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Medical Forum / Diseases and Disorders / Alzheimer's / July 2004What is up with doctors
Hi all I Just came back from Europe to NYC were I have been for the past 6 years in order to help my family during my stepmother's last days, she since past away( Parkinson's) on July 1st. I kept in touch with my father weekly by phone for all my 6 year absence and I have noticed a weird behavior; in the past 2 years e.g.; trying to get family papers or any time my asking very uncomplicated mundane things were resulting in getting my father very upset, for instance crying because he said he was overwhelmed by my requests or he was getting very aggressive (I was merely) asking in one instance if he had an original of my birth certificate and to see if he could mail it to me to NYC. He also claimed that he was fine except that it was hard work to take care of his wife. When I got to New-York 3 weeks ago I realized that my father had most of the symptoms that usually describes severe Alzheimer or dementia,for those who have read the book "Where is my shoes" he is in his own way worse than Martin Avadian. Protective services and the police had to be called regarding his extreme violent behavior towards his sick wife Now my first question if anyone is kind enough to answer is, since my father has diabetes and consequently sees a doctor once in a while,how could a physician not be aware of the situation ?, he can sound rational for a short time but will still ask anyone the same question 10 times within 45 Min he definitely could not hold up to any kind of serious proffesional scrutiny My other problem is that my father likes to play bridge (calls it his life saver), he belongs to a club and attends 365 a year, rain,sleet or snow or wife dying in auspice, my problem with this is that he still drives,badly I might add; now that since he claims that playing bridge is his life I am torn between reporting him to the motor vehicle folks and get him off the car or let him be as happy as possible. Any thought on the matter or anything suggestion would be very much appreciated. Jeanette nobody is going to be happy if he kills himself - or someone else - because he's driving when he really shouldn't be. You need a full assessment for him, ASAP - it could be that there's something treatable going on, first of all - in which case, treatment is imperative. Even if he does have AD, there are medications which might help - in either case, the sooner, the better. His doctor likely should have clued in.... but it's far from unheard of for people with AD to be very good at putting on a front for short periods of time - it could also be that the doctor is aware and has spoken to your father about it - many people choose ~not~ to hear things they don't want to hear - and/or, depending on the losses he's already suffered, your father might just have forgotten, not be able to process the information. Being angry with the doctor won't get you far... you need to express your concerns and get things dealt with - sooner, rather than later Not being able to drive himself doesn't mean that your Dad can't get to bridge... he may well need help sorting out an alternative - and understandably, he probably won't like it - but you NEED to address the driving thing NOW. > Hi all > [quoted text clipped - 41 lines] > > Jeanette Neither you nor your father will be happy if the accident he has while driving impaired results in someone's death. Depending on where you live, you may even be held accountable since you knew he shouldn't be driving. His happiness (and I would bet that he hasn't been happy for some time) is less important than someone's life. Do whatever you have to to get him off the road, even if it means disabling the car. You need to take him to a doctor that specializes in elder medicine and will give him the necessary tests to get a better focus on his condition. Please contact the local Alzheimer's Association in your area. They offer a wealth of information. Driving requires judgment to handle the unexpected situation. If something out of the ordinary happens, he will not be able to handle it. For his sake and others, you need to get him out from behind the wheel. He needs a full workup ASAP. There are many causes of the symptoms of dementia. Alzheimers is one of them that is un-curable. Others can be treated and reversed. You need to find out what is causing his problems. You are facing what can be one of the awful crossroads of life. Becoming a parent for your parent. The parent-child relationship gets reversed. You have to step in and do what is best for him. - M ike, Friendswood TX > Neither you nor your father will be happy if the accident he has while > driving impaired results in someone's death. Depending on where you [quoted text clipped - 9 lines] > Please contact the local Alzheimer's Association in your area. They > offer a wealth of information. I can see how a doctor could miss signs of dementia. If he's