Drug side-effects worse than symptoms?

[bindeweede]

About 6 weeks ago, my mother (85) was told she had an irregular heart-beat - arrhythmia, I think it's called. She was prescribed DIGOXIN, and her life has been misery since. The list of side-effects is horrendous - sickness, nausea, loss of appetite, fatigue, general malaise, abdominal discomfort. She has not felt able to leave her flat for over 6 weeks. On further investigation, I find that the other pills she is taking exaccerbate the side-effects of digoxin. She now has pills to counter-act the side effects of the other pills she is taking!

Last week she did what she probably shouldn't have done and cut the dose of digoxin to 1 pill a day, and she is starting to feel a little bit better. Though she was sick again today. Last Tuesday her GP said he would refer her to a consultant. I offered to pay privately if it would hurry things up, but still nothing has happened.

I know GP's are over-worked, but if I can find info on the internet about side effects and interactions, why aren't the professionals aware of them?

Sorry for the rant - just feeling a bit angry and frustrated.
EDIT And another side-effect is arrhhythmia. And depression, which she already has!

[Mongrel]

*Not a healthcare professional*
Netdoctor (http://www.netdoctor.co.uk)is always a good place to start for clear information and the MHRA has a database of all the Patient Information Leaflets (http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&nodeId=164) (although she should have got one in the box)

Unfortunately any drug that is going to be used long term needs to be carefully monitored at the onset to make sure that it' going to be suitable.

Try to get her talking to her Pharmacist as well, see if she can get a MUR (Medicines Use Review) sorted out, often the Pharmacists are better informed about drug interactions, and if you're lucky your local library MAY have a copy of Stockleys Drug interactions - the definitive UK text. Best advice is to badger the health professionals to either get her drug regime looked at (even for the short run) or changed and gleefully accept any specialist referrals.

[bindeweede]

Dear mongrel

I've tried twice to reply to your kind message, but my connection has been playing up.

Will try again tomorrow.

Tom.

[Cuddles]

Digoxin is a very common drug used to treat heart problems, mainly arrythmia, usually in older people. Quite a high proportion of people suffer side effects, including the sort of things you describe. This is due to there being a very small difference between the amount needed for a theraputic effect and the amount that is toxic. It also has reactions with other common drugs like amioderone, also used to treat arrythmias, and erythromycin, an antibiotic.

You should not assume that her GP isn't aware of the side effects, it may just be that there is nothing he can do about them, which is why he will have refered her to a consultant who specialises is this area. One thing to make sure of is that the GP (and consultant) know about any other drugs she is taking. They should know about any prescription drugs, but over-the-counter drugs can have interactions as well, and is important for the doctors to know about them.

I know it's unpleasant for both of you at the moment, but the best advice is really to wait for the appointment with the consultant. A week, especially one with a bank holiday, isn't really all that long to arrange things. If you haven't heard anything in a coupe more weeks, start badgering the GP, but for the moment it is best to assume they are doing everything they should be and just be patient. Waiting lists are unfortunate, but they are a fact of life, and annoying your GP and getting yourself worked up won't really help anyone.

[bindeweede]

Hello Cuddles
Many thanks for your post. Impatience is one of my many faults ("tomorrow is no good, I want it yesterday!"). I'm sure you will understand that I see my mother's quality of life deteriorating, and I seem unable to do much about it. "Mongrel" mentioned this MUR, which I will look in to. Actually, when I took the prescription to the pharmacist, she wouldn't supply it until she had spoken to the GP. She must have been aware of the potential problems.

My copy of the BMA's guide to medicines lists all of the side effects of digoxin, and my mother seems to have most of them, even though she is now on the lowest dose. She has also had bad reactions to erythromycin, clarythromycin and metronidazole, as well as a calcium inhibitor, the name of which I can't remember.

Ho hum.

Thanks again to you and Mongrel. I don't suppose this is the ideal place to post a message like mine, but the response has been very helpful.

Tom.

[Mongrel]

Thanks again to you and Mongrel. I don't suppose this is the ideal place to post a message like mine, but the response has been very helpful.

All we can really suggest now would be to keep on at the doctor and have a chat with the Pharmacist (They get paid to do the MURs ;)), if you're not happy with the doctors' opinion, that she should wait to see the specialist, she's entitled to a second opinion.
Trying to get a diagnosis from an internet forum is not the wisest course of action so I'm going to wish you and your Mum the best of luck and a speedy resolution and leave it at that.

[bindeweede]

All we can really suggest now would be to keep on at the doctor and have a chat with the Pharmacist (They get paid to do the MURs ;)), if you're not happy with the doctors' opinion, that she should wait to see the specialist, she's entitled to a second opinion.
Trying to get a diagnosis from an internet forum is not the wisest course of action so I'm going to wish you and your Mum the best of luck and a speedy resolution and leave it at that.

I have spoken to the pharmacist about an MUR. He was helpful, but said the Ma needed to be there, and she is house-bound at the moment. I contacted the GP surgery - a request for a specialist appointment was sent in a week ago, although there's no indication when it will be. I have also requested a GP home visit, which will happen tomorrow, and I'll be there, so I don't think there is much more I can do at the moment.

[bindeweede]

Confession. I have fallen in to the old "post hoc, propter hoc" thingy. My mother's symptoms are the same as some of the side-effects of digoxin over-dose, and as they seemed to start about the time she started taking the drug, I assumed the drug was the problem. Recent blood tests have not shown excessive levels of digoxin.

So, please queue here to:-

1... wag a finger in front of my nose.
2....say "Tut,tut".
3.....apply metaphorical slap on wrist.

[Mongrel]

So, please queue here to:-

1... wag a finger in front of my nose.
2....say "Tut,tut".
3.....apply metaphorical slap on wrist.

I would but it's an understandable trap to fall into when someone you care about falls ill.

Any idea what is causing the problems or is it "wait for the specialist"?

[bindeweede]

I would but it's an understandable trap to fall into when someone you care about falls ill.

Any idea what is causing the problems or is it "wait for the specialist"?
One of the GPs came on Thursday and persuaded me the problem wasn't the digoxin or interactions with the other medication my mother is taking. He thought the problem was to do with the stomach/digestive system. He also said the previous GP had referred my mother to a specialist on a sort of "fast-track" scheme where the patient is (apparently) guaranteed to see the specialist within 2 weeks. Those 2 weeks will be up on Tuesday.
I now think I should have persisted, and asked the GP for a private referral - it would have happened a week ago, and the situation might have started moving on.
Spoke to the Ma twice today. She has been sick twice. The only thing she seems able to keep down is porridge. And she is getting more and more depressed. I'll be going over to see her again tomorrow - it's only 18 miles or so, but I know there's very little I can do.
It's a despair situation.
Anyway, thanks for your replies.

[bindeweede]

Our latest theory is a gastric ulcer or gastritis. In theory, a consultant will contact my mother in the next 2 days. I won't be holding my breath.

[Mongrel]

If you're lucky it's a gastric ulcer, it can be tested for easily (simplest is a breath test for Helicobacter pylori) and the treatment is antibiotics and Proton Pump Inhibitors :)

If she hasn't been given anything then Zanprol can help, it's a Pharmacy only medicine, and as always consult with the pharmacist if she's on other medication.

[bindeweede]

If you're lucky it's a gastric ulcer, it can be tested for easily (simplest is a breath test for Helicobacter pylori) and the treatment is antibiotics and Proton Pump Inhibitors :)

If she hasn't been given anything then Zanprol can help, it's a Pharmacy only medicine, and as always consult with the pharmacist if she's on other medication.
Two weeks ago, the GP gave her omeprazole, which I believe is the active ingredient in Zanprol, as well as domperidone. She stopped taking the omeprazole as she thought it was making her nausea and sickness worse. On patient.co.uk, the side-effects are listed as - feeling sick or vomiting, tummy pain, dizziness, general feeling of being unwell, as well as several other things. So again, possible side-effects being as bad at least as symptoms. She is now only eating milky porridge, drinking plenty of water and milk, plus the high-nutrient milk-shake type drinks the GP supplied.

www.patient.co.uk/showdoc/30002133

[bindeweede]

Our latest theory is a gastric ulcer or gastritis. In theory, a consultant will contact my mother in the next 2 days. I won't be holding my breath.
......and as I expected, the "urgent" consultation, after 2 weeks, has not happened. The consultant's secretary even rang my mother to say she was unable to say when the consultation would take place, but she would ring her up when she knew.
I wonder how urgent is "urgent" in the NHS.
I have emailed an official complaint to the NHS Trust, and will probably write to the Chief Executive, in case the email gets "lost".
"My mother has been treated in a shoddy way by a second-rate service. I look forward to your earliest reply", was how I ended the email.

[bindeweede]

......and as I expected, the "urgent" consultation, after 2 weeks, has not happened. The consultant's secretary even rang my mother to say she was unable to say when the consultation would take place, but she would ring her up when she knew.
I wonder how urgent is "urgent" in the NHS.
I have emailed an official complaint to the NHS Trust, and will probably write to the Chief Executive, in case the email gets "lost".
"My mother has been treated in a shoddy way by a second-rate service. I look forward to your earliest reply", was how I ended the email.
Angry? ANGRY? I am incandescent with fury!

[bindeweede]

Angry? ANGRY? I am incandescent with fury!
I mean what do I need to do? I am crying, here.

[bindeweede]

Angry? ANGRY? I am incandescent with fury!
Well, well, well. Would you believe it? It must be a complete coincidence. Yesterday at 2pm, the consultant's secretary could not give my mother a time for an appointment, and yet at 10am this morning, she has said a different consultant will see her sometime on Friday. And I was in the process of writing an official complaint to the Chief Executive, with copies to two MP's. It couldn't possibly be anything to do with my telephone calls and email, could it?????

I'm sure I am underestimating the role of chance and coincidence in shaping events.

[bindeweede]

I mean what do I need to do? I am crying, here.

