A trip to the dentist

We’ve had our first visitors over the past week, first our mothers and then my sister, her husband and my niece – who’s nearly three. It was great to spend time with our relatives and a relief that they all think we live in a nice apartment in a beautiful town.

The visits also coincided with my first health emergency – a infected tooth – and a bit of a step forward with me speaking French.

The tooth was unfortunate. I generally have good teeth, but this tooth has been a problem for two or three years. I have had root canal work done twice and a number of broken fillings and temporary crowns. It has cost me an arm and a leg in dental bills.

The latest episode of the saga started with some pain last Tuesday and a lump of tooth falling off that evening. The next day I felt ghastly and suspected I had an infection. Because of the immunosuppressant medication I am taking for my Crohn’s, I needed to get it looked at.

After consulting with the local pharmacy and the emergency department at the local clinic, I understood that it would be best to see a généraliste. So I went to my doctor to make an appointment for that afternoon.

I saw another doctor in the practice (my doctor was on holiday) and he was very helpful. He listened to my slow and painful French and even had a look in my mouth before accepting that he wasn’t a dentist. I left with a prescription for antibiotics and the telephone number of his dentist.

My partner kindly phoned the dentist at 8.30 on Thursday morning and explained my situation. My French is not good enough to manage phone calls yet. He was happy I was on antibiotics and arranged an appointment for Monday.

The antibiotics quickly kicked in and, after 4 doses, I was feeling a little better by the time my sister’s family arrived on Thursday evening. I’d also been prescribed dispersible tablets which seemed a lot more gentle on my digestive system, so I was able to enjoy the weekend.

Forty-five minutes after waving goodbye to our visitors on Monday afternoon, I was at the dentists, trying to explain the history of my tooth and trying to understand what the dentist was saying to me. It was hard work but ultimately successful.

So, I have a chronic infection at the end of the root. This didn’t surprise either of us because of my immunosuppressive treatment. The dentist said he didn’t want to do anything and wanted to wait to see what happened in the next 3-4 weeks.

I left with another appointment next month, an instruction to phone for an emergency appointment if things deteriorate and I paid nothing. Dentistry in France seems to be part of the health care system.

Interestingly, at the end of a week when I spoke lots of English to people other than my partner, my French has improved quite a bit. I’ve done no study this week and when I felt poorly the last thing I wanted to do was to speak French.

I remembered on Tuesday night and through Wednesday that it is quite scary being ill in another country, but I got the treatment I needed and am now feeling better. I had to make myself understood in French and I did. It is good to know that my survival instinct is in good working order.

The morning after infliximab (Remicade®)

I am always quite tired after my infliximab (Remicade®) infusions, but I am particularly wiped out this time. I don’t think it’s anything to do with the drug – although the extra steroid and anti-histamine might have done something – I think it was going to a different hospital and having to cope with a language I don’t speak very well.

All in all I think I did rather well. I was really nervous beforehand, but the day itself went smoothly. And I now know how it all works and I know that every 8 weeks my French will have improved.

It’s one of those things – if only I had the level of French I will have at the end of the trip now, so I can sort out all these difficult tasks with my healthcare. I would probably cope quite well at the end of the year – when I know how everything works – with the level of French I have now.

I had wondered how different the actual procedure would be compared with the UK. There were some big differences like having my own room, having the anti-allergy cocktail beforehand and actually being seen by doctors.

There were smaller things like getter fed - a particular bug-bear for a fellow infliximab patient I know in the UK - and having a decent cannula in my arm - my bug-bear, if you hadn’t noticed.

In the UK I have got to know the unit staff and, even though I sometimes feel like an extra in M*A*S*H, I have a good experience and feel safe, despite the chaos and $0.01 cannulas made by prison labour in China.

My experience yesterday was on a different level. It was what you’d hope for and, I guess, what I am becoming to expect from the French health system – efficient care where the patient’s health is the only consideration.

My first Remicade® in France

I’ve just got back from my first infliximab infusion in France. Infliximab (or Remicade®) is the regular treatment for my Crohn’s disease. I’ve been taking it for just over two years in an attempt to avoid further surgery. It has worked quite well and I have an intravenous infusion every 8 weeks in hospital.

The high cost of the Remicade® and the trip to hospital every 8 weeks was the reason I needed to get my health care well and truly sorted out as soon as possible after arriving in France.

My appointment was for 8.30am and I got there on the tram in plenty of time, in case I got lost (which I did) or I failed to explain who I was and why I was there (which was no problem).

I was shown to my room, which had amazing views over Caen from the seventeenth floor of the hospital block (not good for my vertigo though). I was offered breakfast and tucked into French bread and a bowl of black coffee.

The nurse looking after me weighed me, looked at my blood results (which I remembered to bring) and explained clearly in French what was going to happen and that I would be there until about 3.30 or 4 o’clock.

The consultant in charge of the unit came and introduced herself to me and asked – in English – a few questions she had for me after reading the letter from my gastroenterologist in Caen and my consultant in the UK.

