Ruth

Brief Outline:

Ruth has pain in both knees, as well as back problems, visual impairment, diabetes and asthma. Her current health problems mean that she is unable to leave the house much, and worries about falling. Ruth had hoped to be offered knee surgery, but accepted the surgeon’s decision when he told her the procedure would be unsafe. She is currently waiting on a nerve stimulation procedure, which she hopes will help her get more active again.

Background:

Ruth has three adult children. She is a retired teacher, nurse, farmer, and carer.

More about me...

Ruth currently has pain in both knees. She was originally diagnosed with having arthritis in her back 50 years ago. The arthritis has since affected her knees, causing significant pain and mobility issues. Ruth also has visual impairment, diabetes, and asthma. Her eye problems include glaucoma, macular degeneration, and retinopathy. She has Eylea injections for her eyes and has previously had laser treatment. Ruth manages her diabetes with tablets and injections, and uses a preventative inhaler for her asthma.

Falling is a major concern of Ruth’s as she lives alone and wouldn’t be able to get help immediately. She has had falls in the past, though she’s not sure if she tripped because of her knee problems or diabetes affecting the sensation in her feet. Having limited eyesight adds to Ruth’s worries about having another fall; she explains: “because I don’t see things, I might put my walking stick, which I use, on a wet patch but then the knee gives way and down I go”. She uses a walking trolley to get around the house and a scooter in the garden. She has been using a wheelchair for about three years when out. The combination of having blurry vision and limited mobility means that Ruth rarely leaves the house at the moment.

For pain relief, Ruth alternates between paracetamol, ibuprofen, Zafin, and Voltarol gel. In the morning and the evening, she applies a heat pack to her knee. Ruth has previously tried physiotherapy and steroid injections, but didn’t find either of these to be effective. At the moment, she finds it difficult to get out of her wheelchair. Ruth struggles to be active because of her knee pain and vision issues.

Ruth went to see her GP about getting more help with her knee issues after having a fall. She was referred to discuss joint replacement surgery on her left knee. She had hoped that knee replacement would enable her to start walking and leaving the house more. Ruth felt that: “you don’t look forward to an operation, but if that’s what it takes, that’s what it takes”. Going into her appointment with a surgeon, she planned on asking about the likely results and recovery time. Based on the people she knows with knee replacements, she considered recovery to be a matter of “doing the exercises and [being] strong willed”. She expected that recovery would take about six months because of her diabetes and vision problems. Ruth was aware that there could be a long wait for surgery, but she hoped to have the operation as soon as possible.

Ruth thought that she may be at more risk of complications from knee replacement surgery because she is diabetic. She previously studied nursing, which has made her more aware of “the pitfalls, but you also see the benefit” of surgery. Ruth also thought that her being overweight, her circulatory issues, and having poor vision would factor into whether she was recommended knee replacement surgery and what risks were involved. Before having her consultation to discuss knee surgery, Ruth felt that “there’s no point in living life not being able to do anything”, so felt that knee replacement surgery would be worthwhile.

At her appointment about surgery options, Ruth’s surgeon told her that he wouldn’t recommend surgery based on her diabetes, heart problems, and issues with breathing. Ruth decided against the operation “straightaway” as it “just didn’t sound a good idea” as she is 86 with other health concerns. She explained that her diabetes makes her more prone to infections and sepsis was a concern, particularly because the surgeon had said it could lead to an amputation.

While it was a “disappointing” outcome, Ruth trusted the surgeon’s opinion. It helped her to feel sure about the decision not to have knee surgery when the surgeon emphasised that he wouldn’t recommend the surgery for his own mother. Ruth found the surgeon to be “caring and kind” and appreciated that he spoke directly to both her and her daughter at the appointment. This was important because Ruth sometimes finds that doctors don’t speak directly to her and instead assume she’s “an old lady and I’m a bit senile”.

At the moment, Ruth is waiting on a referral for a nerve stimulation procedure on her knee. The procedure will involve having three needles inserted into her knee under local anaesthetic. She previously saw a specialist at a pain clinic about this, who she found to be very attentive. Ruth was told that around 1 in 10 people experience issues afterwards, but feels of the mindset to “try anything if I can get rid of the pain”. Ruth is also hoping to come off morphine, which was prescribed by her GP, as the side-effects have been unpleasant and lowered her energy.

