Failure To Diagnose

Headaches are a common symptom of many conditions and almost everyone will experience headaches at some point in their lives. Normally the average headache is nothing to worry about, despite the discomfort you might be experiencing. However, if you get a severe/sudden headache unlike any you have had before, you should always seek medical advice. Sometimes, a headache can be a warning of something serious that needs to be investigated so don’t delay in seeking help.

As I have a long history of chronic sinus infection, I’m well-used to getting headaches. I don’t panic when a headache occurs as I’m familiar with the signs and symptoms of acute sinusitis and have the necessary prescription medications to relieve the pain. However, if I develop a severe headache that I’m not familiar with/it continues to worsen, I will always seek medical advice. If the headache is considered a cause for concern, my GP/specialist will refer me for an urgent CT/MRI scan in order to rule out any serious cause. As I hold private health insurance, I rarely have to wait longer than 24 hours to undergo a scan. If, however, I had no health insurance and was a patient in the public health service, the story could be very different…

THE HSE has apologised before the High Court to the family of a young woman over deficiencies and failures which led to her death from a massive brain haemorrhage. The apology was part of a settlement of court proceedings.

“Louise Butler (21), Cappa Lodge, Sixmilebridge, Co Clare, died at Limerick Regional Hospital on November 16th, 2006, from a large subarachnoid haemorrhage, the court heard. She had worked as a security guard at Shannon airport.

Her family claimed the HSE had failed to properly diagnose she was suffering from the condition when she presented at the hospital just weeks earlier suffering with a serious headache.

Had she been properly diagnosed and referred for treatment after being admitted on October 6th, she would probably have survived, they alleged.

As part of the settlement yesterday of the family’s action for mental distress, the HSE apologised for the anguish and distress caused to the Butlers due to Louise’s tragic death.

The HSE also acknowledged there were failures and deficiencies which led to Ms Butler’s death and accepted her family did everything it could in the circumstances.

The settlement also includes a payment of €40,000 to Ms Butler’s family and was approved yesterday by Mr Justice Michael Peart. The action was brought by her brother James, Cappa Lodge, Sixmilebridge on behalf of the family.

They claimed they suffered mental distress and injury arising from their older sister’s death due to the HSE’s alleged negligence and breach of duty of care. The HSE had denied the claims.

The family claimed Ms Butler’s attended the hospital between October 6th-12th. It was claimed she was ill with a very substantial headache, which she had described as like “a hammer blow” to the back of her head, and photophobia.

She was discharged on October 12th without a CT scan being carried out. She was due to have a CT scan subsequently as an outpatient.

Despite the best endeavours of Ms Butler’s mother and the family GP it was claimed the scan was not arranged until November 13th. It was claimed Ms Butler never got the results of that scan as she collapsed the following day. The scan revealed she suffered a massive bleed in the brain and she died two days later.

It was alleged the HSE had delayed a CT scan which would have alerted medical staff to the existence of her condition. The family claimed their experts would argue, in October 2006, Ms Butler was suffering from a “sentinel” or “herald” bleed, which was a precursor to a large bleed.”

Information Source: The Irish Times 13/07/10

Up close and personal

I was asked recently if I’d ever posted any pictures on this blog to document the problems I’ve had with my head over the years. The answer is, no but it started me thinking that perhaps it’s time I should. Words can only convey so much of a story whereas pictures say so much more. So, thank you Alhi for giving me the push that was needed!

My story goes back a long way as I’ve had multiple surgeries on my head as a result of having chronic sinus infections for most of my adult life. About 5 years ago, a decision was taken to insert a stent close to the base of my brain, to drain a recurring abscess in the right frontal sinus. It was at this stage that my husband decided to record my surgical journey with a series of ‘up close and personal’ photographs. Little did we know then of the battle that lay ahead.

This first photograph was taken in 2005, several days after the operation to have the stent inserted in my head. The incision follows the contour of my eye socket and is continued through the eyebrow for maximum disguise. This operation was actually the fifth time this incision had been used to access the right side of my forehead. All previous access had been gained through my nose or upper jaw.

The second photograph was taken 3 weeks later while I was still recuperating from the surgery. I was actually on a sailing holiday at the time when I developed severe headaches and my eyes and forehead started to swell. I knew something serious was going on but I didn’t know what so we made haste back to the hospital. This photograph marks the beginning of my journey with MRSA.

