Roger

Age at interview: 68

Brief Outline: Roger was diagnosed with heart failure 18 months ago after complaining of breathlessness on lying down, and having a heart attack. He had previously been diagnosed with COPD. As part of research into telemonitoring he has measured his weight and blood pressure daily.

Background: Roger is married with grown up children. He works as a painter and decorator has reduced his working hours as a result of his health problems. Ethnic background: White British.

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Roger went to see his GP about eighteen months ago when he found he couldn’t breathe lying down at night and was having to sleep sitting upright. The doctor suspected a chest infection and prescribed steroids then antibiotics, neither of which had any effect on Roger’s breathing. When Roger nearly passed out in the GP’s surgery he was sent to hospital in an ambulance, where they discovered that about a fifth of his heart muscle was not pumping properly due to a blocked artery (heart attack) and his heart beat was irregular. Putting a stent in was considered too risky, so Roger has been treated with medicines and told to take things easy and control his diet. He has reduced the amount of fat, salt and sugar he consumes and also restricts his fluid intake to two litres a day. After attending cardiac rehabilitation sessions he joined a gym but later decided to go for walks instead to save paying for the gym membership.

Fifteen years ago, before his heart problem was discovered Roger had been told he was asthmatic and later that he had chronic obstructive pulmonary disease (COPD). He gave up smoking at that time because the doctor warned that he could end up in a wheelchair by the time he was sixty if he continued to smoke. As a result of his poor heart and lung health Roger tires easily and gets breathless when walking up hill. He occasionally experiences angina pain, which he treats with glyceryl trinitrate (GTN) spray. He also experiences pains in his legs, particularly at night, which could be due to his poor circulation or a side effect of the statin he takes to control his cholesterol levels. He has two knee replacements, which have cured the arthritic pain he used to suffer from but they restrict his range of movement—kneeling down and climbing ladders can be a problem, particularly as he works as a painter and decorator.

He currently has a check-up with a cardiologist every six months at the hospital and a blood test every month to check his blood clotting time because he takes warfarin. He only sees a GP if he has a problem. In the past he took part in a research study of telemonitoring, which involved him measuring his weight and blood pressure every morning for about four months and using a tablet computer to automatically send the measurements to the hospital over the telephone line. Roger appreciated having such frequent measurements of his blood pressure and would have liked to continue but the study came to an end and the equipment, which had been supplied by the researchers, was taken back. He has since bought a blood pressure home monitoring machine, which he uses two or three times a week. He also weighs himself occasionally but no longer keeps records of his weight or blood pressure measurements. Roger is happy being monitored by the hospital because he feels well supported by the health professionals there and has more faith in them than the GPs. At first he felt depressed by having heart failure but has since learned to accept his condition.

Since taking medicines for his heart condition Roger has experienced pains in his legs in bed at night.

Probably the statins, it’s you get a lot of muscle pain. Yeah, I get pains in the neck, which I never used to get before, like cramp. For two or three hours at night in bed, I get pains in my knees, legs. This one, this one. That didn’t happen until I was on the medicine and my heart went funny. But, yeah, now I mean it doesn’t, it’s not that bad. It’s like having cramp, but without the muscle contractions, you get the same sort of pain. But it goes off quite quick. If you get, get out of bed, walk round the bed, back into bed, it’s gone. But, it will come on just as quick. You are laid there one minute you’re fine and next minute, argh, you know you have to get up quick and exercise it. But that will go on till probably, I mean, I don’t go to bed till, I don't know, most nights, half past eleven, twelve o'clock, and by three o'clock in the morning, it’s back to normal. It’s all right. I am asleep. 

Roger says that taking pills is inconvenient at times and a reminder of his condition but he recognises they are keeping him alive.

It is a bind, to be honest. Cos you can’t ever forget what, you know, what it’s for and that sort of thing. But, yeah. It’s an inconvenience at times, having to take them. But, I mean, it’s keeping me alive. So, it’s something you’ve got to get used to. Your life’s ruled by it. Without the tablets I don’t know where I’d be.

If Roger forgets to take his tablets he takes them later on.

So, lots of people find it difficult to remember to take them. Have you ever forgotten to take them?

Occasionally. Then I start panicking. 

Do you?

