Joan - Interview 10

Age at interview: 73
Age at diagnosis: 69
Brief Outline: Since her forties Joan has had several wrist fractures that were not investigated for osteoporosis. It was only when she fell and fractured both her arms that the diagnosis came about. She was put on medication; alendronic acid but due to side effects it was changed to Strontium ranelate.
Background: Joan is a widow with three adult children. She lived abroad and worked as a radio presenter and as a teacher. She does voluntary work and drives to the continent.

More about me...

At the age of forty Joan fell and had her first Colles’ fracture [type of wrist fracture] during a skiing holiday. She remembers that it took several months for her to recover. The second Colles’ fracture happen when she was sixty in the garden. Each time she developed Sudeck’s syndrome and her arm swells up and was very painful. She had a bone density scan privately done and it revealed that she was borderline. At this stage Joan began to take calcium tablets twice daily.
About four years ago she fell while walking her dog and broke both her arms. Following a scan she was diagnosed with osteoporosis and was started on medication. Joan lives on her own so she was in a community hospital for over two months where she had physiotherapy to help her regained some arm mobility. Both arms still hurt and she is restricted on what she can do around the house. She needs help with cleaning and gardening and the odd job around the house.
Joan says that after this fall she became afraid of falling and lost quite a bit of confidence. She saw an occupational therapist about how to better manage and found it very useful. It helped her regain her confidence with walking and balance. Joan has made changes to her everyday life for instance she does no longer go into the city centre but everyday goes to a park were she feels safe to go walking because of its even surface.
When first diagnosed she was put on Alendronic acid but she has a scarred oesophagus and had to stop taking it. She currently takes Strontium ranelate. Joan says that it is hard to remember to take medication everyday for which you do not see immediate benefits.
She has learned to use a computer and she orders her groceries as well as doing all her banking on-line and relies on a neighbour to get her cash.
Joan says that despite the changes she has made to her life she still has a very happy life; has good friends; enjoys her voluntary work and has supportive and helpful children. She says that she knows her limitations but she has a positive attitude and continues enjoying life.

Changes in Joan's spine affected the accuracy with which her bone mineral density (BMD) could be...

What did the DXA scan say. Increased risk of fracture. No previous scans available for comparison. Results will be elevated simply due to Strontium but to what extent is impossible. Results for the spine scan are compromised because degenerative changes have falsely elevated the BMD (bone mass density) results. The value for the hip may produce a more accurate picture. And it just said that the hip was showing that I was at risk there. I can’t remember that was here.
Treatment recommendations were the calcium and vitamin and it talked about bisphosphonates or Strontium and someone like me has already had a low trauma fracture, a fall from standing height or less. And that they, because I’m post-menopausal no further drastic bone loss expected unless there is a clinical change.
Did these results, did you talk to your doctor about them?
Ok what did he or she say?  
She said yes you must make sure you continue taking all your medication and because you definitely do not want to break a hip. And I agreed with her, no I do not want to break a hip. So the reason I do take them, the hip score is lower. And so yes I, I’d like to think that I’m doing now all that I possibly can in order to help myself.

Alendronate gave Joan severe acid reflux so she started taking Strontium ranelade and has no...

And I started with the, I can’t remember which one, which of the bisphosphonates I took. But I...
Yes. That was the first one and I had a lot of trouble with it really burning me down here. I have had a lot of problems. I have a scarred oesophagus from acid reflux and it really. I did everything to try to. I didn’t even you’re not meant to, to lie down for half an hour. I didn’t even sit down for an hour. I would stay standing. I’d take it in the morning and I just made sure any, every effort to keep taking it. I wanted my bones to be better. And it, because it was so painful.
I tried the other one to see if that. And that was not very good at all. And then that was when I can’t remember who it was. We decided that it was time because of the problems in taking 30 mgs. A day of Lansoprazole that I should try the Strontium ranelade. I find it easier to take actually except it means you can’t have a milky bedtime drink anymore [laugh] or anything. You don’t take those things. And I must admit that I’m probably in, I’m, while I do never forget the Lansoprazole because there are effects the next day if I don’t take it. There are no effects if I forget to take the strontium. So I don’t think I took it last night for example. You know it’s very hard to make sure you... for something from which you don’t feel an immediate benefit to remember you must take it. But I always take the calcium. I take two a day' one in the morning when I eat my breakfast and one at night with dinner. That’s easy.
But I had heard because the, my second drug, the bisphosphonate still hurt me, gave me very bad pains all the way down the top part of my chest, the oesophagus and I had heard from a friend who was at the [hospital name] about Strontium raneilate and it might be worth talking to my doctor about it. And I spoke to my doctor about Strontium ranelate and we decided that it would be worth trying to see if I could tolerate it. And yes I’ve been having it for; I don’t know how long now, a year and a half, two years maybe. And yes I have no problems with taking it. And then last October I think it was she telephoned me to say that the, they would like to take, do a DXA scan on me and do regular follow ups of taking the Strontium ranelate to see if, how effective it was at helping my bones. I would also still have to take the calcium and Vitamin D. 

