Mohammed

Brief Outline: Mohammad had a heart attack in his mid-50s and was found to be diabetic at the same time. He had a stent put in his heart, which later “collapsed.” He is on a minimum dose of metformin, which means his diabetes is mainly self-managed. He is very satisfied with the care he has received.

Background: Mohammad is a self-employed catering manager. He is married with six grown-up children. Ethnic Background: British Pakistani.

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Mohammed didn’t seem too bothered by his health conditions and he appeared happy to trust himself to the care of the health professionals. He had himself worked in the health service and reported to be very satisfied with the care he had received. 

Following a heart attack, and a diagnosis of diabetes, which was discovered at the same time, Mohammed explained these conditions by virtue of his age; which also provided the key to coping:
“You have to recognise your age. You have to recognise that you have certain difficulties and adapt your life around it. You can’t simply go in and have two stents and so on and come back and say nothing has happened.”

Mohammed did not see a link between his heart problems and his diabetes. He doesn’t feel that he needs to know the “clinical details” of his illnesses. He was however very pleased that he did not have to inject insulin and could control it himself. He wanted a minimal dose of metformin, mainly as a form of reminder to himself that he had a condition for which he had to make lifestyle and behaviour changes.

Mohammed reports that “having one [condition] doesn’t help the other” and he feels that patients need to “learn to live with conditions.” When asked, his advice for other patients is to prioritise their conditions in terms of which you need to be most vigilant about. He prefers to be communicated to by health professionals in “layman’s language” 

When Mohammed was admitted to hospital it was found that a stent had collapsed. He was also found to have diabetes, which came as a surprise.

And four or five days later I was asked to come in to be admitted so they could have a look as to why I seemed to be quite fit, but yet the readings don’t go along with my fitness. So I was taken in, or rather I was given admission one evening, and the following morning, first in the morning they took me off to the operating theatre to see what is wrong. And what had happened, the stent they had put in had collapsed.

At that time, we had a discussion as it was done under local. He said, “We have two choices. Either we take you off the table and think about a bypass or we open up this stent and stick another stent through it giving it a little more strength. The narrowing is fairly tight and it might halt but that will leave us the option of doing bypass later on.” He said, “With age, you know, you are in your fifties, well into your fifties but physically, you seem to be a very fit person for your age.” So that is when it was done. Hence, to this day, I am, touch wood, fine, taking my medication. What was concern was the, that at my initial admission they found that I had a blood sugar of about seventeen and they said did I know I was diabetic? I said, “You surprise me because I knew nothing.” I had no indications of it. Nothing ever especially having worked in the operating theatres for fifteen, sixteen years [name] Hospital and routinely having medical tests because of the environment you work. Nothing was picked up in those days, anything, caught out of the blue. Suggestion was made that I was put on insulin injections and I said, “No, I can control this myself with just a few tablets.” And since then, I seem to have brought it down to about six, six point five regularly over the last four or five years and my GP seems to be happy that it is well under control, and that basically is the outline of my condition.

Mohammed believes that people have to recognise their age and adapt accordingly. He compares the body to a motor car where an old one cannot perform as well as a new one.

And do you feel, your conditions, have they caused you to live your life differently? I appreciate that with the diabetes you perhaps modify diet and that type of thing, but you mentioned that it’s in the back of your mind.

Yes, of course, you know. Yes, of course, but I think a combination of both. You have to recognise your age. You have to recognise that you have certain difficulties and adapt your life around it. You can’t simply go in and have two stents and so on and come back and say nothing has happened. Whether they will cause any stress or damage you don’t know, but it’s always in the back of your mind because very much like you sit in a clapped out car and you know that there’s limitation. You know, it’s pointless putting it on a motorway and putting your foot down knowing that it is just not capable of doing that, and I think that applies with your own body as well. Simplest way I can put it.

Mohammed says that multiple health problems bring complications of multiple medicines and professionals. He agrees with how the health service has prioritised his conditions but wonders about side effects.

