Medical Forum / Diseases and Disorders / Alzheimer's / October 2004
Mum's Doc Appt/Sorry for the Length!
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donnah - 21 Oct 2004 02:02 GMT Today was probably one of the saddest and hardest days of my life. and I don't mean to sound melodramatic, my heart hurts if you can understand what I mean... The plan was for my sister to call the doc beforehand and let him know what was happening/alert him so he could plan his approach/treatment or what ever. Either she did not make the call or he did not get the message. Regardless of what happened, I ended up talking with him in front of my Mum. I asked him (and my Mum) if I could speak with him for a minute alone when it became apparent he was clueless. He said no, that he didn't keep secrets from his patients, then he told me to ask my questions. Ok, I was not prepared for this open conversation and tripped over my tongue a few times (my usual reaction in such a situation!). Basically I told him of our concern about Mum's mental and physical health...memory especially. That I had gone to a caregiver's support group and had been advised that Mum needed to be checked out for many things--to rule out what could be causing her problems. In front of her, he asked me questions about the types of memory problems, how often she had them, etc. In all fairness, he was thorough. but it bothered me immensely that he never looked at her or attempted to bring her into the conversation. I was watching Mum's face and it was all I could do not to say something to him...the first thing I saw in her eyes was pure terror! then confusion, anger, tears welling up in her eyes and then she just seemed to shut down. Then he turned to her and told her that before he dxd her with AD he would run some blood work and after he got the results, he would then do other testing (something in his office that takes about 10 minutes?)...then he told her that she might just have vascular dementia, but he was unsure and would check her next month. Am I over-reacting in the way he handled this? My feelings don't get hurt easily so please be honest. I am grateful that he listened to me and is starting testing on her, but it bothered me that he was so "cold" (my perception, I know) in how he handled this. Deep in my heart, I knew it was not going to be easy...I just didn't expect it to turn out this way. He is also ordering some type of vascular studies on her legs--her legs are weak and it affects her balance. Today is the very first time she said they were painful! She has always said they are tired... I had to practically grab him from walking out so I could ask about the meds her psychiatrist has her on...Exelon (sp?) is one of them. All he said to her was, "Oh, so someone is already treating your memory problems" and walked out. Next week I will be taking her to the psychiatrist for her med checkup. And I want to make sure those two start working together. I had asked him about her potassium-restricted diet and he told me some of the things for her to stay away from--I knew the usual ones, but not about nuts. Her psychiatrist has Mum eating nuts as a snack to put on weight. I am so sorry this has turned out to be so long! Perhaps I should have waited until I had time to sort through my feelings and then posted. I just feel so full of so many feelings... donnah
Gwen Love - 21 Oct 2004 01:12 GMT Oh Donnah, I am so sorry this happened. If the call was made and he ignored it, he is a terrible doctor. It is a shame he would not talk to you alone so she would not have been hurt or embarrassed. It does sound, though, that he is on the right track in checking on things. Glad your mum said her legs hurt so that could be attended to. I hope you can get the doctor and the psychiatrist to communicate so she will get the best care. You will be in my prayers, along with your mum. Gwen
> Today was probably one of the saddest and hardest days of my life. and > I don't mean to sound melodramatic, my heart hurts if you can [quoted text clipped - 49 lines] > I just feel so full of so many feelings... > donnah donnah - 21 Oct 2004 14:23 GMT Gwen, thank you...I think prayer is my strength to do what needs to be done. donnah
> Oh Donnah, I am so sorry this happened. If the call was made and he > ignored [quoted text clipped - 87 lines] >> I just feel so full of so many feelings... >> donnah Dennis P. Harris - 21 Oct 2004 03:25 GMT > Am I over-reacting in the way he handled this? My feelings don't get > hurt easily so please be honest. No, this doctor is an insensitive idiot. IT'S TIME TO CHANGE DOCTORS.
donnah - 21 Oct 2004 14:29 GMT Hi, Dennis! those are my feelings exactly, but getting her to agree is going to be tough. My hope is that once he gets his testing done then we can slowly get her to see another doc.(based on her needing someone who knows more about dementia-related conditions). Mum is of the generation, of course, that docs walk on water so it will be hard to convince her to see someone else. Perhaps her psychiatrist will be more help--Mum really likes her and trusts her. Thanks... donnah
>> Am I over-reacting in the way he handled this? My feelings don't >> get >> hurt easily so please be honest. > > No, this doctor is an insensitive idiot. IT'S TIME TO CHANGE > DOCTORS. Evelyn Ruut - 21 Oct 2004 14:23 GMT Donnah,
My dad is the same way. His lousy Doc is someone he trusts and whom he believes completely even though he has shown he has little knowledge of dementia related conditions.