coming in for occasional visits for his diabetes, your father might be in there for maybe 5 or 10 minutes for a quick check, and as long as he answers questions appropriately, the doc won't clue in. Your father was unaware of his own issues, so if the doctor asked him how he was coping, I'm sure he would have answered that he was fine, and that would have been the end of the discussion. Our family doctor is a very perceptive guy, and he saw my MIL frequently - and it wasn't until I brought the subject up to him that he did a little probing with her. After all, its not like a doctor does a mental exam with everyone over 65 everytime they come in for their gallstones or their bunions. She could keep up a very good social conversation, she'd show up appropriately dressed at the right time, so he had no real reason to suspect she was cognitively impaired. On the driving front, don't even hesitate. Report him, or ask the doctor to (I'm hoping you have had him properly assessed and diagnosed). Here is some info about the process in New York state http://www.erie.gov/depts/seniorservices/older_driver/reporting.asp#important It isn't just his safety thats involved here, its the safety of others on the road, passengers, pedestrians etc. Alzheimer's doesn't just impair memory - it impacts reasoning, judgement, emotional stability, reaction time, muscular coordination and depth perception - and you need all that stuff in working order to be able to drive safely. You will never forgive yourself if you let him keep driving when you know he's not capable and he hurts someone. Mary G. > Hi all <snip> > My other problem is that my father likes to play bridge (calls it his life > saver), he belongs to a club and attends 365 a year, [quoted text clipped - 7 lines] > > Jeanette have you had him assessed? Assuming he really does have Az, then imagine yourself explaining to the survivors of the family member that got killed by your father, you thought it was best he kept playing bridge so he would be 'happy'. Now imagine explaining that in court. Your course of action is obvious to anyone with (a) a conscience, or (b) a rational fear of getting sued. Also, he is going to have to pack up driving sometime, why not make that before rather than after he injures someone? BTW, you will probably have to get rid of his car otherwise he will probably forget he his not allowed to drive. There was a case reported here not too long ago of a person with Az being jailed because he woudnt stop driving. If you are worried by his reaction to you, make the doctor the bad guy, or the police, by explaining to them. If he is not a car person, perhaps the car could "develop" a fault that will be fixed "tomorrow" (this depends just how bad he is), Try try disconnecting a lead and see if he can cope or needs to geta mechanic. If the latter, you can have the car removed and it will(always) be back tomorrow.  SignatureTumbleweed email replies not necessary but to contact use; tumbleweednews at hotmail dot com Hi Tripley, You have gotten VERY good advice here. Please listen to us and get the keys away from him, no matter how hard it may be. I know he associates the car with his freedom, independence, viability as a human being, manhood and all of that, but he really shouldn't be driving anymore. Hope you and your family find the courage to deal with this situation. All of us here know how tough it is and have been through it too. SignatureRegards, Evelyn (to reply to me personally, remove 'sox") > Hi all > [quoted text clipped - 41 lines] > > Jeanette > Hi Tripley, > [quoted text clipped - 5 lines] > Hope you and your family find the courage to deal with this situation. All > of us here know how tough it is and have been through it too. I want to thank everyone for their advice/s, please keep the comments coming or new input if something has not being covered. Definitely will get rid of the car ASAP or/disable it somehow and will work with NY DMV to get his license revoked,it should not be very hard, he got lost yesterday going to play bridge and can only go from point A to point B, if he tries AB&C or any slightly unusual traveling configuration he becomes enraged and extremely agitated. Chauffeur or taxi is not an option ,the drivers will not stand for the verbal abuse;as some of the kind people that answered my post said, you do not have to go very far to play bridge and he eventually would have to give up driving therefore he will have to find a place around his neighborhood. Thank you again for all your help Jeanette >> Now my first question if anyone is kind enough to answer is, > since my father has diabetes and consequently sees a doctor once in a [quoted text clipped - 3 lines] > the same question 10 times within 45 Min he definitely could not hold up to > any kind of serious proffesional scrutiny Unless someone asks the doctor to check his mental acuity, chances are, he won't. If he is seeing him for a brief check-up, there is little conversation. Doctor asks questions, Dad