A-Z

Living with multiple health problems

Interactions between different symptoms, conditions and medicines

The people we spoke to commonly pointed to confusion around whether the symptoms they experienced were the result of:

•    a particular health problem, 
•    the side effects of a (perhaps new) medicine, 
•    some kind of interaction between a medicine and an existing health problem or 
•    interactions between one medicine and another. 

Some diseases had the ability to complicate things more than others e.g. epilepsy and diabetes. Pat described how her diabetes was made worse by other conditions and drugs, although she was unsure whether high blood pressure was a cause of her diabetes or a result of it. David was taken off a beta-blocker that he was prescribed in hospital because diabetes staff were concerned that it could shield the symptoms of a diabetic “hypo” which could put his life at risk.
 

Pat isn’t sure whether high blood pressure causes her diabetes or vice versa. Diabetes complicates other conditions. Recent treatments and investigations have badly affected her diabetes.

Pat isn’t sure whether high blood pressure causes her diabetes or vice versa. Diabetes complicates other conditions. Recent treatments and investigations have badly affected her diabetes.

Age at interview: 80
Sex: Female
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Have you got any other health problems at all apart from, apart from the diabetes?

I have raised blood pressure of course, but I don't know whether that's cause or effect. My cholesterol is higher than they like it, but none of the statins or fibrates suit me at all and I've tried about five different types. And so now I just manage it partly through diet but also… well, this is commercial, Benecol - the drink which the consultant advised me to use. And I mean it's not terribly high, it's five point two which in most people would be considered okay, but with diabetes obviously they like it to be lower.

Blood pressure treatment, I have two tablets a day, I was on three and recently I had quite a low blood pressure, it was actually a hundred and fourteen over forty seven. So I was passing out, so that had to stop. 

… I regard diabetes as a condition rather than an illness, 'cos I think if, if you label one… yourself as ill… I don't feel ill, most of the time I'm very well. 

But having diabetes does affect other illness, 'cos two years ago I had viral pneumonia and I actually was quite ill.

And my blood sugars were all over the place. And that took some dealing with really, 'cos I was having hypos because the GP didn't suggest that I cut down my background insulin. So I dropped to two point seven two nights on a run. But I rang the diabetes nurses and they said to me, you know, cut your insulin down to eight from twenty four. 

And I had actually had to phone the GP because he'd prescribed an antibiotic which I think obviously I know it was viral, but there were… the risk of secondary infections with diabetes. So I read the information leaflets it said this medication should be prescribed with care in people with diabetes. So I rang the practice and spoke to the GP, and he said, 'oh no, that's fine, it's perfectly alright.' And then of course I had these horrendous hypos which were a bit scary.

So I rang the diabetes nurse for advice and so she told me to cut it down from twenty four to eight. And in fact I've never got back to twenty four I'm only on twelve now. But it was just… First of all they refused to come to the house. I'd been into the practice the previous week saying that I felt really ill, and he gave me a prescription for antibiotics and said, 'don't take them unless you absolutely have to.' It was somebody I'd never seen before. 

The colonoscopy upset my [chuckles] blood glucose levels dreadfully, and that was to do with the…obviously you have to fast and purge and god knows what for two days beforehand, and you have to gradually reduce your insulin and then come off it altogether, and then go back on it. So that, that was quite a…that was quite intrusive really and then I also had a steroid injection for a trigger finger, which also upset my diabetes control. But things do, if I have an infection that affects it. So it's, it's not an easy condition to manage.
People with diabetes and epilepsy also frequently brought up issues of medicines having side effects or not seeming to work (see ‘Different views on prescribed medicines’).
 

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.

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.

Age at interview: 70
Sex: Male
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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.
 

Anne Y says that her medicines make her feel irritable and bad tempered. Forgetfulness and other frustrations are attributed to her epilepsy rather than prescribed drugs.

Anne Y says that her medicines make her feel irritable and bad tempered. Forgetfulness and other frustrations are attributed to her epilepsy rather than prescribed drugs.