Joan uses relaxation techniques taught to her by a hypnotherapist, to cope with pain.

Have I used acupuncture or reflexology? No. I tried acupuncture a very long time ago. I tried hypnotherapy which really whilst a development I’ve decided of what I did before my first daughter was born in learning deep relaxation and that is something that in fact has been a great help to me.
I’ve just recently been having some dental problems and I can really put myself into deep relaxation to overcome the pain, most pain. And that is very helpful to be able to do, to really learn how to override the pain.
So that’s useful?
Yes it is. I in fact for the hypnotherapist that taught you how to walk down steps. I can still see it and be very careful haven’t I? Walked down steps to a garden and I sit and I have this view and I, and I really am just completely. She could really hypnotise me very easily. And it, I can’t remember. Oh I remember why I was going. It was a friend who suggested it. It was after my husband had died. I miss my husband very much. I still do. I can’t help that. And it was very helpful to me to learn how to relax really, to relax and that has stood me in very good stead since.

Joan has a favourite park for walking because the surface is level and there are plenty of people...

I’m going through a stage of getting confidence back of walking. I will not walk in [city] even with my stick. I really am. It’s so uneven and people sort of almost it seems as though they try to bump into me. No I’m very. I’m. I’ve lost a little confidence again as a result of a fall, just about two months ago.
So you avoid places like high streets with lots of people?
Yes, yes, yes.
Yes I drive, I feel so confident in my car. I changed my car because of the knee problems. I have an automatic now and of course I have power steering. But I feel safe in it. I’m not going to fall. I’m a good driver [laugh]. I drive all over the world.
Do you have spots where you go for a walk?
Yes. I have one very good one that I like very much and I have to drive there. It’s an [name] city park called [name] Park and the reason I like it because I’m, I feel not safe very much on bumpy ground, on grass for example. If it’s got bumps and hollows I find that very worrying. I need to have two sticks with me for that. But [name] Park has around the whole perimeter and lots of little zig zags which are hard surface with a sort of a gravel on the top and there are lots of people around and lots of other dog walkers. So I have targets on keeping moving particularly if my knees hurt or my arms. I also joined a swim club for exercise. I swim usually twice a week. There is a Jacuzzi with steps into it and rails and it’s wonderful. So those are my forms of exercise that my little dog and I do. He doesn’t go swimming but he, the walking yes and it’s. I feel safe. There are people there if I do fall.
I try to avoid. The one thing I can’t do and that’s because of so many fractures. I’ve broken several toes and my big toe before, earlier. I can’t remember. In fact I broke a toe only last year. Is I don’t like slopes. I cannot, I cannot walk up a slope or down a slope. Down a slope is impossible. I’m just a. I tried with two sticks as well and a friend nearby. No. No I will not go down a slope but you know, there are other wonderful places to go without... So I’ve. That’s why I like [name] Park [laugh] It’s level [laugh].
And you feel safe?
I feel safe and it’s wonderful, the trees are just fabulous there.

Joan now does voluntary work at her local hospice where she has made some very good friends.

Yes I think I would say I do have a positive feeling. I cannot cure myself and nor can doctors. I know my limitations but there’s an awful lot of wonderful things that I do even when pain is there. But the positive attitude I think goes a long way to enjoying life. I still have a lot of things I want to do. I lot of things I still want to see. I may never do them all but dreams go a long way in helping.
And you do, do this voluntary work?
Yes I used to be, I just stopped doing it actually in some ways the Neighbourhood Watch coordinator for my whole area. But my main volunteer job I am the Tuesday volunteer in the office at the [name] hospice where my husband was. And I… One of my jobs my particular job at the moment I’m quite busy is looking after the collecting cans that you often see in bars and pubs and shops and this week I have been delivering them and picking up full cans ready for the money to be counted and then the paperwork that goes with that and that benefits a place that I feel is of great benefit to the community because unfortunately the NHS doesn’t cover all the costs. We still have to find a million pounds a year from volunteers and I’m one of the volunteers who will make sure it still survives [laugh].
So I suppose with all this volunteering work you meet other people and you are in touch with?
Oh yes. One of the pleasures of being a volunteer in, at the hospice is that I have made such good friends of many years now. And I really look forward to going each, one day a week or sometimes twice a week. They’re good friends. Yes they are close friends. 

