Ronald

Age at interview: 70

Brief Outline: Ronald has diabetes and heart problems and has had an operation to remove his gall bladder. He thinks he also has a hernia but this has never been investigated or treated. His diabetes was controlled by tablets until he moved onto insulin 7 years ago.

Background: Ronald is married with one grown-up child. He is a retired electrical craftsman. Ethnic Background: White.

More about me...

Ronald’s diabetes was originally diagnosed following referral from an optician in 1982; this was controlled by tablets for around 25 years before he moved onto insulin. He has had recent problems controlling his blood sugar levels and some drugs have affected his kidney functioning, although this is seen as “nothing to be overly concerned about”. He now has a machine to monitor his blood sugars, which makes things easier, although he points out that he was in a position to pay for this, where others may not be able to.

Ronald had two “small heart attacks” that he was completely unaware of at the time. He had a stent fitted, “which didn’t seem to do much”. A couple of years ago he started fainting, but this was resolved when a pacemaker was fitted. Ronald views his pacemaker as cutting edge technology – the workings of which are checked by remote monitoring via Internet.

Before that he had an operation to remove his gall bladder (cholecystectomy) “that really affected me a great, great deal.” His “insides” were badly infected and there was a long healing process that took 4 months. Removal of part of his digestive system has affected mobility through weight gain, but he needs to exercise, which presents him with a conundrum.

Ronald does not report any particular management strategies, saying “I just take each day as it comes.” He believes that his heart problem is hereditary, but doesn’t see any link between that and his diabetes. At the same time however, he doesn’t see his conditions as separate in self-management terms, but “as a job lot” that needs to be dealt with. He is worried that he can’t do a lot of things and relies on his wife for help, e.g. putting shoes and socks on. 

He currently sees a diabetic nurse once a week. Diabetes is prioritised as it “can change quite quickly and so it needs to be monitored.” He thinks he has a hernia, but when he mentions this to health professionals “they don’t seem to offer a comment.”

Ronald doesn’t feel that health professionals always listen properly and he has had problems with side effects from some treatments, e.g. metformin for diabetes. Now kidney problems impact upon which treatments can be used. He values diabetic care, but is critical of the fact that he always seems to see a different diabetic consultant at every visit. He is concerned about appearing as a “whinger” if he keeps bringing up the same issues all the time in consultations. His advice for patient is: “take all the advice that’s given and just get on with it.”

There is a history of heart conditions in Ronald’s family. Since being diagnosed with diabetes he has found out that 2 other family members also have it.

Okay and do you see do you see your conditions as being related in any way? Are they connected or?

Well, my heart problem is it’s an hereditary thing on my father’s side of the family because my father is just, you know, he died, my father died when he was I think about sixty two, and there’s been a long history of heart problems in the family, and his own father died when he was fourteen years old. I don’t know what age my grandfather would have been but it stretches back quite a number of generations because my grandfather, he was a postman up in Derbyshire and so he a quite an active job walking around, and the photographs that I’ve seen, he seemed to be a real sort of sort of gentleman you would expect at that with a nice big sort of moustache. Looked a proper military man. But there always has been problems because my father, that’s what eventually killed him was heart attacks. And he was the same, he had a heart attack and had a chest pain and carried on working through it and he ignored it, didn’t seek advice and so there’s been that. That’s just the sort of thing I suppose doesn’t play on my mind, but I’m aware of it that there’s obviously some, you know, physical defect on the male side of my family, you know, and it it’s one of those things I suppose you have to sort of learn to live with, which is, you know, with genetics and things like that these days, they can probably tell exactly what gene it is that’s causing the problems. But I’ve never felt any ill effects whatsoever because the job I done was really physical. I was climbing up poles and pylons and things like that and climbing up trees, chopping down trees, just maintaining the power lines, you know, and so it’s quite a physical sort of a job, you know, and just one of those things.

So is there, do you think there’s any connection between problems with your heart and the diabetes or is that just coincidence?