Age at interview: 61
Sex: Female
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Do you find you have any side effects from the medications that you take?

Not on, I’m really forgetful now so a lot of things have happened that I should remember, I don’t remember. And I’m usually, my husband says to me, you know, “Oh, you won’t remember anyway.” And he’s quite right. I don’t remember lots and lots of things. Irritable. Bad tempered, I would say, more than normal.

Right.

And insecure in as much as I have to be, know everything that’s happening in my in my sort of situation so.

Right. 

And if somebody says something to me then, as far as I’m concerned, it’s cast in stone. So…

Right. 

Whereas before, you’d, you know, sort of be easy come easy go, now I have to know, you know I can probably say something three or four times to make sure that it’s right in my mind before I can go ahead with various things but.

Right. Right.

I think that’s possibly an effect of that because I didn’t used to be quite so precise but, as I say, I have to know specifically whatever is happening with regards to whatever.

Is that something you feel that has developed as a result of taking all these medications or?

I don’t know if it’s taking the medications or because of the condition. I’m not quite sure which it is. I think I think more the condition than, I think the irritability is possibly through one of the medications.

Right. 

Because he did and, when I said to him I felt I was really aggressive, he did say, “Well, that can be a side effect from the medication.” So that that’s probably all really that I could say and, obviously, of course, the blood problems again because I wasn’t on iron tablets. I’ve had to go back onto those because of big problems that are now occurring with my blood again so.
Fiona and Derrick described having learned how to tell between (perhaps similar) symptoms of different conditions or medicine effects. Fiona learnt how to distinguish between medicine effects and the symptoms of diabetes. Whilst Derrick was still not clear about which condition was causing shortness of breath, he had learned to control his symptoms using trial and error of the alternative treatments. He had also come to believe that he recognised the symptoms of his Chronic Obstructive Pulmonary Disease (COPD) as different to his asthma.
 

When Fiona was first diagnosed with epilepsy she confused the side effects of the medicines prescribed with symptoms of her diabetes. It is no longer an issue now that her body has got used to the medicines.

When Fiona was first diagnosed with epilepsy she confused the side effects of the medicines prescribed with symptoms of her diabetes. It is no longer an issue now that her body has got used to the medicines.

Age at interview: 25
Sex: Female
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Okay and do you find at all that what you need to do for one of your conditions makes it harder to care for any of the others?

Not really. I mean I think, when I was first diagnosed with the epilepsy, there were times where I got confused because when you first take the tablets, you’ve sort of got, you know, like odd dizzy spells and I used to get that confused with my diabetes.

Right.

Low blood sugar and.

Right.

That used to be sort of a bit of a pain, but now that sort of now that my body is used to that medication, it’s not really so much of an issue. But no, I don’t think any of them have really affected the others as far as I’m, from my point of view anyway.

Okay and which of your conditions do you feel that you get the most help with?

From the medical profession?

Yes, yes.

I’d say definitely the diabetes.

Right.
 

It is not always clear to Derrick whether shortness of breath is caused by his heart or his lungs. He learns to control his condition using trial and error of the alternative treatments available to him.

It is not always clear to Derrick whether shortness of breath is caused by his heart or his lungs. He learns to control his condition using trial and error of the alternative treatments available to him.

Age at interview: 61
Sex: Male
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If I could ask you now, your conditions, do you see them as being related in any way? Are there are there any connections or do you see them separately?

Yes, I’d say they are connected, the especially the heart and lung and those two because half the time, with my heart condition and my lung condition, they don’t really know where the shortness of breath is coming from half the time. 

Right.

Is it the heart? Is it a throw off from the heart or is it is it the lungs? I’ve got my for the last year or so now I’ve got my own nebuliser.

Right.

In the house here.

Right.

So that that’s helped a lot.

Okay.

If it’s if it’s the heart I’ve got I’ve got options. I can either go on the oxygen or on the nebuliser, you know, and control it so and learning from one to the other how to control these things.