I feel so embarrassed about this post. I tried to delete it, but I couldn't find a way to do it. But I got into a bit of a state. I lost my Dad in January, and really don't want to lose the Ma as well, so soon.
I have written a letter of complaint to the Chief Exec. of the East and North Herts. NHS Trust, as well as sending an email. The scrotum won't get to see either, I suppose, but I have just sent another email to the useless complaints dept. of the said NHS Trust (don't you think the word "Trust" is irrelevant), saying I have discovered the email adresses of 6 MP's, two local and 4 in the Health service, just in case they think I am not serious about my complaint.

[bindeweede]

Well, well, well. Would you believe it? It must be a complete coincidence. Yesterday at 2pm, the consultant's secretary could not give my mother a time for an appointment, and yet at 10am this morning, she has said a different consultant will see her sometime on Friday. And I was in the process of writing an official complaint to the Chief Executive, with copies to two MP's. It couldn't possibly be anything to do with my telephone calls and email, could it?????

I'm sure I am underestimating the role of chance and coincidence in shaping events.
The Consultant arrived around 3.30, and what a delightful chap he was. He checked the Ma's heart - OK, her breathing - OK considering she has COPD. He examined her abdomen and could find nothing wrong (relief!), and checked out her mobility, which is not great ATM. He listed all the medication she is on, and told her to STOP the digoxin, as well as co-proxamol, which is not supposed to be available, but is on Ma's repeat prescription, and has been for years.

She is now beginning to get back to something resembling a normal life - still eating cautiously, and lacking energy, but it's a start.
After 6 days, the complaints dept. acknowledged my emails, so that's good. No written reply to my letter yet, though.

[Mongrel]

Nice to hear :) Hope she's doing well

[bindeweede]

Nice to hear :) Hope she's doing well
Thanks for that. The Ma actually had a routine appointment with a chest consultant today, and she got the all-clear, which is good news. She just now needs to try to get back to former energy levels.

[bindeweede]

Letter received from East and North Herts. NHS Trust Complaints Dept. Complaint No. 2007/360.
"Thank you for your email received 11 June 2007". But it was sent on the 5th of June! And the written letter was sent on the 6th!

"As a Trust we have a duty of patient confidentiality. In addition, under the Data Protection Act we are not permitted to disclose clinical details or details of any treatment to anyone other than the patient, unless we have the patient's written consent. We there for requirw the signature....prior to the investigations and response to your concerns."

Am I being cynical, or is this just an obstructive and delaying tactic? My complaint wasn't about the treatment, it was about the 2 and a half week wait for an "urgent" consultation.

More. "What will we do? Try to acknowledge all written formal complaints within 2 working days". Failed!
Try to provide a full written response within 25 days".... so 5 working weeks.
No wonder people hardly bother to complain.

[Matt]

Am I being cynical, or is this just an obstructive and delaying tactic? My complaint wasn't about the treatment, it was about the 2 and a half week wait for an "urgent" consultation.


It's rather convenient for the trust but there may well be aspects of the case that they cannot discuss with you without your mother's permission. This includes not only the treatment but details of the consultation. even detaisl which you apparently know cannot be confirmed by them when it's possible you're making an educated guess.

However on one matter, they are incorrect, there's no reason for them to delay their investagation. They can confirm to theit own satisfaction that the charges you level are correct and it would seem to me that they should be grateful to you for bringing such lapses to their attention and express such gratitude to you. They can then assure you that they are interested in finding the cause of the problem and working to rectify it even if they cannot discuss details with you without the patient's permission.

If that is the complete letter then the tone gives the impression that they know they are underperforming and are not interested in doing anything about it unless their hand is forced.

Write you response, ask your miother to co-sign it and copy to your constituency MP.

[bindeweede]

Hello Matt
Thanks for your suggestion. I have just returned from seeing the Ma. She DOES NOT want to sign the paper or want me to go any further with my complaint. She says she doesn't want to "make a fuss" or cause problems, and just concentrate on getting her energy back. I was half expecting this anyway, so I'll have to do as she says and leave it there. It annoys me, as the Trust is just getting away with it again. It looks like my complaint was the 360th this year, which is pretty good (bad) going.

Anyway, I'm off for an 8-day holiday tomorrow, so I'll try to restore my mental equilibrium!!

[bindeweede]

On second thoughts, if I can't go to the official Complaints Dept. there's nothing to stop me going higher up. So, I have sent an email to my MP, attaching a copy of the letter I wrote to the Chief Executive.

And I have sent copies of that email to -

Patricia Hewettt, Secretary of State for Health
Rosie Winterton, Minister of State, Health Services
Andy Burnham, Minister of State (Delivery and Reform)
Ivan Lewis, Under-Secretary of State (Care Services, including Older People's Services.

Well, it keeps me out of trouble.

[bindeweede]

Well, the Chief Executive of the East and North Herts. NHS Trust has not honoured me with a reply to my letter, but my MP has..........

"I understand your concerns on this matter and I have taken up the issues raised with the Chief Executive........ Nick Carver. As soon as I receive a reply, I shall be in touch."

[bindeweede]

On second thoughts, if I can't go to the official Complaints Dept. there's nothing to stop me going higher up. So, I have sent an email to my MP, attaching a copy of the letter I wrote to the Chief Executive.

And I have sent copies of that email to -

Patricia Hewettt, Secretary of State for Health
Rosie Winterton, Minister of State, Health Services
Andy Burnham, Minister of State (Delivery and Reform)
Ivan Lewis, Under-Secretary of State (Care Services, including Older People's Services.

Well, it keeps me out of trouble.

Still no reply from the 4 Health Ministers, though, of course, Patricia Hewett is no longer Health Secretary. I don't know about the others, but it is as I would have expected.

Two years ago I found myself having to complain to the Chief Executive of South Tyneside Metropolitan Borough Council about the way Social Services had treated my Father, who was 88 at the time. She did at least reply to my email, saying she would pass my complaints to the relevant person. I always thought it was a pity she (or her Secretary) couldn't actually manage to spell her name correctly at the bottom of the email. But hey! What does attention to detail matter when you have lots of targets to miss?

Earlier, I'd had an email from my father's Social Worker with 36 typo/spelling errors. OK I know they are easy to make, but had he heard of a spell-checker, or even a dictionary? I for one tend to read what I think I have written rather than what I actually have - easily done, but am I really the only person that thinks this lack of attention to detail is sloppy and displays a slap-dash attitude?
Does it really matter? I think it does.

[Cuddles]

I sympathise with your position, but you have to look at things from the other point of view as well. Whether it had anything to do with your complaints or would have happened anyway, two weeks to get an appointment for a non-critical condition is incredibly fast. Doctors do the best they can with what they have and waiting lists are at their shortest for years. Yes, it is upsetting when the waiting list is personal rather than just a statistic, but you have to remember that everyone else in front is also a person and not just a statistic. It would be nice if everyone could be seen and treated as soon as they turn up, but that is just not possible and never will be. Again, I sympathise with you, but you should not expect your complaints to get anything more than a form reply and be logged as just one among thousands of complaints with no action possible or required.

[bindeweede]

Cuddles,
As you say, the appointment might have been made without me saying I was going to complain. The Secretary to the two Elderly Care Consultants makes it clear in her recorded message that she finishes work at 2pm. She kindly rang my mother at 2.15pm to say she was unable to give my mother any indication as to when she might see someone. The Secretary presumably started work at 9am next day, and by 10am she was able to tell my mother her appointment was two days later. That is quite a quick turnround in the situation.

My complaint is not with the GPs or Consultants, but the management of the Trust concerned. After an "urgent" (no, not "critical") referral to a specialist, my mother waited two weeks and was then told there was no way of knowing when she would be seen. That is what my complaint is about. If I had known that at the time of referral, I would willingly have paid for a private consultation, so that my mother could start to get back to a normal life after weeks suffering the side-effects of digoxin.

I also think that if members of the public write in person to the head of a State-run organisation, funded by taxation, they might expect the courtesy of a reply. As I said in an email to my MP earlier this week, he might be a bit more fortunate than I have been so far.

[Matt]

I also think that if members of the public write in person to the head of a State-run organisation, funded by taxation, they might expect the courtesy of a reply. As I said in an email to my MP earlier this week, he might be a bit more fortunate than I have been so far.

Your point of contact with government should always be your constituency MP. He or She is the correct channel if you have a question for a department of state. Your MP will then direct it as appropriate.

I see that you have written to your MP who has determined that the correct person to deal with your complaint is the chief executive. Your MP has informed you that they have forwarded your complaint to the chief executive. Minsiters will not tend to reply to correspondance that is not sent through such channels.

[bindeweede]

Matt
I didn't really expect responses from ministers - it's just me going a bit OTT. But I think I might have received at least an acknowledgement of my letter to the Chief Executive of the NHS Trust concerned.

[Matt]

Matt
I didn't really expect responses from ministers - it's just me going a bit OTT. But I think I might have received at least an acknowledgement of my letter to the Chief Executive of the NHS Trust concerned.

Considerig that your letter has been forward to him from your MP as the appropriate person to respond to your issues then yes. The trsust should indeed respond.

[bindeweede]

Well, I had my second letter this week from my MP, following my email earlier this week telling him I'd offered twice to pay for a private consultation.

"I understand your concerns on this matter and I have taken up the additional points raised with the Chief executive...."

I'm not sure if this means he has written a second letter or not.

I have to say I'm quite impressed with him - I contacted him twice over BHA campaigns, and he replied quickly, writing to the relevant Minister, and forwarding their replies. But, he is a Conservative MP, and I am a not-Conservative voter, so I won't be able to support him at the next election. I've looked at his voting record on "TheyWorkForYou.com", and he is too much to the Right of his party for me to support him.

http://www.theyworkforyou.com/mp/peter_lilley/hitchin_and_harpenden#numbers

[bindeweede]

After some internet searches I've found out a bit more about what has been going on.

At my mother's local NHS hospital (Lister in Stevenage), there are 4 Elderly Care Consultants. All 4 of them also have clinics at a private hospital (Capio) about 5 miles away, and those clinics are on Friday afternoons. My mother was seen by the excellent Dr Tong at 2.30pm on a Friday afternoon, so I'm wondering if this actually was a private visit paid for by the GP Surgery. There is a new scheme, which started in January this year, which gives patients more choice. This BUPA page gives more info, though I assume it applies to most private hospitals.

http://www.bupahospitals.co.uk/patientchoice/html/faqs/#anchorone

[bindeweede]

Matt
I didn't really expect responses from ministers - it's just me going a bit OTT. But I think I might have received at least an acknowledgement of my letter to the Chief Executive of the NHS Trust concerned.

