Confused & disorientated after surgery [Archive]

annelb

11-19-2006, 02:13 AM

Did she have general anesthesia? Nitrous oxide can deplete stores of B12. If she was low in b12 already that could cause a problem. here is one article
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=10584542&query_hl=67&itool=pubmed_docsum
Lakartidningen. 1999 Nov 3;96(44):4801-5. Links
[Nitrous oxide can cause cobalamin deficiency. Vitamin B12 is a simple and cheap remedy]
[Article in Swedish]

* Lindstedt G.

Avdelningen for klinisk kemi och transfusionsmedicin, Sahlgrenska Universitetssjukhuset, Goteborg.

Nitrous oxide may cause neurological and haematological signs and symptoms, as a result of its tendency to form complex with cobalt(I) in methylcobalamin, the cofactor for methionine synthase (EC 2.1.1.13), resulting in irreversible oxidation of the cofactor and inactivation of the enzyme protein. Formation of active enzyme requires new protein synthesis, as well as cobalamin supply (vitamin B12). Patients with low or marginal cobalamin depots (commonly found in the elderly) are at risk. The risk may be avoided by giving vitamin B12 to patients with confirmed or suspected cobalamin deficiency in good time before surgery involving nitrous oxide anaesthesia.

PMID: 10584542 [PubMed - indexed for MEDLINE]

Hope the symptoms resolve quickly and the elbow heals well.
Anne

Tootsie

11-19-2006, 05:00 PM

How old is your mother? Advanced age can cause varied reactions to all kinds of drugs, especially those used in anesthesia and pain control. It takes their bodies longer to clear the drugs from the system. Lots of fluids and an increase in Vitamin C might help.

Did she have any difficulties with confusion or disorientation before the surgery? Anyone with the early symptoms of any kind of dementia would be further affected by the drugs used.

This sounds like one of those "Wait and Watch" situations. Just be sure she cannot injury or hurt herself during an episode of confusion. Cheerio.

rose

11-19-2006, 06:58 PM

I do hope you will do what you can to get her to take methylcobalamin. Could be needed whether nitrous was used or not, and if nitrous was used it is imperative that she get methylcobalamin immediately.

And if she doesn't need it, it won't hurt.

rose

Jaycee

11-20-2006, 01:13 AM

Annelb, Tootsie and Rose,

Thank you all for replying. Not getting any answers from the Docs and hospital.

My mother is 85 and had bouts of forgetfullness but certainly not like this. Still not sure whether she had a local or general anaesthetic for her op.
Possible stroke and/or bladder infection has been mentioned.
All they keep saying is the morphine may have affected her but as time goes on I'm getting more worried.

Will ask the Sister about Vitamin B & C, better still I may personally get it into her system.

I'm convinced the elderly are not treated as they should be.

Once again, thank you.

Hugs
Jaycee

mrsdoubtfyre

11-20-2006, 11:27 AM

patients get delusional/have delirium with H2 antagonists. Zantac/Pepcid.

examples:
Psychosomatics 1996; 37:349-355
Copyright © 1996 by Academy of Psychosomatic Medicine

ORIGINAL RESEARCH REPORTS
Famotidine-associated delirium. A series of six cases

G Catalano, MC Catalano and VA Alberts
Department of Psychiatry and Behavioral Medicine, University of South Florida College of Medicine, Tampa, USA.

Famotidine is a histamine H2-receptor antagonist used in inpatient settings for prevention of stress ulcers and is showing increasing popularity because of its low cost. Although all of the currently available H2-receptor antagonists have shown the propensity to cause delirium, only two previously reported cases have been associated with famotidine. The authors report on six cases of famotidine-associated delirium in hospitalized patients who cleared completely upon removal of famotidine. The pharmacokinetics of famotidine are reviewed, with no change in its metabolism in the elderly population seen. The implications of using famotidine in elderly persons are discussed.

and
Definition of Drug-Induced Cognitive Impairment in the Elderly
from Medscape Pharmacotherapy

Drugs Associated With Cognitive Impairment
Taking a thorough drug history is one of the first steps that should be performed when assessing an older patient with changes in cognitive function. This history should include prescription drugs, over-the-counter medications, illicit substances, alcohol use, herbs, vitamins, nutraceuticals, homeopathic products, and naturopathic remedies, including the use of home remedies as well as other forms of complementary or alternative medicine. In the elderly, an increased number of medications may have a greater negative impact on orientation and memory as opposed to concentration and judgment.[28] The more complex a drug regimen, the more difficult it may be to identify the specific drug(s) that may be causing cognitive impairment. It is important to note that in the elderly, drug-induced cognitive impairment may occur even in the presence of nontoxic or therapeutic levels of a drug. Further, there may be intraclass differences in the propensity to induce cognitive impairment.