This last photograph was taken following my treatment for the orbital cellulitis. Once the MRSA wound infection had been diagnosed, the stent had to be removed from my head and it took several courses of intensive IV antibiotic treatment, administered over a 3 month period before I was finally discharged from the hospital. I’ve included this picture as it shows how well the incision healed despite the setback.

Less than a year later, the MRSA infection recurred and resulted in the development of chronic osteomyelitis in the frontal bone of my head. Further extensive surgery and treatment has been required in the meantime but I’m going to save those pictures for another day.

Chapter 27

This being the start of a new year, my surgeon had a new senior registrar in tow at his out-patient clinic yesterday. Having outlined my extensive medical and surgical history, the consultant summed up by saying that a book could be written about my case. Four different surgeons have operated on my head at this stage and at least four more have been consulted, in an effort to solve the problem of chronic infection. Just recently, I found an old file at home which contained a detailed record of all the surgery I’ve had over the years. I was amazed to find that on my head alone, I’ve undergone a staggering 26 operations under general anaesthetic. I knew it was a lot but I’d lost count years ago as I’ve been through many day procedures and other operations as well. Yesterday’s consultation concluded with the surgeon suggesting, not for the first time, that I should write a book about my experiences. Right now, a new chapter has already begun.

My last trip to the operating theatre 2 weeks ago, was for a ‘drill-out’ of a small area of recurring bone infection in my head. The exposed bone was treated with an antibiotic medication and I was discharged home the following day. Once I’d recovered from the effects of the anaesthetic, my head felt good and I was confident that the treatment had been successful. However, a week later my symptoms gradually returned and my hopes were shattered once more. An uncharacteristic despondency descended over me as we entered the New Year.

On examination in the outpatient clinic yesterday, the surgeon confirmed that the infection has recurred in the bone. I was concerned that he would opt to refer me back to the specialist unit in the UK but to my relief, he decided to proceed there and then with some further work on my head. While the treatment was unpleasant (without anaesthetic), it certainly wasn’t unbearable and I have been asked to return in 2 week’s time for another session. If this treatment fails, then I will definitely have to return to Nottingham for further assessment. The story continues.

Making History

Last June, I was admitted to a specialist unit of an NHS hospital for surgery on my head. I was no stranger to the place having had a major operation there two years previously. Revision surgery was now required as further complications had developed. On this occasion, I was under the care of  a surgeon who specializes in image-guided endoscopic surgery. I was about to undergo an operation which required high precision and carried a significant risk of accidental damage to critical organs. I was also about to make medical history.

I was admitted to the hospital the day before the operation, to be assessed for the complex surgery which lay ahead. My first port of call was to a photographic studio in the basement of the hospital, to have my head photographed from every angle. This was because of my stunning good looks to record the cosmetic defect in my facial profile, due to previous surgery. Next, it was off to the nuclear medicine department to have my head scanned under the supervision of the surgeon. These scans were subsequently used for navigational purposes throughout the technically demanding surgery.

When all the preparations were complete, it was time for a consultation with the surgeon and his team. It was at this stage I learnt that plans were afoot to record my operation for teaching purposes. My history of multiple sinus surgeries* provided the surgical team with an unusual challenge and the operation now planned, had the potential to become a valuable training resource. I had absolutely no hesitation in granting them permission to make me a ‘film star’ for a day. Anything that helps to lessen the risks associated with complex surgery and ultimately, increases patient safety, is to be encouraged.

*For those with an interest in Otorhinolaryngology…

My ENT surgical history includes : A bilateral antrostomy; a Caldwell Luc procedure; multiple endoscopic nasal surgeries; 5 external frontoethmoidectomies; a Riedel’s procedure and a modified endoscopic Lothrop procedure (Draf 111).

My ENT medical history includes recurrent sinus infections, chronic frontal sinus disease, MRSA infection, orbital cellulitis and osteomyelitis.

I also have an inherited connective tissue disorder called Ehlers-Danlos syndrome (EDS) which has added to the complications over the years.

Well, as you can see, I’ve lived to tell the tale. While the signs are encouraging, it’s still too early to know if the latest operation will prove successful in the long run. After what seems like a lifetime of surgery, I feel I’ve earned a place in medical history.

