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Roger - Interview 23

Age at interview: 67
Age at diagnosis: 64
Brief Outline: Roger had a TIA/minor stroke in 2007 during which he felt disorientated and unable to coordinate his speech. He was unable to get a GP appointment on that day, but contacted NHS direct who advised him to seek medical attention so he made his own way to the emergency department of the nearest hospital, and was later admitted for further tests.
Background: Roger is married and has one adult child. He works part time as a musician. Ethnic background; White British.

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 Roger had felt ‘not quite right’ the day before he sought medical help but had felt that his symptoms might be regarded as trivial by the GP and didn’t want to trouble him. On the following day he continued to feel out of sorts, his speech was affected and his arm ached. He was having a conversation on the phone with a colleague but realised that he wasn’t able to participate in the conversation in the usual way which made him feel anxious and upset. He rang the GP surgery but was unable to get a definite appointment and was told to ring the next day to see if there were any cancelled appointments available. Roger decided to phone NHS Direct for advice and when he described his symptoms was told to go to the Emergency Department of the nearest hospital as soon as possible. On arrival at the hospital he was assessed by a triage nurse who ensured that he was seen immediately. Roger was admitted to hospital and underwent a series of tests including ECT, CTI and a Carotid Doppler, and he was monitored overnight. A few days after he had been discharged he was told that he had had a TIA or minor stroke. He was prescribed blood thinning medication to take on a daily basis. 

 
Roger felt let down by his GP surgery and feels that the receptionists and other health professionals there should be better trained to understand and recognise the signs and symptoms of TIA/minor stroke, particularly in view of the knowledge he now has that treatment within 24 hours is critical. 
 
Roger feels that there is a connection between his condition and stress levels. Thinking back he feels that he may have had previous TIA’s/minor strokes a few years ago when he was experiencing some stressful life events. He now makes a conscious effort to take things more slowly and tries to ensure that on busy days he allows time for a short rest and doesn’t push himself too hard. He also builds regular exercise into his week to ensure that he keeps himself as fit as possible. Since he had the TIA/minor stroke Roger has not experienced any further symptoms although he feels that a couple of sessions with a speech therapist might be beneficial as he occasionally finds that when he is tired his speech can become a bit slurred. Roger feels that generally people associate stroke and TIA with advancing age, and finds that when he tells people what happened to him they are generally surprised to hear about his experience. 
 
 
 

When Roger phoned the surgery asking to see the GP the receptionist didn’t offer him a same day...

When Roger phoned the surgery asking to see the GP the receptionist didn’t offer him a same day...

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I think, try and recognise if someone contacts you what you can do to help and if you’re a receptionist perhaps you can definitely refer to a GP or a boss or whatever, a supervis… superior. But I feel there needs to be more, stroke particularly needs to be taken more seriously probably by the professionals in this, and obviously it would be good if you could have a GP service which was more round the clock, as it used to be, and I understand they may be bringing that back at some stage.
 
So it sounds as though the hours of the surgery is kind of quite …prohibitive of being able to...
 
You are very cut off aren’t you. There’s something about yes, nine to elevenish and then four till seven, four to six sorry. And then no weekends. They’ve started bringing two evenings but I think it would help more towards the old idea. And of course in the old days the GP would come round after hours to see you and see what was up. And straight away they’d know because they dealt with you all the time. Whereas, I think the NHS Direct is very good and they recommended me going to A & E.
 
But it was through NHS Direct that you got told to get medical attention rather than through your GP...
 
Yes, it was NHS. Yes, absolutely, so. And it’s a yes, yes GP and no …
 
And I presume now you’re aware now of that kind of delay.
 
Yes, yes.
 
That’s quite an important aspect.
 
yes.
 
The quicker you’re seen the better the outcome I think
 
Yes, yes. I did actually complain to the PCT in London.
 
Did you?
 
Yes. And to the head of the practice. But they tried, what they said was that we don’t deal with, you’d rather see people who’ve got ongoing problems surely at home rather than… And I just felt well it would be nice if you could deal with somebody who’s presenting an unusual problem, presented straight away in front of you more or less….
 
Sorry they’d rather see people who …?
 
Who are ongoing problems.
 
Who’ve got ongoing problems?
 