Yeah, ‘cos I don’t know what’s going to happen if I don’t take them, that’s the thing, if I haven’t taken them then I’ve always taken them later. If I forget to do it in the morning then I’ll, like yesterday, I should have took three of them at lunchtime or ten o'clock. Only I didn’t take them, I thought, ‘Oh damn, I haven’t taken the tablets’. So I had to take them at dinnertime. Don’t think it made any difference but well you shouldn’t double the dose if you miss out, so I did, instead of taking the other ones at teatime, what I do, I take two in the morning and two of them, evening meal, at night. I left it till just before I go to bed, just to sort of equal out the time between so then and try and get back on track the next day. It was all right. Yeah, but…

Roger joined a gym after he finished the cardiac rehab programme but has since left to save money and walks instead.

Well, basically it’s just doing lots of exercises without straining too much, you know, treadmill stuff, that sort of thing and bikes. I was in there for about, just over an hour a day when I was in there, which was all right. But it keeps you fit. So but the only problem with that is, is getting to the hospital. It’s a bit of a pain; the parking and that is a problem. Yeah, I did once that one finished, I did start to go to the gym. But, I thought, well this is silly, because I am paying nearly four pound a time just to go on a treadmill. I might as well go for a walk. So I didn’t, I done it a few times and then I thought, no, no, I will go for a walk, which is what I do now. 

Roger’s daily weight and blood pressure measurements were automatically transferred to a tablet computer and then to the hospital over the internet.

Oh yes, that was basically, its blood pressure testing every day. And weight. Then it was all put onto an iPad, which they monitor from the hospital. That’s basically all it was, really. 

So you were doing that yourself at home every day?

Yeah, yeah, every morning doing blood pressure and weight. 

How long did you do that for?

Oh…Probably three, four months, I would think. 

And they supplied all the kit?

They supplied the kit, yeah, yeah. I wanted to carry on with it, ‘cos it helped me as well to keep an eye on my blood pressure and that. But they said, there is so many people they want to do it, you know, they let somebody else have a go. And if they started it again, they’d consider me for another round. But it didn’t happen, so… 

So you were weighing yourself and measuring your blood pressure. What time of day did you do that then?

That was first thing in the morning. 

First thing in the morning. And you had to enter the figures into an iPad that they’d given you. 

That was automatically done. 

How was it automatically…

It’s apparently the scales talk to the iPad.

Oh really? Now that’s clever isn’t it.

Yeah. Yeah, it was. And then the only thing I had to do was put the weight in. It’s blood pressure. No that done it as well. That’s right. The blood pressure machine spoke to the iPad, or communicated whichever you want to put it. No, they both did, that’s right, didn’t have to do anything except switch it on. It’s good.

And then how often did you have to take the iPad up to the hospital, or didn’t you?

I didn’t. That’s, that was, that was remotely monitored through the Internet. It’s all, all good stuff. 

Roger likes to know what’s going on so is comforted by knowing that someone is keeping an eye on his heart condition.

Oh it’s a good idea. Definitely a good idea. I mean, you know, ‘cos you like to know what’s sort of what’s going on and that. And it’s nice to know somebody is taking that interest and keeping an eye on you. ‘Cos if I had been just sort of left to my own devices then I wouldn’t be very happy. And I would be worried, to be honest. But, yeah, I’m quite happy with it. 

Roger has little faith in GPs since they failed to diagnose his heart problem, so he prefers to be looked after by hospital specialists.

What about if they said, for instance, there’s no point you going to the hospital for these check-ups, you may as well have them at your GP’s surgery instead. How would you feel about that?

Not really happy about it. Do you want me to give you a reason?

Yeah.

Okay. ‘Cos two doctors missed the fact that I’d got a heart problem.  

Right.

And I’m not that impressed with them, to be honest. No. I mean, both of them done a test with me and, you know, had the stethoscopes out and that. As I say, when I got to the hospital, the first thing he said was, ‘You got a heart problem.’ Straight away. Now I don’t know whether they should’ve picked it up or not. I mean, I wasn’t very happy with them. I did put a complaint in about it. Because I mean, for two weeks, as I say, I went on steroids for the first week and the second week, that didn’t do any difference. The second time I went down there, they put me on antibiotics, which didn’t work. ‘Oh yeah, it’s chest infection, chest infection’. That was all they kept on about. Because I was asthmatic, or COPD, that was the first thing they done. But they only had to monitor the heart to know that it was all to hell, my heart beat was every which way but level, you know, very erratic. My pulse now is terrible. It’s not a steady, dum, dum, dum dum, you know. It really goes whacky at times.