Thanks Bill. Sounds like I'm using the app correctly.

Unfortunately I'm now in need of total ankle replacement surgery. An orthopaedic doctor at Portimao hospital confirmed this after I'd paid 375 euros to have an MRI carried out. He said that he would refer me to a public hospital in Lisbon where they have ankle specialists. This is more than six months ago and I've heard nothing else since.

I decided out of necessity to talk to orthopaedic doctors in the private sector, the first one of which at HPA Alvor said that he doesn't recommend replacement for people over 65 due to the risk of infection. As such he recommended fusion, where pins are driven in to fuse the two main bones together. He also said that this would result in no weight bearing for the first eight weeks after surgery, and that as the ankle would be fused the joint would no longer hinge as it normally does. My final question to him was, what is this likely to cost, but he told me to communicate with his secretary who would be able to provide an estimate.

The following day I emailed the secretary, only to be told that I would need an x-ray and a CT scan before an estimate could be given...

One of my friends recommended another doctor in the HPA system, as he had been successfully treated by the doctor previously. So I made an appointment and saw the doctor the following day in Lagos. He said that he recommends replacement over fusion as the ankle would then provide natural movement. He explained a lot about the procedure and also showed me quite a lot of images to demonstrate what happens both during and after surgery.

When I told him his colleague recommended fusion over replacement due to the risk of infection he said that fusion would be a much simpler operation for the doctor, and that if infection did occur he would treat it with antibiotics the same as he does for any other infection. I asked what would be needed to be done before surgery and he said a blood test and an ECG. No need for further X-rays or CT scans.

I told the doctor that I had had a blood test only two weeks earlier at the A&E in Lagos and he said that the results of this would be fine. The final question once again was the cost and once again I was referred to a secretary.

The secretary confirmed that the cost of surgery would be 18,500 euros, which would likely include one night in hospital. Not cheap. She confirmed that a blood test and ECG would be needed as this was hospital policy for everyone undergoing surgery. Disappointingly the 18.5k does not cover any post surgery follow up such as dressing changes, stitch removal or physio.

I was hoping to be able to log on to the SNS 24 system to download the blood test results but it seems this is not possible.