Do you think that multiple conditions are an issue in healthcare?

The issue well, multiple conditions are presented so they become issues. If a single condition is presented to the medical profession, then they know what they’re treating. If multiple conditions are presented, then the treatment has to vary that one does not affect the other. I know a pharmaceutical company will accept the fact that drugs don’t have side effects and the concern is that in treating one condition, is it going to have an effect on the other condition that the person is presenting, of course there will there will be a concern and of course there is concern even for the patients. As to the medication they are taking, is it helping one and making the other worse or is not affecting. One doesn’t know and you know as well as I do, a lot of the data from pharmaceutical companies isn’t quite available at public level, or at medical level for that matter, but so yes. And also having multiple conditions means that you are seeing multiple people. People that are specialists in that area, and so it’s a question of who decides to prioritise what, those would be the patients’ concern whether the whether the cardiologist has the priority of the neurologist, I don’t know. So there will be cause for concern.

And do you feel that one of your conditions has been prioritised over another?

I felt yes, my heart condition probably had priority over my diabetes I felt. Whether that is right or wrong, I don’t know, but that is the impression I got.

And is that, were you happy with that or would?

I’m happy with that because diabetes is something that I can learn to live with. My heart condition is not something that I can learn to live with or can control it. If a deterioration is going to take place, it’s going to take place. So will the diabetes but the diabetes is a long term thing and coronary disease is, it’s a question of what rate does it grow and deterioration take place. I’m happy with the fact that I’m given, I’m given the impression it’s a priority rather than my diabetes, yes.

And you just mentioned interactions there in terms of medication in obviously having more than one condition. In terms of medication, or just living with the conditions, do you find, do you notice any interactions at all between the two?

Not so much interaction between the two but maybe slight signs of side effects, but they are clearly indicated in your packaging as well as by your GP, it’s certain there will be some. They are of concern and the concern is, is that side effect making the condition worse or is the medication treating but the side effect is something you have to learn with. That tends to be the concern, yeah. For example, you know, is a medication you are taking to treat an illness, it has a side effect. Is that side effect making the illness worse? I don’t know. That is for you people in the industry to look into and but that would be the only slight concern in my mind, to worsen.

Mohammed thinks that side effects from medicines are inevitable. However, he is concerned about whether such side effects might be making his underlying conditions worse.

In terms of medication, or just living with the conditions, do you find, do you notice any interactions at all between the two?

Not so much interaction between the two but maybe slight signs of side effects, but they are clearly indicated in your packaging as well as by your GP, it’s certain there will be some. They are of concern and the concern is, is that side effect making the condition worse or is the medication treating but the side effect is something you have to learn [to live] with. That tends to be the concern, yeah. For example, you know, is a medication you are taking to treat an illness, it has a side effect. Is that side effect making the illness worse? I don’t know. That is for you people in the industry to look into and but that would be the only slight concern in my mind, to worsen. 

Mohammed says that the medical profession is set up to deal with single conditions. With multiple conditions and specialists, it is not clear who has the overall power to prioritise.

The issue well, multiple conditions are presented so they become issues. If a single condition is presented to the medical profession, then they know what they’re treating. If multiple conditions are presented, then the treatment has to vary that one does not affect the other. I know a pharmaceutical company will accept the fact that drugs don’t have side effects and the concern is that in treating one condition, is it going to have an effect on the other condition that the person is presenting, of course there will there will be a concern and of course there is concern even for the patients. As to the medication they are taking, is it helping one and making the other worse or is not affecting. One doesn’t know and you know as well as I do, a lot of the data from pharmaceutical companies isn’t quite available at public level, or at medical level for that matter, but so yes. And also having multiple conditions means that you are seeing multiple people. People that are specialists in that area, and so it’s a question of who decides to prioritise what, those would be the patients’ concern whether the cardiologist has the priority over the neurologist, I don’t know. 