Ruth feels that her experience with the NHS has been great but “a bit slow”. She reflects that “once you get on the system it’s absolutely brilliant”, but that “it’s just the time and as you get older you haven’t got time” to spend waiting. She worries that her overall health may be on a “downward trend”. Ruth has started taking candesartan for high blood pressure, and is waiting on an electrocardiogram for chest pain and to receive a CPAP machine for breathing issues while sleeping. She is also concerned that her mental and physical health are worsening because of being unable to go outside and do things. With a nerve stimulation procedure planned though, Ruth remains hopeful that the treatment will help: “if it works it will be brilliant, and if it doesn’t, we’ll try something else”.

When Ruth saw her GP about her knee problems, she was offered a steroid injection and asked to come back in six months.

When you did get to your GP and they started the process? How much did they say about the next steps of what you'd have to do—?

Well, they gave me an injection first of all—in the-, is it a cortisone or a steroid thing?

But that didn't work, and then they said, oh, come back, what was it? I think it was after a year or something,—the injection, you know, after six months or something.

So I went back and then started the ball rolling for this.

Ruth, who is in her late eighties, had talked to the surgeon with her daughter about her other health problems and she decided not to have knee replacement surgery.

And how quickly did you and your daughter decide that it wasn't something you wanted to pursue?

Oh, straightaway really. We agreed with him, you know, because I am 86, and you know, and we know I've got other health problems.

And was there a specific example of a health problem or a specific risk, or was it just generally it didn't sound like a good idea?

Well, it just didn't sound a good idea and, you know, if I'd had sepsis or anything else, it would have-, if I'd had any infection, and being diabetic, you're likely to get more infections, which I knew any rate. So you know, it’s just-, it was a foregone conclusion really. But you live and hope, don't you?

Well, I think the anaesthetic was one of the problems, but I think it was the infection-, if I'd had an infection, they would have had to take my-, the whole leg off, you know, and that’s not a very good thought, is it?

No, but he was very good and he knew what-, you know, he was exceptionally good in fact.

What made him exceptionally good?

I don't know, he was just caring and kind and talked to me and to my daughter.

That’s important, isn’t it? When it’s-, when you've got somewhere-, someone with you, you want to both be talked to and both be informed at the same time?

Yeah. And sometimes they just talk to whoever’s with me and thinking I'm an old lady. And, you know, I'm a bit senile, but no, he discussed it with me, you know, as well as my daughter.

When knee replacement was not recommended by the surgeon, Ruth was referred to a pain clinic where she is waiting to have nerve stimulation on her knee.

Well, I went to see the surgeon and he said he couldn't do it, so they put me on the pain clinic and I've been taking morphine, which is absolutely dreadful, the side effects has just upset me.

Anyway, I had a meeting at the pain clinic last week, I think it was, and they decided that they'll put three needles in my knee, under local anaesthetic, and he said it was like putting a microwave wave right through the needles.

I don't know what-, it’s got a proper name but I can't remember what the name was, it was some long name, and that should stop the pain, and he said it would be done before Christmas. So, I'm looking forward to having that done and coming off the morphine.

But the pain clinic man was brilliant.

And did you have to wait long to see the pain clinic man after seeing the knee surgeon?

Well, what’s it been... it was about, oh, I suppose it’s about six months, isn’t it?

Oh okay, so it was quite a delay then?

Yeah. Which is why they put me on the morphine, I think. So, hopefully, I'll come off the morphine and we'll see what happens.

Was the morphine the surgeon’s suggestion or your GP’s suggestion, or the pain clinic’s, whilst you were waiting for that appointment?

The GP.

Oh okay, yeah.

While I was waiting for the pain clinic.

Ruth says it’s worth trying treatments, such as nerve stimulation therapy, to manage your pain. If it doesn’t work, try something else.

Well, I went to see the surgeon and he said he couldn't do it, so they put me on the pain clinic and I've been taking morphine, which is absolutely dreadful, the side effects has just upset me.

Anyway, I had a meeting at the pain clinic last week, I think it was, and they decided that they'll put three needles in my knee, under local anaesthetic, and he said it was like putting a microwave wave right through the needles.

I don't know what-, it’s got a proper name but I can't remember what the name was, it was some long name,  and that should stop the pain, and he said it would be done before Christmas. So I'm looking forward to having that done and coming off the morphine.

And with the treatment that you're due to have before Christmas with the needles, have you-, do you know anybody else in your personal life that’s had that treatment before?

No, it’s completely new, I think.

I don't know whether it’s an experiment with the [hospital] because they're quite-, they're forward-thinking, aren’t they, that...?

But you see if it-, you know, we'll try it and if it works, and it will be brilliant, and if it doesn't, well, we'll try something else.

Is it the type of treatment that you might need several times or is it a sort of one-off treatment, do you know?

I don't know. I think it’s quite a new treatment because I haven't heard of anybody else having it.