Martin

Age at interview: 70

Brief Outline: Martin had chemotherapy for Non-Hodgkin’s Lymphoma in 2009. He has been well since but attends regular hospital check-ups. He also has rheumatoid arthritis and atrial fibrillation. He feels well-informed by his GP and is unconcerned about having a mild decrease in kidney function.

Background: Martin is a retired local government officer. He likes to keep active at the gym 3 times a week. He lives together with his wife, has one child and recently has become a grandfather.

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Martin has had rheumatoid arthritis for many years and used to take methotrexate and diclofenac for this condition. Around the same time, he also developed asthma and was prescribed reliever and preventer sprays to manage this.

Then, in 2009, Martin was diagnosed with Non-Hodgkin’s Lymphoma. He was told to come off all medications before having a novel type of chemo-therapy called R-CHOP, involving eight session at 3-weekly intervals. He has been well since though he still attends regular hospital check-ups with a cancer consultant, which were recently spaced out from 4-monthly to 6-monthly appointments.

In the aftermath of his chemotherapy, Martin found that one of the cancer drugs he was given (rituximab) had also helped with his rheumatoid arthritis - he did not experience any flare ups during the last five years, apart from once, a few months ago, when he had a chest infection. He also no longer seems to have any problems with his asthma.

Martin feels generally in good health and leads an active lifestyle which includes going to the gym 3 times a week. A year ago, whilst exercising, he became concerned about his rather high pulse rate. He consulted his GP and had an ECG which found an irregularity in his heartbeat. He was referred to hospital and diagnosed with atrial fibrillation. He was prescribed perindopril, bisoprolol, soluble aspirin and simvastatin.

Martin describes himself as very proactive with regard to his health, saying that his experience of cancer has taught him the importance of taking care of problems quickly. He regularly asks about the results of his blood tests, including his kidney function, but found that neither the cancer consultant nor the rheumatology consultant were concerned about his readings. Martin has a lot of confidence in his current GP, as he was the person to recognise his Non-Hodgkin’s Lymphoma when another doctor had misdiagnosed it previously, and made sure Martin was fast-tracked for hospital investigations and treatment. Martin’s GP explained to him that while his kidney function is mildly impaired, with an eGFR of 59, he is only just past the threshold to warrant being monitored and that there would be no need for action unless his kidney function dropped below an eGFR of 30.

Martin finds it reassuring to have regular check-ups and likes the fact he is still kept ‘in the loop’ by his cancer and rheumatology consultants, even though he has not had any problems for several years. When he experienced an arthritis flare up in conjunction with a chest infection, he phoned the consultant and was able to get an appointment within four days. He thinks a downside of preventive check-ups is that they can make you worry about things which probably do not warrant serious concern, and he thinks his mild decline in kidney function is an example of this. Personally, he would like to be told straight if there was a serious problem, but he can understand that some GPs might be cautious in telling patients with multiple other health problems about a decline in kidney function so as to not cause additional harm by worrying them.

Martin has comprehensive tests every year as part of the after-care for his Non-Hodgkin’s Lymphoma. Last year the oncology team told him he had a decrease in his kidney function but did not seem concerned about it.

Tell me when were kidneys first mentioned to you and by whom?

Well, it’s about a year ago I guess. I think it may have just been flagged up with the… Non-Hodgkin’s lymphoma team. I think it was just mentioned, you know, “oh, your kidney function is a little bit on the low side”, something like that. They weren’t concerned about it.

And didn’t say anything about going to see your GP. But then I mean he’s got access as well to the results of the blood test and it was… probably about six months ago that he mentioned it, you know, that… there was some… you know, just an issue over the readings.

You know, it’s just, it’s marginal.

And what were your concerns or questions at the time? When that was mentioned to you, what did you want to know about it?

I wasn’t really that concerned because nobody seemed to have regarded it as an issue. The rheumatologist didn’t, but there again, that maybe because she’s looking for other factors. And the Non-Hodgkin’s lymphoma people they’ve never really mentioned it, just acknowledging that… it flagged on the, you know, on the on the list of, because it’s not just the kidney test they do. They do like a full blood count, liver function, various other tests.

And kidney function is just one of the tests. And they just said in passing, “Oh, you know, your kidney function is just a little bit on the low side.” But no one has made an issue about it and it’s only recently, with my GP really, that he has sort of… pointed out like what the figures relate to.

And what the future might have in store.
 

Martin had a check-up with his GP this morning because when he picked up his medicines from the pharmacy recently a note had been included saying he had gone past his annual review date.

And so take me through… the steps in having a check-up test at the GPs. How does it come about? How do you-

Well, it’s, it was determined by him this morning. Because I went back because, when I picked up my prescription for my atrial fibrillation medicine about a month ago, there was a slip in there.

