Nigel

Age at interview: 58

Brief Outline:

Nigel has cardiovascular problems, type II diabetes and a history of strokes and depression; he is waiting for a hernia operation. He feels tired all the time and attributes his worsening health to caring for his parents. His diabetes is poorly controlled.

Background:

Nigel is divorced with 3 adult children. He is a self-employed driver and also cares for his parents. Ethnic Background: White British.

More about me...

Nigel links his worsening health to not looking “after myself as well as I should have done” (e.g. heavy drinking) and the work involved in caring for his parents. Self-monitoring of diabetes involves pricking his fingers four times a day, which is painful. He always feels tired and wants to sleep all the time.

Nigel has had five “small strokes’” to date. He was told these were linked to high blood pressure, high blood sugar levels and high cholesterol. Medication changes following the strokes means he currently takes over 30 tablets a day.

Nigel has angina, which he links to a family history as both his mother and father have heart problems. He is affected by diabetic neuropathy, causing bad circulation in his legs, which are now “nearly numb up to my knees.” He has a family history of diabetes too. He goes for podiatry once a week because of problems with his feet. He is due for a hernia operation in 6 weeks’ time. He got the hernia when attempting to lift his mother out of bed. The surgery will be complicated by the blood thinning medications he takes, his blood pressure and diabetes.

Nigel has found that he can get conflicting advice from different health professionals, but personally prioritises diabetes as “that can do so much damage to you.” Nigel values his GP over other health professionals “because she knows me best”. When he is given tablets by a specialist he always refers back to his GP to see if the drugs are okay given his other health conditions and the high volume of medications already being taken.

Nigel had a bad bout of depression in 1994 and tried to commit suicide.

 “Well, anyone that’s just starting out with diabetes, just look after yourself. Really, really, really, really take care because it affects so many parts of your body, you don’t realise and when you’re thirty, you think you’re indestructible, and because I didn’t look after myself at the beginning, I’m sure where a lot of these problems have started from. And I don’t think people realise how it gets you down, one thing after another after another seems to knock your spirit, and I suppose the only thing I can say is keep your chin up and keep fighting.”

Nigel thinks other people do not understand how unwell he feels because his conditions cannot be seen. He says people need to keep faith, fight the symptoms and carry on with things.

It’s just, I don’t understand how people don’t realise how poorly you feel with diabetes. You know, there’s a lot of conditions where you can’t see it but it affects you so much, and it’s not only diabetes. There’s a lot of conditions but everyone sort of says, “Oh you look well.” And yet you feel absolutely terrible and that’s the only thing I… it just seems to wear you down from inside. It’s just constantly on at you all the time. 

And do you feel you’re ever able to, if somebody says, oh you look well, do you feel you’re able to say?

Oh, yeah, I always say, “Well, I don’t feel it.”

Right.

But I will say that or I’ll say, “I wish I did feel well.” But one thing you’ve got to have is a lot of faith. You’ve got to keep at it because it will get you down if you let it, well, or the conditions, they will slowly drag you down if you let them and every day you have to say, “No, I am going to walk into town. I am going to do this. I am going to do that and I’m going to fight it.” No matter how tired you get you’ve got to fight it and carry on.

Nigel feels like he gets one health problem after another. He attends many health appointments where different doctors give him different advice. He refers to his GP because she knows him best.

But, generally, you just feel as though like you just one thing after another keeps occurring. You just sort of get yourself a little bit better and then something else seems to crop up. I mean as next week, I’m going to one hospital on Monday, one hospital on Tuesday and another hospital on Wednesday for three different problems. So it’s a constant someone saying, “You must do this.” And then another doctor saying, “You shouldn’t do that. You should do this.” And it seems, because they’re only treating a condition, but the diabetes I think is the one you have to really look after because that can cause so much damage to you.

And if you do get, you mentioned there that you perhaps see a different specialist and there’s a different focus.

Yeah.

For each of those.

Yeah.

How do you deal with that? 

