Interviewer (I): What is your name? How old are you? What chronic illness do you suffer from?
Patient 1 (P 1): My name is Pete. I am 37. I have diabetes. It is a chronic illness: Immune Mediated Type 1 Diabetes.
Patient 2 (P 2): My name is Sara. I am 58. I suffer from Rheumatoid Arthritis. It is a chronic disease which is characterized by severe inflammation of joints.
I: When were you first diagnosed with your disease?
P 1: I was first diagnosed with diabetes when I was 15. I had serious health problems and could not take part in sport competitions. After medical examination, my doctors said: “Your body cannot use sugar properly. I have diabetes, a so-called sugar disease. We have found high levels of glucose in your blood”ť.
P 2: I was first diagnosed at the age of 49. I am a cook by profession and had to work in terrible conditions. My working day lasted more than 12 hours. I had to lift heavy objects, 10-15 liters of water, etc. As a result, I’ve got inflammation of joints.
I: Did you display symptoms prior to your diagnosis?
P 1: Yes, I had serious problems with my health: frequent urination, and constant hunger. In addition, I was very nervous and always felt thirsty. Sometimes, I drank more than 3 liters of water a day. Moreover, I was obese and often had problems with my peers who often laughed at me at school.
P 2: My joints felt warm to the touch and I had a decreased range of motion, as well as serious inflammation, swelling and acute pain in the areas around the affected joints in the knees, fingers, wrists.
I: Are you currently receiving treatment for your illness?
P 1: Yes, of course. I am receiving treatment for diabetes at the local hospital. I often visit my doctors and control my blood glucose level to avoid possible complications. In addition, I use some medications to lower the high level of glucose in blood.
P 2: Of course, I am receiving treatment for my illness. I use special medications to reduce inflammations of joints and relieve the symptoms. Some of them are very effective and can reduce pain immediately.
I: Do you currently have medical insurance?
P 1: Yes, I have medical insurance. My mother takes care of me and she has arranged my health care insurance coverage. Medicaid coverage gives an opportunity to receive medical nutrition therapy services at hospitals as our family is a low-income family.
P 2: Medicare covers the procedures for the patients with severe rheumatoid arthritis. As I have more than 5 swollen joints and more than 20 tender joints, as well as morning stiffness, it is a severe form of rheumatoid arthritis. That is why I have Medicare coverage.
I: Has your illness affected you financially?
P 1: My illness affected my financially because I need only high quality products which are very expensive. I cannot eat much bread, or flour confectionery, bananas, pasta, ice-cream and drink Coca-Cola, or alcohol. I spend much money on medications and vitamins.
P 2: Of course, it affected me financially, as I have to buy not only pills and injections, but also special creams, gels, lotions and balms in order to reduce inflammation and pain.
I: Do you require assistance?
P 1: No, I don’t require assistance. I think that I can earn money myself. I do not want to be weak. My profession allows me to support my family.
P 2: I am 58. I really require assistance. Unfortunately, I have no children and live alone. That is why it is very hard for me to cope with this spending.
I:Â Has your disease affected you socially?
P 1: I do not think that my disease affected me socially. In case I follow my doctor’s instructions, eat only healthy food and do physical exercises, I feel that I am a normal person. I take an active part in the social life of our community.
P 2: Of course, rheumatoid arthritis affected me socially. Today I have no opportunity to participate in social events. I have lost my job because it is too difficult for me to perform my duties as a cook.
I: Are you employed and what is your annual income?
P 1: Yes, I am employed. I am a computer engineer at the local firm. My annual income is $40,000.
P 2: No, I am not employed.
I:Â Has your life changed pre-versus post diagnosis?
P 1: I think that my life has changed because I have changed. I have changed my attitude towards food. I know that it may be dangerous to eat much food, especially if it is Coca-Cola and hot dogs, or pizza. In addition, I know that obesity is the major cause of diabetes. I try to do everything possible to control my weight. I use sugar substitutes instead of sugar.
P 2: My life has changed because I lost interest in intensive physical activities, such as hiking and riding a bike. Now I can do only some simple exercises. In addition, I have to eat a balanced healthy diet, control my weight, and avoid stresses.
I: How many physicians have you seen? What kinds?
P 1: I have seen several physicians: a therapist, an endocrinologist and a cardiologist.
P 2: I have seen several rheumatologists, a therapist and a cardiologist.
I: Did you ever disagree with medical advice?
P 1: To tell the truth, I have never disagreed with medical advice. I am sure that our medical service is reliable. The physicians I met helped me to cope with many difficulties in my life. Now I feel well, although I have diabetes.
P 2: Yes, once I refused to take disease-modifying anti-rheumatic drugs, because these drugs caused headache, fatigue, diarrhea, and some problems with my heart beating.
I:Â Have you ever felt discriminated against because of your illness?
P 1: Yes, I often feel discriminated because of diabetes. I have no opportunity to live a normal life without taking control over the blood glucose level. I have to use a glucometer, and when I go somewhere I always take a glucometer.
P 2: Of course, I am discriminated because I have no opportunity to work as a cook, although I love my profession and have a great desire to return to work again.
I:Â Do you have a daily routine that does not facilitate medical intervention?
P 1: No, I do not have a daily routine that does not facilitate medical intervention. Practically, every day of my life I try to make plans and to follow the major points of my plans. My daily routine facilitates medical intervention because I follow the instructions of my doctors.
P 2: No, I don’t. My daily routine does not affect my medication intervention.
I: Has your illness led to other illnesses/complications?
P 1: Diabetes is a serious disease. Of course, it has led to other illnesses. I suffer from some skin disorders (such as infections around the nails, diabetic dermopathy and allergic reactions), depression, atherosclerosis, and eye disorders.
P 2: Rheumatoid arthritis has led to pericarditis, chronic dryness in the eyes, and even pleurisy.
I:Â Has anyone else in your family been diagnosed with this illness?
P 1: Yes, my father has been diagnosed with this illness. He has Type 2 Diabetes. I know that this illness is inherited.
P 2: No, I am the only person in my family diagnosed with this illness.
I: Do you seek support for your illness? Be more specific””do you mean financial or social?
P 1: I seek social support for my illness. I need respect and understanding of others in our community. Many people ignore me because I suffer from diabetes and because I am obese. I do not need financial support because I have a good education and have an opportunity to earn money myself.
P 2: I seek both social and financial support for my illness. It is very difficult for me to go shopping, to cook and clean my flat. I need somebody to help me with these tasks. In addition, I need financial support because gels and creams are very expensive.
I: Have you discontinued treatment when you were not supposed to?
P 1: No, I have not discontinued treatment. I always try to follow the instructions of my doctors. I believe that diabetes is a curable disease. I know many people who managed to reduce the effects of diabetes on their lives. Most of them were treated by naturopathic physicians who do not use medications in their treatment methods, but prefer to use natural products, such as herbs, flowers, plants, etc.
P 2: No, I have not.
I: Have you ever felt ashamed because of your illness?
P 1: Yes, I have felt ashamed because of my illness. I often visit other cities and have to participate in different sessions and meetings, but I have to limit my activities.
P 2: I always feel ashamed because of my illness. My joints are damaged. I am limited in my mobility, and have an acute pain. My hands are ugly because of the inflamed joints.
I: Do you seek medical knowledge on your condition?
P 1: Yes, I seek medical knowledge on my condition. I want to know more and more about new effective treatment methods. I have got some information concerning effective treatment for diabetes from Ayurveda.
P 2: Yes, I always try to learn more about my disease. I buy medical literatures and read books about rheumatoid arthritis.