Today, I received a letter from the Customer Service Centre, Department of Health, replying on behalf of Patricia Hewitt, who I emailed on June 18th. It didn't say anything unexpected - max waiting times, money going in to the NHS, etc, but at least I was granted the courtesy of a reply.

I had to smile when I read.... "You may wish to contact the Patient Advice and Liaison Service at East and North Herts NHS Trust on....." I tried that number twice the day I eventually ended up making a complaint, and I tried the "Complaints Dept" number too, not, at the time, to complain, but just to speak to someone about waiting times for "urgent" referrals. On all 3 occasions I got..."There is no one in the office at the moment. Please leave your message after the tone."

The latest Healthcare Commission report on this Trust gives it "weak" for management of resources. I'd never have believed it.

[bindeweede]

Well, I returned the 24 - hour heart-monitoring device to the hospital on Tuesday. The Ma is still complaining of palpitations, or whatever, so things are not as OK as I had thought.

I am wondering if there is a more modern alternative to digoxin - it has been around for decades. Perhaps there is something that has the beneficial effects without the awful side-effects.

My MP wrote to me on July 2nd that he was waiting for a reply from the Chief Executive of the N&E Herts NHS Trust regarding my letter of complaint, and his follow-up letter. Still no reply.

Diana Ross sang.... "I'm still waiting......".

EDIT. I have tried doing internet searches for alternatives to digoxin, but have not come up with anything. I know many people take it without any problems, but the Ma has a very sensitive stomach. I wonder if there are any pharmacists out there who have an answer. When one of my mother's GPs prescribed digoxin, the pharmacist questioned it, as she knew all the other drugs my mother was taking, but apparently, she was over-ruled.

[Mongrel]

EDIT. I have tried doing internet searches for alternatives to digoxin, but have not come up with anything. I know many people take it without any problems, but the Ma has a very sensitive stomach. I wonder if there are any pharmacists out there who have an answer. When one of my mother's GPs prescribed digoxin, the pharmacist questioned it, as she knew all the other drugs my mother was taking, but apparently, she was over-ruled.

What reason did she give the Doctor and has your Mother told the Doctor the same thing?

If it was an interaction\too high dosage then the Doctor should have changed it.

If she's only telling the pharmacist then the Doc may not see a reason for it to be changed.

I'm afraid this question is beyond the scope of an internet message board :( There's too many variables and too much scope for things to go wrong with incorrect advice. The only thing I might say is have you sat in with her at the doctors? Some people get intimidated at the surgery or have the "I don't want to bother the doctor" attitude and so the doctor may not be getting the full picture because he only sees it as a minor thing.

[bindeweede]

What reason did she give the Doctor and has your Mother told the Doctor the same thing?

If it was an interaction\too high dosage then the Doctor should have changed it.

If she's only telling the pharmacist then the Doc may not see a reason for it to be changed.

I'm afraid this question is beyond the scope of an internet message board :( There's too many variables and too much scope for things to go wrong with incorrect advice. The only thing I might say is have you sat in with her at the doctors? Some people get intimidated at the surgery or have the "I don't want to bother the doctor" attitude and so the doctor may not be getting the full picture because he only sees it as a minor thing.

When I handed the prescription to the pharmacist, she told me she couldn't supply it until she had spoken to the GP, and could I come back later. I did, and she said the GP had told her to go ahead and supply the medicine. She said he was "aware" of her concerns, whatevey they were. Obviously I don't know what was said between the two.

Later, Ma was seen by a specialist who gave her verapimil, I think it was. This made the nausea and vomiting worse, so the GP who prescribed the digoxin originally told her to stop that, and take twice the digoxin. This also made things intolerable, so the Ma went back to the lowest 62.5 mcg dose, I think it was, without telling the GP. Not a good idea, I know, but it seemed the only way to alleviate the effects. Even after that I twice called a GP because of my concerns about the side-effects of the digoxin. As soon as she was taken off it, she started to recover.

I wouldn't expect a diagnosis over the internet, of course. One of my concerns is that GPs prescribe medication, but they don't seem to have the time to assess its suitability after a short period. And yes, I have been with her for all but one of the GP visits.

My other concerns have been raised earlier in this thread, so no need to repeat them.

[Mongrel]

Unfortunately I think your Ma is at the stage where they're having to fiddle with the drugs and balance the side effects to make her as happy a possible over the long term.

Reducing the dosage for important medicines is a bad thing without consulting a professional. Once again (I do tend to repeat this :tongue:) her local pharmacists are normally easier to get in contact with and chat to than doctors.

Meanwhile make sure she keeps notes of what's happening in a diary so she can take it with her to the next appointment with the Doctor\Specialist.

[bindeweede]

Unfortunately I think your Ma is at the stage where they're having to fiddle with the drugs and balance the side effects to make her as happy a possible over the long term.

This is exactly what the first Elderly Care Consultant said. He said Ma's arrhythmia was not serious, nothing to worry about, relatively common. It just might take a bit of time to juggle the medication. And so the original title of this thread.

This is also why I have been trying to find out if there are any modern alternatives to digoxin. The Ma should soon be sent the results of the 24-hour heart monitor. She does still get palpitations, so it might be she needs some sort of medication on a permanent basis.

OK, I get wound up. But I saw the state she was in on the digoxin. She is a very independent, even stubborn person, and not a malingerer, but she did not have the energy to get dressed, let alone leave her flat. I looked at the link you posted, and she had most, not all, of the side effects of digoxin.

Many, many thanks for your contributions and concern. I hadn't thought about the diary idea. I'll ring her up this minute and suggest it.

[bindeweede]

Well, the 24-hour heart monitor has indicated a fast and irregular heart-beat, so we are not out of the woods. The consultant, the delightful Dr Tong, has written to the GP, and intends to call the Ma in to his out-patient clinic.

I'm just hoping the GP comes up with something other than digoxin, as the Ma says she won't take any more of it!

[dalriada]

I'm sorry to hear that. I hope you can get a medication that your mother can tolerate sorted out soon- good advice about checking with a pharmacist, they're highly skilled and a considerably under-used NHS resource.

(I remember a great quote I heard from a pharmacy prof about Doctors treating diseases about which they know little, using drugs about which they know less, on patients about which they know nothing! He may have been somewhat bitter...)

Fingers crossed for you.

[Mongrel]

they're highly skilled and a considerably under-used NHS resource.

They haven't been underused in the past couple of years, with the new contracts coming into place and lots of extra responsibilities (that they aren't paid enough for)

[dalriada]

I was involved in a piece of research not so long ago* about medicines management and cancer therapies and the pharmacists were most definitely of the opinion that they were undervalued.

Also, I watch Desperate Housewives, a sitcom which teaches you to truly fear the awesome power of the Pharmacist....

*Hughes, Cousins, Wilson, McElnay & Hughes (2006) British Pharmaceutical Conference www.healthlinks-events-bpc.co.uk/sessionsposters.pdf (http://www.healthlinks-events-bpc.co.uk/sessionsposters.pdf)

[Mongrel]

I was involved in a piece of research not so long ago* about medicines management and cancer therapies and the pharmacists were most definitely of the opinion that they were undervalued.

Also, I watch Desperate Housewives, a sitcom which teaches you to truly fear the awesome power of the Pharmacist....

*Hughes, Cousins, Wilson, McElnay & Hughes (2006) British Pharmaceutical Conference www.healthlinks-events-bpc.co.uk/sessionsposters.pdf (http://www.healthlinks-events-bpc.co.uk/sessionsposters.pdf)


Oh yeah - whenever the NHS has some new pro-active, community outreach idea it always seems to end up on the pharmacists laps, and given how they're the one group of 'frontline' healthcare who's pay has remained pretty much the same for the past 5 years or so... :-[

[bindeweede]

I phoned one of the pharmacists yesterday, asking about alternatives to digoxin, but he said I needed to contact the GP. I tried 3 extensions at the Surgery, but could not get anyone to speak to.

A new post of Community Matron has been established at the GP Surgery. The lady visits Ma regularly and monitors BP and other things. The GP's Secretary told the Matron it would take "up to a month" for Ma to see a Consultant again. The CM told Ma she would contact the Consultant's Secretary direct, and this morning, as if by magic, a letter arrived with an appointment for the 14th of this month, with a follow-up appointment on September 3rd. I am hoping the excellent Dr Tong will be able to find something that will regulate the heart-beat and the pulse - the Ma seems to think the two are independent of eachother - without the adverse side-effects of digoxin.

I suppose it would be rather cynical of me to say that, here we are, three and a half months since the problem was identified, and while a lot has happened, the situation is basically the same - Ma has heart-arrhythmia and is waiting to have it treated. So I won't say it.

I really don't think it is very good.

[bindeweede]

And the progress has been that the Ma has, today, been able to have a little walk round Tesco - the first time since the middle of April.

EDIT. This thread has had a lot of views. I am amazed, as I am aware of my emotional ramblings. I just wonder how many other people have had similar experiences.

[Mongrel]

And the progress has been that the Ma has, today, been able to have a little walk round Tesco - the first time since the middle of April.

EDIT. This thread has had a lot of views. I am amazed, as I am aware of my emotional ramblings. I just wonder how many other people have had similar experiences.

All I can offer in a vague supportive way :-[

The NHS is stretched and cash strapped, not helped by the PFIs. Whilst your Ma is "uncomfortable" she's probably not in mortal danger or going to fall over any time soon (and if she cares enough about random people on message boards, give her my best wishes), therefore she gets bumped down the queue in favour of the the more urgent cases. Don't forget that the elderly population, thanks to medical advances, is growing at a tremendous rate and your NI contributions will only go so far...

