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James - Interview 36

Age at interview: 82
Age at diagnosis: 81
Brief Outline: James is on alendronic acid once weekly and calcium tablets two a day. He also takes Omeprazole and Domperidone for his acid reflux. For a dysfunctional bladder he takes amitriptyline at bedtime. He had vertebroplasty surgery done three times to repair collapsed vertebraes but the last time it was unsuccessful and is waiting to have it done again.
Background: This person is a retired teacher, lives at home with his wife and both are in their eighties. James recommends vertebroplasty to others because he says that he enjoyed, albeit briefly, its benefits.

More about me...

In 2006, James started having lower back pain and consulted his GP about it. The GP didn’t attach any urgency to his symptoms but referred him to the hospital as a non-urgent case and in November 2007 he was called for an MRI scan. By then, James was experiencing lots of difficulties; getting in and out of bed was difficult, his back would go into spam and getting up from a chair was also a problem. James realised that there was a more serious problem when he saw the consultant and was told that the MRI scan found he had collapsed vertebrae. He was offered vertebroplasty surgery.
 
In April 2008 James went into hospital to have vertebroplasty surgery for his collapsed vertebrae. James says that the procedure did work for a while and he felt comfortable and able to do more because he had no serious back pain or spasm but a couple of months later he was diagnosed with another collapsed vertebra and the same procedure was repeated with equal positive results on his quality of life. But when vertebroplasty was done to repair a third collapsed vertebra, the procedure had to be stop because the paste began to leak. James was made aware that paste leakage into the blood stream is a main risk in such a procedure. Despite this, James recommends vertebroplasty to others because he says that he enjoyed, albeit briefly, its benefits. At the time of the interview he was booked to have his third vertebra done again.
 
James is eighty-three and until two years ago he says that he had the strength and energy to do what he wanted and needed to do but his level of activities and mobility has been gradually and drastically reduced by his back problems. He loves gardening but it is one activity that he can no longer do. He took pottery after retirement but his back no longer has the kind of strength needed for him to pursue this. He is able to walk for no more than ten minutes and able to do short car drives. Consequently, he and his wife have been unable to go on holiday for the last three years. James says that it is difficult to come to terms with physical limitations.
 
Jame’s’ wife is also over eighty and James has been her carer for many years but she does not need any physical-type of assistance. Their daughter used to live close by but recently has moved to live abroad. They have one neighbour that they could call upon and their other two sons live in other parts of the UK.
 
Regarding household organisation; they have two hours of home help each week and therefore they don’t do any heavy housework like changing beds, hovering, etc. They shop once a week in a supermarket that packs and then delivers their groceries straight to their kitchen table. So, James says that it is a question of keeping their home tidy and comfortable and doing the cooking and washing up. James says that they have a well balanced diet but one that is simple and does not require lots of preparation.
 
Pain continues to be a problem but it varies from day to day. He manages it by resting in the afternoons and when it is very bad he has to lie in the mornings as well and takes paracetamol. At the hospital he was told to limit his activities and not to try and push through the pain barrier but he hasn’t received comprehensive advice on this matter. He manages by using common sense.
 
James is on alendronic acid once weekly and calcium tablets two a day. He also takes Omeprazole and Domperidone for his acid reflux. For a dysfunctional bladder he takes amitriptyline at bedtime.
 
 

After seeing his GP for backache, James was referred for a non urgent MRI scan, which found that...

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Well my back pain goes back to the beginning of last year perhaps if I’d stopped to think about it just before Christmas the year before so that was in 2006. I saw my doctor, Doctor [name], and he didn’t seem to attach any great urgency to it so I had to go back to him later because I’d had correspondence with the hospital and they said my case wasn’t urgent. It said it would be some weeks before I could be assessed and possibly have an MRI scan. I had to go back to him to say that the condition was not comfortable. And then unfortunately we have an accident in the house with the plumber and he did a lot of spilling of, of the fluid when he drained the radiators.
 