Yes, you know the one. And with yourself it said, because if you presented to the surgery, we couldn’t do anything for you anyway, you’d have to go to hospital?
 
Is that what they said to you?
 
Hm.
 
That’s… how did you feel about that?
 
That I meant nothing much to them at all really. Like a small, like I wasn’t....they were talking about a small, well insect on the floor, I think they’d feel more about an insect then the way they said that. So very, very lowering to me.
 
And they must recognise - sure they’ve got a very responsible job, but they must make it even more worthwhile, by recognising these signs straight away. I’m sure that had my normal GP had seen me, they would have ...although it’s a great, and also if you see the GP generally it should be a feeling of, it’s comforting. You get that comfort. And that must be part of the getting well. They could have helped tremendously with that probably. Whereas I felt on my own, I talked on the phone to somebody and they helped me along as best they could. But going along you felt suddenly as though you were very vulnerable like.

And you also had to initiate those things yourself?

You’ve got to initiate everything. You’ve got to go and see the triage nurse, haven’t you, and say well I’ve got, they say it’s a stroke, and of course they’re very good and they go through the process. But you feel all the time, you’re very much of a number and…

It sounds as though you didn’t feel, you felt a bit abandoned really by your GP practice?

That’s right, yes, certainly, yes, yes, yes abandoned by them. 

So I mean going back to, we’re talking about messages to different people, the messages to the health professional would be … to take things seriously it sounds like?

[laughs] yes, yes, get it together. Or get, go for it or something. But get on the job, and yes, take it a bit more. I also think receptionists in particular, are very much, they seem to be there to put people off and to act as a sort of defence, which they sort of are really. But they don’t encourage people to go in. And all the time you’re thinking I want to do this job, I want to go to the GP or the dentist but I’ve got to go through this, these receptionists, and you don’t like… that’s another thing which I don’t want really. 

Which makes it more difficult?

Yes, yes, it’s awful yes, yes.

So really as you’re saying when you’re feeling vulnerable and ill…

Yes, and ill.

You really want things to be made easier for you rather than to be?

That’s right. Yes. Because stroke causes, is also cause by stress you don’t want that stress initially to come in because something hasn’t gone well, when you’re not happy with the situation.
 
 
 

Roger was told by his consultant to be careful about how much alcohol he drinks which can...

Roger was told by his consultant to be careful about how much alcohol he drinks which can...

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I try to be careful with alcohol. Not too much alcohol. Although the consultant did say, if he had his way, he would put, put red wine, a glass of red wine on the drugs trolleys [laughs]. I mean it’s the sort of thing that.. a glass of red wine now and again. I mean I do like that. And a glass of home-made ale or something now and again. But I don’t smoke generally.
 
So when you’re talking about the alcohol, just going back to that is that something that you would have perhaps had a bit more of previously?
 
Yes, because as a pianist, entertainer - and yes, and you go somewhere, and people ask you, and you said yes, that’s right. And particularly things like, it’s a great shame, because they are very welcoming a bubbly glass of, a glass of fruits of bubbly or something, which people like to present, but particularly the bubbles- I understand they go to the brain or something... whether it’s an old wives tale I don’t know. [laughs] So yes, that sort of thing, and its [rrrrp] straight away and it affects you. But yes. I’ve had to watch it a bit, and I did wonder if some of the drinking may have contributed, one of the contributory factors to be honest.
 
All he said, the consultant and GP, all they said basically was, “Well watch the alcohol.”

 

 

Roger didn’t know the term TIA before his experience, but now understands that it’s less serious...

Roger didn’t know the term TIA before his experience, but now understands that it’s less serious...

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No, no I didn’t. I didn’t realise the difference between… I wasn’t aware of different reactions that they could give. I understand a TIA is a short circuit in the brain. And I think it’s a more, a heavier stroke or whatever that is more of a devastating thing.

 

Roger didn’t seek medical help initially as he said he felt “It’s a man thing”.

Roger didn’t seek medical help initially as he said he felt “It’s a man thing”.

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The feeling hadn’t gone away. I mean I did think it was what we call - like a man thing, that okay - first it was just, oh it’s silly, get over this come on. And then the next day it was still there...I don’t like this.

 

 

Roger felt that the receptionist at the GP surgery should have offered him an urgent appointment.

Roger felt that the receptionist at the GP surgery should have offered him an urgent appointment.