 Signature Regards, Evelyn
(to reply to me personally, remove 'sox")
> Hi, Dennis! > those are my feelings exactly, but getting her to agree is going to be [quoted text clipped - 12 lines] >> No, this doctor is an insensitive idiot. IT'S TIME TO CHANGE >> DOCTORS. donnah - 22 Oct 2004 15:17 GMT thanks, Evelyn...Mum really does think this RO is a good doc, and he may be in some ways. But he isn't showing he has any signs of being sensitive about dementia related problems. donnah
> Donnah, > [quoted text clipped - 20 lines] >>> No, this doctor is an insensitive idiot. IT'S TIME TO CHANGE >>> DOCTORS. Mary Gordon - 21 Oct 2004 12:35 GMT I'm with Dennis. This doctor is a clod. Even his diagnosis "plan" is a clunker. Get a new family physician (believe me, if she has AD, this is only the start of the miserable conversations with this idiot - you need someone a little more sensitive and with it - someone YOU and the family can trust and relate to). You are going to have zillions of questions and problems, and you will need some help, and this guy isn't going to provide that.
Get a referral to someone who knows what they are doing. Can the shrink not get her referred to a dementia specialist for a work up and diagnosis?
I'm so sorry you had such an awful time. I can't believe he wouldn't step out in the hall for 20 seconds with you. Argh, what a horrible man.
Mary G.
donnah - 21 Oct 2004 14:45 GMT Mary, I really appreciate your advice. She does trust her female psychiatrist so that may be the avenue we take. And we are fortunate in that the AD association sent me a list of docs here who provide the care she is going to need. Getting her to agree is another matter, but I guess I'd better cross that bridge when I get there. Her shrink appt is next week, and if she is still speaking to me by then, I'll be taking her.When I have taken her in the past, the shrink usually asks about how she has been doing. This sounds so horrible, but I am dreading going down later to make lunch! I just can't imagine what her--and Dad's reaction--is going to be. I thought my other sister, who flew in for a visit, was going to talk with him. Now I don't know if that was done, either. When I left their house yesterday, I heard Mum starting to scream in anger. I started back in, then realized that she may have needed to get it out of her system. One thing about my Dad is that he would have no problem in calling me if he needed me, so he probably listened to her and will confront me today. I had to laugh for a minute--nothing like feeling like a wayward child at my age! But it's showing me that I definitely need to regroup and start again... donnah
> I'm with Dennis. This doctor is a clod. Even his diagnosis "plan" is > a [quoted text clipped - 17 lines] > > Mary G. Beth Cole - 21 Oct 2004 15:25 GMT > Mary, I really appreciate your advice. She does trust her female > psychiatrist so that may be the avenue we take. And we are fortunate [quoted text clipped - 4 lines] > then, I'll be taking her.When I have taken her in the past, the shrink > usually asks about how she has been doing. Your mother, if she has AD, is probably past the point where her agreement is worth much.
Would you try to get a young child to agree to seeing a different doctor? I'm guessing the answer is "no".
In many ways, no matter what form of dementia you are dealing with, you are going to have to treat her as you would a child.
This may sound harsh, but I've now lived through this twice (grandfather and MIL). It doesn't get better. If you accept this now, it gets easier to do.
Beth
 Signature The problems of the world cannot possibly be solved by skeptics or cynics whose horizons are limited by the obvious realities. We need men who can dream of things that never were. --John F. Kennedy our home page: http://www.IsleOfSky.net
donnah - 22 Oct 2004 15:14 GMT Beth, thank you... I'm beginning to see that my "head" and my heart aren't agreeing with how to proceed--if that makes sense! But, I am getting honest and direct answers and support here and I need to hear these things. donnah
>> Mary, I really appreciate your advice. She does trust her female >> psychiatrist so that may be the avenue we take. And we are [quoted text clipped - 20 lines] > > Beth Darryl - 22 Oct 2004 23:32 GMT >Beth, thank you... >I'm beginning to see that my "head" and my heart aren't agreeing with >how to proceed--if that makes sense! I can safely say that we all understand how you feel. Everyone's already offered the good advice. I'll just say hi!