And how do you know which is the appropriate one to use?

Well, if it’s a throw off from the heart, I’ll have a shortness of breath and afterwards then I’ll feel very tired and I’ll have a have a headache.

Right.

And I know, once I get that headache, I know I know, “Oh, it’s alright, this is a throw off from the heart.” 

Right.

It’s the heart playing up and then, if it’s the lungs that’s playing up then it’s only it’s only to be a shortness of breath, and then once I put the oxygen on and for the lung that will help it and after two hours it’ll vastly improve. 
There are many ways in which medicines and conditions could interact with one another:

•    One condition might make another worse e.g. somebody with arthritis who finds it too difficult to exercise in order to manage a heart or lung problem. 
•    One condition could lead to another, as in diabetes contributing to cardio-vascular disease or high blood pressure leading to a heart attack or stroke.
•    Medicines might clash with each other, making one ineffective or producing side effects. 
•    A treatment for one condition might make the symptoms of another worse or 
•    Produce a new or previously hidden condition (such as “latent TB” in Gog’s case). 

Michael Y had been misdiagnosed due to existing problems, leading to prescription of a medicine that caused memory problems and an increased fear of falling over. Jean could not take a recommended treatment for a heart condition because of other health problems.
 

Mohammed says that multiple health problems bring complications of multiple medicines and professionals. He agrees with how the health service has prioritised his conditions but wonders about side effects.

Mohammed says that multiple health problems bring complications of multiple medicines and professionals. He agrees with how the health service has prioritised his conditions but wonders about side effects.

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Do you think that multiple conditions are an issue in healthcare?

The issue well, multiple conditions are presented so they become issues. If a single condition is presented to the medical profession, then they know what they’re treating. If multiple conditions are presented, then the treatment has to vary that one does not affect the other. I know a pharmaceutical company will accept the fact that drugs don’t have side effects and the concern is that in treating one condition, is it going to have an effect on the other condition that the person is presenting, of course there will there will be a concern and of course there is concern even for the patients. As to the medication they are taking, is it helping one and making the other worse or is not affecting. One doesn’t know and you know as well as I do, a lot of the data from pharmaceutical companies isn’t quite available at public level, or at medical level for that matter, but so yes. And also having multiple conditions means that you are seeing multiple people. People that are specialists in that area, and so it’s a question of who decides to prioritise what, those would be the patients’ concern whether the whether the cardiologist has the priority of the neurologist, I don’t know. So there will be cause for concern.

And do you feel that one of your conditions has been prioritised over another?

I felt yes, my heart condition probably had priority over my diabetes I felt. Whether that is right or wrong, I don’t know, but that is the impression I got.

And is that, were you happy with that or would?

I’m happy with that because diabetes is something that I can learn to live with. My heart condition is not something that I can learn to live with or can control it. If a deterioration is going to take place, it’s going to take place. So will the diabetes but the diabetes is a long term thing and coronary disease is, it’s a question of what rate does it grow and deterioration take place. I’m happy with the fact that I’m given, I’m given the impression it’s a priority rather than my diabetes, yes.

And you just mentioned interactions there in terms of medication in obviously having more than one condition. In terms of medication, or just living with the conditions, do you find, do you notice any interactions at all between the two?

Not so much interaction between the two but maybe slight signs of side effects, but they are clearly indicated in your packaging as well as by your GP, it’s certain there will be some. They are of concern and the concern is, is that side effect making the condition worse or is the medication treating but the side effect is something you have to learn with. That tends to be the concern, yeah. For example, you know, is a medication you are taking to treat an illness, it has a side effect. Is that side effect making the illness worse? I don’t know. That is for you people in the industry to look into and but that would be the only slight concern in my mind, to worsen.
 

Angela was told she is at increased risk of stomach bleeds and infections due to clashes in her medicines. Repeated sickness absence eventually led to her losing her job.

