Mike

In 2010, Mike felt lethargic and noticed blood in his urine. His GP diagnosed hypothyroidism, prescribed thyroxine and referred Mike to the hospital renal unit for further investigations. Mike now attends 12-monthly GP check-ups and feels pretty healthy’.

In 2009, Mike went to his GP because he felt increasingly lethargic and experienced discomfort when passing urine. After some tests, his GP diagnosed him with an underactive thyroid (hypothyroidism) and prescribed the drug thyroxine. The tests also showed up a small amount of blood in Mike’s urine, so his GP referred him to the hospital renal unit for further investigations of his kidneys and urinary tract.

Further investigations at the hospital, including urodynamic tests (measuring the flow of his urine) and a camera investigation of the bladder failed to find a cause for the haematuria (blood in the urine). A historic entry on Mike’s medical record suggesting a more severe decrease in kidney function that had remained uninvestigated at the time could not be reproduced with current tests. So Mike believes that it may have been a one-off erroneous result. The consultants at the hospital reassured Mike that while his kidneys showed a mild impairment, it was quite possible to live happily with just one kidney and therefore he did not need to think of it as a serious problem. Mike continued to be monitored by the hospital outpatient clinic at six-monthly intervals for almost 3 years and during this time his kidney function remained stable. He was eventually offered to be discharged and now is continuing his 12-monthly check-ups at the local GP surgery instead. This is much more convenient for him in terms of time and travel.

Taking thyroxine for his underactive thyroid has helped with Mike’s symptoms of lethargy and he has felt well since. Taking the medication is straightforward and he has not experienced any side effects. Mike’s mother and twin sister both also have hypothyroidism, and the question whether there is a genetic predisposition that he could pass on to future children is a mild concern but not something he has discussed with a health professional to date.

As part of his 12-monthly check-ups, Mike has been given lifestyle advice from the nurse at his GP surgery. He was told to quit smoking, given a leaflet on healthy diet and encouraged to lose some weight. Mike is very pleased that he managed to give up smoking a year ago with the support of an NHS counsellor. However, he was not that interested in changing his diet. While he enjoys regular walks by the seaside, Mike’s desk job means that his lifestyle is overall quiet sedentary and he would like to become a bit more active again in due course.

Mike is glad that he has the option to attend regular check-ups for his kidney and thyroid function and feels reassured that this will help to detect any more serious problems he might develop in the future in good time so they can be treated. However, he does not spend a great deal of time worrying about his health and is happy to leave dealing with the details of his test results to the health professionals.

Mike was referred for professional help to quit smoking. For four months he sucked a nicotine lozenge whenever he craved a cigarette. He hasn’t smoked since.

Age at interview 36

Gender Male

Have you had any lifestyle advice about diet or exercise or anything like that as part of your consultations with the GP or nurse?

Yeah, yeah. I got told to lose some weight and I got told to stop smoking and . So I stopped smoking and that was a year ago and , but I haven’t lost any weight [laughs]. I just haven’t

It’s a bit much both at the same time I guess [laughs].

Yeah, yeah, yeah. My job is fairly sedentary so it doesn’t really it’s not conducive to being a, you know, a fit and active person, but you know, I fully intend to- to look at that and do something you know. But

Was thatwhen did that happen? Was that right at the start in 2009 when you had the diagnosis or?

No, no that was, well it was a year ago I went to see the nurse and it was about this time.

For the kidney and the blood test and she weighed me and and she asked about smoking and , from then she gave me an appointment with the ‘stop smoking’ lady and I went to see her and then following that I’ve given up smoking, and she gave me a booklet about a healthier diet, you know, so that was but I haven’t read it so [laughs]. Yeah so I did the smoking thing but I didn’t do the diet thing.

Well done on giving up the smoking.

Thank you.

How was that did you find that helpful, the ‘stop smoking’ lady? How does that work?