Darryl.
donnah - 23 Oct 2004 13:57 GMT and Hi! back at you, Darryl...and thank you. donnah
> >Beth, thank you... >>I'm beginning to see that my "head" and my heart aren't agreeing [quoted text clipped - 5 lines] > > Darryl. Adelle D. Stavis, Esq. - 21 Oct 2004 16:47 GMT .
> Mary, I really appreciate your advice. She does trust her female > psychiatrist so that may be the avenue we take. And we are fortunate [quoted text clipped - 8 lines] > be. I thought my other sister, who flew in for a visit, was going to > talk with him. Now I don't know if that was done, either. Have you checked with your sister? Sometimes, its hard to get past those front desk dragons. Maybe your sister did call. Maybe they even remembered to put a note in the file. If yes, did the doc actually glance to see if there was anything new in the file before walking in the door? Would he have acted differently? I somehow doubt it. He was being a rushed, insensitive clod.
My MIL could never get the doctors to really hear what was happening to my FIL because he held it together so well in the exam room. No delusions or talking about the delusions. No real serious pursuit of agressive treatment fo dementia until he landed in the hospital for CHF because he wouldn't take his diuretic (refused to believe he had a cardiac condition). It was only when the nurses had a chance to view him for 24 hours that the doc found out just how true MIL's descriptions were. The doc then insisted it was time for a nursing home. FIL had been driving just a few days before. Scary, huh?
Where were we? - 400 miles away. Doug was raised in the 'thou shalt not contradict nor question your parents actions' mode. If his mom said things were fine, they were fine. Until one day she called and said, I can't handle it anymore. Leave work and please come home now.
> When I left their house yesterday, I heard Mum starting to scream in > anger. I started back in, then realized that she may have needed to [quoted text clipped - 5 lines] > start again... > donnah Maybe the psych, whom she trusts, can refer you to a neuro-psychiatrist. They are the right specialist for this, especially if they have a focus on gerontology. Having the right consult makes a world of difference in how effectively we can care for a loved one.
Adelle
donnah - 22 Oct 2004 15:25 GMT Adelle, when I asked him if he had the message from my sister, he looked in her record and said no. so I don't know if she called or the message just didn't make it to her file. She was getting ready to go to Florida, and may have forgotten...if so, I can understand. It wasn't "pretty' the way it happened, but I can't change it and don't want to give my energy to it. So guess I am absorbing more than I thought I was in that I am picking my battles a little bit now. And thanks for the heads up about the neuro-psych...another avenue for me to look into. donnah
> . > [quoted text clipped - 78 lines] > > Adelle Barbara Rose - 21 Oct 2004 13:42 GMT Donnah, the same thing happened to me with my Mum and I know how you feel. They discussed her as though she wasn't there, even though I had written beforehand and said I need to talk alone.
I can't believe how insensitive some doctors can be, luckily they're not all like that.
Barb in UK
> Today was probably one of the saddest and hardest days of my life. and I > don't mean to sound melodramatic, my heart hurts if you can understand [quoted text clipped - 45 lines] > I just feel so full of so many feelings... > donnah donnah - 21 Oct 2004 14:51 GMT Barbara, thank you for sharing that with me! I've never liked the man because this is not the first time he has been an RO, but she does like him... So, I guess this journey has taken an unexpected twist and I'd better get used to it happening. donnah
> Donnah, the same thing happened to me with my Mum and I know how you > feel. They discussed her as though she wasn't there, even though I [quoted text clipped - 62 lines] >> I just feel so full of so many feelings... >> donnah AD - 21 Oct 2004 15:10 GMT Donnah, It doesn't sound like the doctor is as sensitive as he could be. Your mother does need to have a doctor who will speak with you privately and return phone calls, and certainly she needs a primary care doctor who will exchange information with her psychiatrist. How long has your mother taken Exelon? What is her dosage? You mentioned that she is very thin now and Exelon can suppress appetite. It also sometimes makes my mother a little nauseated which makes her not want to eat. Best of luck to you - it is never really easy. A.D.
Songbird - 21 Oct 2004 17:48 GMT > Donnah, > It doesn't sound like the doctor is as sensitive as he could be. Your > mother does need to have a doctor who will speak with you privately > and return phone calls, and certainly she needs a primary care doctor > who will exchange information with her psychiatrist. I agree the doc is a clod BUT...