It's not fun but take heart that Doctors won't knowingly or willingly leave patients by the wayside to fend for themselves

[bindeweede]

Mongrel

Your posts have been very helpful. And I agree that if Ma's condition had been life-threatening, she would have been seen very quickly. But anyone would become alarmed when their heart starts racing when they are resting in bed. She is actually in a fortunate position - the GP surgery is literally 30 yards from her sheltered accommodation, the GPs are excellent (well, there's one I don't think is quite as sensitive with older people), the Community Matron is excellent, the staff at the Surgery are pleasant and helpful, and the hospital is about 1 mile away.

And yet, I feel it has been a one-man battle to get the problem attended to. And of course, the issue is still not resolved. And the main problem turned out to be the digoxin!

[Zaira]

bindeweede,

"EDIT. This thread has had a lot of views. I am amazed, as I am aware of my emotional ramblings. I just wonder how many other people have had similar experiences."

I just wanted to add my best wishes for your mother.

[bindeweede]

bindeweede,
"EDIT. This thread has had a lot of views. I am amazed, as I am aware of my emotional ramblings. I just wonder how many other people have had similar experiences."
I just wanted to add my best wishes for your mother.
Zaira,
Many thanks for your good wishes. I have just been re-reading some of the posts here. I'm wondering if this theme (thread) has turned into one of those "blogs". Not really sure what a blog is, but no doubt someone will clarify.

The Ma has an appointment with the charming Dr Tong on Tuesday (2.30pm), so he might be able to give her something to control the heart thingy without the drastic side-effects.

People on this high-powered site have been amazingly tolerant. It has been a real source of support for me.

And I mean REALLY.

[Zaira]

bindeweede,

Net friends can be just as important as real friends in times of trouble. It is very encouraging to know that it isn’t always about putting the world to rights here. There is always space for concern and compassion for one and other when times get difficult. I have been involved in many forms and this is not new to me - People can still surprise me with their concerns for one and other.

Remember to take care of yourself too.

[bindeweede]

Zaira
Remember to take care of yourself too.

Actually, that is something I'm not so good at. I sent a PM to John fairly early on in the thread apologising for the stuff I'd posted. He said he had no problems with it, and Jocky said the same. This isn't really the right forum for the topic, perhaps, although I believe I was right to say that the side-effects were actually worse than the Ma's symptoms.

What I have written doesn't have a great thread of logic, but my tinnitus is driving me up the bend at the moment.

Thanks for your supportive comments, and the same to others who have posted. Knowing that there are people in the anonymous ether who can be bothered to make contributions is strangely reassuring.

[Zaira]

Don’t be so surprised at the affect something like this thread can have on people. It’s a sign of the times. More people than not are communicating through computers today. Not so strange really. I for one feel very privileged to be allowed to share my feelings and thoughts at this very sensitive time for you. Thank you.

[bindeweede]

Well, the Ma's problem seems to be "atrial fibrillation", one of a number of types of arrhythmia. The NHSDirect website told me a lot.
http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=39

We were seen by a Registrar initially, who went through all of the information carefully. Considering Ma's reactions to digoxin and verapamil, she thought about beta-blockers, but decided to consult Dr Tong. He came in and was charming, saying how much better Ma looked than the last time he saw her. Eventually it was decided to try a calcium channel blocker called DILTIAZEM - but a very low dose of 60 mg in a slow-release formula to ease the possible side effects. Ma will also start on a course of Warfarin as well, to thin the blood.

We were in the consultation room for about 35 minutes, so no hint of rushing anything. Fingers crossed, the possible side-effects of diltiazam will not appear.

[bindeweede]

Well, the Ma is definitely getting back to her former energy levels. On Friday, she wandered round a large garden centre and Tesco as well, though admittedly using her 3-wheel walker as a support.

And today, with nice weather, we had a trip to the attractive Cambridgeshire town of St Ives, picturesquely situated on the Ouse, I think it is. Ma's spirits are also on the up - she went on a little spending-spree - don't know if "retail therapy" is a scientifically recognised phenomenon - although the lunch was not up to standard ["raw" vegetables !]

The irregular heart-beat (and pulse;)) are still present, so there may need to be changes to medication when Ma sees the Consultant next Tuesday. And she starts the anti-coagulant treatment on Wednesday.

There have been over 2000 views to this thread. Amazing.

[Zaira]

Great news! Retail therapy, good. O0

[Allo Allo]

The irregular heart-beat (and pulse;)) are still present, so there may need to be changes to medication when Ma sees the Consultant next Tuesday. And she starts the anti-coagulant treatment on Wednesday.

There have been over 2000 views to this thread. Amazing.

Every time I read about Ma's irregular heartbeat I remember a man I knew who used to go to the local hospital (South Africa) for electrical shock?? treatment costing R3000 a time (no NHS there). In those days R3000 was a fortune! This would get his heart going properly for about two weeks when it would go out of rhythm again. He discovered he could get a much better and longer lasting result by paying R1:40 for a roller coaster ride on the Durban beach front......I'm not suggesting this for Ma - I'm just remembering something I thought amusing at the time in the days before there were better treatments and understanding of the problem.

I think we follow Ma's story because we all have/or had "Ma's" - it's so..... well.... human!

[Zaira]

I loved the roller-coaster story, Allo Allo.

My son has an irregular heart beat. He has been rushed to hospital twice this year after passing out at work. Not sure if it’s the same thing your Ma has, bindeweede, but I put my hand on his chest once and his heart was pounding real hard. He works away and so I'm a little concerned that he isn't having it checked out. Not wanting to be the nagging mum, I stepped back and told myself, "He's a grown man and he can take care of himself." Your thread gave me the push I needed to push him into getting it checked out properly.

[bindeweede]

Every time I read about Ma's irregular heartbeat I remember a man I knew who used to go to the local hospital (South Africa) for electrical shock?? treatment costing R3000 a time (no NHS there). In those days R3000 was a fortune! This would get his heart going properly for about two weeks when it would go out of rhythm again. He discovered he could get a much better and longer lasting result by paying R1:40 for a roller coaster ride on the Durban beach front......I'm not suggesting this for Ma - I'm just remembering something I thought amusing at the time in the days before there were better treatments and understanding of the problem.

I think we follow Ma's story because we all have/or had "Ma's" - it's so..... well.... human!

I sent for a booklet on AF from NICE. It mentioned electic shock treatment as one possible course of action, but probably only in more serious cases, and not with an 85-year old!

[bindeweede]

I loved the roller-coaster story, Allo Allo.


My son has an irregular heart beat. He has been rushed to hospital twice this year after passing out at work. Not sure if it’s the same thing your Ma has, bindeweede, but I put my hand on his chest once and his heart was pounding real hard. He works away and so I'm a little concerned that he isn't having it checked out. Not wanting to be the nagging mum, I stepped back and told myself, "He's a grown man and he can take care of himself." Your thread gave me the push I needed to push him into getting it checked out properly.

I'm glad your son did what his Mum said! Neither grown men nor women are necessarily good at taking care of themselves. The Ma often tells me what to do, and I always do it, partly to keep the peace, and because if I say I have, but haven't, she can see straight through me. I'm a hopeless liar.

There are all sorts of causes of irregular heat-beat, as I'm sure you will have researched. I really hope it all works out OK.

[Zaira]

Thanks. I do too.

[Cuddles]

I sent for a booklet on AF from NICE. It mentioned electic shock treatment as one possible course of action, but probably only in more serious cases, and not with an 85-year old!


There are actually very few problems with having an irregular heartbeat, the big problem is the switch from regular to irregular. "Electric shock treatment" called cardioversion, is basically the same as defibrillation, the shock overrides the signal from a faulty pacemaker (the heart's natural one that is, not a fake one) and allows it to regain it's proper timing. However, if there is an underlying problem that caused the heart to go out of rhythm in the first place it is very likely that it will just do so again.

It is usually easier, more comfortable and safer to live permanently out of rhythm, with blood thinners to reduce the strain on the heart, than to repeatedly jump in and out of proper rhythm, both of which are dangerous.

Around 10% of people are affected by arrhythmias, most of which aren't dangerous and don't require any real treatment. This site has a lot of information about this sort of thing: http://www.heartrhythmcharity.org.uk/

[Zaira]

Thanks. That was quite helpful.

[bindeweede]

Cuddles,
Thanks for that post. I've added your link to "favourites".

[bindeweede]

Well, the Ma has started her Warfarin treatment. Last Wednesday, we spent 50 minutes with the nurse, as she explained to Ma ,very carefully, and at least 3 times, how the treatment works. A few years ago Ma had a DVT, so she was reasonably familiar anyway.

And today, we saw the wonderful Dr Tong. He is increasing the dose of the current medication, as it still has not fully resolved the problem. He also asked if Ma was trying to keep mobile, and how important it was. His face was a picture when she said she did 6 cartwheels across her living-room floor every night;D. He suggested she up the cartwheels to 10 or 12.:shocked:

[bindeweede]

Oh dear. The Ma is back on antibiotics as her breathing is bad again. The GP is trying oxytetracycline, which I think is quite an old AB, but I'm guessing she is doing so as she doesn't want Ma to develop a resistance to amoxycillin, which she can take without side-effects. Ma has had about 3 courses of that in the last 4-5 months.

It just seems to be one problem after another at the moment. It seems to be what happens with quite a lot of elderly folk.

[Mongrel]

It just seems to be one problem after another at the moment. It seems to be what happens with quite a lot of elderly folk.

Age is one of the side effects of modern medicine unfortunately, one that we don't have a cure for yet :(

[bindeweede]

Age is one of the side effects of modern medicine unfortunately, one that we don't have a cure for yet :(

I think you are right. I might just pop along to my local Healing Crystals shop, and see what they recommend;). As Ma doesn't pay for her prescriptions, I'm sure whatever they suggest will be "Abundance Contribution Exempt":cheesy:.

[bindeweede]

Well, I expected this, having looked up the side-effects of the latest anti-biotics. Ma was sick twice yesterday, bringing up not only the AB's but the other tablets as well, and again this morning. She decided to stop taking them as she says she feels worse than when she was on the digoxin, weeks ago.

Fortunately the excellent Community Matron got the GP to try something else, so tomorrow Ma starts on co-amoxiclav, which contains amoxycillin, which she does tolerate, combined with clavulanic acid, another AB.

What a saga...