Yeah the- the lady well I don’t know , I don’t know what her sort of remit is but you basically go in and talk about your habit and you blow into a carbon monoxide machine which registers the amount of carbon monoxide that you’re breathing out, and she records that. She prescribes you some stop smoking aids, in my case I had lozenge mints, and then you go away really. She gives you some information, some generic information that you can read up. You go away and then use the- use the stop smoking aids when you feel like smoking, and then go back to see her at a pre-prescribed time, like a month later, and the same process happens again you blow into the machine and then she gives you a bit more of the stop smoking aids if you want, and I’m pretty sure I took it was four months to stop using the stop smoking aids. So it took that long a time to

You did it quite gradually.

Yeah I stopped smoking on thein February lastthe last day was the fourth, and then I was using these pill things, the little mints. Every time I felt like smoking I’d suck a mint and then it would stop me feeling like it, and I was just using those for a while and she said it’s better to keep using the mints rather than smoke cigarettes so, you know, that’s why it took four months to stop. But then, since then that’s, you know, I’ve not smoked in, you know, on theyeah I’m very happy about that.

Yeah. I don’t know whether that’s improved my health, I don’t know. Well I’m sure it’s improved it but I don’t know whether it’s improved my condition that were talking about here.

Yeah mm

But it’s definitely, you know, definitely a good yeah I’m happy I’ve done it you know.

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Mike would prefer to talk to a doctor than a nurse about his condition and test results because they have greater expertise, whereas he would be happy to receive lifestyle advice from either.

Age at interview 36

Gender Male

And who do you think is the most appropriate person to give you information about your kidneys, like sort of clinical information?

The doctor

The doctor rather than the nurse.

Yeah, yeah.

And can you say why you think that?

Well they’re qualified, you know, in that and they’ve studied long and hard to know about these sorts of things. I’m not saying the nurses haven’t but I’m saying, you know, they’re nurses and doctors, they’re two different things aren’t they, you know?

And what about lifestyle advice who do you think is the best person to give you that?

The nurse or the doctor yeah, I think, you know, that’s something that’s probably a bit less specialist so, you know, I’d say you know, either of them can do that. But I don’t know, you know, I’ve got no , no reason no reason why, you know, the nurse or the doctor would or wouldn’t do it, but I think, you know, they’re, you know, they’d both be capable of doing that.

What about receiving your test results who would be the best person to give you those?

Well a doctor but I know that the- the receptionist person does that sometimes. So yeah, I’d rather the doctor because then if you’ve got questions they can answer your questions straight away and, you know, satisfy you about it, whereas if somebody who’s not so specialist, like the nurse, like the receptionist, you know, they might not be qualified to understand your condition specifically and therefore diagnose it, you know, further for you, you know, if you’re got answers the need to sorting out for your results.

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Mike thinks that being given test results straight away could avoid the anxiety that sometimes occurs while waiting for them.

Age at interview 36

Gender Male

But you quite like the instant results because theres now there might a possibility of introducing point of care testing into GP practices as well, like in the hospital that you wouldn’t have to wait for the week.

Yeah

But you could have them there and then, so that would, from your point of view, that would be quite a good thing?

Yeah, yeah definitely yeah. I think they’re quite a good thing for everybody.

Why do you think that?

Well it just saves on a huge amount of anxiety doesn’t it? You know, plenty of people worry more so than I do about things and even trivial things I think they can get themselves in a stupor about and so if the doctor could satisfy them that the sample wasn’t wrong, or something was wrong straight away, then they can act quickly can’t they? And they act to forget about it and move on or they act to repair themselves for whatever the problem is.

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Mike wonders whether his kidney health may have been affected by excess weekend drinking when he was a teenager and young adult but has not discussed this question with his GP.

Age at interview 36

Gender Male

And what is your understanding why you have developed a kidney problem?

I don’t know it might have been lifestyle because I used to drink quite a lot on a weekend you know? When I was a late teenager and early twenties I’d go out and I’d drink alcohol on a Friday and a Saturday night and to excess. I’ve never been into hard drugs or anything like that so that but obviously the kidney is filters all the alcohol and whatnot and there was quite an extended period of time where I’d usually, I’d drink most weekends. I don’t do that now and I’m, you know I don’t really drink alcohol you know; it’s not something so that could have been a contributory factor, if theres a problem, to that problem. You know and yeah it’s foolish behaviour and, you know, that’s

Is that just your personal reasoning or is that something you’ve discussed with a health professional?