A junior doctor then came to see me, looked at my blood results, my weight, asked me, in French, if I was allergic to anything and if my general health was okay and then wrote up my Remicade® prescription.

The nurse put a cannula in my arm just before 10am. She was a bit worried that my veins were small and then, when needle was in, she was amazed how the vein she picked suddenly changed direction. I reassured her that they were always like this and it seemed to help her calm down a bit.

The cannula looked very sturdy and 21^st century – I don’t think the first priority here is finding the cheapest cannula available on the world market. Immediately after the cannula was in I was hooked up to a litre bag of saline which was run in slowly at 125ml per hour.

I was then given a small dose of steroid and of anti-histamine. This is a precaution against allergic reactions to the Remicade® and is not uncommon, but I hadn’t had this before in the UK. This was run in intravenously over 10 minutes and then I was left on the normal saline until 11.30am.

At 11.30am the Remicade® was set up and run over two hours. I had a hot lunch – egg salad, beef stew and potatoes and bread and cheese (no wine though) – and settled down to finish the book that I’d started earlier.

I was told that I needed to remain in bed, lying down, while I had the infusion and to rest for two hours afterwards. Throughout the infusion and for the rest period an automatic blood-pressure machine took my blood pressure and pulse every 15 minutes and a nurse popped in 3 or 4 times an hour.

The IV wasn’t hooked up to a pump, it just ran into my vein, in the old-fashioned way. So the infusion ran a little longer than the two hours. But that was fine and I finished my book – ‘J-Pod’ by Douglas Coupland, which was a good read.

Everything was finished just before 4pm. I was given a wallet full of documents to take to the ground floor, got my next appointment time for 8 weeks, said my goodbyes and I was off.

I wasn’t entirely sure what I had to do will my wallet of stuff or where on the ground floor I had to go – it’s one of those things that people just expect you to know and then are utterly bemused when you try to explain there is no such paperwork in the NHS.

Anyway, the woman on reception directed my to where I needed to go and the clerk in the discharge office spoke a little English and took the wallet from me and copied my social security certificate and the letter for my next appointment. I checked that I didn’t have to do anything else or send any forms anywhere (I didn’t) and I was finally off home on the tram.

An introduction to French football

I went along to my first French football match on Sunday afternoon, a Normandy derby match between the Caen reserve team and Rouen in the amateur CFA league.

The match itself wasn’t great. A nicely worked goal from Caen and some great goalkeeping meant a 1-0 victory, despite the Caen captain being sent off with 25 minutes to go.

I did enjoy the afternoon. It was a lively crowd and I heard a lot of the banter and chanting that will be a feature of the first-team games, but the crowd will be ten times bigger. So it was a gentle introduction and gives me the opportunity to go away and learn some more vocabulary and a few things to say.

On Sunday I was utterly cowardly when it came to striking up a conversation. I could have done, but I didn’t. I don’t think it will be long until I do pluck up courage to start talking to people. Talking about the football with other fans is an easy place to start.

Yesterday I queued up for tickets for next Saturday’s Ligue 1 game against Valenciennes. It is the first home match of the season and after last Saturday’s 2-1 defeat away at Bordeaux, it is an important game to win.

Over the next couple of days I need to write down a few conversation pieces to use while I’m having my infliximab infusion on Thursday – it could be a four hour stay, so I do need some conversation…

One topic to prepare could be about football, I can then refine it and use it again on Saturday. This practice, together with my daily study and online BBC ‘Ma France’ lessons will quickly get my confidence up. I’ve already noticed how much my comprehension has improved, particularly reading the sports news.

A different perspective?

Bad weather – intense heat and humidity followed by storms and rain – has meant we’ve spent a lot of time in our flat this week. It’s reminded us that we have often spent days and weeks indoors at our home in the UK and perhaps made us a little homesick.

Our home in the UK is a small three-bedroom terrace. It’s not huge, but the perfect size for us. Here, our large studio flat has seemed a little small this week. I think it will be perfectly fine – there is enough space for the two of us and I’ve not felt cooped in – but it is different.

In a house you have the possibility of climbing the stairs and changing your perspective on the outside world. Both here and in the UK we live right on the road in a lively neighbourhood. Here we live on the ground floor, so when we look out on the world the world can look in on us.

It seems strange, but I do really miss the opportunity of choosing whether to watch the world go by from the first floor or step out of the front door and be part of the neighbourhood. Here, when the shutters are closed, you can hear what’s going on, but not see it. And at the moment I need both words and pictures to understand what is happening.

I’m finding that the different elements of living in a new home and in another country combine in unexpected ways. The challenges of getting through a day or carrying out a task are subtly different.

Today could be the first day I go and see a football match. In the UK, going to see the football would mean a trip to London, making sure I can get as near to the stadium as possible on public transport, getting away from the stadium afterwards and then taking a week to recover.

For anyone who’s been to a match with 60,000 other people and understands all the issues Crohn’s disease throws up, you’ll realise what a challenge this is and why I only do it once or twice a season.

