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Interview 03

Age at interview: 67
Brief Outline: She had multiple TIAs from the age of 65 and eventually had carotid endarterectomy age 67. Medication' perindopril (blood pressure), simvastatin (cholesterol), aspirin (antiplatelet), clopidpgrel (antiplatelet).
Background: Is a widowed retired nurse with one adult child. Ethnic background/nationality' White/German.

More about me...

This woman has had multiple transient ischemic attacks or mini strokes since the age of 65 she is now 67. The TIAs caused transient limb weakness, slurred speech and loss of vision. 

She initially went to see her doctor and was referred to have a CT scan and a vascular scan of the carotid arteries that carry blood to the brain through the neck. She was referred to a consultant to discuss the possibility of surgery (carotid endarterectomy) to remove the blockage from the artery. She decided not to go ahead with surgery at this stage because she was concerned about the slight possibility of having a stroke during the procedure. 

She opted to take medication to prevent blood clot, control her blood pressure and reduce cholesterol. She knew, however, that this was not a long term solution. The TIAs kept occurring and were sometimes more severe. She eventually decided to have the operation but feels that the decision was entirely hers. She opted to have the surgery under general anaesthetic and feels the surgical team were all very sympathetic.

She was interviewed 2 weeks after the operation and was recovering well. She now has to take perindopril to control blood pressure, simvastatin to reduce cholesterol and aspirin and clopidpgrel to reduce the risk of a clot.

 

Explains that a MRI scan was scarier than the CT but music was playing and there was a mirror....

Explains that a MRI scan was scarier than the CT but music was playing and there was a mirror....

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Yes so the CT scan stands for computerised tomography yeah and then they can tell what's happening if which parts of your brain have been affected yeah? And it's the same with the MRIs they can tell and there was one tiny, tiny spot, a tiny little lesion, and it was said to me that was probably when I've had some high blood pressure.

Right.

Yeah, yes, yes.

And what was it like having those scans?

Well you see this scan is fine, it's kind of like a big wheel you go in there, that's fine but the MRI is very scary because it's like, like a coffin, you go in there and then it closes all in onto you and they play some music and you have got a mirror, you can look there and it's making a lot of noise.

It's like a what?

Making, it's making a lot of noise.

No you said it was like something, it was like a?

It was like a coffin.

Oh a coffin

A coffin it's all closing in onto you and of course if you are claustrophobic like me, I am claustrophobic and when I had my very first MRI scan I did the Lord's Prayer very fast, Our Father in heaven, hallowed be they name, very, very fast.

 

She had mixed experiences of nursing care but feels that personal care was sometimes neglected...

She had mixed experiences of nursing care but feels that personal care was sometimes neglected...

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What about the nursing care, you haven't mentioned that?

The nursing care well we could do with some more nurses. The, we've had auxiliary nursing and also healthcare assistants, they did a lot of jobs but I was a little bit disappointed with the nursing care really after I came back from surgery, from recovery, my blankets and my bed was all ruffled up and it irritated me and there was one patient opposite me she said 'Oh God I can see you are very agitated, you are not very happy with your bed.' Yes I've had a quick wash and change of nightie and of course bed pan given and I wet to bed [laughs], I wet to bed, it didn't go in the bed pan. But the night staff they were fantastic, really no complaints and a lot to do you know changing the drips and checking the blood pressure and, and, and all that if toes are wiggling alright, fingers, everything alright and giving you medication, they were fantastic. And in the mornings yes the bed has been made for you and you get your wash bowl but there was a lack of mouthwash, there was a lack of evening wash which I remember you know we used to get these evening washes and the mouth wash and your sheet was straightened and your pillows were made comfortable. That was very, very much lacking I must say.

Do you think that was something to do with shortage of staff?

Yeah, yeah

Or just the way they were trained?

I think because the nursing staff today they are doing more jobs now, the jobs which doctors used to do once upon a time, you see so the nurse hasn't got really time to do the jobs which nurses used to do like pressure care, tidying the bed at night, bringing you a wash bowl, your mouth wash, if you have dentures you want to clear them or if not after a meal you want to clean your teeth and rinse, that was very much lacking I must say and that did upset me. But when it came to the other nursing care like medications and checking the drips and everything and your blood pressure, or if you wasn't well, if something straight on the monitor, that was superb. 

 

She explains that there are lots of different medications to control blood pressure and they have...

She explains that there are lots of different medications to control blood pressure and they have...

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And you said you did have high blood pressure as well?