Any guesses what label I’ll be given? 🙄

The Intelligent Pill

Let me introduce you to the next generation of pills. Electronics maker Philips has announced the development of an intelligent pill, the iPill, that has the potential to release drugs exactly where they are needed in the gut. The iPill is a capsule, the same size as a camera pill, that has been designed to be swallowed and to pass through the digestive track naturally. The purpose of the pill is to release medication closer to the source of the problem, in a specific area of the body, resulting in more effective treatment. This development has great future potential.

Digestive tract disorders such as Crohn’s disease, colitis and colon cancer are becoming increasingly common, particularly in the western world. Crohn’s disease and colitis can be treated with drugs, notably steroids, but many of these drugs have adverse and unpleasant side-effects for patients when administered systemically. While capsules containing miniature cameras are already used as diagnostic tools, they lack the ability to deliver drugs. The iPill uses a tiny microprocessor, battery and wireless radio to control a built-in medication reservoir. It has a sensor that gauges acidity in the stomach to determine it’s exact location and can be electronically programmed to control the delivery of medication. By delivering the required drugs directly to the site of disease, dose levels may be lowered and many of the side effects reduced.

Philips, which is one of the world’s biggest hospital equipment providers, will officially present it’s intelligent pill capsule later this month at a scientific meeting in Atlanta. According to the company, the iPill is ready for serial manufacturing despite still being demonstrated as a prototype.

This fascinating new development brings great hope for the future. For years, I’ve been struggling with recurrent sinus infections and abscess formation (chronic osteomyelitis) in the frontal bone of my skull. When an infection erupts, high dose systemic antibiotics are required to deliver treatment to a tiny area of my head. Doctors have often commented that one day hopefully, there will be a breakthrough in medical research which will allow for direct drug treatment in specific target areas of the body. This new iPill is the beginning of such technology and while it’s still a long way off solving my problem, it’s a step in the right direction.

Hole in the Head

When it comes to medical emergencies, it could be said that I’m a bit of an old-timer. You see, I have a long history of emergency admissions to hospital and friends and family tend to joke me about it. I never quite know what lies around the next corner but as the saying goes, “if you’ve gotta do it, at least do it in style.” I do my best.

No one pays much attention to their sinuses until they start to hurt. I’ve suffered from sinusitis all my life so headaches are commonplace but pregnancy really exacerbated the problem. The hormones of pregnancy can have a direct effect on the lining of the sinuses and in my case, it left behind a real legacy. Having successfully delivered my second child after a pregnancy fraught with difficulties, I continued to have severe sinus headaches. A CT scan revealed that an abscess had developed in the frontal sinus, very close to the base of my brain. Endoscopic surgery was carried out to drain the abscess and the relief was instantaneous. However some months later, the pain began to slowly return again until one day I awoke in so much pain, I knew I was in real trouble. On calling our family GP to the house, he immediately decided that emergency treatment was required and contacted the surgeon who had previously operated on my head. The surgeon was in the operating theatre at the time but the hospital he was in, did not have the surgical instruments he required for my head. He recommended that I should be transferred to another larger hospital by ambulance to await his arrival. I was duly rushed to hospital and taken straight to theatre to be prepared for emergency surgery on my skull. Despite being in severe pain, I have a vivid memory of lying on the operating table while one of the theatre nurses took a call detailing the ETA of the surgeon and his anaesthetist as they both rushed across the city to come to my rescue. The drama of the occasion resembled a scene from Casualty except that there was nothing fictional about this episode.  It was all too real.

I awoke several hours later feeling decidedly frail having had several holes drilled in my skull to relieve the pressure. The surgeon appeared looking totally exhausted and announced that he’d needed my emergency operation about as much as “a hole in the head.” I knew exactly how that felt. It hurt to laugh but it was hard not too.

Battle of the Bugs

Steph’s back! And so is Staph. I had a bit of blip with my health last week but I’m back on form again. At first, there was concern that it might be the unwelcome return of the superbug, MRSA. As it turns out, I have a nasty Staphylococcus aureus (Staph A) infection in my head but luckily, I have a non-resistant version of this bacterium which is very treatable. The problem I now face is finding a way to effectively eradicate this bug from my system.