I just think it’s coincidence really because it’s, when I was diagnosed, at the time, I was the only member of the family that had had diabetes so I thought. Then there’s like most families, have skeletons in their cupboards. I had an aunty that was the black sheep of the family, which we never, ever hardly see, saw at all, she was appeared on the scene and she told us that she was diabetic as well. So that’s my mother’s youngest sister, and until then I wasn’t aware that there was any sort of diabetes in the family. And now my sister, in recent years, has been diagnosed with diabetes and that was only discovered because she had an infection of the leg, which thought was an insect bite, which didn’t really sort of heal up at all. Then they discovered that the reason why it wasn’t healing was because of diabetes and that was how she was diagnosed. So that that side of the family is something totally but I don’t think it’s not related, not in my mind, but somebody of greater knowledge might tell me different but…

Some of the medicines that Ronald has been prescribed for his diabetes have made him feel really ill. He cannot take some treatments because of a pre-existing kidney condition.

Perhaps what services they offer or the way that they are, or is there anything particular that you think, oh, that’s really useful or really helpful or?

Well, I think the diabetes clinic is the most helpful because they suggest all different types of treatment. And what I do for them is if you tell them that you don’t like the treatment, because there’s several different types of tablets they’ve tried me on, which affected my comfort zone. 

It affected my lifestyle, made me feel horrible and things like that because right from when I was first diagnosed, I had a reaction to metformin. Just couldn’t tolerate and then about eighteen months ago, they said there’s a new type of metformin, which is a slow release metformin, and tried that and that had exactly the same effect as the normal metformin. And then there was another treatment they tried, which was it’s supposed to be a diet suppressant drug as well in controlling insulin, and that I just couldn’t tolerate. It made me feel really ill and so that was discontinued. But when you, you know, just tell them that it’s just not working, they dictate, you know, we’ll try something else. But a lot of the things that they wanted to try, they can’t try because of my deterioration of my kidney function. There’s one they wanted to try earlier on this year, when I went, and they couldn’t do it because the kidney function, you know, wasn’t too good. So I would say diabetes is the one and they seem to, you know, be very, very helpful.

Following a worsening in Ronald’s diabetes, new treatments affected his kidneys. After having his gall bladder removed it took a long time for the wound to heal but his GP performed a minor operation to help the healing.

I’ve been diabetic since 1982 and I have only been on insulin since 2006. Up until then I just relied on tablets and diet and everything seemed to be going on okay. But with diabetes in recent times, my blood sugar levels have been going up and they’ve tried various tablets and treatment on me, some which didn’t work and really affected my kidney function. And I’m regularly monitored for my kidney function with a blood test with every couple of months from my GP and the kidney function seems to be returning a little bit back down to acceptable levels. There’s nothing really, it’s not good but it’s not nothing to be sort of really overly concerned about. 

And you mentioned that you also had a cholecystectomy?

[mm mm]

I’ve written here that keyhole surgery, not a success and then.

No.

You required open surgery?

That’s right, yeah.

And you had some infection, which took.

A lot of infection.

Right.

Yeah.

And that took quite some time to heal?

Quite some time, yeah. It was so bad that my GP I had at the time, he happened to be a surgeon before he was a GP and the settee where you are sitting now, he actually performed a minor surgery to assist the healing process because it wasn’t going the way he’d have liked. And eventually, it did clear up, you know, because the antibiotics that they gave me, they tried me on god knows how many different ones, and I was going through course after course of these without much effect at all and, eventually, it cleared it. But it was a far bigger, had a far bigger effect on me, the operation, than I ever thought it would be.

Right.

You know, because it really, not psychological, but it sort of felt really bad to the system. They explained to me that obviously, foods that I’d eaten before would be not tolerated due to the sort of the part of the stomach being moved, removed and by and large, it hasn’t done that much sort of damage but the thing is I, what it has done, and I’m pretty sure it’s led to my not processing my food the same. My weight has increased quite a lot and it’s not very pleasant.

When asked, Ronald says he thinks that health professionals don’t always listen properly. From experience, he knows it is more difficult to take blood out of his arms than from the back of his hands.