Numerous drugs have been identified in The Medical Letter on Drugs and Therapeutics as causing a multitude of psychiatric symptoms, including hallucinations, fearfulness, insomnia, paranoia, depression, delusions, bizarre behavior, agitation, anxiety, panic attacks, manic symptoms, hypomania, depersonalization, psychosis, schizophrenic relapse, aggressiveness, nightmares, vivid dreams, excitement, disinhibition, rage, hostility, mutism, hypersexuality, suicidality, crying, hyperactivity, euphoria, dysphoria, lethargy, seizures, Tourette-like syndrome, obsessiveness, fear of imminent death, illusions, emotional lability, sensory distortions, impulsivity, and irritability, which can impact on mental capacity. Further, there are a number of medications that may be linked to causing cognitive impairment by inducing delirium, confusion, disorientation, memory loss, amnesia, stupor, coma, or encephalopathy. Among these drugs are: acyclovir, anticholinergics and atropine, anticonvulsants, tricyclic antidepressants, asparaginase, baclofen, barbiturates, benzodiazepines, beta-blockers, buspirone, caffeine, chlorambucil, chloroquine, clonidine, clozapine, cytarabine, digitalis g*****ides, disulfiram, dronabinol, ganciclovir, histamine-2 antagonists, ifosfamide, interleukin-2, ketamine, levodopa, maprotiline, mefloquine, methyldopa, methylphenidate, metrizamide, metronidazole, pergolide, phenylpropanolamine, pilocarpine, propafenone, quinidine, salicylates, seligiline, sulfonamides, trazodone, and trimethoprim-sulfamethoxazole. Often these medications produce more than 1 type of psychiatric symptom.[29]

from http://www.medscape.com/viewarticle/408593_5

Sometimes it is a combination of effects..from several drugs.

annelb

11-20-2006, 10:24 PM

Thanks for posting the drug article MrsD - I will find time to read it. I see so many people on long lists of drugs and I really wonder how anyone can figure out whether the disease is causing the problems or the drugs are causing the problems. The solution all too often seems to be add another wonder drug.
Anne

Jaycee

11-23-2006, 10:27 PM

Hello I'm back

It appears Mum's mental state may be due to the fact that she was taken off Capadex (Dextropropoxyphene Hydrochloride).
When Mum was admitted 7 days ago for her broken elbow the hospital did not administer the Capadex. I spoke to the Sister & she said they do not use Capadex ???
I advised the hospital on admission what her meds were.
Spoke to another Doc yesterday & she is back on the Capadex.
Wonder if the withdrawal symptoms are typical.
Have searched for withdrawal symptoms through Google but can't find any info regarding this.

Any comments please.

Very concerned
Jaycee

Lara

11-24-2006, 12:43 AM

Hi Jaycee,
As far as I know, Capadex is a combination drug of dextropropoxyphene and paracetamol. My daughter had surgery a few months ago and when she was released was prescribed Digesic, which is the same as Capadex as far as I know. The Dextropropoxyphene is listed on a NSW site as Schedule 8 drug of addiction. [page 51 of 302 - http://www.health.nsw.gov.au/audit/manuals/patient_matters_20.pdf
I'd wonder a few things. How long she'd been taking it. Were they administering other type of pain relief while she was in hospital? Did she have surgery? Was she given any other medications like blood-thinning agents if she had surgery?

I'm just looking at some Queensland Health information to see if they say more in there.

September 2006
Prescribing Practice Review 35
National Prescribing Service Limited
Analgesic choices in persistent pain
http://www.nps.org.au/site.php?content=/html/ppr.php&ppr=/resources/Prescribing_Practice_Reviews/ppr35
In the section "Consider an opioid when non-opioids offer inadequate pain control
or NSAIDs are unsuitable"
Choosing a weak
opioid: codeine, dextropropoxyphene
or tramadol?
"Avoid dextropropoxyphene because regular use leads to accumulation of the parent drug (causing dizziness and confusion) and its cardiotoxic metabolite."

Still looking, but I found this...