It’s just over a year since I had surgery to stamp out a chronic osteomyelitis in my skull which had resulted from an MRSA wound infection following previous surgery. A few months later, I started to develop minor sinus infections and was reassured when laboratory tests showed that I was only positive for the more common form of the Staph aureus bug rather than it’s resistant form, MRSA. This bacterium is commonly found on the skin and in the nose of healthy people but it is not harmful unless it gets into the bloodstream. Approximately 20–30% of the general population are ‘Staph carriers’. I was treated with an sensitive antibiotic but the minor infections still continued to occur. Last November, I developed a nasty infection in my hand which turned out to be another Staph A infection. I was treated aggressively with oral antibiotics for 3 weeks and commenced a 6-month decontamination programme with the application of a topical antibiotic ointment to the inside of my nose. This process would appear to have failed as last week, nasal swabs and blood tests showed that the infection in my head is due to a heavy growth of Staph aureus. This latest development is worrying as it confirms that I am again systemically infected with this bacterium. I have responded well to a tetracycline antibiotic so there is no immediate cause for concern.

The reality is that Staph aureus is everywhere. It may well be that I have just been unlucky to have been contaminated/infected on several different occasions. My own theory is that my immune system has been weakened following intensive antibiotic treatment for MRSA and it has become a breeding ground for opportune bacteria like Staph aureus. The problem now is how to find a way to shake off this damned bug before it gets an even greater hold on my system. I cannot afford to let things go wrong with my head again. My GP has gone away to think about the options over the weekend. If anyone reading this has any knowledge on how best to proceed, I would be eternally grateful for your advice. I intend to win this battle.

When I became generally unwell last week and my head started to hurt, I lost all enthusiasm for blogging. I deserted the blogosphere but it didn’t desert me. My new-found blogging friends reached out and gave me the support and encouragement needed to get back on track. Thanks guys! I’m really, really grateful. Blogging – Yes! it’s the way to go!

Public or Private?

Do you have private health insurance? I do, as does over 50% of the Irish population. I have no problem in admitting that it offers a welcome safety valve in an otherwise chaotic system of healthcare. I can think of lots of other useful things to do with the money I spend on health insurance but I choose to make healthcare my priority. It’s not a decision I take lightly. I firmly believe that the way forward for our health service is a system of universal health insurance, funding a single tier health delivery model which promotes equity of health care. However as our health service is in such complete disarray, I feel I’ve no other option other than to continue to invest in health insurance. I’ve certainly had reason to be thankful for it over the years though it has proved at times, to be a bit of a double edged sword.

In late 2004, I was told that I needed some complex surgery carried out to arrest a chronic frontal sinus infection. I was under the care of a consultant surgeon who operated a private practice as well as a public service contract. With my health insurance policy, I’m fully covered for surgery in a private hospital with accommodation in a single room. However, my choice of doctors and hospitals is limited as I have a complicated medical history. On this occasion I was informed that the surgery would have to be carried out in a large public hospital where the necessary back-up facilities would be available. I was duly given a date for surgery and booked for post-op recovery in a high dependency ward. Two days before the operation, the hospital phoned to ask me to report immediately for admission. I initially protested at the stupidity of taking up a bed for two days pre-op but was told that a bed could not otherwise be guaranteed. I had no option but to agree to this crazy plan. By the time I had my overnight bag packed, the hospital phoned again to say that the bed was no longer available due to an admission from casualty. This process was repeated several times over the following two days until eventually, my surgery was cancelled due to the failure to secure a bed. The surgeon was furious as an operating theatre and a surgical team had been booked solely for my lengthy operation and it all went to waste that day. Frustrated by the restrictions imposed, the surgeon suggested that a stop-gap procedure be carried out in a small private hospital. I was duly admitted the following week and underwent some relatively minor surgery. However, this action also backfired as the surgery was unsuccessful and within months I had to return to discuss the bigger operation. The surgeon again insisted that the surgery should be carried out in the large teaching hospital and in order to secure a bed, he put special arrangements in place to allow me to be transferred to the nearby private co-located hospital, to recuperate. This was only possible because I had health insurance. It should not have been necessary.

