Weight change & associated health problems

And then when I went to have this process of the gastric band my diabetic nurse were such a support to me and she and the dietician at the diabetes centre helped me through that process of finding the right thing. So, through that process they asked me would I go and see a psychologist to talk to me about a complete lifestyle change. So, I had that advantage that I did go and see him for about six times and he were brilliant. So, I knew before I went to have the gastric band that everything was going to change.

So, I started putting weight on again until I’ve got to the stage now where I’ve become diabetic and this was diagnosed just over a year ago.

But I’m on the borderline and I can stabilise it with diet. So, I’ve had two blood tests and I’ve just recently had a third, but I haven’t had the results yet. Both of the first two were just on the borderline and so I only keep to a diet. I’ve been to lots and lots of diabetic sessions that have been organised by diabetic nurses at the different surgeries that I’ve been to because with having moved, I’ve had to change doctors, and everybody’s been brilliant. There’s a diabetic care, care call that rings me up to keep me on track with the, with the X-PERT diabetes course that I took and it’s been fabulous.

Okay.

So I’ve had all the tests, diabetic retinopathy and all kinds of tests and everything’s been absolutely great. So, fingers crossed, you know, I can really get on top of it.

Because when I was first diagnosed, you know, you think, ‘Oh, what do I do, you know, who’s going to help me?” and believe you me there, I have had so much help, it’s just untrue. Absolutely excellent.

From?

Well…

The diabetes nurse?

Well the whole diabetes thing in [City] has been fantastic. I get, as I say, I get, I’ve had the courses and the follow up is the diabetes Care Call and they’ve been absolutely fabulous.

So they called you once…

I’ve had three phone calls and the lady who’s, who I speak to, [Name], she keeps me on course with talking about my diet, different things that I could be doing and all kinds of things, suggestions. Just a myriad things. So, I’m very, very lucky I count myself as being exceptionally lucky because I’ve got this and of course I see the diabetic nurse in the medical centre twice a year.

And the advice came after you were diagnosed?

Yes, yes.

Okay and how do you feel about what was offered at that point?

It was fine from that point. I think because [nurse] specialised in diabetes and she’s very much a people person. I think that’s another thing as well, I think you need to know how to approach people to get across to them that you’re not having a go and saying, you know, “You’re just fat. You need to do something about it.” That’s not going to work. You need to be able to talk people through it properly and say, “Look, your weight is an issue. You know, at your height, you know, and your, your build, we should be looking at you being x-amount,” and a realistic sort of thing and saying, “Well look we need to start….” which [nurse] did. But up to that point, no.

Okay.

But after that, it was fine, there was support there and there was encouragement and there was, [nurse] would be like, “Yes. That’s great. We’ve lost another four pounds.” And, and sometimes I’d say, “Oh, it’s only four pounds.” “You’ve lost. You’ve not put on. So, let’s be positive, you know. Let’s try more for the next month or the next quarter, or the next six months, but you’re not putting it on. It’s still going down.” So, I think that’s it.

It’s a lot of encouragement.

Yes, yeah and I think you’ve got to have some of that to, because you need, you need the, the stick and you need the praise. But you need the stick in a way that you’re going to respond, and not just say, “Well I don’t care what you say because I like food.”

So, you have a good rapport with her?

Yes.

That helps.

and the other nurses there and the receptionist and as I say, Dr [name of Dr.] as well. 

I'm sort of interested to find out when you were diagnosed with osteoarthritis, did they talk to you about your weight and how to lose weight?
 
No. No, to be fair to them I think they were probably just more focused on keeping my alive because I was quite poorly. I was forty-eight hours from a coma and multiple organ failure, so I think they were probably more concerned about keeping me alive. And the antibiotics they were giving me were just so toxic – they have to test your blood every day to make sure that the antibiotics they're giving you aren't killing you [laughs]. How could this be, you're giving me something to make me better. Yeh, but it could make you really ill. Oh, OK, carry on then. The diagnosis on my ankles and my feet was just literally an aside from that. It was... but it did make me think, 'Well at least I know now why the tops of my feet are always painful,' and that’s why because of the wear and tear. So, it was very much an aside that no... but nobody ever sort of took it up. I think, as I say, they were more concerned about keeping me alive.