Information about Dextropropoxyphene
http://www.auspharmlist.net.au/ebulletin/vol17/eb17-02.pdf
Dextropropoxyphene and the elderly
Dextropropoxyphene (also referred to as propoxyphene) is a low potency opioid analgesic structurally related to
methadone. Dextropropoxyphene has no anti-pyretic effects or anti-tussive activity and is generally considered to lack
sufficient potency to be useful in the management of severe pain. In Australia, dextropropoxyphene is available as a single
agent as Doloxene (100mg tablets) or in combination with paracetamol (32.5mg dextropropoxyphene with 325mg
paracetamol), e.g. Capadex or Digesic.

Combination products incorporating dextropropoxyphene and paracetamol are generally not recommended for the elderly,
especially for chronic use. This is because the two drugs have different kinetics, meaning that accumulation of the
dextropropoxyphene metabolite may occur with chronic use. The pharmacokinetic profiles of dextropropoxyphene and
paracetamol are outlined in the table below.

Chronic use of dextropropoxyphene may cause physical and psychological dependence, and doses in excess of 800
mg/day have resulted in psychosis and convulsions. Acute toxicity from overdose results in symptoms similar to those of
acute opioid intoxication and may include coma, respiratory depression, circulatory collapse and pulmonary oedema.
Rapid death has been reported following overdose, particularly in association with alcohol. This factor should be taken
into account when there is a possible risk of suicide or intentional overdose.

Jaycee

11-24-2006, 03:49 AM

Hi Lara and Mrsdoubtfire !!!!

I was formally Janette1010 - remember me?
Changed my name when Braintalk was down & had to register again.

Thank you for that information, not in a good frame of mind at present but will read what you posted later.

Just returned from hospital. Asked the nurse what pain killer Mum was on and it's Panadeine Forte.
Yesterday a doc. said she would administer Capadex again as Mum should not have been taken off this in the first place but the Gold Coast Hospital do not supply Capadex & I would have to bring some in myself. I think this is ridiculous !!! What's going on ???
I am a very placid person but was fuming today as feel I've been given the run-around.

In answer to your questions - Mum has been taking Capadex for 10 years originally when she had a back op which wasn't a success. She has been taking Cartier regularly.
Mum hasn't had any side effects with Capadex before.
If Capadex has so many side effects why didn't Mum have symptoms after her previous operations two months ago when she broke her shoulder and then wrist? Her head scan was OK & I'm just wondering what could be causing her confused state of mind.

There are so many doctors at this hospital and am yet to find the one in charge. Feel like moving her to a private hospital where there aren't so many chiefs with no answers.

Thank you so much, I just don't know what to do & feel so helpless.

Regards
Jaycee

Boopers

11-24-2006, 05:16 AM

Hi Jaycee,
I'm so sorry to hear about your Mom. I do hope you can get to the bottom of this and she returns to normal. The last two times I had surgery which is the last two years, the first one, right after surgery, I got carbon monoxide poisoning and the second one, I got a blood clot in my left lung. So, now, I am very scared of what would happen should I need another surgery. I do understand your worries and hope everything will be OK.
Take care,
Linda

Jaycee

11-24-2006, 08:33 AM

Thanks Linda.

So sorry to hear about your experiences. One never knows what can happen during and after surgery but the hospitals make sure you sign a consent form which covers them if complications occur.

Cheers :D
Jaycee
x

Lara

11-24-2006, 01:58 PM

Hi Janette,
I had looked for your name actually and wondered where you were. I was hoping you weren't ill and unable to post. Good to see you, but am sorry to read about all these problems your mother is going through right now.

The moment you said who you were, I realized exactly which hospital you would have meant if it was a public one. We won't go public on the coast here anymore. Pindarra is close and we've had mostly good experiences there but you need to have someone overseeing treatment. My daughter was in there for one of her operations earlier in the year but for the other one she went up to Brisbane.

My only thought this early in the morning is that if she's been on the medication for 10 years, then she'd most likely have some type of discontinuation symptoms as it is basically a narcotic. If she was on morphine after surgery, they might not have wanted her taking this medication as well. I just re-read your original message and see that she _was_ on morphine after surgery. I also wondered if she'd been given any blood-thinning medications after surgery as I read something in the drug info. regarding complications with taking anticoagulant medications at the same time as the paracetamol.

The other thing I was thinking was why she's having so many falls. 10 years seems to me to be a long time to be taking capadex or digesic. From all I read I'm thinking there might have been something better, but I'm not a doctor, hey. I didn't know too much about it until I looked at info. yesterday.

Here's what I'd do... and some of it you probably won't be able to do until tomorrow morning, 'cause it's the weekend.