[Zaira]

Tom,

I'm sorry to hear things are not so good again.
Take care. Keep us informed. ;)

[bindeweede]

Tom,
I'm sorry to hear things are not so good again.
Take care. Keep us informed. ;)
Nice to see you back here againO0

[Zaira]

Thank you. It's nice to be back. :smiley:

[bindeweede]

The excellent Community Matron reckons the increased dose of Diltiazem has stabilised the Ma's pulse rate. Certainly Ma is not now complaining her heart is racing in the early morning.

She does complain that she has no energy - is easily tired - and I try to explain that with a complicated lung problem and heart problems, even though they seem to be stabilised, she is not likely to get very much better. Ultimately, I suppose there is only one cure, which, well.......you know is inevitable. I'll continue to do my best.

[Zaira]

Good morning, Tom. Hope this doesn't offend. Just wanted to leave more than a few lines. Have a good weekend. R.

Something More

You'll never know how much I long
to be the dutiful son
who could bring you on this Christmas day
laughter, family and fun
but I am made of ill-fitting pieces
and have wandered meandering roads
to wind up here in this uneasy silence
aching to be something more

What gift could I ever give you
that would show my love and regard
or my undying appreciation
for making little go so very far
that only as a man do I understand
that we were, in fact, rather poor,
and I find myself in uneasy silence
wishing I was something more

Instead of giggling grandkids
I can bring you only my songs
or a few disturbing stories
that I wrote once when I was strong
or a handful of hasty sketches
I made once when I was bored
shall I sing to fill the silence
and keep wishing I was something more?


posted by Wicasta @ 10:23 AM

Borrowed from -

http://www.wicasta.com/poetry/poetry.html

[bindeweede]

Zaira

Many thanks for the poem - I'm going to print it off.

but I am made of ill-fitting pieces

absolutely right there......;D

[Zaira]

"but I am made of ill-fitting pieces"

Aren't we all!! ;)

[bindeweede]

Actually, the Ma is not the easiest of people to get along with. The Manager of the Sheltered Accommodation place where Ma lives knows all about that. And I did get a bit impatient with her today - I know I shouldn't, but sometimes she can test the patience of...a...an.....someone with super-human levels of patience. Which I don't have.

We patched it up, and she bought herself a new coat from John Lewis, and some high-strength Codliver Oil Pills from Boots which were HALF-PRICE! So not such a bad day, all in all.^-^

[Zaira]

Tom,

Perhaps she is simply trying to hang onto as much of her independence as she can. Go with it. We don’t live forever. You know you are doing your best - we are not saints. That’s what it feels like to me - just through your posts.

My life was …. Well you read my posts. I hated my mum for such a long time for putting up with it and for not getting to hell out of there. Then I sat by her bed in the hospice, in 1998, for ten days, she was only sixty-one. She was out of it most of the time on morphine but when she was with us she was so soft spoken, so gentle, I knew I was speaking to the woman who was my mum, the woman she would have been without all the crap.

Do what you can for her, it’s all you can do. :smiley:

[bindeweede]

Tom,
Perhaps she is simply trying to hang onto as much of her independence as she can. Go with it. We don’t live forever. You know you are doing your best - we are not saints. That’s what it feels like to me - just through your posts.
My life was …. Well you read my posts. I hated my mum for such a long time for putting up with it and for not getting to hell out of there. Then I sat by her bed in the hospice, in 1998, for ten days, she was only sixty-one. She was out of it most of the time on morphine but when she was with us she was so soft spoken, so gentle, I knew I was speaking to the woman who was my mum, the woman she would have been without all the crap.
Do what you can for her, it’s all you can do. :smiley:
I think you are right about the independence thing. It is staring me in the face really, but I am the Tortoise, not the Hare.

T.

Well, you know.......you know.....

[bindeweede]

I think you are right about the independence thing. It is staring me in the face really, but I am the Tortoise, not the Hare.

T.

Well, you know.......you know.....

And we know.

[Zaira]

O0

[Zaira]

Just checking in and hoping everything is ok.
That music is wonderful.

[bindeweede]

Glad you like those songs - thought you would. It's the 3rd verse of "Beim Schlafengehen" that reduces me to a heap - every time.

[Zaira]

Thank you. :smiley:

[bindeweede]

Well, the anti-coagulant treatment seems to be working. The target figure, apparently, is between 2 and 3 international units of.... something. The Ma's figures have varied from 0.8 (far too thick ), to 5.8 (far too thin). The latest blood-test result produced a figure of 2.8, which appears to be acceptable, as the Ma does not need to go for another blood test until Oct. 22nd.

Progress. Even slight.

[bindeweede]

Well, the Ma won £105 on the Thunderball on Saturday. Not a lot, but she is happy with it. The warfarin treatment is still not quite stabilised, but the people who monitor the blood-tests are doing a good job. IMO.

[Zaira]

Hi! Always glad to hear things are going quite well.
Take care of you. R. :smiley:

[bindeweede]

I had to smile today. The Ma does have a "thing" about toilet paper. We were in Tesco's, and I found a special packet with 3 rolls free. Well, Ma's eyes lit up with delight - that will bring her total storage-count of toilet rolls to about 30.

Then, there was the pepper shortage she read about in "The Sun", some years ago.......

Still, when I ask her how she is, I get, "Well, I suppose I'm not too bad, considering",......which, approaching 86, is probably as good as it is likely to get.

[siestatime]

My parents stockpile too, I think it´s because their generation had rationing to contend with, making nutritious meals out of half a cabbage, three carrots and a pair of socks.

[Muttley]

Blimey. Three carrots? We could never afford that many. And a whole pair of socks?:shocked:

[bobdezon]

You were lucky...............[/python]

[bindeweede]

Well, the Ma's latest problem is an itchy skin that has covered most of her body over the last 2 weeks. She saw a GP last week, and was prescribed "Oilatum" I think it is called - mostly liquid paraffin?? But the Ma says it is not helping. She is convinced the problem is something to do with her blood, not a skin issue.

She has decided, against my advice, to stop taking one of her diltiazem pills, as she thinks it is those that are causing the itchiness. Well, she might be right. I THINK I have persuaded her to go back to see a GP tomorrow, if she can. Perhaps an antihistamine ointment might help.

Perhaps it is some sort of reaction to all of the medication she is taking.

[Mongrel]

Well, the Ma's latest problem is an itchy skin that has covered most of her body over the last 2 weeks. She saw a GP last week, and was prescribed "Oilatum" I think it is called - mostly liquid paraffin?? But the Ma says it is not helping. She is convinced the problem is something to do with her blood, not a skin issue.

She has decided, against my advice, to stop taking one of her diltiazem pills, as she thinks it is those that are causing the itchiness. Well, she might be right. I THINK I have persuaded her to go back to see a GP tomorrow, if she can. Perhaps an antihistamine ointment might help.

Perhaps it is some sort of reaction to all of the medication she is taking.

Likely, a random Diltiazem (http://www.medicines.org.uk/) has this to say about possible side effects,


In rare cases, skin reactions may occur. These include exfoliative dermatitis (flaking skin), angio-oedema (swollen skin), erythema multiforme (red, swollen skin), and vasculitis (inflammation of the blood vessels). Another rare reaction is gingival hyperplasia (overgrowth of the gums).

If any of these trouble you or you have any other problems, please tell your doctor.

as for the Oilatum, yes it's mostly Liquid paraffin\Soft paraffin although some of the preparations also contain Wool alcohol.

First thing to make sure of is that she goes to see the Doctor and the next thing is to make sure she's using the ointment properly, slather is the appropriate word not "apply sparingly"

[bindeweede]

Mongrel,
Thanks for that. Ma saw another GP this morning. Apparently, the doc went through all the stuff Ma is taking, but couldn't find anything that might be causing the itch. What you linked to about diltiazem is interesting - rash is listed as a rare adverse effect in my BMA Guide to Medicines and Drugs. However, Ma has been on the diltiazem for quite a few months now, and the itch/rash has only been there for a couple of weeks.

Anyway, Ma has been given Dermol Cream to use as well as the Oilatum, and chlorphenamine tabs, which I gather is a antihistamine, so we'll se how she gets on with these.

I'm guessing you are a Pharmacist - you certainly seem to know a lot about the "DT" - yup got there!

[bindeweede]

Mongrel

I've just come across the NHS Electronic Drug Tariff - some interesting reading. I'm assuming the prices are in pence per unit pack.

http://www.ppa.org.uk/edt/November_2007/mindex.htm

I know you will be aware of it, but others might be interested too.

[Mongrel]

I'm guessing you are a Pharmacist - you certainly seem to know a lot about the "DT" - yup got there!

No I'm not, my GF is though and we have 4 here at work where we compile and upkeep a database used by Pharmacists ;)

[Mongrel]

Mongrel

I've just come across the NHS Electronic Drug Tariff - some interesting reading. I'm assuming the prices are in pence per unit pack.

http://www.ppa.org.uk/edt/November_2007/mindex.htm

I know you will be aware of it, but others might be interested too.

Nearly forgot - this is a better link http://www.ppa.org.uk/ppa/edt_intro.htm , the URL you're using changes monthly. :)

[bindeweede]

Mongrel,

I have just read through this whole thread to remind myself of the story. I want to thank you for all of your contributions - they have been very helpful. I think you must be a totally wonderful person, and your God Father (;)) is a lucky person.

Seriously, thanks.

[bindeweede]

Today I received a letter from my MP containing a copy of the letter the Chief Executive of the East and North Herts. NHS Trust wrote, on November 9th, in reply to the MP's letters of around June 25th and July 2nd. What a fast worker he is.

Basically, because of the Data Protection Act, he cannot respond to my emails, my letter of complaint, or the MP's letters , as Ma didn't want to cause any fuss by signing the Consent Form. I smiled at this.....

"Mr Roberts (that's me!) originally wrote to the Trust via e-mail on 5 June 2007, however it was sent to an e-mail address used by our Complaints Team." That's because it was a complaint.

Brick-walls and heads.

[bindeweede]

Well, the Ma had to go back to the GP, again, yesterday, because of this itch/rash, as it has not get any better. She has now been given whatever the generic name is for Clarityn - another antihistamine I think.