Well I didn't have high blood pressure before, it came as a shock to me when all of a sudden my blood pressure was going up and going down up and down and of course when I was seen at one of the out-patients in March, on 7th March 2005 the blood pressure was a up and one of the doctors said I think we ought to put you on blood pressure tablets. And so I went first on 2mgs and then because it was going up I was put on the 4mgs. And there are so many different types of blood pressure tablets you know and you as an individual you will find out which one suits you, you know but the one which was given to me seems to be working for me.

Which one was that?

It's the Coversil, I can't pronounce, it's the Coversil and there's another long name to it as well.

 

At first she decided not to have the carotid endarterectomy because of the risk but when she kept...

At first she decided not to have the carotid endarterectomy because of the risk but when she kept...

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And then the result from the vascular scan I was shocked, I was told that the right artery, or carotid artery was furred up between 65 and 70% and that was a shock to my system. So of course also immediately I was seen by a specialist, a vascular surgeon, consultant, the out, the out-patients appointment was made almost immediately and he talked, he explained to me a lot what could happen although I was put also on two aspirin actually, one is 75mgs, it's a tiny white one and then another one, I can't pronounce the name, Clavix, 75mgs and also the Simvastatin 

Is that once a day?

Yeah once a day and the Simvastatin, which you take at night and that is to keep the cholesterol level down and that was 4, 40mgs. Then I was seen by a, a vascular neurosurgeon, consultant and he explained to me he said, 'Although, if you are on medication it does not mean that you are safe from having TIAs or mini-strokes or that you are safe from having a major stroke. There is an operation, a surgery we can perform, and it's quite safe, it's about 95% it is safe but although with each operation there is always a risk, yes? But it is quite a safe operation, it is safer to have the operation and you have a lesser, risk, chance in getting a stroke, than being just on the medication although you may never have a major stroke while on medication but you see it's the uncertainty. Then I decided, alright after I saw the consultant I decided not to go ahead with the surgery, because he also explained there is a possibility that I might have a stroke under surgery and end up in a wheelchair, but it's a very, very small risk. And I wasn't pushed, I wasn't pushed in any way, just take your time, think it over and that's it and I left. 

Then Easter Sunday I went to church and I was there for about twenty minutes and I was saying to the person next door, we were supposed to stand up for the Bible reading and I said 'Oh I don't feel well, I don't feel good.' And again vision went and I felt like passing out, I felt really dreadful. So they took me outside into a cooler place and there again it was speech went, again slurred speech and difficulties with walking and my left arm again very heavy. So those kind people brought me home by car and phoned the emergency doctor, she came straight away, almost immediately and she said 'Well there's not much I can do about your medication you know, I think we ought to transfer you to the hospital yes?' Phoned the ambulance, ambulance came, blood pressure high again and I was seen again by a registrar and he discussed again the type of surgery. And he did say to me, 'You've had quite a few of those mini-strokes now and the ones you've felt of late they've been more severe than they were the first ones.' He said, 'Well if it was me I would go ahead with that surgery because it is very successful now and you're going to have a good quality of life.' And that made me thinking because you know the fear, am I going to have a major stroke in town, walking up the road, is it going to happen in the shop, is it going to happen in the bus, is it going to happen in my garden? I'm on my own, I'm a widow, what is going to happen, am I going to have any more of those mini-strokes anywhere you know and what is going to happen? And I also thought alright I'll think about it. And the consultant he did say to me, or registrar, I beg your pardon registrar, he did say to me, 'I'm going to make another out, out-patients appointment with the vascular surgeon yeah? But as soon as possible.' And this was done and the appointment was for the 26th of April this year, 2005, for admission on the 25th and then for surgery on 26th. 

So anyway the day of surgery arrived and I was given my pre-med, of course I saw of course the anaesthetist and she was lovely, absolutely, and she explained a few things and then I saw somebody from the research centre as well who deal with this type yeah. And I was asked if I would be so kind and it’s that, they called it the plaque, which, the furring of the artery, if I would be so kind and donate, leave this for medical research which I agreed and you have to sign of course the consent form. And I agreed to this and also for some medical students to be present at the surgery but unfortunately they were called up to a lecture yes. But they were there, when I was taken before the general anaesthetic they were in that room. And the anaesthetist she was absolutely superb, very, very understanding and she explained, “I have got a very nervous patient here, very nervous so I’m going to give her some oxygen first and some relaxing as well,” so and that was it. And then I woke up in recovery and I moved my hand and my leg and I said “I am fine.”
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