Well, that entailed a lot of packing up from the rooms that were affected and getting rid of quite a lot of stuff. And that put a strain on my back and that’s when things deteriorated very noticeably.
 
It wasn’t until the November that I then got another call from the hospital to go back for an MRI scan.
 
By that stage I was in a lot of difficulty getting in and out of bed was very difficult, my back was going into spasm, getting in and out of bed, getting up from a chair was just as difficult sometimes. And it was then that they realised that there was a more serious problem and the assessor sent my name to Mr [consultant’s name] for his assessment. And then from the MRI scan which I had a collapsed vertebrae was diagnosed. I went into hospital in April for two collapsed vertebrae. 
 

James’s level of activity has been greatly reduced and he said that getting used to that was one...

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Ten minutes is about the average, yes. Just occasionally I can do a little bit more but they told me at the hospital not to try and push through the pain barrier.
 
And before you started having this backache how much were you able to do in terms of walking?
 
Well, I have, I suppose until about four years ago I could do a couple of miles quite easily, before that very much more. I’ve been quite an active walker.
 
How old are you now?
 
Eighty three.
 
Late seventies you were still walking quite ….?
 
Oh yes, quite comfortably. And I must say until then I, I thought I had the strength and the energy to do what I wanted to do. What I needed to do which was fine. It’s been very difficult coming to terms with that.
 
So it’s basically just within the last couple of years that you have to limit what you do?
 
That’s when there’s been the serious decline.
 
And how did you feel about it?
 
I totally unprepared I would say. People tell you about old age but until you begin to experience it you simply don’t have the full knowledge or the full conception of that. And that’s, that’s been the difficult bit.
 
I suppose there’s some element of disappointment that life is ending like this. But otherwise I think I’ve been reasonably philosophical about it. There isn’t much alternative [laughs]. 
 

James’ mobility is severely affected but he can still drive short journeys.

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Ten minutes is about the average, yes. Just occasionally I can do a little bit more but they told me at the hospital not to try and push through the pain barrier.
 
And before you started having this backache how much were you able to do in terms of walking?
 
Well, I have I suppose until about four years ago I could do a couple of miles quite easily, before that very much more. I’ve been quite an active walker.
 
How old are you now?
 
Eighty three.

 

Late seventies you were still walking quite ….?
 
Oh yes, quite comfortably. And I must say until then I, I thought I had the strength and the energy to do what I wanted to do. What I needed to do which was fine. It’s been very difficult coming to terms with that
 
It’s one of the reasons why since I’m in the way that I am she’s (wife) in the condition that she is we can’t travel very far. I can still drive and so can she but twelve eighteen miles is my limit because if I go that distance in order to do something I have to bear in mind that I’ve got to travel and drive back again. If we have to do anything longer than that until now my daughter or my son in [city] has come over to take us. But my daughter has gone to Spain and she’s no longer around for us to be able to call on her.
 
Until now I’ve been fortunate in that my daughter’s been able to take me. And she did so the last time I went in June before she left for Spain. Fortunately, my immediate neighbour was able to come and collect me when I was ready to leave the hospital and that was a great help. But when I have to go in September I don’t know what’s going to happen. It’ll probably mean I’ll have to get a taxi.
 
Have you talked to your doctor, to your GP or to the hospital people about it?
 
Yes, I understand that there is a facility but as it happens the operation takes place in the private hospital. They have the equipment there to do this procedure, the vertebroplasty procedure, and I was told that they won’t take people to a private hospital. Now, I have to confirm that.
 
You are an NHS patient.
 
Oh yes. 
 

James says that because he is not exercising a lot he now has small, simple meals.

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I think we have a pretty good diet but we keep it as simple as possible which makes sense.
 
What do you mean? Can you tell me more about it? 
 
Well, we wouldn’t spend a lot of time each day preparing a big meal. We, we do have a roast joint once a week. But otherwise we buy in things like fish cakes or prepared meat pies. Things like that and the evening is, is a small meal. It still has to be prepared as, as does breakfast of course. But again, we keep that simple so that it’s either cereal or, or porridge. It seems the only sensible thing to do but after all if we’re not exercising an awful lot we don’t need heavy meals do we.
Just enough to be of adequate nutrition.
 