I always refer back to my GP.

Right.

Because she knows me best. These people see me once or maybe twice. My GP sees me maybe twice a month and she knows how I react to certain situations. I’ve suffered with depression since I was twenty and she knows if I’m on a certain tablet, that can trigger a depression again. So she’ll advise me or she’ll advise me not to take that tablet and to give an alternative. I always I always go back to my GP because she knows me best and she knows more about me than the people at the clinics, at the hospitals.

Nigel adjusts his insulin when other medicines are added. He is going in for a hernia operation which is complicated by diabetes and medicine taken to prevent stroke. His GP is seen as the best person to manage his care.

My medication was changed and then, because your medication changes, that affects your blood sugars, so then you have to start adjusting your insulin to affect the change they’ve give you in your tablets, because every tablet that they give you has a side effects, obviously, and that alters everything else. I’m on over thirty tablets a day now.

Okay.

For all my different conditions.

Okay and you mentioned that you’ve got high blood pressure.

Yeah, that that’s what, that’s what the cause of the small strokes, the high blood pressure. It was extremely high and so they added another drug and up to the dose of two more and now they’ve got it under control, the high blood pressure. 

Because of my diabetes, like I’m going in for an operation in in six weeks’ time for a hernia, but because of my diabetes I’ve got to go in a day before to make sure my blood sugars are fine, my blood pressure is fine before they’ll operate. And then, obviously, because you take all these blood thinning tablets to keep your blood thin so you don’t have another stroke, you have to come off them for a week before and then, so the blood will clot properly after the operation, and they say it could cause complications. So obviously, you’ve got that worry that something might go wrong but that’s life isn’t it? But yeah, I think I think it’s the thought of having to do it every day for the rest of my life that it’s worse than actually doing it, thinking, “Oh no, not again.” And because I live on my own and I do suffer a lot of hypos, which are very frightening when you live on your own, because that means your blood sugars suddenly crash and if it goes, you can go into a coma if you go under two. I roughly average out about nine or ten, which is a little bit too high. Your blood sugar should be seven, in between five and seven, but some days mine will go to thirty for no apparent reason and my diabetic nurse will tell me it’s because I get stressed and stress can do so much.

To your body. It can override everything.

I fully trust her because she knows that if I take a certain tablet, it can affect another part of my diabetes or my heart, or I’m going to see a surgeon on Monday about prostate trouble. Now I know for a fact that if he gives me a tablet and I read the instructions and it’ll say, “Do not take this if you’re a diabetic.” Or whatever is in there, I will go down to my GP and say, “What we what do you think about this?” But I find the worst thing is that the surgeon I see on Monday, he should know about the effects of a tablet in relation to ongoing problems but they just seem to, I’m speaking before I’ve seen him, actually, but he might not, you know, but, if he does give me a tablet I think or I read might not be suitable for me, I will go and see my doctor and she will advise me. 

Nigel is very satisfied with his GP and describes how she followed through when tablets didn’t have any effect by making a speedy referral for investigation of his prostate.

… she’s totally interested me as a as a case and she will follow-up. As I say, I’m going in to see someone about my prostate gland on Monday, and this is because she’s actually followed-up and sent me there. She’s started me off on tablets. That didn’t that didn’t have any great effect. Then she gave me another tablet but that didn’t work at all like it was supposed to. So she’s actually followed-up and got me an appointment to see a specialist at the [city hospital]. So I’m being looked after again because she has followed the case through. She’s not sort of made me go down there and say, “What’s happening?” Within, I think it was three days of me going down the last time, I had an appointment an appointment for the [city hospital]. So she’s obviously followed that up and got me there as quick as possible. No, I get looked after very well by my doctor, very, very well and yes, the, if I go there with a problem, she’s only keen and willing to try and sort it out for me, and I feel like it’s a fifty-fifty relationship where I trust her and she will do her best for me.

Nigel takes over thirty tablets a day. Every time another tablet is added it might affect his diabetes and change his insulin dose

And were you, your medication changed as a result or?