If you have talked to health professionals about the weight, especially after you had the heart attack and things like that, have you explained these things to them?

No, I can’t.

Why not? Do you think….?

It’s just not come around I don’t think. It’s, I don’t think it’s, it’s, I want to, you know, what I mean but I haven’t really had the chance to see any yet, the doctors after my heart attack. I’m seeing them next month. So really I did see a nurse about that, a nurse, a rehab nurse, but that was only to see how I was doing as, as, straight after I came home, so not about healthy eating. She just said, “You’ve got to healthy eat, live healthily and, you know, eat your five a day and eat plenty of protein for your everything else,” you know, and no reason, no how am I going to do this budget and how am I going to do this, you know, the actual paying for it.

I think they should work with each other with the person more closely looking at it holistically, like I said before. If you, if you look at the whole person and the situation around them you can get a fair idea of whether they possibly may be able to afford to healthy eat or not, so the best way is to find out if they can. If they’re not, they’re not going to choose the healthy option. They’re going to choose the, to be honest it’s cheaper to eat out at a McDonalds than it is to eat healthily.

So, they don’t give us an option really. For people who can’t manage it, they’re going to opt for a take away aren’t they?
 

So it seems to me that what you would like is to have a kind of review of both of your condition, the medications and the healthy eating or healthy lifestyle.

Yeah, the more, I think holistic, I think holistic…

Holistic, yeah.

…..approach. It’s not, that’s there, that’s there. It’s bring them both together and saying well, “You’re doing that, you’re doing this.” It, it’s fine for anybody to say, “Oh, you’ve got to lose weight,” and you think yeah I know but, “you’re giving me this, if I reduce that will that help or if, what is the thing that’s making counteracting with each other? Is there something?” you know, I’d love to have more knowledge if there a certain food type that disagrees with beta blockers, so if you’re on beta blockers don’t, try to avoid. Not, not just standard carbs and fat, because we all know that, but is there something that perhaps is linked. Is there some enzyme or something that is, is created? I know it looks like you’re trying to find an excuse but it’s, I really feel there’s, there’s something there because the biggest change for my life has been all this medication that I’m now suddenly on and nothing else.

You need intervention to find what is interfering with what?

Yes, it would be lovely to have the research or to find out especially when so many people take this medication now. You know, I know, I know people have said, “They’ve lost a bit of weight here, they’ve lost a bit of weight,” but in general most people that I’ve spoken to on the groups of social media have said, you know, “It’s a huge effort, you know, and a lot of people are a lot more ill than what I am and they still said, “It’s so difficult,” you know.

Have you asked this type of question to health professionals?

To the cardiac nurse the last conversation I had, and she said, “Go to the Slimming Club.” And it is difficult because they have, they only have so much information that they can give you, but that was her, that was her advice.

Okay, but you would like more kind of targeted information?

I think targeted information, and also, again being able to sort of control things from the medication front myself a bit more. Having a bit more input with that and I know that, that cardiologist could listen to me and think, ‘Well, what does she know.’ And I could be doing, and I could, you know, do it for a week and think, ‘Actually, I feel really unwell by doing this. They were right all the way along.’ I’m quite happy to take that chance for a few days. It’s, it’s being able to, I feel certainly for cardiac patients there’s, the, the big three medications you’re given are the statins, ACE Inhibiters, beta blockers and it’s like a, “That’s what we give you. That’s what we give you...” and there’s no because the evidence has shown they are good, they bring good results which is fine, but I feel that I’m not, I can’t, I haven’t got the chance to say, “Can I change it a little bit?” Can I, can I lower it? Can I do it?” And them saying, “No you can’t,” sort of thing.

That’s where I feel a bit frustrated and I could be totally wrong, and I know that. I could try it for a week, as I said, and have palpitations or have whatever and then I think, “Actually they’re right. It’s not that then. I’ve got to try and find another solution or, or live with it.’

But just being able to try, not just eating well, which is what I’m doing, but let’s, let’s try tweaking this one, see if that helps as well.
 

Were the doctors or nurses suggesting that you ought to lose the weight, the extra weight?

Yes.

Yep.