We try to keep a sensible balance of, of fish and meat, eggs, cheese that kind of thing. And, and such vegetables as we feel inclined to have or prepare and cook.
 

Recognise that as you get older your strength and energy will become limited. It is not just...

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I probably lifted something which was too heavy for me on my own but given the circumstances and the need to move as much stuff as I could I just did what I felt able to.

 

And as I’d said earlier I seemed always to have the strength and energy to do what I wanted to do [laughs]. But this time I pushed it too far.
 
I suppose the important thing is to recognize that as you get older your strengths, your energy becomes more limited and you have to take recognition of this fact. I remember my old tutor in London who was roughly the same age no, I’m sorry, he was not quite as old, I think he was about seventy five at that stage. And he himself was unwell for a short time and when he came back for more tutorials he said, “One’s body has to be cosseted.” So I think that’s a fair summing up of what’s necessary but it’s a very difficult thing to do. It is a slowing down process and we don’t always realise it.
 
The other thing that is difficult is one’s parents have got older, relations have got older and they may seem, say things about being old but you never quite understand what it is that they are going through and that you yourself will be going through at some stage. That’s quite hard and it must be quite hard well, it must have been quite hard for them to think that people didn’t fully understand what they were going through. And how does the younger generation fully grasp, fully understand what it is that you’re going through now, what you can do and what you can’t do. Not easy.
No, and some people don’t want to talk about it, can’t talk about it and perhaps there isn’t an adequate language to deal with it.
 

It took a long time for James’s collapsed vertebrae to be diagnosed because his GP referred him...

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I suppose when they discovered that there were the collapsed vertebrae it would need treatment and they could give treatment, I did begin to wonder what the condition had to be for the doctors to pick this up earlier and get a referral to the hospital before it actually happened in my case.
 
How long were you going to the, to the GP complaining about back pains, before he referred you to the hospital?
 
It could have been over a comparatively short period perhaps two or three months but because he didn’t indicate that he considered it anything urgent the response from the hospital was that because the doctor hadn’t indicated that it was an urgent case they couldn’t fit me in for an MRI scan and it took several months before that happened.
 
It wasn’t until the November that I then got another call from the hospital to go back for an MRI scan. By that stage I was in a lot of difficulty getting in and out of bed was very difficult, my back was going into spasm, getting in and out of bed, getting up from a chair was just as difficult sometimes. And it was then that they realised that there was a more serious problem and the assessor sent my name to Mr [consultant’s name] for his assessment. And then from the MRI scan which I had, the collapsed vertebrae were diagnosed.
 
 
 
 

James has had two vertebroplasty to repair collapsed vertebras.

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I went into hospital in April for two collapsed vertebrae which they proceeded to fillwith the paste with the treatment or the procedure as they choose to call it. And for a little while after that I was relatively comfortable. There was no serious pain, spasm. I could walk more easily and more comfortably. Things began to go wrong again and so I was sent back for another MRI scan and they discovered there was yet another collapsed vertebrae. That was dealt with in June of this year and at first for just about a week, it seemed very much better again. The back pain was less and I was able to walk more freely again. But when they discovered a third vertebrae had gone I’ve had to go back for the for the third treatment and they had to stop the procedure because the paste began to leak so that any benefit from that third filling didn’t last very long. And the result is that I have to go back now on the ninth of September. They hope then to complete the filling of that third collapsed vertebrae and I think it’s a question of seeing that through.
 
Now, would you recommend this procedure to other patients.
 
Yes, certainly, yes. Well, when you’re in pain and difficulty you need whatever support or help is recommended and I don’t have a problem about going into hospital. If that kind of help is available I’m extremely glad to take it. And in addition to that of course I for short times after the procedure I’ve derived some benefit. My, my walking has improved. Unfortunately, it didn’t last very long but that was only because there was a collapse of the third vertebrae. And I’m hoping that when I have it done again in September that will be corrected.
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