Angela was told she is at increased risk of stomach bleeds and infections due to clashes in her medicines. Repeated sickness absence eventually led to her losing her job.

Age at interview: 46
Sex: Female
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The other thing was that I was told right at the start that the medications I have to take for my, you know, to keep my blood thin and also medication I have for my colitis, I was told that they clash with each other so that there increased risk of me bleeding into my stomach.

Right.

And that it would also compromise my immune system. Now I was working in a school and as well as being school secretary, I was first aider for, I was coming into contact on a daily basis with sick children and I caught everything going. I had five weeks off just before Christmas with bronchitis and then New Year’s Day I came down with the norovirus and missed the first week of the new term, at which point I was summoned by the headmistress and told that my absences were unacceptable and if things didn’t improve, I would be put on disciplinary with a view to ultimate dismissal. They sent me to see an occupational therapist, who wrote a report to the headmistress saying, you know, I couldn’t really hold down a full time job anymore and that aspects of it were causing me significant difficulties, and that I would never be able to give one hundred per cent attendance again. 
 

Jean describes a range of health problems. The risk of brain bleeds means that she cannot take the anticoagulants which would help with her heart condition.

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Jean describes a range of health problems. The risk of brain bleeds means that she cannot take the anticoagulants which would help with her heart condition.

Age at interview: 80
Sex: Female
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The heart muscle was damaged and so, subsequently, I’ve been suffering from angina and heart failure, which went into atrial fibrillation, which I’m in constantly.

Can’t get out of, and this has affected other parts in that I developed diabetes. One of my kidneys doesn’t work very well and periodically I have I have periods of where I bleed in my brain. I have to be very, very careful on anticoagulants because that causes me to bleed in my brain and I lose my balance and I’m off my feet for several days. So it’s like the true devil and deep blue sea really. They can’t give me anticoagulants because it makes me bleed and yet that’s the one thing that would stop the heart, the blood from coagulating and giving me more thrombosis. So we stagger on from day to day. So, basically, that that’s what’s wrong with me is heart failure and also this problem with the brain tissue being damaged right, I go between the two and with the diabetes as well doesn’t help, and recently I’ve started to have problems with my breathing. 

I’ve been on oxygen now for about two years, off and on, but my use of oxygen has become more and more constant. In fact, I can’t get through the night without oxygen now. 
Cross medicine-condition issues seem to happen more often when each condition is treated separately due to their own ‘specialist model of care’. Nigel describes how his treatments are complicated by other ones and again stresses the complicating nature of diabetes when it comes to routine operations. For Nigel, GPs are best placed to provide an overall consideration of a patient’s management and wellbeing.
 

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.

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.

Age at interview: 58
Sex: Male
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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. 
For some people, the confusion, limitations and uncertainty around apparent cross medicine-condition issues led them to re-visit their ideas about what caused their health problems (see ‘Causes of health problems: certain and uncertain’) in the first place. There were lots of examples where people could not have a treatment, or a recommended treatment, because it would interfere with an existing health problem or medicine already being taken.
 

One of Fred’s illnesses makes him vomit, which means he cannot take his diabetes medication. He wonders whether his conditions are related to diabetes.

One of Fred’s illnesses makes him vomit, which means he cannot take his diabetes medication. He wonders whether his conditions are related to diabetes.

Age at interview: 85
Sex: Male
Age at diagnosis: 40
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This Meniere’s Syndrome, does that include heart problems and diabetes as…as part of the syndrome?

No, I don’t know whether it’s impacting, when you get this Meniere’s attack, you don’t want to do anything, you’re vomiting. This week I’ve been vomiting like brown gravy, but… thin gravy browning… just vomiting this stuff up. And as a consequence I’ve not been able to take the diabetic treatment I’m taking, I’d had to miss out on that, ‘cause I couldn’t take anything down. And, I was wondering what the effect is on the diabetic system. Because of it. That was worrying… but the doctor wouldn’t mention… didn’t mention it, and he just said, oh, you know, don’t take these tablets. But I’ve no… I’ve no reason… they haven’t given me any reason, if there was, of a relationship, but he said not, he didn’t say anything. So, I don’t know. 