I duly checked into the co-located hospital early on the morning of my operation and within hours, was whisked away to the operating theatre in the main hospital where I remained for the rest of the day. When I next came to, I was back in the private hospital in a shared room with three other women. I now had a sophisticated stent in my skull to facilitate drainage and a surgical wound over my right eye. I received good post-operative care and was discharged home feeling extremely lucky that all had gone so smoothly. About two weeks later, my post-operative pain began to worsen and I developed severe swelling around both eyes. I was asked to report to the busy A&E department in the main hospital where I was assessed and admitted. My health insurance again secured a bed for me in the private hospital and I happily settled into a 5-bedded room, secure in the knowledge that I was lucky to have a bed at all. Three days later, it was discovered that my surgical wound was infected with MRSA and thus began a lonely journey which continues to this day. The following week while I was longingly gazing out of the window of my isolation room, I spotted a woman I recognised in the car park. I’d shared a room with her in the private hospital a month previously, immediately following my operation. I waved frantically to attract her attention and she came over to chat to me through the open window. That’s when I learnt that her problem had turned out to be an MRSA infection and that’s when the penny dropped!

The airwaves are constantly buzzing these days with sad stories about the failures within the public health service but private hospitals are not the answer to the problem. They are selective and only serve to perpetuate the upstairs downstairs model of healthcare in this country. They do no offer A&E services which means that all patients requiring emergency treatment must be processed through the chaotic system in the public hospitals, regardless of their insurance status. Those with complex medical/surgical conditions generally cannot be treated in private hospitals because the medical back-up there is too limited. And anyone who takes out health insurance in the belief that they’ll be entitled to a single room, is in for a big shock if they are hospitalised. There is a huge shortage of isolation facilities across the country and single rooms quite rightly, have been prioritised for infectious patients and those who are dying. Our public health service is expected to provide all these service yet it’s on it’s knees through years of neglect and inadequate funding from the Government. Unfortunately, our Minister for Health continues to believe that the way forward is to promote the present unsatisfactory public/private mixture of healthcare by encouraging the development of co-located private hospitals. You have to question the wisdom of backing a policy that further perpetuates inequity of healthcare. We have a booming economy in Ireland but our health service is failing the most vulnerable people in our society. This is not about public versus private healthcare, it’s about saving lives.

A Sting in the Tale

It’s almost ten years ago since my daughter had a big operation in the Children’s Hospital. There were a few unexpected set-backs along the way but otherwise she sailed through the experience with the benefit of youth on her side. If only everyone could be lucky enough to enjoy this kind of outcome.

My 8-year old daughter was admitted to the hospital the day before surgery to undergo routine pre-operative tests. She was accustomed to being in hospital having required frequent treatment throughout her childhood for chronic kidney disease. On this occasion she was delighted to be allocated a bed beside the window where she and her all-time favourite teddy bear, called LoveBear, could watch the world go by. I was given the key to a very small, sparsely furnished cell-like room in an adjacent building and this was to become my home for the following ten days. Early the next morning, my daughter was wheeled off to the operating theatre bravely clutching LoveBear, her loyal companion. Several hours later she was returned safely to the ward sleeping soundly despite all the paraphernalia associated with complicated surgery. When she came to, the only thing she wanted was her adored LoveBear but to everyone’s horror, he was nowhere to be found. His trip to theatre had not gone according to plan and there was now great concern for his welfare. After a frantic search, he was eventually located in the hospital laundry looking a lot worse for wear. He had accidentally been put through an extremely hot wash with some sheets and now needed urgent resuscitation. He survived the ordeal and was soon tucked up in bed back with his loyal owner.

The following days went relatively smoothly and I, like all the many other parents there, spent long hours keeping watch at the bedside. Whenever my daughter slept, I would return to my own sleeping quarters for a few hours rest but I found it very difficult to sleep there. I had to keep the window shut because of noise in the street below and this left the room far too hot and stuffy. As the days went on, I developed an intense headache that wouldn’t go away. I put it down to the heat in the hospital and continued to take medication every four to six hours to dull the pain. I finally woke one morning to find that one eye was hugely swollen and had completely closed over but at long last, I had relief from the intense pain in my head. The hospital staff soon sent me packing to see my own doctor and later that day I was admitted to another hospital for an emergency surgical procedure to drain an abscess in the frontal sinus of my skull.