If you are in US, under HIPAA he may feel he cannot discuss her privately with you unless she has signed a release authorizing him to do so. (The workaround: he can listen to you -- he just can't respond, agree, whatever. Input OK, output not allowed.)
I got both folks to sign release with argument that what if you are too sick to call, unconscious, whatever.
Still, when I took Mom in Monday to discuss medication with doc, doc questioned whether they were needed yet, since Mom seems pretty together in exam room and has a MMSE of 29. I had to detail the behaviors we have seen recently in front of her, which was pretty uncomfortable, but I knew it was necessary to get her the help she needed. I did it as lovingly as possible, and Mom hugged me afterwards. As soon as I finished, the doc said, "I think we should start with 5 mg of Aricept." Sometimes you have to do the hard things even if it makes your LO mad. I expected Mom to be upset with me, and I am just grateful she wasn't. She will be at some point, I'm sure!
Hang in there!
Songbird
Tumbleweed - 21 Oct 2004 20:36 GMT >> Donnah, >> It doesn't sound like the doctor is as sensitive as he could be. Your [quoted text clipped - 26 lines] > > Songbird I recall a social worker telling me that some sufferers were aware of their condition, and some weren't,(and my dad was as far the right of the latter category as you could imagine). Sounds like your mum is to the left of the former, luckily for you. Good luck.
 Signature Tumbleweed
email replies not necessary but to contact use; tumbleweednews at hotmail dot com
donnah - 22 Oct 2004 15:48 GMT Tumbleweed, sometimes I just don't know! At times she is really alert and lucid and, more likely, forgetful/angry/confused. And I guess I'd better get used to it. Thanks...the more I read, the more I see this is not going to be easy, and that I need to take care of me, too. donnah
>>> Donnah, >>> It doesn't sound like the doctor is as sensitive as he could be. [quoted text clipped - 35 lines] > right of the latter category as you could imagine). Sounds like your > mum is to the left of the former, luckily for you. Good luck. donnah - 22 Oct 2004 15:32 GMT thank you, Songbird... I asked Mum about being put on her records as ok to talk to, and she did sign the paper before he came in for the exam. <s> I am hanging on with both hands! donnah
>> Donnah, >> It doesn't sound like the doctor is as sensitive as he could be. [quoted text clipped - 29 lines] > > Songbird donnah - 22 Oct 2004 15:29 GMT AD, she wouldn't let me near her meds yesterday to check on the Excelon so I am calling her pharmacy today--or will drop by as they know me. She has been on it for several months which made me stop and think that is about the time she lost interest in food (and that may just be a coincidence, I know) Thank you! donnah
> Donnah, > It doesn't sound like the doctor is as sensitive as he could be. [quoted text clipped - 10 lines] > Best of luck to you - it is never really easy. > A.D. Charlene Donahue - 23 Oct 2004 01:43 GMT Hi Donnah,
I don't write often but can't help commenting on the 10 minute mental test. She needs a good neuro-psych test which will take at least a day. In my husband's case, the tester broke it into 2 days because he became tired & I'm guessing agitated after so long into the first day. The pyshiatrist should be able to arrange this.
I agree with others about finding a new doctor. We have been lucky because my husband's doctors have all been open to talking to me---this does not mean they ignore John---They & I both wait for John's responses to questions & then they defer to me. They will ask if my perceptions are the same as John's & on occasion he has been surprised when I mention something he has forgotten. For your own, for lack of a better word, "sanity" in the future, you need to find a more empathetic doctor.
Always,
Char
> Today was probably one of the saddest and hardest days of my life. and > I don't mean to sound melodramatic, my heart hurts if you can [quoted text clipped - 49 lines] > I just feel so full of so many feelings... > donnah donnah - 23 Oct 2004 15:01 GMT Char, thank you! I thought the same thing after the "shock" of how that appt went...when I applied for disability, I had the day long test, too. So I couldn't imagine how a 10 minute test would give him enough info unless it's just a basic screening to help him decide if more is needed. Sanity is a fine word to use right now! If he can't be more helpful and understanding, then we are going to have to change docs. And that is going to be one heck of a necessary battle... I have hopes that her psychiatrist will be willing to get involved, or at least give referrals. Again, thank you for your suggestions. I sincerely appreciate them, Char. donnah
> Hi Donnah, > [quoted text clipped - 74 lines] >> I just feel so full of so many feelings... >> donnah
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