So the…you were saying that the Meniere’s attacks fluctuate, and you don’t know when one is going to come?

No.

How often…are those attacks, I don’t know, every week, every month? Is…?

I have…the last one I had was about a year ago. This week I’ve had one, two… I’ve had three, very close to one another, and I don’t know whether this is related to the fact of this heart operation that I’ve had, has weakened my resistance, the heart operation and the infections I picked up in the hospital, which I never got over. I don’t know whether that’s affected it, but, um, they’d been a long time before then. They’ve not come very frequently, no.

You’ve already explained one specific problem that you’ve got, so obviously when you’re being sick, you can’t take the diabetes medication. Are there any other issues with your medicines, that you’d like to talk about?

No, that is the major thing that struck me, when I was laying there, thinking is… is part of this problem diabetes related? I can’t… I couldn’t figure that out. I mentioned it to the doctor, but he said… he just passed it off, and I’m still not sure. I’d like clarification though to see if the diabetes is related, but I don’t… I don’t think it is.
 

Rosemary was told she could not have a particular treatment because it would raise her blood sugar. She turned down the treatment but feels anxious about the right course of action.

Rosemary was told she could not have a particular treatment because it would raise her blood sugar. She turned down the treatment but feels anxious about the right course of action.

Age at interview: 67
Sex: Female
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Do you feel that the GP prioritises things in the same way as you do, or is there a mismatch between what’s important to you and them?

Well, there’s never very long with a GP because they’re so overworked and when you’ve got a popular GP of course he, all the patients want to go to him. He’s very thorough. He is good and is very thorough but when I go to the different consultants at the hospital like the diabetic and so on, the rheumatoid consultant. Who else do I go to? They wanted, now, something that happened recently. If I take, “We can’t give you so and so because it’ll make your blood sugar go high.” And that’s the only time I’ve really turned down anything simply because it would have been a worry to me, although I should have all the time in the world to, you know, sort things out. The last thing I wanted was having to having to explain, when you go to the diabetic consultant, why your sugar has gone high, you know.

Because you’re always being told, you’re not really told off but they keep on to you, “Keep it, you know, keep it right,” sort of thing and it’s not always easy to do that, and when you get a flare, when I get a flare-up of what they call rheumatoid, when you see all lumps here.

And sometimes, in fact, I went to my GP for the first time in about a year a few weeks back, the hand the hand was swollen, and you can see it’s swollen now can’t you?

I, you know, I just, what was the question? What was I saying? Oh, I do lose track.

I’ve forgotten now, the question. Just whether looking after one condition makes it harder for you to look after the others in any way really?

Yeah, I mean I think there’s maybe something they could give me or things that they could do, which would certainly affect the diabetes like he said, the consultant, not my GP, that’ll make your sugar high. So you know, it leaves me in a quandary, what do I do?
 

Robert’s previous doctor told him that they cannot operate on his hip due to his other medical conditions. He puts up with a limp as a result.

Robert’s previous doctor told him that they cannot operate on his hip due to his other medical conditions. He puts up with a limp as a result.

Age at interview: 80
Sex: Male
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But I found this morning, actually, my breathing was better and my walking was a little bit better but I do walk with a stick.

Right. 

Because of my hip actually and the other doctor I had, he retired on New Year, he said, “They won’t do your hip.”

Right. Right.

Because he said, “With that crumbling bone and with your heart attack, with your COPD, with.” 

Right. 

So he said, but he said, “You can get it done. You can get it done. There is, you know.” He said, “For instance, if you’re out and about and had an accident and broke your hip, they’d do it.”

Right. Right. 

 “They’d take you in and they’d do it.”

Okay.

He said, “Its hard work to get into hospital.

Yes, and.

But I can understand where they’re coming from so I limp.
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