So, 2 ointments and 2 tablets, on top of all of the other stuff she is taking. But they don't seem to be trying to find out what the problem is - just trying to treat the symptoms. Ma has this idea it is a blood problem - but the 3 different GPs she has seen haven't responded to that.

I really wonder if giving elderly patients more and more drugs is such a great idea. But I don't know.

[Mongrel]

Well, the Ma had to go back to the GP, again, yesterday, because of this itch/rash, as it has not get any better. She has now been given whatever the generic name is for Clarityn - another antihistamine I think.

So, 2 ointments and 2 tablets, on top of all of the other stuff she is taking. But they don't seem to be trying to find out what the problem is - just trying to treat the symptoms. Ma has this idea it is a blood problem - but the 3 different GPs she has seen haven't responded to that.

I really wonder if giving elderly patients more and more drugs is such a great idea. But I don't know.

To be fair a reaction to the digoxin would be expected to show up near the start of treatment. Have you had a look under the sink for new chemicals she may have been exposed to or tried a different (hypoallergenic) laundry detergent\fabric softener?

The only other problem seems to be (and I don't mean offense at this) that your Mum doesn't want to kick up too much of a fuss :( Does she have a friend she can go with who might bolster her a little, she may see you as too aggressive, maybe she could speak to one of the practice nurses they may listen better. Even see the Pharmacist for an MUR (I believe I've mentioned this before), they get paid to do them and it's another set of eyes to look at the data.

[bindeweede]

Mongrel

Yes, we have thought about any changes in detergents. I've persuaded Ma to go over to non-Bio washing powder. She is using the same fabric conditioner as usual. Her diet hasn't changed. She drinks filtered/bottled water, and has done for ages. I speak to her every night, and she is still complaining about this itch, making herself bleed, and getting depressed about it.

Unfortunately, the excellent Community Matron is off sick, but someone else is coming to visit on about December 12th, but that is still a fair way away. I'll be over to take her out tomorrow, and I'll mention this MUR, which yes, you did refer to a fair while ago.

It's getting boring saying "Thanks", so I won't. Oh, I don't mean that the way it might sound. But I'm sure you get my drift.

[dee]

Just a thought - I tend to get itchy and scratch myself to bits when I'm stressed or have coke (the drink not the stuff you sniff>:-)) - it may be worth looking into to see if she's developed an allergy to something. Also my dermatologist told me to have a cool bath whenever the itchies get too much and this does help too. Hope this helps, if not nothing ventured and all that...

[bindeweede]

Just a thought - I tend to get itchy and scratch myself to bits when I'm stressed or have coke (the drink not the stuff you sniff>:-)) - it may be worth looking into to see if she's developed an allergy to something. Also my dermatologist told me to have a cool bath whenever the itchies get too much and this does help too. Hope this helps, if not nothing ventured and all that...

Dee
You've raised a couple of interesting points there - thanks. Ma doesn't like Coke, but she does get through quite a lot of "diet" lemonade - uses it to water down the brandy she takes to help her sleep. Though she has thought of this too, and now just adds water.

I don't believe she is particularly stressed, but she does get annoyed with herself when one of her ailment plays up - as if it's her fault. She has found that a short shower helps in the short-term, but the effect wears off. It might, as you say, might be an allergy she has developed, but I believe trying to identify the causes of these things is tricky.

[bindeweede]

Mongrel

We discussed this MUR this morning and Ma has one booked for next Wednesday. Nothing to lose, and the pharmacist might be able to come up with a possible cause of this itch/rash.

I did see Ma's repeat prescription today. She takes 10 different types of medication every day, and at the moment a further 2 antihistamines. But one of the GPs went through them a couple of weeks ago, and didn't think anything she was taking was likely to be the cause of the problem.

[Mongrel]

Mongrel

We discussed this MUR this morning and Ma has one booked for next Wednesday. Nothing to lose, and the pharmacist might be able to come up with a possible cause of this itch/rash.

I did see Ma's repeat prescription today. She takes 10 different types of medication every day, and at the moment a further 2 antihistamines. But one of the GPs went through them a couple of weeks ago, and didn't think anything she was taking was likely to be the cause of the problem.

Well Pharmacists are normally better at spotting problems like this, their training (and continual training) focuses much more on the drugs and all the fun ways they can interact with the human body. What you have to make very clear to your Mum is that
i) It's not a bother for the Pharmacist
ii) They can only make accurate recommendations base on the information given to them. The more accurate it is the better assistance they can be.

[bindeweede]

Mongrel

The pharmacists have all Ma's medication on their computer. They did say that she would need to tell them if she is taking anything prescribed by the hospital, but that doesn't apply. She also takes multi-vits and cod-liver oil tabs, but I can't imagine they would cause any probs.

I do remember, early on in the saga, one of the pharmacists would not dispense one prescription - I can't remember which one it was - until she had discussed it with the GP. It'll be interesting to hear what they say on Wednesday.

O0

[Mongrel]

The pharmacists have all Ma's medication on their computer.

There's a fairly good chance that it's the software I help maintain ;)

But yeah, the pharmacists are trained to recognise potential problems with prescriptions. With an MUR they have a chance to sit down and take a bit of time over it as opposed to the normal 'on the fly' method when they're just dispensing a script or a quick double check when the system flashes a warning at them.

[bindeweede]

Mongrel

Just out of interest, yesterday I made a chart of the medication Ma is taking, and listed common side-effects, rare side-effects, and interactions. Over the last 4 weeks, she has developed an itch which is really disturbing her. 7 of the 12 medications Ma is taking list rash/skin irritation as rare side-effects. She has always had a sensitive stomach - can't even take aspirin, for example.

I presume that whatever the pharmacist recommends at the MUR, he will not advocate a change in medication: that would need to come from a GP?

[Mongrel]

I presume that whatever the pharmacist recommends at the MUR, he will not advocate a change in medication: that would need to come from a GP?

If needed the pharmacist will give your Mum a letter at the end of the consultation with recommendations for your Mum to give to the Doctor. They can advocate a change but only the GP can 'sign it off'.

[bindeweede]

Mongrel

By the way, will there be a charge for this service?

[Mongrel]

Mongrel

By the way, will there be a charge for this service?

Perhaps....;)

It may involve beer ^-^

[bindeweede]

Well, today, another letter from my MP arrived. In my email replying to his last one, I said I had found the letter from the Chief Executive of the Trust unhelpful, unco-operative and obstructive. I said his comment about my email of complaint going to the Complaints Dept. was stupid. I said I did not see why my mother's medical records needed to be seen, when my complaint was about the allocation of consultant appointments following an "urgent" GP referral. And I said I'd had neither an acknowledgement nor a reply to my letter of June 6th.

Today, he says is has taken up my concerns with Alan Johnson, Secretary of State for Health. I did not ask for, or even suggest this. I thought there was no point in trying to go any further.

I presume - could be wrong, of course - that the MP does not feel my comments have been satisfactorily addressed.

I have to give him fill marks for tenacity.

[bindeweede]

Ma had her Medicine Review on Wednesday. A very pleasant pharmacist spent almost 30 minutes carefully going through the medication Ma is taking. She couldn't suggest what might be causing the itch, but said she would send a copy of her report to the GP, suggesting he try a different antihistamine, as the 2 Ma is currently taking don't seem to be having any effect.

As the Pharmacist was a woman of Middle Eastern origin, I didn't really think offering to take her down the pub for a pint was such a great idea.:-[

[bindeweede]

So, Ma had to go to see a GP again today, regarding the itch. Well, she is "scratching herself to shreds", which might be a slight exaggeration, but her sheets and clothes are spotted with blood.

An antibiotic (flucloxacillin?) has been prescribed, plus more antihistamines. If this doesn't work, then a referral to a dermatologist is likely to be necessary. Which will take some time, of course.

But Ma will be 86 in 6 days, so in spite of all of the problems, she ain't doing too badly. There are others a lot worse.

[Janot]

For what it's worth, and that is probably not much, I have had skin irritation for 20 odd years, and several doctors were unable to diagnose what was clearly a rare skin disease. I discovered by accident (by running out of it, and further experiment) that I was allergic to soap. No soap, problem almost solved. Regular application with a neutral moisturizer keeps those areas once itchy under control most of the time. It might not have anything to do with medication, but even if it has, a good moisturizer helps a lot.:smiley:

[bindeweede]

Janot,

Thanks for that. Out of interest, what would you call a "good moisturiser" ? Ma already has Oilatum and Dermol Cream, and has bought E45..She uses Dove soap - the non-perfumed hypo-allergenic stuff, and has for a few years. We can't think of anything that has changed in her "life-style", but she's had this problem for nearly 6 weeks.

Yet another GP visit this week I fear.

[Nasib]

Janot,

Thanks for that. Out of interest, what would you call a "good moisturiser" ? Ma already has Oilatum and Dermol Cream, and has bought E45..She uses Dove soap - the non-perfumed hypo-allergenic stuff, and has for a few years. We can't think of anything that has changed in her "life-style", but she's had this problem for nearly 6 weeks.

Yet another GP visit this week I fear.

Bindeweede,

Some internally taken medications can be the very cause of the itch.

Not sure if you can get over the counter, but ask GP if can prescribe Emulsifying Ointment BP. Recently prescribed for me by GP who also "ordered" me not to use Dove soap (only soap I can use).
Any soaps will just aggravate the itch.
I'm using in conjunction with Dermovate ointment (altho this is steroid based, so must be used sparingly, as over-use will thin the skin)

Notes on the tub:-
Emulsifying Ointment BP
What is your medical preparation and what is it used for? Emuslifying Ointment is a semi opaque waxy ointment and is used as an ingredient in the preparation of Aqueous Cream (my note here: Aqueous cream is used to ease the effects of radiation treatment on the skin) and Buffered Cream.
Consitutents: Emulsifying Wax 30% w.w, White Soft Paraffin 50% w.w and Liquid Paraffin 20% w.w.
Before using this product: Inform your doctor or pharmacist if you are allergic to any of the ingredients listed above.
What about side effects? Side effects are unlikely with use of this product.