Mohammed was pleased that he could control his diabetes with diet and a low dose of medication. He sees his heart condition as being beyond his control and is prepared to take drugs for it.

I don’t have anybody in my family background that is diabetic or was diabetic and maybe I still psychologically believe that maybe it’s because of my sweet tooth rather than necessarily being diabetic. But with a blood sugar of seventeen, you know, clinically that’s what you are a diabetic, so and I I’m very happy that I was able to control it myself, rather than going on the dependency of having injections daily to be able to control it because once the body gets used to is then, you know, that’s it. You’re stuck with it and I want to be able to control it myself rather than be totally dependent on medication.

Okay. So you mentioned there that insulin was suggested for you but you said that you’d prefer to try and do it differently.

The very lowest strength of metformin or something I said would do it because maybe it’ll give me mental satisfaction that I’m taking medication rather than actually.

Okay.

It will remind me that I need to control the intake of my starch and sugar and what not.

Okay, and how was that received when you said that that was what you’d prefer to do?

Oh they said fine because even if it doesn’t come down then, you know, we we can consider that at our next appointment but since then, no fine. Seems to have gone down to a fairly what they would classify as an acceptable level. What is normal is very vague I’m afraid but it has, from seventeen it has come down to about six and a half and over the last five six years or rather five years, yeah, it’s stayed around that level so they’re quite pleased. The GP is pleased and the hospital is pleased that I was able to control it and bring it to that level and retain it at that level.

And in terms of impact I suppose on your life of your two conditions, which would you say is more important, for want of a better word?

Well, I suppose my heart condition would obviously be considered. Of course, diabetes is of concern but I feel that diabetes is to a degree, controllable. You can’t eradicate it you can’t, but you can do a lot of things to control it. Regarding my heart condition, I often feel it is outside my hands. I can stick to specific diets and I keep on taking my medications on time but beyond that, I don’t have much control over it because the difficulty lies, when you do have a a heart attack, you can speculate the percentage of damage that has occurred to your heart but you can never be exact. So there is a dilemma of how far you can push yourself with that condition and it’s always in the back of your mind, especially if you if you travel a lot like me, but that that is of concern at time, rather than the diabetes. But then again, having one doesn’t help the other, so I’m told by medical professionals that. 

Mohammed would like professionals to use layman’s language when talking to patients as medical jargon can induce fear. He would also like to see more checks on inpatients by nursing staff.

If you could give any messages, firstly, to healthcare professionals to improve the care that you receive, is there anything that you would want to tell them?

Just possibly a slight request, otherwise no instruction, but I request for clinical staff to possibly explain to the patients in layman’s language about the illness and the treatment they envisage to give, and that and that could be quite helpful. Because often people hear a lot of clinical names and that puts this like fear, element of fear in them when helping basically, maybe virtually very little. In terms of I know there is a shortage of nursing staff but I think when a patient is admitted to a hospital, it is a frightening environment for some and it would probably be nicer if there was a reasonably frequent visit, just a visual look to keep them, give them that element of satisfaction that they are being looked after, rather than occasionally feeling they having the feeling of being thrown on the scrapheap and even as little as a young student nurse is popping and saying, “Hello, are you feeling okay?” So something is happening, whether anything is happening is irrelevant but it gives you that satisfaction that something is happening. And I think that that would be the only literal request that I would have, rather than advice.

Mohammed suggests that you have to learn to recognise your age and any damage from health problems. Then you can adapt your life to the new circumstances.

You have to recognise your age. You have to recognise that you have certain difficulties and adapt your life around it. You can’t simply go in and have two stents and so on and come back and say nothing has happened. Whether they will cause any stress or damage you don’t know, but it’s always in the back of your mind because very much like you sit in a clapped out car and you know that there’s limitation. You know, it’s pointless putting it on a motorway and putting your foot down knowing that it is just not capable of doing that, and I think that applies with your own body as well. Simplest way I can put it.