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Unfortunately because it was Thursday at one o’clock GP’s close and of course [inaudible] [laugh]. And there was a feeling that a stroke - the GP receptionists and other people should be trained to recognise the sort of signs, which they don’t, patently not at the moment.
 
Did you feel that the GP’s receptionist wasn’t…responding?
 
No, I didn’t think they knew and cared particularly. And I did say to him later, I’ve said to my GP several times about this and he raises his eyes and says it’s very bad. And he’s not the leader of the actual clinic, but he obviously feels that it is bad. They should be trained obviously to recognise whatever the signs as much as possible and not to put people off. It seems like this one did. It wasn’t done deliberately, but you get a feeling that you’re being a complete nuisance and you have to pester people and you know, it’s
 
How does that make you feel?
 
Well it makes you feel unwanted and unloved I suppose is the main thing.

 

 

Roger isn’t happy taking medication and has been thinking about alternative therapies, but he...

Roger isn’t happy taking medication and has been thinking about alternative therapies, but he...

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And in terms of, you know, your future health and the risk of further TIAs or minor strokes, I mean what have you been told about that, how do you think about it?
 
Nothing at all really. And it seems as long as I keep taking the tablets as they say. Yes. Hm. [shrugs]
 
So your expectation is that you keeping taken your medication and things should remain stable?
 
Yes, because, I actually asked some, until things....yes. I’ve actually asked if I can stop the tablets and I think the implication is that you don’t, you know, you keep taking them. But I did wonder about it. Then I had a friend who does the alternative therapy. She seems to be very into not taking them. But she’s not pressed me on that lately so…
 
So was it her influence that led you to think about may be stopping taking your medication? Or was it your …?
 
Connected. Connected. But it was something that I’d, because I’d managed with Bendrofluazide, but seeing what happened with just the Bendrofluazide and not having other tablets. Or maybe it was just the stress kicking in.
 
Was there a side effect from that?
 
Bendrofluazide? - unsure really. I’ve had various things like rhinitis or sinusitis rhinitis generally, swallowing a bit. Just generally the rhinitis I think, the what do they do call it post nasal….
 
Blocked?
 
Yes, blocked and you feel all the time you can sort of …
 
Can’t clear your nose...?But that’s something you don’t know if that’s linked?
 
No, I don’t. Because I had a deviated septum, but I did go to sorry to the hospital, and they said they looked, and I said about an operation for a deviated septum and she said, “Well its relatively clear to be honest because of the tablets you’re taking and the risk factor and we wouldn’t, it wouldn’t be a logical step.” or whatever they …
 
So what was it that made you want to stop taking some of the medication?
 
I just felt perhaps I felt, well I feel well at times, you know, I feel if I’m carefully eating… watching my dietary considerations, exercising, perhaps I don’t need them?
 
But the medics have said keep taking the tablets?
 
They said, yes, they did yes. I mean psychologically I do wonder about it, psychologically. And I think sometimes there are other factors that work looking after you, I suppose thinking from a spiritual background...
 
Yes, I mean, that’s interesting, because some people do, you know, kind of relate to that in, when they go through an illness or something like that. Is that something that’s been….
 
Yes, for me.
 
Is that since the illness or…?
 
It’s always been that way. Always been there. And I’m not sure about the tablets. And I know the alternative therapy lady said, “It’s a shame to see you going down that road.” She said that about five years ago.
 
And is that to do with not kind of wanting to pollute your body with…
 
Yes. I think it is actually.
 
… drugs?
 
Yes, yes.
 
And what sort of alternative, have you looked into any kind of alternative therapies that you might take on?
 
Some of them yes. Then others - people say, oh they’re untested and they unproven. So, yes, I have looked. Obviously they’re not on the NHS. You have to pay for them privately or whatever, so …

What kind of things have you thought about?

Oh. I’ve heard the names of them, but usually they look to me as a small white tablet, that this particular lady has. She sometimes … she gets them from Tunbridge Wells.

Are they herbal things like that?

Yes, herbal thing, herbal homeopathic. Hm. And there’s Chinese medicine and all sorts. I’m looking into things and perhaps I’ll go along those lines.

You’re thinking about that for the future may be?

Yes, the future. Although I feel the GP service would be totally, well unhappy about it. 