Yep, especially the rheumatologist ,…….Yeah. …..you know, she kept saying, “That’s you put on another two kilos, Joan,” and I was like that, “I know.” And she had written to the GP to ask if they would discuss the weight management with me.

Okay.

The GP didn’t. I brought it up and said, “I would like if you could refer me to the weight management at the Health Board,” and the GP was like that, “Good idea. Okay I’ll put the referral off for you.”

Okay. The rheumatology was the one that has been encouraging you and said, that, “losing weight has a very positive effect on your,..?”

Yes, what she said is, “If you continue to put on weight, I don’t know how long you’ll be on your feet,” so that was a really good motivation, you know, because I was really struggling with walking.

Okay and she was blunt?

She was, and do you know, I would rather as much as a lot of the truth hurts, I’m more perceptive to people who are completely up front with me rather than, ‘Oh well,” you know. Whereas she was like, you know, “You really need to lose weight. You’re not doing yourself any favours. It’s up to you. I’ve told you what my opinion is.”
 

So the diabetes nurse gave you a shock in 2012, when she said…

Yes.

If you…

That was what that was what kicked it into, that was a diabetes nurse who basically said, “Look, you’re not managing it probably and, if you don’t, this is what’s going to happen to you. Your life expectancy is.” [aah] [Laughs.] “So and you’ve got to lose weight and you’ve got to do this.” And that that’s what started it off and that was followed up I think after six months but that nurse left. That the shock was what was started me monitoring it myself and I’ve kept that up since. That’s demonstrated to me personally that I can correlate between how I feel and how much I weigh and how much, and my blood sugar, if I if I put on weight, my blood sugars go up and, if I take off weight, they come down. And it that, it correlates more to that than to anything else.

Do you think the nurse who actually gave you a fright, how did she put it? Was she kind of forceful?

Yes, she...

How did she do it? Can you explain to me a little bit more?

She was quite straightforward and she told me that I, you know, that I wasn’t helping myself. You know, we can give you all these drugs but you’ve got to help yourself and you’re not controlling it and the reason you, and you’ve got to control it because you’re going to have to diet more. You’re going to have to do this, she emphasised the weight and she told me that if I didn’t control the weight and the blood sugars and the blood pressure, my life expectancy was and she went into the computer and she put my weight in and she did this and she said, “Oh well, you know, you’ve got this many years.” And I went ‘Oh that doesn’t sound very many’.

Okay, so.

Shock treatment.

Shock therapy.

And she gave me another copy of what I’d already had, the diet and she said, and the other thing she said was, “At that stage,” she said, “If, you’re going to have to go onto insulin.” You know, I wasn’t on insulin then. I’m still not. And so she, she painted quite a bleak picture and she had a follow-up more frequently than my normal follow-up had been.

When I went back to her, I had lost weight and my blood sugar had gone down and she very much pointed that to me.

Okay.

And she, that was the kick-start. That was the kick-start.

So she really frightened you.

She frightened me, yeah. I was getting, I was I was bumbling along whereas, subsequently, she’s left now, she did me a lot of good. Thank you very much. I don’t know where she’s gone. Now I go in for an annual check-up and they’re, “Oh yes, Mr [Name], you’re doing very well and this is very good and that’s very good.” And it’s much more pat.., that’s not what, I need a, you know, they don’t say, “You need to lose another five pounds.” Which is what, you know, I know that. But they don’t tell me that.

The only dietary advice I’ve been given was basically in connection with the heart condition and I was told in 2015 that I had, had a heart attack and that I was also suffering from heart failure and as a consequence of that they didn’t actually send a dietitian to speak to me but the cardiologist and the heart failure specialist nurse advised me on dietary matters and how much fluid to take and all this, that and the other. But because of the drugs I was taking at the time for the epilepsy he couldn’t find a diuretic to reduce the fluid retention. They have done now.

How did you find that advice? Was it sufficient?

No.

What else do you think?

No, I could, I could do, I think with finding some form of regular exercise that’s not going to exacerbate the problems that I’ve already got and the main one there when it comes to exercise of course is the osteoarthritis. The secondary one would be the shortness of breath through the lung condition and the heart condition. But apart from that if I could find some sort of exercise where I could gradually lose weight, I’d be a lot more happy.