I awoke the following morning feeling somewhat sorry myself having been told that I had to stay in the hospital to undergo a course of intravenous antibiotic therapy. I was worried about how my daughter would cope in the children’s hospital without the help she needed. Of course, she was absolutely fine as her Dad took over the role bringing welcome new energy to the equation and they got on famously together. My own surgeon appeared before breakfast at my bedside and informed me that I’d had a lucky escape. The constant headache of the previous week had been caused by a large abscess in my skull which had been pressing on a very thin wall of bone between it and my brain. Luckily for me, the abscess had pushed forward as it expanded causing the swelling in the eye. Had it gone in any other direction, he said, it’s likely I wouldn’t be here to tell the tale. As I looked at my surgeon in disbelief, I noticed that he looked totally exhausted and close to tears. Surely the news wasn’t all that bad? He then told me that he’d spent the whole night in the operating theatre trying to save the life of a close relative of his own who’d been knocked down by a hit and run driver. The young lad, very sadly, did not survive the night. This news cast a whole new light on our family situation. In time, I made a full recovery and so did my daughter. LoveBear, while looking a bit worn these days, still has pride of place. We were the lucky ones.

That’s Life!

I heard an item on the radio this morning concerning an article written by the journalist Kevin Myers, in today’s Irish Independent. In this piece he refers to the perfect contours of the late Princess Diana’s nose which, when combined with her appealing eyes, made her into a real photogenic beauty. It started me thinking about the contours of my own nose and forehead which have been altered by recent surgery. My medical history is complex – I’ve had a lot of surgery, in various specialities and have the surgical scars to show for it – but none of these compare to living with a slight facial disfigurement.

I was admitted to an NHS hospital in northern England earlier this year to undergo a complex operation at a specialist Head & Neck surgical unit. This surgery is unavailable in Ireland unfortunately. I have a long history of serious sinus infection which has necessitated regular surgical intervention and intensive antibiotic treatment over the years. As a result of this, I now also (surprise, surprise) have a history of recurrent MRSA infection. The MRSA presented itself as orbital cellulitis following my last episode of frontal sinus surgery and this infection manifested into chronic osteomyelitis in the frontal bone of my skull. All surgical efforts to establish drainage from the frontal sinus had failed and despite intensive antibiotic treatment, I continued to develop abscesses in the bone close to the base of my brain. As this had an associated risk of developing into a brain abscess/septic meningitis, I was referred to the UK for assessment. Here I was advised that the most effective way to stamp out chronic osteomyelitis would be to have all the infected/dead bone removed, and an operation called the ‘Riedel procedure’ was recommended. I was fully informed that there would be a cosmetic disfigurement post-operatively and having considered my predicament very carefully, I finally agreed to proceed.

My little friend, the superbug, is thankfully still responsive to a tetracycline antibiotic, Vibramycin (Doxycycline), and this enabled me to obtain the requisite ‘all-clear’ from MRSA screening prior to the surgery. The operation itself went very well and was completed in just under four hours. My head was opened from ear to ear (zig-zag coronal incision), my ‘face’ was peeled back to the bridge of my nose and the anterior and inferior walls (bone) of both frontal sinuses were removed completely leaving a large hollow in my forehead. The margins of the frontal sinus along with the supraorbital rims were then ‘chamfered’ (planed) to make a gentle curve rather than a sharp step out of this hollow. This allows the soft tissue of the face to fall in and line the vacated frontal sinus area and improves the cosmetic defect which results from the procedure. My ‘face’ was then put back where it belongs and the coronal incision was stapled together before a pressure bandage was applied with a drain in situ to minimise haematoma formation. I had no post-operative complications other than vomiting copious amounts of blood when in the recovery room – this had drained into my stomach during the surgery. Ten days later when I had the staples (59 of them) removed from my scalp, the incision was healing beautifully and I was well on the way to making a good recovery.

That all happened five months ago and I remain free of infection. The post-operative numbness of my scalp has almost resolved though it has left behind an unpleasant neuralgia which requires medication. The surgery has left a definite legacy – a facial cosmetic defect. The bridge of my nose ends abruptly where the large hollow begins in my forehead. I’ve got used to seeing my new ‘look’ in the mirror although photographs still tend to take me aback. I’ve also had to get used to having conversations with people, usually strangers whose eyes are firmly fixed on my forehead while they try to work out what’s happened to the contours of my face. I’ve had a few tactless comments but nothing that humour can’t handle. You have to keep things in perspective – I’ve been given a second chance at life – not everyone gets that chance. My surgeon has offered re-constructive surgery (a split calvarial bone graft/titanium plate) in the future but for the moment anyhow I’ve no wish to go there and certainly no wish to invite further trouble. And anyway, I’m proud of my war wound – my husband refers to it as the ‘bomb crater’- it was a hard fought battle and I’ve come through it still smiling 😀

I’ve just gotta face it – I’ll never be a Princess Di. But then, that’s life!