My medication was changed and then, because your medication changes, that affects your blood sugars, so then you have to start adjusting your insulin to affect the change they’ve give you in your tablets, because every tablet that they give you has a side effects, obviously, and that alters everything else. I’m on over thirty tablets a day now.

Okay.

For all my different conditions.

Nigel prioritises control of his diabetes. Otherwise he will feel terrible and it will impact on his other conditions.

Okay, and in terms of your multiple, different conditions, how do you decide what takes priority and what you need to do first?

First and foremost I need to keep my diabetes under control because that will reflect on everything else. I know if my sugars are high, I feel terrible, very very very very sluggish, slow, can hardly lift my feet off the ground. But with my heart, I can only take the tablets they’ve given me. They give me digoxin and then with my spray I feel a bit out of breath but I don’t suffer very many angina attacks, maybe one or two a month or maybe less than that. 

Okay.

But, generally, you just feel as though like you just one thing after another keeps occurring. You just sort of get yourself a little bit better and then something else seems to crop up. I mean as next week, I’m going to one hospital on Monday, one hospital on Tuesday and another hospital on Wednesday for three different problems. So it’s a constant someone saying, “You must do this.” And then another doctor saying, “You shouldn’t do that. You should do this.” And it seems, because they’re only treating a condition, but the diabetes I think is the one you have to really look after because that can cause so much damage to you.

Nigel feels he gets good advice from his GP about whether he can take new drugs on top of his existing illnesses and treatments. However, it is up to him to take the drugs and look after himself.

Yeah, I have hundred per cent confidence in her because, as I say, she knows me best and she’s only got my best interests at heart, and I fully trust her because she knows that if I take a certain tablet, it can affect another part of my diabetes or my heart, or I’m going to see a surgeon on Monday about prostate trouble. Now I know for a fact that if he gives me a tablet and I read the instructions and it’ll say, “Do not take this if you’re a diabetic.” Or whatever is in there, I will go down to my GP and say, “What we what do you think about this?” But I find the worst thing is that the surgeon I see on Monday, he should know about the effects of a tablet in relation to ongoing problems but they just seem to, I’m speaking before I’ve seen him, actually, but he might not, you know, but, if he does give me a tablet I think or I read might not be suitable for me, I will go and see my doctor and she will advise me. 

And do you feel the onus is on you to.

Yeah.

To.

Yeah, I, well, I look after myself. I mean my doctor tells me what to take but, at the end of the day, it’s up to me to take it. She can only advise me to take it or not to take it. It’s up to me whether I take it and try and look after myself as best of my ability.

When Nigel gets advice from specialists at clinics and hospitals he always checks back with his GP about tablets, because she knows about his other conditions and treatments.

And if you do get, you mentioned there that you perhaps see a different specialist and there’s a different focus.

Yeah.

For each of those?

Yeah.

How do you deal with that? 

I always refer back to my GP.

Right.

Because she knows me best. These people see me once or maybe twice. My GP sees me maybe twice a month and she knows how I react to certain situations. I’ve suffered with depression since I was twenty and she knows if I’m on a certain tablet, that can trigger a depression again. So she’ll advise me or she’ll advise me not to take that tablet and to give an alternative. I always I always go back to my GP because she knows me best and she knows more about me than the people at the clinics, at the hospitals.

Nigel recommends that people with diabetes look after themselves and then “keep fighting” when other conditions come along.

If I could ask you any messages that you might have for people that are living with more than one condition, what might you say to them?

Well, anyone that’s just starting out with diabetes, just look after yourself. Really, really, really, really take care because it affects so many parts of your body, you don’t realise and when you’re when you’re thirty, you’re think you’re indestructible, and because I didn’t look after myself at the beginning, I’m sure where a lot of these problems have started from. And I don’t think people realise how it gets you down, one thing after another after another seems to knock your spirit, and I suppose the only thing I can say is keep your chin up and keep fighting.