She remembers her mother breaking bones and in later life becoming quite bent and losing height...

It started off. I saw my mother in a reflection. My mother died many years ago. I suddenly saw the reflection of myself in, in a shop window and it was me and I was quite bent. And I already knew that I had, we call it in English, a Dowager’s hump. I can’t, I’ve forgotten the name now in French. Yes Dowager’s hump I suppose. And I'd realised that I was getting bent. And then at some point I don’t know for what, I was measured and I was [laugh] much shorter than I thought I was.


So your mum had osteoporosis, your mother?
One didn’t know about it then. She did break her arm and she did have a plate put in, screws because I looked. I was the eldest of the four of us. And I was 13 at the time and I looked after the household while she was in hospital. And certainly she became very bent and that’s one of the things that does it for me. I do, if I see, catch a reflection I do try and straighten up but the very top doesn’t straighten.
I look back and I realise although she wasn’t thin in fact she was larger than me she certainly, her bones didn’t feel, repair well and certainly she was, became very bent. 

The surgeon has told Joan that if she fractures her right arm again, he would not be able to...

So yes. I’d broken both my arms...


Several times by?
My left arm was a complicated Colles’ in that I now have still the plate and screws in and I had a bone graft on the little finger side. Bone taken out of my hip, and put in the right arm. I lost the head of the radius, that’s completely shattered and gone. And about, it’s a funny shape, about four fractures along here and a plate and you can see it doesn’t quite go straight again and it hurts still.
I think certainly when I broke both of my arms. [name surgeon] said I had, I certainly had osteopenia and start taking and you probably need to be checked.
Did they check you? What did they do?
No they didn’t then. I think they were. I was. No. I mean life was quite difficult for me I must admit when I got home certainly. But at that time it was just one operation after another to be honest.
And things really didn’t start happening until I’d broken both my arms and my [surgeon] said said that he, I had osteopenia. I think it was a matter of putting my arms together because he has told me I’m not, not to go out now when it’s slippery and my right arm, he probably wouldn’t be able to put it back together so that it works as well as it does now [laugh]. 

Joan who lives alone, has several gadgets to help her around the home and she has learnt to use...

Well the change in my life particularly after I had both arms fractured and I became more mobile was really to master my computer. And I use the computer, and I still do for ordering my groceries. And I must say the people who deliver have always been very helpful to bring them into the kitchen, to lift them up for me onto the counter. And I do my banking, the only thing that the computer won’t do is give me cash so I’ve always had to rely on a good neighbour. But yes the computer has been the thing that I had to really learn to use.
My life has changed in that there are several things that I can’t, couldn’t do were it not for a knife with the handle on the top that the occupational therapist found for me. And I have a toilet-seat raiser. My chair is on higher and not long after I used. I unfortunately used to make the mistake of getting in chairs that are too low for me. That’s always a problem wherever I go if I needed to visit someone or a new waiting room you look around to look for a chair that is high enough.
My own lifestyle? I think it’s, I still have a very happy life and my two sons, one son especially, has been most helpful in looking out for things that he thinks would help me and any mention of ice on the weather forecast is enough to get all my friends telephoning me and saying, “Please don’t go out. Please telephone us if you want something.” But certainly groceries can be ordered by telephone even, not just computer but yes it works well.
And what about organising your kitchen for instance? Have you sort of needed to take that into account?
Yes, yes my kitchen I can’t reach top shelves safely. Top shelves wherever they are a problem and I either ignore them. I have a small step stool which has a thing that I can hold if absolute dire emergency. But I don’t use. I’m putting. There are funny things, two dinner plates are the maximum that I can lift to put in the cupboard on the middle shelf. Any more which means there’s obviously somebody in the house who’s been eating with me therefore they have to do that.
The, oh I had to change quite a lot of things. The, my electric kettle was too heavy with water in. I can’t, still can’t do that. So I either use the electric kettle which is a metal one with just enough water which in fact, of course, is more economical just for the amount for me. And I also have a small plastic one if I need to have more water to boil.
I also have a cutting, a slicing board that I was given for Christmas by the other son. They went to look for things to make it easy because a sawing action I found very difficult and this is like a serrated knife that you pull the handle down and that was good. Yes I have a lot of funny little gadgets that I have.
Oh and the best gadget and I’m sure everyone who is disabled has one is the thing that will pick up things or if you drop your walking stick you have your wonderful gadget that picks everything up and it has a magnet on the end to pick up pins or little metal things or at least drag them nearer to one. And there’s one in my car and there’s one in my bedroom. And I think there is my father’s old one in the hall. So I have them all over the place. 