Here, we live a short walk from the stadium which will have a crowd of around 1,000 for today’s reserve team game and a capacity of 20,000 for a top first-team match. I will be checking out routes and toilets, but the real challenge for me will be the language and hoping that I can make myself understood if anyone talks to me.

Of course, being able to speak to people and ask questions is an important part of managing my Crohn’s disease. Yet the need to focus so much time and energy on learning the language has somehow changed the way the stress of living with Crohn’s affects me. It’s a different perspective and, at the moment, it seems to be doing me good.

First blood test

I had my first blood test in France yesterday and also tested out exactly how my new French social security number works.

The blood test was fine. I had been given a blood form by my gastroenterologist and told to have the test about a week before my infliximab infusion. I took the form to our local laboratoire, where local doctors send their patients for a variety of tests, including blood tests.

My plan was to make an appointment for later in the week but I was offered one there and then, if I could wait a couple of minutes. By the time the receptionist had taken my details and social security number, the previous patient had gone and it was my turn.

I was relieved to find out that having blood taken in France is exactly the same as in the UK. The phlebotomist commented on my small veins and ended up picking the same one to try. The only thing different was the plaster, which was superior to NHS plaster and didn’t irritate my skin at all.

The blood results will be sent back to me and I will take them with me to the hospital when I have my infliximab infusion. So there will be no desperate searching in my notes or on a computer system.

It is an interesting way of working and one that dates back a long time. The laboratoire I went to in Place Malherbe has been there for over 80 years – or so says the mural in the square.

In the UK there are always problems getting blood tests done, particularly for people who work nine to five, with GP practices having different arrangements and different forms only being accepted by certain phlebotomy departments.

There are dozens of laboratories around the city, often next to a pharmacy, and there are also nurses’ offices (cabinets d’infirmières) where you go to have injections or dressings done. So GPs just need their office, a pen and a pile of forms and don’t have to worry about providing all these ancillary services or computer systems.

I’m not sure if this is old-fashioned, but it does seem to work. Looking at the health service and local government here, being in France is not unlike the UK before the cataclysm of the 1980s.

My social security number seems to work a treat. I went to settle the bill (€28.00) for seeing my gastroenterologist and when the receptionist saw the magic phrase “100% sauf medicaments vignettes bleues” she photocopied the form and that was the bill settled.

Likewise, at the laboratoire, the receptionist looked at the form, saw the 100% figure and that was it. I am so relieved that I went down this route to get my health care covered.

Studying French

I haven’t come to France with any great ability at speaking French. I only did three years at school, over twenty-five years ago, and then have re-learned the basics at home and attended an excellent ‘intermediate-level’ evening class over the past year.

In addition to the class, I have watched French TV news online a couple of times a week and read the sports news paper L’Equipe regularly. And, of course, I have practiced speaking on our regular trips to France over the past 2-3 years.

I have been quite astonished by my progress, particularly over the past year, as I’ve never been very successful learning foreign languages. My comprehension of written French is really quite good and my comprehension of spoken French is improving.

However, I actually think my talking has deteriorated over the past three weeks. I think this is mainly because I’ve got lazy. Maybe it is because we have had a lot to do and I have not been sitting down looking at grammar and learning vocabulary.

Also, in the past, I would plan for hours what I might say in a certain situation and make sure I knew all the words and how to put them together. Now I expect just to be able to talk without preparation, which is a little optimistic!

So from this week I am starting to systematically learn French again. I am going to quickly revise my French course and the grammar I learned. I am going to revise verb conjugations and tenses and learn five new words a day to expand my vocabulary.

There are also some exercises to do, both in my course book and online and I just need to step out of the house to be able to practice listening to and speaking French – and there are many situations that I can plan and practice for.

The most exciting aspect of this year abroad for me is to be able to take part in a different way of life and learning a new language. Learning does take some effort and planning, but I am in the perfect situation and have the motivation to do it.

Finding an equilibrium

The past week has felt like a time of recovery after the stress of sorting out my health care. I hadn’t realised quite how stressful a time it had been.

I am slowly catching up on lost sleep and taking things easy. I realise I need to start working hard on learning and speaking French, but first I do need to get mind and body back into equilibrium.

We did go on another trip to the seaside on Wednesday and have continued to get to know the city and its inhabitants. We’ve also helped arrange trips and accommodation for our first visitors, who are coming at the end of the month.

On Tuesday I plucked up courage to have my first haircut in France. The barbers was packed with people getting a hair cut before they went on holiday and full of conversations and social interaction – all familiar, but slightly different to what I’m used to in the UK.

Finally, when it was my turn, I didn’t get to say very much apart from how I wanted my hair cut – which was understood and executed well.

I’ve also joined the French Crohn’s and Colitis organisation this week and received a big envelope full of information. The advice seems very similar to the UK, but it will be very useful to have the vocabulary at hand to describe symptoms and the treatments I’ve had in the past.

My Crohn’s has not been much of a problem since I’ve been here, despite the change in diet, micro-organisms and the stress of being in a new country and finding health care. That has left me happy, relieved and wondering why…