[seren]

Wow, do you need a prescription for that? It sounds like posh Vaseline.

I used to eat Vaseline when I was a kid. I'm probably going to get cancer or something now, aren't I? :-[

[dee]

Janot,

Thanks for that. Out of interest, what would you call a "good moisturiser" ? Ma already has Oilatum and Dermol Cream, and has bought E45..She uses Dove soap - the non-perfumed hypo-allergenic stuff, and has for a few years. We can't think of anything that has changed in her "life-style", but she's had this problem for nearly 6 weeks.

Yet another GP visit this week I fear.

Theres a really good gloopy one that I use called Cetraban (sp?) It's only available on prescription I think and comes in a big white pump dispenser. It lasts for ages - I'm still using one from the start of the summer.

[Janot]

what would you call a "good moisturiser" ? Ma already has Oilatum and Dermol Cream, and has bought E45..I use E45 moisturizing lotion as the most effective for me. It really is amazing how difficult it is to get a skin product with no additives to which you might be allergic. I can't use Dove soap, because it is, surprisingly, soap.

[Mongrel]

Wow, do you need a prescription for that? It sounds like posh Vaseline.



It is, but

a) It works really well as a moisturiser and it's incredibly rare to be allergic to it

b) It's cheap and comes in big tubs, she should be using lots of it

c) If she can get it on Prescription it's free

[DrS]

For me, Clarins body moisturizer is the best I've found. Not cheap, but it does a brilliant job for the dry skin I get on my joints (rheumatoid arthritis, so stubborn dryness). Totally non-allergenic, it seems.

[Nasib]

Wow, do you need a prescription for that? It sounds like posh Vaseline.

I used to eat Vaseline when I was a kid. I'm probably going to get cancer or something now, aren't I? :-[

Bet it's done wonders for your bowel movements tho, Seren :smiley:

[bindeweede]

Thanks to all for the ideas. I'll try to get some Emulsifying Ointment BP, and the Clarins moisturiser. Will also mention the Cetraban to Ma before she sees a GP, hopefully, on Wednesday.

BW

[seren]

Bet it's done wonders for your bowel movements tho, Seren

;D;D

There's no reply I can give that's remotely tasteful so I'm keeping schtum. But that did make me lol.

[bindeweede]

Thanks to all for the ideas. I'll try to get some Emulsifying Ointment BP, and the Clarins moisturiser. Will also mention the Cetraban to Ma before she sees a GP, hopefully, on Wednesday.

BW

I spoke to a friendly local pharmacist, and she suggested trying the Emulsifying Ointment (£2.99 for a big pot) before spending £10-15 on the Clarins option. Ma says her itch isn't quite so bad ATM - might be the ABs, or nature. Life is a mystery. I think even Cuddles might agree with me there.

[Mongrel]

I spoke to a friendly local pharmacist, and she suggested trying the Emulsifying Ointment (£2.99 for a big pot) before spending £10-15 on the Clarins option. Ma says her itch isn't quite so bad ATM - might be the ABs, or nature. Life is a mystery. I think even Cuddles might agree with me there.

Don't forget that Clarins is a beauty product, so it's price bumped for nice packaging an agreeable scent and chemicals of dubious efficacy that sound scientific in the Ads ;)

EDIT - While I've got me books open...

Cetraben is White soft paraffin 13.2%+Light Liquid Paraffin 10.5% so it's an oilier version of Oilatum (Light liq paraf 6%+ wsp 15%) but is also available over the counter.

[bindeweede]

Don't forget that Clarins is a beauty product, so it's price bumped for nice packaging an agreeable scent and chemicals of dubious efficacy that sound scientific in the Ads ;)

EDIT - While I've got me books open...

Cetraben is White soft paraffin 13.2%+Light Liquid Paraffin 10.5% so it's an oilier version of Oilatum (Light liq paraf 6%+ wsp 15%) but is also available over the counter.
Mongrel,
Sorry to be a bore. Can you say what the difference is between Cetraben and Dermal (ol?) cream? Is it just down to different combinations of paraffins, or completely different?

As always, thanks in advance.

[Mongrel]

Mongrel,
Sorry to be a bore. Can you say what the difference is between Cetraben and Dermal (ol?) cream? Is it just down to different combinations of paraffins, or completely different?

As always, thanks in advance.


From the EMC (http://emc.medicines.org.uk/)
Dermol - Liquid Paraffin 10.0% w/w; Isopropyl Myristate 10.0% w/w; Benzalkonium Chloride 0.1% w/w; Chlorhexidine Dihydrochloride 0.1% w/w.


Liquid Paraffin and Isopropyl Myristate are both emollients "permit rehydration of dry skin by forming an occlusive barrier within the skin surface, thus reducing drying from evaporation of water that diffuses from the underlying layers."

Benzalkonium Chloride and Chlorhexidine Dihydrochloride are both antiseptics "Its antimicrobial properties assist in overcoming infection, whether from Staph aureus, the pathogen which often complicates eczema and associated pruritus, or secondary infection caused by scratching."

[bindeweede]

Well, I had to smile. Ma is here for the Chrisymas period. She enjoyed her meal tonight, but decided on an early night. "I'll just take a drop of brandy to get me off to sleep". "I'll get you a glass." " NO, a mug please." I gave her the top of a Schweppes bottle that contains a triple measure. In go 2 and a half caps-full. That about 7 singles! But she put a bit of water in, so that's OK!

Well, at 86, she's allowed.

Happy Christmas to all.

Crimblephobe.

[Mongrel]

Well, I had to smile. Ma is here for the Chrisymas period. She enjoyed her meal tonight, but decided on an early night. "I'll just take a drop of brandy to get me off to sleep". "I'll get you a glass." " NO, a mug please." I gave her the top of a Schweppes bottle that contains a triple measure. In go 2 and a half caps-full. That about 7 singles! But she put a bit of water in, so that's OK!

Well, at 86, she's allowed.

Happy Christmas to all.

Crimblephobe.

Whilst knocking back another fine Badger Brew I'm just going to stick with "The poison's in the dose" O0

You and Ma have a good 'un BW

[bindeweede]

Mongrel

Thanks for your good wishes. I hope you and you folks had a pleasant time too.

This itch of the Ma's seems to be getting better - it might be the ointments, antihistamines, antibiotics - or it might have done so anyway.

I had another smile - we had 3 games of Scrabble. Guess who won them all. Yup, Ma. In the last game, she scored 72 points with "quad" - got the "Q" on a double-letter and triple word score. She has her physical problems, but I'm pleased to report her brain is still pretty sharp.

And she can still see straight through me if I don't exactly present her with quite the whole story.

Happy New Year to you too.

[bindeweede]

Well, Ma's itch has got worse again. She has even bought a couple of pairs of cotton gloves to try to stop the damage the scratching is causing.

She has an appointment to see a GP on the 18th of this month, but I've convinced her that she needs to see someone sooner - she said she would go over to the GP Surgery at 8am tomorrow and see what they can do. There is one particular receptionist who has been particularly helpful, apparently.

She might need to be referred to a Dermatologist this time. Which will take a while. I wonder if it is worth trying to get a Private Consultation, although when I made the offer last time, it didn't do any good.

[bindeweede]

Ma's itch/skin problem seems to be spreading. The Housing Officer saw the state she was in this morning and wanted to get a GP out, but as it's not really an emergency, she'd have to wait.

Ma is getting quite distressed about it now - it has been going on for quite a time - can't sleep, is getting depressed and physically shaking all of the time. Anyway, after a few phone calls, she has an appointment for a consultation at a local Private hospital - 4pm tomorrow. (15th) I hope the Consultant will have some good options for treatment.

[siestatime]

I wish both you and your mother all the best tomorrow.
:smiley:

[bindeweede]

I wish both you and your mother all the best tomorrow.
:smiley:

Siestatime,

Thank you for your good wishes. I must also thank the good DrS, from another thread, for her (I think) good wishes too. I'm a bit late there.

[bindeweede]

The visit to the Consultant was useful. She told Ma to STOP the terbinafine, which was given to her on Friday. It is an anti-fungal drug. The Consultant looked at Ma's repeat prescriptions and said the terbinafine had interactions with the other stuff she takes. That might explain the shaky, distressed state she has been in for a few days.

Ma has also been prescribed Fucibet, Trimovate, Eumovate, Elocon and Zirtec. Some of these are steroidal creams. We bought the Trimovate and Zirtek at the hospital - invoice in post - but the GP Surgery refused to put the other drugs on an NHS prescription. New PCT rules, apparently. OK, fair enough I suppose. If a rich old woman on income support can afford to go for a Private consultation, she can afford to pay for medicines outside the NHS.

The local friendly pharmacist suggested Ma take the private prescription to her GP on Friday. When some of the stuff runs out, they might be kind enough to put it on an NHS prescription if needed.

The bill for the consultation is in the post. Actually, I thought it was very trusting of them.

[DrS]

I must also thank the good DrS, from another thread, for her (I think) good wishes too. I'm a bit late there.

Hope it all turns out well bindeweede, it sounds extremely distressing. And yes, I'm definitely a "her"! ;)

[bindeweede]

The Dermatologist asked for blood tests, so last week, 5 or 6 samples were taken. Today's results showed no problems. So I'm not sure where to go from here. These steroidal creams are not supposed to be for long-term use, especially with asthmatics.

Ma says the itching is still getting her down, especially at night, and she is not sleeping at all well. Another GP visit I think.

[Matt]

Pyjamas to reduce itching? Daily Mail (http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=512284&in_page_id=1770&ICO=NEWS&ICL=TOPART) to the rescue...

http://img.dailymail.co.uk/i/pix/2008/02_01/pyjamas1SWNS0402_468x759.jpg

Or not as the case may be.

[Mongrel]

Pyjamas to reduce itching? Daily Mail (http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=512284&in_page_id=1770&ICO=NEWS&ICL=TOPART) to the rescue...

Or not as the case may be.