And would that make you think again about it, you know, if you wanted to do something that wasn’t advised by the medical profession is that something you would take. How would you feel about that?

I feel you would have to weigh all the factors up. And also when one’s close what’s it.....partner, relative, seems to be against it. Because you have to go by, well you have to go by what you feel personally, and their experience is something that they’ve had a lot of experience perhaps in a certain field, and plus my wife is very against alternative, I think more or less alternative, because she’s worked in the mainstream medical.

So you wouldn’t necessarily rule it out?

No I wouldn’t.

 

 

Roger sees the GP once a year for blood tests and monitoring but says he can talk to the local...

Roger sees the GP once a year for blood tests and monitoring but says he can talk to the local...

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just blood tests, perhaps every twelve months or something, but generally not anything else.
 
I’ve started to get the repeat prescriptions from the pharmacist, rather than go back and annoy the GP all the time.
 
Right, so does it feel quite more comfortable to talk to the pharmacist, more casual maybe?
 
Yes. Yes. It does in a way. Yes, and you don’t need an appointment obviously, and you can just walk in, and in fact some of them are thinking of taking on more medical jobs as such. So yes, I mean, he’s very useful.
 
Some pharmacies do actually have a little consulting room.
 
Yes, they do.
 
I don’t know whether you actually… or yours is a more casual type of conversation.
 
It is more casual yes. More casual. They do have one at but there is some…
 
So do you feel as though, if you’ve got an issue or a worry that you could go to the pharmacist?
 
Yes, yes, that’s right. You could, yes, that’s right. They will think about it and try and help you through. Yes. They’re useful pharmacists.

 

 

Roger found it difficult to get to see the GP because the receptionist wouldn’t give him an...

Roger found it difficult to get to see the GP because the receptionist wouldn’t give him an...

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The actual TIA came in let me see... two thousand and, January 2007. And I rang the local GP’s, spoke to the receptionist and she said, “Oh come in next week.” And I said, “No, I’m feeling quite ill.” My arm was aching and I had that was the worst part, it was aching. And my sight was alright, my speech… but I was definitely feeling not good, not well. And so, “Come in tomorrow morning. We’ll see if there’s a cancellation.” And I said, “No.” 

So then I put the phone down and rang NHS Direct and they said, “What you must do now is….” they asked me questions, and said, “You must go to... Because it was a very stormy day, stormy weather I walked in to there was loads of traffic around, so the traffic was at a standstill, so to get an ambulance... and I walked into the A & E past all the minors there was triage nurse there who saw to that. 

And it was something which one of our friends, she’s a nurse consultant, a medical one, and she said, “Oh you do realise you were very vulnerable.” And of course, that’s it. It was strange. I walked along sort of as if I was drunk on one side and that was it. 

And basically apparently what I heard, I had had five little they said short circuits or TIAs before. I don’t know if they were TIAs or what they were. But there had been previous instances, when I’d felt not quite with it, as I say for instance.

And the first thing they said in A & E of course, “Why didn’t you come yesterday.” Because they could have actually done other things, but luckily it wasn’t a huge one and I take five various tablets to ….
 
So it was about 24 hours?
 
24 hours, yes, I went into, hmm.
 
And at that point, did you know at that point that it was important to get help…?
 
Yes, because the feeling hadn’t gone away. I mean I did think it was what we call - like a man thing, that okay - first it was just, oh it’s silly, get over this come on. And then the next day it was still there...I don’t like this. So and at one o’clock, but unfortunately because it was Thursday at one o’clock GP’s close and of course [inaudible] [laugh]. And there was a feeling that a stroke - the GP receptionists and other people should be trained to recognise the sort of signs, which they don’t, patently not at the moment.
 
Did you feel that the GP’s receptionist wasn’t…responding?
 
No, I didn’t think they knew and cared particularly. And I did say to him later, I’ve said to my GP several times about this and he raises his eyes and says it’s very bad. And he’s not the leader of the actual clinic, but he obviously feels that it is bad. They should be trained obviously to recognise whatever the signs as much as possible and not to put people off. It seems like this one did. It wasn’t done deliberately, but you get a feeling that you’re being a complete nuisance and you have to pester people and you know, it’s …
 
How does that make you feel?
 
Well it makes you feel unwanted and unloved I suppose is the main thing.

 

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