There was a slip in there to say that I’ve gone past my review date on my medication and to make an appointment… and so I made an appointment to see my GP and I saw him this morning. And as I said, he took my blood pressure and urine test and just looked at the figures again on the screen, talked me through what information I’d given to you about the ninety, sixty and the thirty reading and he explained, you know, a little bit more about that. And that was it really and he just said he was going to up, put my bisoprolol from one point two five to two point five and that was it. He Gave me a new prescription and go back and see him in six months.

And do you see the nurse at all as part of the check-ups?

If I have a blood test at the surgery, I see the nurse, yeah, yeah, yeah.

But this time it was just the urine test and.

A urine test and blood pressure. Yeah, yeah.
 

Martin’s GP had explained a bit about what the levels of kidney function mean and told him that his eGFR of 59 was nothing to worry about but that his kidneys were ‘about 10 years older than you’.

And he did explain to me this morning that if you’re a healthy young man, your reading would be something like ninety. It’s only when it gets below sixty that they might start looking at it, you know. And when you get below thirty then they-, you know, that is the time to really looking at it. But he’s told me my readings were in the fifties and, in fact, they’ve gone up. The last time I had the blood tested in February, it was fifty nine.

So was just below the sixty, so it’s marginal. I’m on no medication for it whatsoever and I don’t seem to, I’m not particularly concerned about it at the moment.

He said that you- “they’re probably about ten years older than you”, but….

Was that helpful information?

Not really, no [laughs]. No, no, not… not really. Well, in a way, it was. I mean he was being honest, which is which is fine, you know. He’s that type of guy.

And what was your understanding of what that actually means?

Well, it, to me it means that I could have problems with my kidneys at some time in the future, if I live long enough.

Because they are ageing ahead of you.

Yeah, yeah, yeah.
 

Martin is unsure whether lifestyle and drinking alcohol affects kidney health but is confident he could find more information if he wanted to. He leaves it to the professionals to tell him what he needs to know.

Are there any questions in the area of lifestyle - I mean like, you know, it sounds like you are doing a lot of things yourself and you’re very educated through reading the- the papers and looking things up on the internet, but are there any particular things that you wonder about that you would like to know more about?

Not really, I don’t think. …No, I don’t think so. I think I think the information is there if you want it. You can- you can glean information from multiple sources really not, the internet, your doctor, specialists, even nurses, you know, I guess you can get information from so I think I think the information is out there and I mean there’s more information about these days than… [laughs] well, there’s too much of it really.

And what’s your understanding about the kinds of things that are likely to cause kidney problems?

[Sighs] …I don’t really know. …I think it’s the lifestyle to a degree could have something to do with it. But I mean I don’t know exactly what it would be- I mean I go out, I enjoy a beer. I was out last Saturday night. I had two, three, four pints even on a Saturday night. I drink a glass of wine with my meal occasionally and that’s about it! But I don’t over I don’t over indulge in alcohol but usually it’s the liver that’s the one they worry about with alcohol, so I- I don’t really know what causes the kidneys to pack up, other than, as I’ve already explained to you, I’ve got a history of taking all sorts of medication. Whether that, you know, can have an adverse effects, ultimately, on your kidneys, is a possibility and I don’t know enough about it.

To… I’m not one to go and research it really. I just rather, I’d rather rely on the professionals. You only end up worrying if you, you can convince yourself you’ve got everything if you look too much into it really. I just get on with life.
 

Martin’s ACE inhibitor tablet has to be taken 30 – 45 minutes before eating, so he does that before breakfast; he takes soluble aspirin with breakfast then a bisoprolol tablet afterwards, and simvastatin at night.

And how easy is it to take your medication as prescribed?

Oh it’s very easy. Yeah, it’s not a problem. The only inconvenience is in the mornings, I have to the perindopril, I have to take it thirty minutes to forty five minutes before I have any food. So I tend to get up early or I take it up to bed with me at night so I wake up in the morning, I got some water and then I knock it back. And then I eat after about forty five minutes. The rest of, I then I then take a soluble aspirin with my breakfast.

Because, obviously, aspirin can cause internal bleeding. But it’s only a very low dose so I always take it with food. And then after I’ve taken that, I take bisoprolol. I take the simvastatin at night, which is what I’m told to do, and so it’s not a problem, you know. I’m used to it now.

What helps you remember taking it?

Well, I don’t, I do it just automatic I think. I just, I’m into the routine. I’ve been taking it for what probably a year now. And it’s really not an issue for me. There have been occasions I think when I’m- “ have I taken the tablet or not?” You know, I mean I sort of go and have a look at the thing and say, I think, I think I’ve taken it, yeah.