Bernard has mild diabetes and heart disease and had a bypass operation 5 years ago. Shelley has osteoarthritis, insulin-dependent diabetes and Charcot’s feet. Both had been monitored for mild kidney impairment. A few weeks ago Bernard was admitted to hospital with pneumonia and his kidney function rapidly declined.
After he had been recruited for this study on the basis of having a mild kidney impairment, Bernard contracted pneumonia and was admitted to hospital, where he had to stay for a month. During his hospital stay, his kidney function declined rapidly. He was interviewed one week after returning home from hospital.
Bernard says he has enjoyed good health for most of his life and likes to stay clear of doctors and hospitals if he can. His wife Shelley, an ex-psychiatric nurse and social worker, takes care of health matters for both of them.
In 2000, Bernard had a mild heart attack. He was prescribed medication but he did not feel affected by it in any major way. However, around five years ago his heart rhythm started to fluctuate. He was admitted to hospital and eventually had a bypass operation. Three years ago, Bernard was also diagnosed with Type 2 diabetes, but he has not needed any medication for it and now is no longer supplied with tests sticks either, so it does not really affect his day to day life. Bernard currently takes bisoprolol, aspirin and simvastatin. He also used to take amiodarone, but since his recent hospital admission for pneumonia, he has stopped amiodarone and started taking furosemide.
Shelley also has Type 2 diabetes and she and Bernard attend their 6 monthly GP check-up appointments together. Shelley also sees a hospital consultant once a year. Shelley’s diabetes is more severe and much more long-standing than Bernard’s and she has developed Charcot’s foot in both her feet. (Charcot’s foot is a progressive degenerative condition that affects the joints in the feet and occurs as a consequence of peripheral neuropathy, i. E. nerve damage in the extremities). This means Shelley can’t wear normal shoes and finds it very difficult to walk about. She also has osteoarthritis in both her knees.
When Bernard was well, he used to do the cooking, shopping and housework. Shelley is angry that when Bernard was assessed for his support needs before discharge, the occupational therapist did not take into account that he used to be Shelley’s main carer as well. Now that he is weakened from the recent infection and needs to rest, they rely on the support of friends and neighbours to manage somehow. They are currently waiting to have a home from hospital’ social services assessment to try and get additional support with practical tasks. Shelley contacted the council to ask for meals on wheels on a temporary basis. She also wears a CareLink necklace to call for help if she should fall over and they have had a key safe fitted to the house so helpers can enter without them having to come to the door. They would much prefer to manage independently but realise that at the moment they need outside help.
Bernard and Shelley have routine kidney checks as part of their diabetes clinics. Shelley usually asks about test results for both of them. Shelley and Bernard were aware that Bernard had high levels of creatinine in his urine, but were told that these values were normal’ for him. Before his most recent hospital admission, Bernard’s creatinine levels were around 150 but the infection in his body made it rise to 300. Shelley is confident to ask questions and seek out information whereas Bernard usually takes a back seat and trusts his wife to lead the discussion. They both found feedback on tests to be much more detailed in hospital compared to what they are told by the nurse at the diabetes clinic. Shelley and Bernard have had dietary advice and lots of leaflets as part of their diabetes care, but nothing specifically addressing kidney health. They eat a low-salt diet and Bernard does not drink any alcohol. After Bernard’s recent decline in kidney function, Shelley went online to find out further information about the symptoms of kidney disease.
Shelley regularly helps out with teaching at her GP surgery as a test patient for medical students and has found this to be a good source of information about health matters in general. It was during one of the teaching sessions that she found out that she herself also had a kidney impairment, when she overheard the GP explaining her case to a student. She was shocked but not surprised’ because she knew that kidney impairment is a possible complication of diabetes.
During a home visit following his discharge from hospital that happened during a break in the interview, the GP explained to Bernard that his heart condition had resulted in excess water retention in his body. The diuretic (i. E. water-removing) tablets he was given to reduce the water retention had made his kidneys work very hard and as a result his kidney function had decreased quite rapidly. By reducing the diuretic medication (furosemide), his GP hopes that Bernard’s kidney function will start to show some signs of recovery. Bernard will continue to have close monitoring of his kidneys with frequent blood and urine tests over the next few weeks.