
I think I need a cortisone injection but I don't know how to proceed. I think I need to see a specialist for that, I don't know.

We are here in London until the end of May and then go on to Iceland ( !! ) for a week. I have travel insurance, but I don't know what to do next to get the help I need. Going to an Emergency ward seems wrong. Can anyone advise me, please?

posted by uans to Health & Fitness (13 answers total)

Best answer: Go to the urgent care centre at St Mary's, Paddington or University College Hospital. Do not pass Go, do not collect £200.
posted by holgate at 8:47 PM on May 21, 2016 [10 favorites]

Go to A&E! This is 100% what the NHS is for. They'll triage you and you'll have to wait longer than the folks with their head split open, sure, but they'll fix you up or set you up with a specialist. They might well give you some of those cheapo crutches, which might help you enjoy your remaining vacation a little more.

If there is going to be any wait time to see a specialist I highly recommend you wait for care in London where it's free and you speak the language.
posted by pickingupsticks at 10:00 PM on May 21, 2016 [2 favorites]

And yes, to elaborate: London is a big city with a lot of visitors, and visitors sometimes get hurt or need medical treatment, and it'd be stupid in a developed nation for them to have to suffer. While the NHS beancounters are more stringent now in distinguishing between residents and non-residents at the door, the medical side is still there to make sure you're okay, and it's not like you're in NYC where you'd probably need to leave a kidney as a deposit.

If your symptoms cross over the threshold of the urgent care centres, either hospital has A&E and its triage. Just explain your situation.
posted by holgate at 10:21 PM on May 21, 2016 [1 favorite]

Best answer: Please don't go to A&E - we've had a bad winter and our emergency departments are still creaking under the strain. A&E is for life-threatening and rapidly worsening conditions, or sometimes when you need equipment not available elsewhere (broken bones). Depending on the hospital they may even make you wait and once you are assessed be told to go to a more appropriate setting.

Urgent care or a walk in centre should be able to see you and access whatever treatment would be provided for a UK person in your situation. If you do need hospital treatment, they will also be able to get you into the hospital without going through the initial stages of A&E. If you have insurance and the the wait would be unacceptably long, you may be able to talk to your insurance about accessing whatever you need privately (which will certainly be available in London).

Good luck.
posted by kadia_a at 11:52 PM on May 21, 2016 [5 favorites]

Seconding holgate! Go to the Urgent Care Centre - which is not the same as A&E.
Sort out your insurance later.
posted by vacapinta at 12:47 AM on May 22, 2016 [1 favorite]

Nthing that you need 'urgent care centre' or a 'walk-in centre' not A&E - better for them and for you.
If you can't make the ones suggested here, or are confused by your options, you may also be able to call 111 the non-emergency NHS number, and ask their advice - the system changed 18 months ago & I haven't used it since, but they should be able to recommend where to go based on your needs/status/location.
posted by AFII at 1:33 AM on May 22, 2016 [1 favorite]

Response by poster: Thank you so much--for sure I will try an urgent care or walk=in centre, not an Emergency ward. I have a further question for those living in London: it is now 10 a.m on a Sunday. Should I wait until Monday to go? If I were in a similar situation at home in Ontario, I would spend all day waiting (Sunday is the worst)
posted by uans at 2:11 AM on May 22, 2016

Be careful - there is no reciprocal agreement between Canada and the U.K. for health care, so you may have to front the money and try to claw it back from Ontario Health.
posted by gingerest at 2:38 AM on May 22, 2016

Walk in centres have a set number of patients they can see in a day - so best call ahead. If you do go tomorrow, arrive before the doors open. Here's the details for the Soho walk in clinic.
posted by teststrip at 3:27 AM on May 22, 2016

Best answer: England doesn't do naproxen over the counter. The best you may be able to get is long-acting ibuprofen which is available at Asda, Wilkinson or Boots (more expensive there). They have codeine over the counter here so that may be an option if you really have to use it. If you are really in pain, I have generic Aleve with me and can courier it to you.
posted by parmanparman at 3:59 AM on May 22, 2016 [1 favorite]

Response by poster: Thanks so much, but I have Aleve with me, parmanparman. That is very kind.
posted by uans at 4:21 AM on May 22, 2016 [1 favorite]

Best answer: If you're expecting your travel insurance to pay for this, you should be calling them FIRST. They should have a 1-800 number where they want you to call before accessing treatment if possible. Call them and they will tell you where they want you to go. Yeah, it's probably more of a pain, but if you give them an excuse not to pay, they will grab it.
posted by If only I had a penguin... at 5:04 AM on May 22, 2016 [6 favorites]

As a fellow knee arthritis sufferer I just want to chime in that RICE is considered to be ineffective and not supported by the science. My experience, and the advice of my surgeon is that heat, movement through full ROM, and quickly increasing activity level as tolerated has been the most effective in managing my pain.
posted by mikek at 5:32 AM on May 22, 2016