Well that sort of body covering to protect skin is available on the NHS, if you have it real bad you can even get your jammies in silk (http://www.ppa.org.uk/edt/February_2008/mindex.htm) ;)

[bindeweede]

A nurse made a routine visit to Ma today, and was so concerned about the state of her bottom and legs, she made an emergency appointment with the GP. He has prescribed more antibiotics and hydroxyzine, which is some sort of anti-anxiety drug, as Ma is getting really worked up through lack of sleep.

Looks like a second visit to the Dermatologist will be necessary.

[Pebble]

A nurse made a routine visit to Ma today, and was so concerned about the state of her bottom and legs, she made an emergency appointment with the GP. He has prescribed more antibiotics and hydroxyzine, which is some sort of anti-anxiety drug, as Ma is getting really worked up through lack of sleep.

Looks like a second visit to the Dermatologist will be necessary.

Time for a second opinion, I think. Dermatology is really an art, if there is no obvious cause on initial tests, you need someone who really thinks outside the box. Teaching hospitals not a bad place to look. I am assuming that vasculitidies, hematological malignancies, liver disease, endocrinopathies and allergies have already been considered and ruled out.

[Pebble]

Bindeweede,

Looking briefly through the thread I get the impression the rash started in early November. Shortly after starting diltazem (unusual cause of rash) and about 6 weeks after starting warfarin (relatively common cause of rash). Any other drugs started around that time. Most drug rashes start within 2 weeks, but not always.
Warfarin can be replaced by Phenindione, more side effects overall so not usually first line, but very useful if warfarin intolerant.

[bindeweede]

Pebble,

Thanks for your suggestions. We have an appointment with the Consultant on Tuesday. Ma's problem is not a rash - just this awful itching, and she can't stop scratching. It keeps her awake at night, so much that she says she is only getting 2 hours of sleep. But there might be some exaggeration - at 86 she is allowed. She is certainly in a distressed state about it.

The Consultant has already been through all the meds Ma is on, but I will ask if an alternative to Warfarin might be possible. My latest idea is that this feather mattress she wanted me to buy her for Christmas might be making the problem worse. She saw it on a shopping channel, and as she's always been a bad sleeper, she thought it might be nice and soft to lie on.

When she was with me over Christmas, I put a synthetic duvet on the mattress to make it a bit softer. She certainly wasn't scratching as much then.

Just clutching at straws, really.

[Pebble]

Well, the Ma had to go back to the GP, again, yesterday, because of this itch/rash, as it has not get any better. She has now been given whatever the generic name is for Clarityn - another antihistamine I think.



Sorry, got impression from this and I think entry 95. Warfarin may cause a nasty rash, itching without rash less common. But when desperate most will try removing medicines one at a time for 2 - 3 weeks. This can even be done with warfarin so long as the risk of stroke is not too high (>7 - 10%) per year.

[bindeweede]

The Ma took Warfarin about 5 years ago, because of a deep-vein thrombosis. At that time, there were no problems.

The Consultant has now prescribed steroids by mouth - Prednisolone - for 2 weeks, to see if that might reduce the itch. Ma has taken that for her bad chest anyway, so there should not be any problems. If that does not improve things, she said some skin tests would need to be done.

Ho hum.

[bindeweede]

Today, another GP said she saw no point in skin tests. An 8-week course of steroids has been started. The Ma rather depressed, atm.

[Fiona]

I am sorry to hear that Bindeweede. This must be very wearing for her.

[bindeweede]

Fiona,

Ma is now 3 weeks into this new course of treatment, and the improvement is dramatic. She is still scratching a bit, but not doing anywhere near the damage she was doing. A retired nurse friend of mine said the steroids actually REDUCE the body's immune reaction to infection, which I don't really understand. But, apart from a slight puffiness in the face, which I'm told is to be expected, and a greatly increased appetite, things are improving.

I just don't understand why it took so long to get the right course of action.

[Mongrel]

Fiona,

Ma is now 3 weeks into this new course of treatment, and the improvement is dramatic. She is still scratching a bit, but not doing anywhere near the damage she was doing. A retired nurse friend of mine said the steroids actually REDUCE the body's immune reaction to infection, which I don't really understand. But, apart from a slight puffiness in the face, which I'm told is to be expected, and a greatly increased appetite, things are improving.

I just don't understand why it took so long to get the right course of action.

Steroids are a bit of a double whammy, they have immunosuppressant properties AND they reduce inflammation, thus turning off one of the immune systems 'activeate' switches.

Still, good to hear about Ma :smiley:, did she get any explanation about the other treatment?

[bindeweede]

Mongrel,

Thanks for your kind words. Spoke to Ma today - she hasn't won the Thunderball, which she does mostly weekly. We go for a blood-test tomorrow - the warfarin thingy.

I'm afraid I didn't understand what you said about the explanation about other treatment.:-[

[Mongrel]

Mongrel,

Thanks for your kind words. Spoke to Ma today - she hasn't won the Thunderball, which she does mostly weekly. We go for a blood-test tomorrow - the warfarin thingy.

I'm afraid I didn't understand what you said about the explanation about other treatment.:-[

Did they say the old treatment was a reaction\side effect\too high a dose?

[bindeweede]

The terbinafine, prescribed by one of the 5 GPs at the surgery, reacted with the atorvastatin. Fortunately, Ma had only been taking it for 4 days when the Consultant told her to stop it straight away. Apart from creams and antihistamines, which didn't seem to do much, the only treatment for the eczema had been 2 separate 7-day courses of steroids. They helped briefly, but the problem worsened again as soon as they were stopped.

Ma is 3 weeks into the 8 week course now, and it has made a huge difference. Apart from not scratching anywhere near as much, Ma is sleeping better and her whole mood is so much better. The dosage reduces steadily over the next few weeks. I'm hoping the problem won't return when she is off the steroids completely.

[DrS]

Well, it's been a very long haul, bindeweede, but I am so glad she is beginning to improve. :smiley:

[bindeweede]

Well, it's been a very long haul, bindeweede, but I am so glad she is beginning to improve. :smiley:

DrS

Thanks for that, but I spoke too soon. The anti-coagulant people rang this afternoon - Ma's figure is over 8, which apparently is dangerously high - the highest it has ever been. Probably has something to do with the steroids. We have to go to the local hospital tomorrow for - well, not sure quite what - more tests. The vitamin K level is low - unfortunately Ma doesn't always hear correctly or understand, so I'm not really sure of the issues.

I'll find out tomorrow.

[DrS]

Very good luck today at the hospital, bindeweede.

[bindeweede]

Very good luck today at the hospital, bindeweede.

DrS,

It was all rather simpler than I feared. The anti-coagulant target is 2-3. Yesterday, Ma's was 8.4, but today, 7.5, so moving in the right direction. The very helpful nurse said simply for Ma to stop the warfarin for 3 days, and return on Friday for another blood test.

Ma sometimes gets the messages a bit mixed up, then starts to fret. Understandable.

[Lord Muck oGentry]

bw,

That looks like good news. Hope the Ma is on the mend.

[DrS]

It is understandable, and probably quite frightening which just adds to the confusion which makes everything seem more fearful ... . It all sounds a bit more positive today though.

Keep us updated, please.

[bindeweede]

It is understandable, and probably quite frightening which just adds to the confusion which makes everything seem more fearful ... . It all sounds a bit more positive today though.

Keep us updated, please.

DrS,

Yoyo time. The latest test, last Tuesday gave a result of 1.4 - too low. So the warfarin has been increased very slightly. Next test tomorrow. I wonder why the figure is varying so widely.

Still, Ma is still tucking the food away - never seen her eat so heartily.

[Mongrel]

DrS,

Yoyo time. The latest test, last Tuesday gave a result of 1.4 - too low. So the warfarin has been increased very slightly. Next test tomorrow. I wonder why the figure is varying so widely.

Still, Ma is still tucking the food away - never seen her eat so heartily.

Everybody's metabolism is different, at least now they have some baseline measurements.

Make sure she's read the Patient Information Leaflet as there's a lot of things that can change the potency of the drug in her system (this (http://www.hc-sc.gc.ca/iyh-vsv/med/warfarin_e.html)is a fairly comprehensive list)

Finally it may take a few repeat visits to dial in the correct dosage, don't despair though, given how long she's going to have to take it it's far better to take some time now and get it right than possible complications down the line due to incorrect dosage.

[bindeweede]

Mongrel,

Thanks again. For her age, Ma is still pretty sharp. The people at the Anti-coagulant clinic are very good, and tell her what she needs to be aware of quite regularly. She knows she has to avoid cranberry juice. A pity, as she is fond of it. She also knows she must inform them of any changes in medication. The steroids are steadily being reduced, and I don't think the itching has returned. We'll have to wait until she is completely off them I suppose.

Ma does these word games and puzzles in magazines as she wants to keep her brain active. And of course, she knows how to keep me on my toes..............

[DrS]

It all sounds rather more positive than it did even just a few weeks ago, which is a blessing. At least her appetite is good, and her mind is obviously sharp. It does sound, as Mongrel says, as though they're on the right track now, and that the treatment is being fine tuned ... rather than giving the appearance of shooting in the dark.

All very best to her :smiley:

[bindeweede]

DrS

Thanks again. Well, the latest test score was 1.3 - a move in the wrong direction. The nurses are mystified. So the warfarin is increased to 2mg alternating 2.5 mg. A bit of a mystery, Though Mongrel did say diet plays a part too. Still, the professionals seem to be on top of it.

Mood-wise Ma is positive, and you should have seen the roast beef lunch she put away yesterday!. The trouble is, her hands are a bit shaky, so by the time she gets the fork to her mouth, most of what was on it has fallen off. It took her about 25 mins yesterday to just about clear the plate. Still, her problems could be much worse than that.:smiley:

[bindeweede]

Self-indulgent, I know - Ma in hospital, but complaining a bit, so returning to normal. Social Services/ Intermediate Care team will hopefully come up with a support plan.

[I nearly fell of the chair when she said, "I'm easy to please, aren't I"]

No, not easy.

[Mongrel]

[I nearly fell of the chair when she said, "I'm easy to please, aren't I"]

I've normally found that a code phrase for "Bring me chocolates and flowers" if the hospital food isn't up to par a sneaky fish and chip supper is a known replacement O0

[bindeweede]

Many thanks for so much support. The saga is close to its end.