Joan who lives alone has found ways to make it easier to shower and dress herself.

So I have a shower. It’s [pause] a risky manoeuvre because I have to step over the side of the bath. I do have a step from the lovely occupational therapy people so there is a white plastic step to step over the bath and there I have my shower. To have a real shower is on the top floor of my house and that means two flights of stairs and that’s, doesn’t work quite as well so I stay in the one. Oh and I have a procedure even then. My telephone I take and it stays on the edge of the bath so that in case I fall I have a problem I can grab my phone.
The other thing that is rather amusing is that I, to dry myself is also a problem. So before I start my shower, it’s a funny routine, I put a towel, a large towel, on the bed and that’s the way I can dry my back and a lot of me as well [laugh]. Oh and dressing is
Is a problem. Again I have changed because I can’t manage to do fastenings, fastenings on the left side or right side, on side fastenings or back. I mainly have elasticated tops and sometimes I can manage to do a fastening on the left but I. Looking for clothes is something that I always now have to take note of. And because of vanity I, this, the arm with the scars on it particularly I wear longer sleeves which is rather more flattering any way. They’re all very loose. I don’t think there’s anything that’s tight. I was just going to try but I It’s higher than that I suppose that is the problem, higher than just shoulder that is the problem. This shoulder is a, one shoulder has, perhaps I do it the other way, even putting on a coat can be not as easy as it used to be.
It’s been quite a while so I just accept there’s certain limitations. I don’t even think about them anymore. And other people do who come to visit and haven’t realised. They say, “Oh why didn’t you ask me to do that?” Well because I do it myself. I’m alone and so I do.
Yes and I think I have adjusted to the changes caused by the osteoporosis. And I just get on with living.

Although Joan lives alone she has great support from her family, her neighbours and from paid...

My, none of my family lives nearby. They all live a long way away. My daughter lives in the U.S. My two sons live south [city] and the other was in [county] Quite a long way away I’m afraid. And my dearest, dear friend she sold and moved away and we. She still telephones but most of my friends now I have to go and stay with unfortunately.
But do you have sort of good neighbours and friends around?
Yes, yes I have good neighbours and we’re a. The area in which I live is wonderful. There are. We do tend to know our other people and I do have people, neighbours that I ask. For example if I have something, if I have gone shopping and there is something in the car they have put it in the car for me I come back and I wait until I see somebody that I think could. I trust, and I will ask them if they will help me just to take it into the house for me. And I’ve, I’m now, that doesn’t bother me anymore. I feel confident to be able to ask other people for help when I need it. And that is one thing it took me a long time to learn.
So I have a cleaner to help me in the house I have, it’s quite a large house. They don’t clean the whole house at a go but they... I have a cleaner once every two weeks and I also have a young man who comes to do the garden once every two or three weeks. And over many years now he has, I would say, become a friend and he will help me do a Christmas tree. He will help me with any small job. I had a small strip light in the kitchen. I can’t do that or change a bulb. And I wait. I keep the list by the kitchen calendar and there is a list for either him or for a son or a grandson, for the next person to come. But I keep a job list and I think that’s a very sensible thing to do. Those small things like the electric bulb and cutting something in the garden or.
Because most of my problems, I mean I’ve had other, other medical problems I have had, two cataracts removed from both. Cataracts and the obstructive jaundice is always really my elder son. He has been absolutely wonderful. He is so important to me. And he will not every night now but probably four times a week will telephone me. Always at 10 o’clock at night. The telephone rings and I know it’s him. He is very important, he has a. He’s a very busy man. He has a very demanding job and a wife and three teenage boys all of whom are doing their A levels or GCSEs at the moment and also a very full life. And he’s an optimist as well [laugh].
Do you see him often?
No, not often enough but we talk a lot and I can always talk him, telephone him in the day at work if I’m, if there is something I need immediate advice about. And he will tell me whether he, “I’ll call you, I'll call you in half an hour mum”. So he’s always available and he will. Any time I have had a big problem he will always, he will come immediately and the other son will also come. It’s not been as easy for him but yes he will come.
I live alone. My friends, we all accept each other’s difficulties or failings and you just accept whatever the situation is. I’m very grateful the fact that my family love me and my grandchildren.
Two weeks ago my eldest grandson in England turned up on my doorstep with a friend who’s at university here, had been visiting him and they both came to visit me. And see if there was anything they could do for me, which is very nice and I felt very moved the fact that a grandson would just come to see me, to see what he, if there was anyway he could help me. 
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