Jill
Age at interview: 77
Brief Outline: Jill found out that she has a mild decrease in her kidney function a few weeks ago through a routine blood test. She felt reassured when her GP told her the decrease was due to normal ageing. She is currently awaiting results from a urine test.
Background: Jill is a retired recruitment manager and previous lay member of a mental health review tribunal. She has atrial fibrillation and intermittent back pain from spinal stenosis. She is widowed, has 2 children and lives by herself. Ethnic background: White British.
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Jill had been leading a very active lifestyle involving lots of travelling when 14 months ago she developed swelling in her ankles. She consulted her GP and was promptly referred to be seen at hospital, where she was diagnosed with atrial fibrillation. She had a cardioversion and was prescribed warfarin, amiodarone, digoxin and furosemide. She had to be admitted to hospital once more since, but her heart went back into sinus rhythm without the need for a cardioversion on that occasion.
Jill has also been diagnosed with spinal stenosis (with her vertebrae pressing on the nerves in her back) which can cause her severe intermittent pain, but is not keen to have an operation or to take steroid medication.
Jill’s consultant trusted her to decide for how long she needed to stay on furosemide, a diuretic. As the swelling in her ankles had reduced, she stopped taking furosemide a few months ago. She was surprised to find that she now wakes up twice a night to go to the toilet and also has greater urinary urgency during the daytime but has not discussed this with her GP yet.
Jill found out about her mild decrease in her kidney function a few weeks ago through a routine blood test. The hospital had asked her GP to conduct a kidney check. She then received a call from the GP to make an appointment and subsequently was told that her kidney function “was down to 30%” but that this was normal ageing and that the renal specialist “would not jump about” until it was reduced to 15%. This greatly reassured Jill. Many years ago, she trained as a nurse, so she feels she has a basic understanding of health issues and also feels confident to ask questions and challenge medical advice when she feels she needs to.
Only last week the nurse asked her for a water sample to conduct a urine test checking for protein. Jill asked why this was necessary but felt that she did not receive a satisfactory answer. She is currently awaiting results from this test. On reflection, Jill feels it would be helpful to receive more detailed information about her kidney health, such as what exactly a 30% reduction means for her, what kind of symptoms might be associated with a further decline in kidney function and what she might be able to do to keep her kidneys healthy.
Jill is still very active but now makes sure to only undertake one major activity each day. She walks to the shops every day to get her newspaper and she has tried to eat a healthier diet, though she is not ‘a vegetable person’. At the age of 77 and with a strong religious faith, Jill is not afraid of the idea that she might die, though she still very much enjoys her life.
Additional information (Events following on from date of interview on 3rd February 2014)
A couple of weeks after completing the interview, Jill became violently sick with diarrhoea and vomiting. She found that her urine had turned dark and cloudy and also noticed blood in the pan. She went back to her GP and was prescribed antibiotics. A second course of antibiotics eventually cleared up the infection. Her urine returned to normal and a further blood test at her GPs did not show any changes to her liver and kidney function. However, Jill has now self-referred to a private urology centre for further investigations, taking along a letter from her GP summarizing the test results done at her NHS surgery. She is currently awaiting results from a kidney CT scan and is also about to have a cystoscopy.
Jill has also been diagnosed with spinal stenosis (with her vertebrae pressing on the nerves in her back) which can cause her severe intermittent pain, but is not keen to have an operation or to take steroid medication.
Jill’s consultant trusted her to decide for how long she needed to stay on furosemide, a diuretic. As the swelling in her ankles had reduced, she stopped taking furosemide a few months ago. She was surprised to find that she now wakes up twice a night to go to the toilet and also has greater urinary urgency during the daytime but has not discussed this with her GP yet.
Jill found out about her mild decrease in her kidney function a few weeks ago through a routine blood test. The hospital had asked her GP to conduct a kidney check. She then received a call from the GP to make an appointment and subsequently was told that her kidney function “was down to 30%” but that this was normal ageing and that the renal specialist “would not jump about” until it was reduced to 15%. This greatly reassured Jill. Many years ago, she trained as a nurse, so she feels she has a basic understanding of health issues and also feels confident to ask questions and challenge medical advice when she feels she needs to.
Only last week the nurse asked her for a water sample to conduct a urine test checking for protein. Jill asked why this was necessary but felt that she did not receive a satisfactory answer. She is currently awaiting results from this test. On reflection, Jill feels it would be helpful to receive more detailed information about her kidney health, such as what exactly a 30% reduction means for her, what kind of symptoms might be associated with a further decline in kidney function and what she might be able to do to keep her kidneys healthy.
Jill is still very active but now makes sure to only undertake one major activity each day. She walks to the shops every day to get her newspaper and she has tried to eat a healthier diet, though she is not ‘a vegetable person’. At the age of 77 and with a strong religious faith, Jill is not afraid of the idea that she might die, though she still very much enjoys her life.