I’ve got a question here, do you feel that healthcare professionals listen to you?

Not a lot of the time. You know, the, just a minor thing where I try to explain to nurses and the people that are trying to take blood, I know from painful experience that it’s very difficult to get it out of my arms, where it’s normally taken. I have to insist that they take it out of the back of my hands because of the veins are quite prominent, whereas what the condition I’ve got, the same, must be hereditary, my sister is the same, when they stick a needle in, the needle doesn’t penetrate the vein. It pushes it and I have finished up, at one time, at the [hospital] with five different holes trying to take one blood test. So now I pretty well insist that they take notice and take it out of the back of my hands. I know it’s painful at the back of my hands but it’s less painful than being stabbed multiple times in the arm, you know. That’s the only complaint I’ve got really but most know me now and they listen.

Ronald feels that concerns he has following a gall bladder operation have not been addressed by his GP. He is concerned about appearing as a “whinger” if he keeps bringing up the same issues.

Just in terms of the cholecystectomy, you say that you haven’t been listened to, is that perhaps problems you might have been having and you feel they’ve not been addressed, or is it something that you feel perhaps, you know, the GP or could have helped with and hasn’t or?

The GP could have helped more I felt and it’s something that can be quite easily seen to, and it would help me just to set my mind at rest, you know, and it’s seems just a simple thing to sort of spot and it just seems to fall on deaf ears.

And do you feel that you’ve brought it up a number of times now.

[mm mm]

And is it something you could raise again or is it?

Well, I could raise it again, we live in hope, but at the moment, my GP, she’s going to be on maternity leave so if we get an half decent young man or young lady, you know, who knows? But keep bringing up the same thing all the time, it probably might think you’re a whinger and things like that. And I mean, these days, you don’t need much, they don’t need much of an excuse to get rid of you off of their books and I’m always aware of that.

Ronald’s diabetes is totally under control. The biggest impact comes from mobility problems.

I think the biggest impact would be the pace pacemaker, followed by the cholecystectomy and then diabetes because diabetes is, you know, it’s totally under control. They are doing the best that they can sort of do at the moment, and the rest of them just seem to be in the hands of the gods, so to speak. But no, I don’t really let them bother me. It’s just my mobility that, you know, affects me more than anything but psychologically, not at all. I just accept I’ve got it and just get on with it.

Ronald has told health care staff many times that he is having problems with what he thinks is a hernia. Nobody responds to him on this issue.

And would you like more help with any of your other conditions, or is the one that gets the most help about right or?

Well, the cholecystectomy, there’s not much they can do. The only thing that I may have is a hernia but I’ve mentioned this so many times to my GP and various other people, and they don’t seem to offer a comment at all, which I think, you know. Because I am a bit lopsided and I know what a hernia looks like, and not many people seem to be interested. But it doesn’t cause, very very little physical discomfort. 

The only thing is, I have to lie on my right side when I sleep because it’s the most comfortable. Other than that, nothing really affects me much at all.

Do you feel that the GP prioritises different things to you yourself or.

No.

Is the match about right or? 

I don’t I don’t know really this, you know, it’s a case of I would think, there’s a job to do and he just sees so many people, and it’s just one of those things. I think it’s the system rather than the doctor.

Ronald suggests that his GP does not always listen properly to his concerns which, if addressed could improve his quality of life. He believes this happens because doctors see so many patients.

Could I just ask you if you’ve got any messages that you might give medical professionals, about how they could improve the care that you receive for your different conditions?

No, most of them are doing a very, very good job. The ones that I visit quite often, it’s just there just needs to be a little bit more care and attention. If somebody has asked you about a problem more than once, then please listen and do something, you know, because it’s not a waste of time. It might be a waste of time in the GP’s eyes but to the patient who’s got to live with it, it could mean a better quality of life.

Okay. Do you feel that the GP prioritises different things to you yourself or.

No.

Is the match about right or? 

I don’t know really this, you know, it’s a case of I would think, there’s a job to do and he just sees so many people, and it’s just one of those things. I think it’s the system rather than the doctor.