No personal reasoning, no I’ve not no, no I’ve not no I’ve not sort of had a discussion about that.

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Mike had blood in his urine and as part of his diagnostic investigations had a camera inserted into his bladder to examine it, as well as a urine flow test. The results of both tests were normal.

Age at interview 36

Gender Male

I did have a camera look in my bladder. That and a [in response to interviewer looking surprised] yeah exactly yeah [slight laugh]

[laughs]

And a flow test, a urine flow test , so yeah I’ve had those, that sort of thing done, but nothing, no sort of scan or anything like that no, no.

Would you be prepared to describe that in a bit more detail because it sounds , how does that actually work, that sort of investigation?

A camera is put in your penis and looked up inside the bladder.

Mm

And that, yeah, that’s as painful as it sounds, yeah. So that was , that’s what I had done yeah.

Were you conscious at the time or did you have an anaesthetic?

Yeah, no, no. There was anaesthetic used I’m sure yeah, yeah but, you know, it’s extremely uncomfortable.

Mm

And I wouldn’t want to do it my eyes are watering now thinking about it again [laughs]. So yeah it was extremely uncomfortable but the it was needed to do because of the I was having discomfort urinating and it was all part of the same, you know, in the same thing, to eliminate potential problems for the blood in the urine, you know? So yeah so that was that, and the flow test you wee into a special contraption on a that’s fixed to a toilet and it measures the rate that you can urinate at. So if you’ve got restrictions yeah.

[laughs] Sounds like a competitive sorry, it sounds like something you can use for competition.

Well yeah I suppose you could reg [laughs] you know, record the speed and yeah and do it that way. So- but there was nothing, with either of those there was no problem, you know, there was no issue.

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Mike explains what happened when he was having check-ups at the hospital renal clinic and that he appreciated learning his test results straight away.

Age at interview 36

Gender Male

Was it mainly a consultant you spoke to at the hospital or were there specialist nurses as well?

Yeah, yeah there was specialist nurses who’d take your blood and weigh you and do your blood pressure and then there was a consultant you’d sort of go and do several things at once. You know, you’d sit there for a bit and then you’d go and have your blood done, then you’d go see a consultant a bit later on, and then they would tell you either to come back again or, you know, or whatever. So, so that was how it sort of worked, there was different people to do different things. But you were mainly there to see the consultant I think. He would look at the results of your blood tests and your urine tests and they must do it there and then they must somehow have a way of testing your blood and urine straight away, so- to give you some feedback straight away.

So yeah that’s probably what the waiting round was you were waiting for things to be looked at and analysed and measured, and then you yeah the last person you’d see would the consultant and they’d tell you, you know, what they’ve found and obviously they’d do a bit of an examination and, you know, take appropriate action there. So yeah, the final time the guy said, “Don’t come back again, you know?

And did you like having your results available so quickly?

Yeah, yeah that was- that was good. I was quite impressed with that because, you know, that doesn’t help anybody waiting around to find out if theres something wrong with them or something right with them, so yeah that was quite a goodthat was a quite good thing to be able to find out straight away.

And how long ago was it that you were discharged back to your GP?

I’d say 2011, 2012 something like that?

So about three years ago now, two years ago.

Yeah, yeah.

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Although Mike suspects he was originally told details of his kidney performance he cannot remember any specific values and doesn’t understand whether he still has a kidney problem.

Age at interview 36

Gender Male

And were any values mentioned with that? So when you talk about how your kidney function has developed over the last few years since you have been monitored, do you know what your current values are?

No

Whether they’ve gone up or down or just stayed the same?

No, no I can’t remember. I did see some values at the time on the screens that they had and they may well have mentioned ranges of normality, so I’m sure theres been values discussed, but as far as remembering what it is, no I don’t know what I don’t even know what they use to record the function.

I don’t, I still don’t fully understand what, you know, what the situation is because, you know, they just said that I’ve got to be constantly monitored now, but whilst I don’t know whether I did exactly have this nephrosis thing or whether I still do or or whether I’ve got a future risk of getting something like that, I, you know, I’m not sure that I’m not entirely reassured, you know, with the current status of the condition.

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