Additional information (Events following on from date of interview on 3rd February 2014)
A couple of weeks after completing the interview, Jill became violently sick with diarrhoea and vomiting. She found that her urine had turned dark and cloudy and also noticed blood in the pan. She went back to her GP and was prescribed antibiotics. A second course of antibiotics eventually cleared up the infection. Her urine returned to normal and a further blood test at her GPs did not show any changes to her liver and kidney function. However, Jill has now self-referred to a private urology centre for further investigations, taking along a letter from her GP summarizing the test results done at her NHS surgery. She is currently awaiting results from a kidney CT scan and is also about to have a cystoscopy.
Jill, who also has atrial fibrillation, is not overly concerned about her kidney impairment. If she were younger she might feel different.
Jill, who also has atrial fibrillation, is not overly concerned about her kidney impairment. If she were younger she might feel different.
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Yes.
What happened next?
Yes, well, the result was that I’m now thirty percent, whatever that means, it doesn’t- I don’t understand how- he said to me that really, if you, you know, “when you’re young your, and your kidneys are fine, you’re about sixty per cent.” I’m down to thirty per cent and he said if it got down to fifteen per cent, that’s when he would involve the kidney team but hopefully, this was fairly recent, so hopefully that…I won’t need to see anybody.
And how were you told the result of this test and that you were thirty per cent?
Because I went back to see him. No, well, let me just think… I- if you - …at the clinic, you can ring up after three in the afternoon and they’ll give you the results. But I think I must have gone to see this GP about something else. I can’t think what it would have been? …And he gave the results himself and that’s when we could discuss it.
I honestly can’t remember why I went back to see him.
And so that was just a few months ago was it? Or-
Yes, that was fairly recently. Yeah, I would say probably around Christmas time. That sort of time.
And can your remember that consultation when you were told that your kidney function had decreased? What were your feelings and thoughts at the time?
Well, uuuuhhh (frightened sound) I wasn’t very happy about it but he, the fact that he explained it all to me and, you know, reassured me that I needn’t worry at this stage, but he would keep an eye… on me, and do… kidney tests.
And I think… you know, if I was fifty eight or fifty whatever and these problems were all coming up, I would be much more worried. But I sort of feel, well, I’ve got to seventy eight, that’s not bad. And my children will inherit my money [laughs] so that won’t be bad. I’m sort of very you know, I have a strong religious belief, too, and that is an enormous comfort with the idea that you’re going to die soon. It doesn’t frighten me that I’m going to die soon. I don’t want to die soon [laughs] but it I’m not frightened by it.
Jill was surprised to be asked to provide a urine sample recently. She was told it was to look for protein, but she wasn’t told why.
Jill was surprised to be asked to provide a urine sample recently. She was told it was to look for protein, but she wasn’t told why.
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Yes. Actually, they just asked me for another urine test because they want to see if there’s any protein. I queried the nurse as to why- because this came out of the blue as to why, it was last week, why had I got to have a urine test done, she said, “We want to see if there’s any…” She was a bit reluctant to tell me and she said, “We want to see if there’s any protein.” Well, protein means blood really doesn’t it? in my urine, so I don’t know why they’ve suddenly come up with this. In fact, I only had it done on Friday so I, it’s not good phoning up until probably next Friday to find out the results, which I will do because I’m interested to know why. They’ve suddenly decided I’ve got to have this test.
And you say you had a urine test before?
Yes, I have but I can’t really remember when, no, it was some time ago. I couldn’t tell you, actually, when that was.
And it wasn’t together with the blood tests that you had for the kidneys.
No. Well…it was, this this last one, I had my INR done. I’d cut my leg and I had to have that treated [laughs] and the blood test, it was all done at the same time.
So when, now with the urine test, that came as a bit of a surprise to you when the nurse called you up?
Yes, I was surprised. I nobody had mentioned to me that I’d got to have a urine test done. Whether it’s a routine thing because of the medication which it could be. I really don’t know.
But this has been the first one you’ve been asked.
Yeah.
And how did you find doing the urine test? Is that is that.
That’s no problem.
Fairly straightforward.
No, and, as, you should know, they wanted with your first time in the morning.
That was, actually, I was up at three o’clock in the morning so I did it then.
Since a pharmacist advised Jill not to treat catarrh with any over-the-counter products because they could interfere with her conventional medicines, she always seeks advice before buying anything.
Since a pharmacist advised Jill not to treat catarrh with any over-the-counter products because they could interfere with her conventional medicines, she always seeks advice before buying anything.
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No because now I’ve had a terrible attack of catarrh and I went to the chemist and said what would he advise? “Could I take this, that and the other.” And he said, “No, you can’t take any of them.” So I am limited to what I can take and I always ask the pharmacist.
Well, not always because I, that was the one and only time I think I wanted something and he was adamant that, he said, you know, “I don’t think you can take that bit, you can speak to your GP about it.” But the pharmacist here is so good that I decided that I’ve just got to suffer it and it comes and goes.
So you’re quite careful now with what other medications you’re taking.
Yes, I wouldn’t take any medications without advice because it doesn’t, they do interfere I think with things.