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question on Physician for Mom
Theresa615
Posted: Friday, February 9, 2018 11:25 AM
Joined: 1/12/2018
Posts: 7


Hello, I'm very new here and to this situation.  I appreciate all your posts, they're helping me everyday.  Mom was diagnosed Christmas week and spent a week in a Psyc unit now lives with me.  My niece stays with me at night after work, which allows both of us to get sleep when Mom is up and upset. It's a tag team effort here.  A sister most times will come and spend time with Mom so I can run errands or catch up on chores.  It's exhausting as you all know juggling all the balls in the air. Mom seems to be in stage 6.  My question is do I need to change her primary care Doctor (internist) to another that might be able to streamline all her meds and may be more geared to treat what's coming next?  She's currently seeing a psychiatrist and a dermatologist for psoriasis.  Any suggestions are helpful,

Thank you

Theresa

TN. (middle/northern area)


jfkoc
Posted: Friday, February 9, 2018 11:50 AM
Joined: 12/4/2011
Posts: 15110


The first thing to do is to make certain that her diagnosis is correct. There are physical problems that cause dementia that are very treatable.

https://alz.org/alzheimers_disease_diagnosis.asp

You also want to know what variety of dementia she has. Yes, the meds are different.

This is usually done by a neurologist and involves cognitive testing that is hours long.

You are so close to Vanderbilt that that is where I would go. After all initial work is done your PCP can probably do follow up.

https://www.vumc.org/vmac/

The nailing down of this is terribly inportant.


Theresa615
Posted: Friday, February 9, 2018 3:36 PM
Joined: 1/12/2018
Posts: 7


Thank you so much for the information, I was looking at Vandy
Jaybird28
Posted: Friday, February 9, 2018 4:12 PM
Joined: 2/9/2018
Posts: 1


I am in the same boat.  My sister was diagnosed at age 59 and is now 66. We just recently moved her back to Cincinnati ( she lived in NYC her entire adult life ) and is in an Alzheimer facility . The nursing home has a primary care physician who treats her now but we are wondering if she should see a neurologist on a regular basis ? She became very anxious and agitated for awhile----now it appears they have overmedicated her as she is very lethargic. Is this the disease or the medication ? Any help appreciated .  Thanks 

jfkoc
Posted: Friday, February 9, 2018 6:57 PM
Joined: 12/4/2011
Posts: 15110


I looked at "Vandy" and would have traveled from Oklahoma. 

You may have months to wait. That is not abnormal at all.


Taking A Deep Breath
Posted: Friday, February 9, 2018 7:13 PM
Joined: 7/2/2013
Posts: 510


My mom doesn't have a lot of medical problems.  Her doctor seemed very comfortable treating her Alz symptoms after a head ct, blood work, and urine were checked.  He's been treating her for 5 years and with her ever changing symptims, his recommendations have worked for us.  The neurologist I took her to in the beginning told her it was ok to drive when she was having enough symptoms that I needed to have her checked in the first place.
His Daughter
Posted: Saturday, February 10, 2018 12:21 PM
Joined: 6/25/2014
Posts: 2153


Hi Theresa,

   In our situation, my dad was seeing a geriatric internist  He referred us to a neurologist for the dementia testing.  Once that was complete, we were back in the hands of the geriatric internist for the duration of his disease.  (You mentioned her doctor was an internist) My father also had a cardiologist we saw once a year, who guided his heart medications.  The two doctors saw each others note and coordinated his care.  But it really was the geriatric internist who handled most issues.  Had I used Hospice, they would have provided their own doctor, who would have taken things from that point forward.  But somehow, I really wanted the doctor I had worked with for years involved to the bitter end.  And since I didn't use Hospice, it was the geriatric internist who even signed my father's death certificate.  

  This does get confusing since everyone is so specialized these days.  But I think what's important is that you have someone you really trust, and can oversee and coordinate care.   


jfkoc
Posted: Saturday, February 10, 2018 12:27 PM
Joined: 12/4/2011
Posts: 15110


Just an FYI...we used our own Drs (PCP and Neuro) while on Hospice.
His Daughter
Posted: Saturday, February 10, 2018 7:44 PM
Joined: 6/25/2014
Posts: 2153


Jfkoc, that's great.  That wasn't an option here.  Once we went on Hospice, I would have lost all contact with Dad's doctor we had used for years.  But good to know there are some programs that allow that.
Theresa615
Posted: Wednesday, February 14, 2018 5:39 PM
Joined: 1/12/2018
Posts: 7


Thank you for that. She has been diagnosed while being held in the Psychiatric Hospital for the week of Christmas.  She's not happy with her present PCP, and thought maybe the geriatric Dr. might be better to go with. She also has severe psoriasis all over her body. We finally have her going to a Dermatologist for that, She sees her Cardiologist also. With all the sleep disruptions, never knowing if it'll be a 2hr night or 4 or 8 hour sleep, I'm running out of gas.  Placing her at this point isn't possible. She made no provisions for this and it all falls on me. A sister and brother visit, but that just gives me time to run to the store or clean up downstairs. Thank you all for the advice, I'll check her insurance coverage to see if I can locate one through her plan.
Jo C.
Posted: Wednesday, February 14, 2018 7:12 PM
Joined: 12/9/2011
Posts: 8879


Hello Theresa, I was primary caregiver for a mother and step-dad who both had dementia.  What I found through experience, was that it is far best for the long haul to have a "team," of medical providers.  Small team, but expertise can be extremely important as things move forward.

My mother had a Board certified Geriatrician as her primary MD.   Unfortunately, he misdiagnosed her for type of dementia and had prescribed inappropriately which ramped things up and made behaviors far worse.  There is a rather significant degree of misdiagnosis or missed diagnosis for type of dementia.

I did get my mother to an excellent Neurologist who after assessment discerned the accurate diagnosis.  He then tapered off the inappropriate med and initiated a care plan specific to her dementia which was FrontoTemporal Dementia.  Big difference was almost immediate.

There were some physical needs, so we had a primary care Internal Med MD as well as Neuro  The Internist did all physical care needs and only Neuro was allowed to prescribe or change dementia meds.  This held us in good stead during the dementia years up to and including the time of Hospice and NH care.

As an RN, I have seen both professionally and personally what a positive difference a good dementia specialist can make when dementia progresses; and an accurate diagnosis for type of dementia as noted is extremely important and key to everything else. 

J.


Marty Cares 79
Posted: Thursday, February 15, 2018 5:41 AM
Joined: 11/1/2017
Posts: 97


His Daughter,Hospice must have different rules for diff areas?I still take hubby to drs. even tho he is under Hospice and they support my decision


Jo C.
Posted: Thursday, February 15, 2018 12:00 PM
Joined: 12/9/2011
Posts: 8879


Hospice is under federally formatted criteria and yes; one can indeed continue to have one's own physician; many people are not aware of this.  A Hospice physician must continue to certify a patient for continued need for Hospice care, but one can indeed opt for one's own MD as their provider of physician care.

J.


 
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