answers, doctor says "good patient" or "bad patient", writes new scrip ... please pay here. Doctor has never SEEN him for a 45 minute stretch. Plus most people in this situation speak as little as possible, so as not to "slip." With as many patients as one doc sees, he is unlikely to notice deterioration of skills from visit to visit unless someone says "Please check this." I'll second what everyone else says about the driving -- get him off the road!! Is he still able to play a decent game of bridge in this condition? I can't remember what's been played and I don't have AD! Songbird Well Songbird you are probably right, he can be quite clever for a short while he does see a doctor for his diabetes and the visits are probably very short. However he drink 3 fourth of a large bottle of Martini & Rossi (after bridge :) and it is practically impossible to stop him; which brings me to another question,he does not seem to suffer physically nor feel any kind of discomfort matter of fact it can be 95 degrees in the apartment and refuses to turn on the AC.;he had a maid/nurse coming 7/7 5 hours a day for 4 years and the poor girl was told that the AC was broken I never seen anyone more shocked and annoyed after toiling for years in the heat. I have to call the doctor anyway to figure out his medication schedule, he keeps forgetting to take them and forgets 3 minutes later if he has taken his medication I will try to diplomatically mention his extreme confusion (maybe the doc will pay a little more attention). Getting rid of the car is fairly easy but to get him evaluated is another ball of wax he has not seen a dentist in years & we have one right downstairs (same building) Regarding playing bridge Songbird ,that is a mystery to me also, he claims that he is one of the top player in the tri-state area, I have no idea if it is possible, although he has played all his life & maybe that part of his brain is not affected (I personally don't believe him) maybe years ago, I just do not know, the only rational explanation is that his partners feel sorry for him and just let him win,I did notice that quite often he ends up without a partner which sounds bizarre since he has to call & call & call (forgets he called) in the morning in order to be matched with a partner, lots of people are bailing out (excuses galore).I did check with the bridge club to tell them that I was back from Europe and requested to be put on record in case of problems,they seemed quite guarded and made me feel that it was not all that important that the name of a family member or a person to notify be on record and when I asked if everything was ok, problems...? their response was yep he is OK which is really hard to believe given that the day before he stated" I play bridge 7/7 did I play yesterday"? it sounds to me that someone is not telling the truth about the quality of his game nor his interaction with the other members. That is for today You all have a good evening Jeanette > However he drink 3 fourth of a large bottle of Martini & Rossi (after bridge > :) and it is practically > impossible to stop him; > I have to call the doctor anyway to figure out his medication schedule, he > keeps > forgetting to take them and forgets 3 minutes later if he has taken his > medication These two issues right here could be part of the problem! > I will try to diplomatically mention his extreme confusion (maybe the doc > will pay a little more > attention). To hell <sorry if anyone affended> with diplomacy. Say to the doctor, "I know I've been away for a while, but my father seems much more confused and forgetful than I would have expected from our phone conversations. I'd feel much more reassured if we had a full work-up for memory loss." That's not rude, that's not, "You idiot, why didn't you notice this?" It's to the point and yet polite. If he says "I don't think it's necessary" -- tell him what you're seeing, as objectively as possible. If he still balks, find a new doctor -- tell your dad he has to switch for insurance reasons or any excuse he will accept. My mom's old doctor totally glossed over her memory problems because she was fine during her visits. Her new doctor (she has moved nearer to me) is definitely concerned and is running a full battery of tests, even though she was fairly pulled together in the exam room. I told the doctor what I was seeing and asked for a full work-up. We're getting it -- results next Friday. Songbird > > However he drink 3 fourth of a large bottle of Martini & Rossi (after > bridge [quoted text clipped - 30 lines] > > Songbird Songbird, Did I ever tell you that I admire your directness? My kind of pal! I always call things the way I see them too! SignatureRegards, Evelyn (to reply to me personally, remove 'sox") from what I've seen with my MIL, things that she has done for so long, she has been able to do for longer...as long as she doesn't THINK about them.... as soon as she starts to THINK, she's lost.... and if she misses them for a bit, forget