Living with multiple health problems

Causes of health problems: certain and uncertain

Dealing with any illness can be easier when the reason for it is understood. Health problems can be caused by a person’s genetic make-up, lifestyle behaviours (e.g. smoking), exposure to toxic substances (e.g. asbestos) or other reasons. With multiple health problems, one illness or its treatment might lead to another.  The reason for a disease might become clear after a long period of uncertainty, perhaps involving a large number of tests and investigations or being referred to many different health professionals. Sometimes people never know why they have one or more illnesses. If a medical reason cannot be found, then a person might form their own ideas, such as it being down to “bad luck.” 

Occasionally  the people we interviewed were able to attach a cause for an individual health problem. Andrew linked his heart disease to smoking. Sue had been told that her colitis was caused by slimming drinks. It was suggested to Graham that an irregular heart beat might have been caused by excess alcohol consumption. Following his own experience and research, he had also found that flare ups of rheumatoid arthritis were associated with stress. Barry thought his COPD (Chronic Obstructive Pulmonary Disease) could have been caused by occupational exposure to asbestos. Nigel said that his diabetes and the “small strokes” he has had are linked to each other. Tammy’s epilepsy came on at an unusual age. This made it more difficult for her to understand why she had it.
When there was a history of a particular disease within a family this offered a clear explanation for people. However both Gogs and Pat lacked information about their family history which made ruling an inherited cause in or out difficult. Ronald only found out that an aunt also had diabetes after his own diagnosis. With multiple conditions, one cause might be genetic but another could come without explanation. Lee contrasted her type II diabetes—which was caused by a “wonky gene”—with a lifetime history of asthma for which there was no apparent explanation.
In some cases, people developed certain health problems when in hospital. Amy suffered a brain injury as a result of a lack of oxygen when she could not breathe properly and the doctors were trying to find out what was wrong with her. It turned out to be a rare, life threatening condition called necrotising pancreatitis. Kevin’s urinary system was damaged during a routine operation to remove a kidney stone. Fred assumed that he had picked up an infection whilst in hospital, but he had never been told exactly what was wrong and there was confusion about whether a worsening in his symptoms was linked to a heart operation or an infection acquired in hospital (see also, ‘Risks and potential harms for patients with multiple health problems').
The complexity of having several health problems could bring confusion and uncertainty around the symptoms or causes of illness. Seeing different health professionals, especially an expert, could help find a more definite cause as sometimes they could see what was going on where others had not (see also, ‘Continuity of care’). Farza had been on a long journey to find out what was wrong. Eventually, a doctor was consulted who knew straight away that it was Tourette’s syndrome. Gogs wouldn’t have found out that a drug she was taking for rheumatoid arthritis could activate latent tuberculosis if she had not changed consultants. However, investigations for one condition might also lead to something else turning up. Whilst Mohammed was being investigated for a heart condition he was also found to have diabetes which he had been unaware of.
Lottie was confused as although changes in her blood sugar levels from her diabetes were identified as triggers for her seizures, there was no clear explanation as to why she had epilepsy in the first place and her epileptic seizures appeared to come out of the blue. She contrasted this with her husband who also had epilepsy caused by  a head injury in childhood. Val had been told she had fibromyalgia (a condition that causes pain all over the body), which she did not feel was a “proper” diagnosis, although another consultant had told her it might be ankylosing spondylitis (a type of arthritis that mainly affects the back). Sometimes there was a reason why she was in pain, but on other occasions pain seemed to come for no reason at all. Pat was unsure whether high blood pressure was a symptom of her other health problems or the cause of them.
Sometimes people will never learn why they have a particular illness. Where there is no clear reason for a disease it is known as having an “idiopathic” cause. Madelon, David and Sue all said that they did not know why they had strokes, although there are known risk factors. Where people did not feel that there was a concrete reason for having one or more illnesses, they sometimes put this down to bad luck. This was the explanation used by Amy for her necrotising pancreatitis.


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