it.... anything she doesn't do regularly is GONE.... actually, at this point, even things she has done regularly are being lost at an alarming rate... there is no good news with this blasted disease. But for now, she's still managing bingo (with occassional help)- as long as she just plays without thinking too much about what she's doing ..... Do you play bridge? He'll likely ~last~ longer at it if a family member were to get involved > Well Songbird you are probably right, he can be quite clever for a short > while [quoted text clipped - 52 lines] > > Jeanette Jeanette, I think most of us in "the club no one wants to join" will agree that writing a letter to the doctor is often a good tactic in this sort of situation. A doctor you have no relationship with may not want to talk to you about your dad unless you have medical POA. He or she can be curt, impatient, or even dismissive with you in a verbal conversation, and may suspect your motives - so it can be hard to get them to really hear you out, particularly since this is an emotional subject for you - having a rational exchange can be hard when you are upset! The one thing a doctor can't ignore is a letter, either faxed or mailed, that lays out the issues. Writing it out lets you organize your thoughts, explain what you are seeing with specific examples and time lines, be clear about what your fears and concerns are, and you would like to see happen etc. etc. It will get read, so its your chance to get the whole story "heard" by the doctor, who can then chew on it and figure out what to do. Any responsible doctor is going to sit up and take notice, and either get the patient in for an assessment, or check out the allegations at the next routine visit. Mention the driving issues in your letter (since this means the doctor knows there is a problem - he or she will know they could be liable if they don't act). Cover off your father's hostility, and lack of insight into his own problems, so you can enlist the doctors help to get him seen. The doc could call and say he needs to have his diabetes checked, or that the insurance company says he needs a physical - whatever you or the doc tell your dad to get him in there doesn't have to be true. He needs to be seen and have this checked out, so between you and the doc, you gotta do what you gotta do. There is nothing to be gained by trying to reason with your dad about this either. You can argue until you are blue with someone with brain damage, but that won't let them see what is obvious to you. Mary G. <snipped> My MIL with dementia or AD was also a lifelong bridge player and played at a very high level. After she became unable to drive herself to the bridge club, she rode to bridge with her partner and as long as she played with him, she still managed to enjoy herself. After he passed away, her remaining bridge skills eroded quickly. Maybe he had been covering for her all along, as he knew she had significant memory problems. At her request, we tried taking her to bridge again about three years ago, but after one visit, she didn't want to go back. We suspect she had forgotten how to play and was bothered when asked questions she couldn't answer or comprehend. She was also a compulsive solitair player and about 5 years ago she quit playing solitair completely. What once was a passion is now just a dim memory. I'd also suggest getting your Dad's license taken away. After a few days of indignation, he'll probably be relieved of the responsibility of driving. Get someone at his bridge club to give him a ride each day, even if you have to pay for the gas. We went thru this stage of decline of abilities also. There's always someone at the bridge club willing to give a ride for a few bucks. > My other problem is that my father likes to play bridge (calls it his life > saver), he belongs to a club and attends 365 a year, [quoted text clipped - 7 lines] > > Jeanette > <snipped> > [quoted text clipped - 9 lines] > also a compulsive solitair player and about 5 years ago she quit playing > solitair completely. What once was a passion is now just a dim memory. Agreed, my dad had a couple of passionate hobbies, he can barely remember them now. > I'd also suggest getting your Dad's license taken away. After a few days of > indignation, he'll probably be relieved of the responsibility of driving. > Get someone at his bridge club to give him a ride each day, even if you have > to pay for the gas. We went thru this stage of decline of abilities also. > There's always someone at the bridge club willing to give a ride for a few > bucks. If he really does have Az, the bridge playing will probably go pretty quickly anyway, you cant hold on to a game like that with Az, and you also cant impose yourself on other people if you are inept, its one of those games where you need to be a similar level to the others. SignatureTumbleweed email replies not necessary but to contact use; tumbleweednews at hotmail dot com |
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