I'd phone the Pharmacy at GCH. I'd ask them why the hospital said you have to bring in your own Capadex. They may carry Digesic instead, just an example. I was just looking at Queensland Health - THE HEALTH (DRUGS AND POISONS) REGULATIONS http://www.health.qld.gov.au/phs/Documents/ehu/9101.pdf They list dextropropoxyphene in our state as Restricted drugs ( Schedule 4) of dependency. I know for a fact that my daughter was administered the same drug by staff in a Brisbane private hospital, so can't quite figure out why they won't do that at GCH unless it's some sort of legal thing. weird. A Registered nurse should be able to administer this drug in a ward setting as long as it has written approval from a doctor.

Who admitted your Mum? If you went through casualty, you probably weren't referred by your regular GP, but if you were, get onto her/him straight away. They'd probably be there on Saturday/today. If not someone at the surgery can get in touch with them and then he/she can get back to you.
Also I wonder who did the surgery. If it was a local Orthopaedic specialist, then often they work both the GCH and the private ones. If you can get onto them that would be very helpful whether you move your mum to another hospital or not.

I'm really sorry your Mum is having so many problems right now. I sure hope she's feeling better soon. Please keep us updated,
Lara

Lara

11-24-2006, 02:06 PM

This info. is about Digesic. I looked up to find the manufacturer in Au. and it's Aspen. Not sure who make the Capadex, but am guessing that's the generic? Janette, frankly I'd be concerned about taking the paracetemol that's in that drug for 10 years let alone the dextropropxyphene as well. Take care there and let us know how she and you are doing.

from Drug Database (https://www.eknowhow.com/ekh_drugdatabase/html/s02_article/article_view.asp?id=200015001&nav_cat_id=432&nav_top_id=56&dsa=0) Dextropropoxyphene hydrochloride with paracetamol

"Drug Interactions:

General: Dextropropoxyphene may inhibit the hepatic metabolism of concomitantly administered drugs. Should this occur, higher serum concentrations of the concomitantly administered drug may result in increased pharmacological and/or adverse effects of that drug. Such occurrences have been reported when dextropropoxyphene has been administered to patients receiving antidepressants, anticonvulsants or warfarin like drugs.

CNS Depressants including Alcohol: Dextropropoxyphene in combination with alcohol, tranqullizers, sedative-hypnotics and other central nervous system depressants has additive depressant effects and the patient should be so advised. Patients taking Digesic should be warned not to exceed the dosage recommended by their physician (See Warnings).

Warfarin: Concomitant warfarin and dextropropoxyphene administration may increase serum concentrations of warfarin. Paracetamol may affect prothrombin time in patients receiving anticoagulant therapy. Warfarin dosage adjustments may be required.

Carbamazepine: Concomitant carbamazepine and dextropropoxyphene administration significantly increases carbamazepine concentrations and may result in moderate to severe neurotoxicity (ataxia, nystagmus, diplopia, headache, vomiting, apnoea, seizures, coma).

Orphenadrine: Confusion, anxiety and tremors have been reported in a few patients receiving dextropropoxyphene concomitantly with orphenadrine."

Tootsie

11-24-2006, 04:43 PM

Propoxyphene is sold by prescription in the US as Darvon, and comes both in combination with aspirin, or, with acetominophen (known as Tylenol in the US.)

According to studies, it is considered to be about the same effectiveness as plain aspirin as far as pain control goes. However, I have found that not to be so. It is one of the only analgesics I can tolerate as long as it is the one combined with aspirin. I cannot use tylenol and react badly to any form of codeine, synthetic or otherwise.

There are general warnings that it should not be used in the elderly (including me!) Reading over the previous posts, I think that warning has to do with the poor liver clearance. It is never used for long term pain control.

I would assume that the hospital that does not use it, has made this decision because of the warnings and problems associated with it. When I need something for pain, like after minor surgery, I always have to ask for it and remind the doctor of my problems with other pain medications.

I would also assume, that if it was constantly renewed, and prescribed, for someone in advanced years, that the individual doctor had found that the patient had tolerated the drug well and found it useful in controlling chronic pain. As long as that doctor saw the patient regularly, to re evaluate her mediation needs, and monitor liver function by use of blood tests, then there is no violation of any medical standard. Cheerio.

mrsdoubtfyre

11-24-2006, 04:46 PM

from propoxyphene products can be severe...
Please read this:

A Case of Severe Withdrawal Syndrome due to Dextropropoxyphene
right arrow Karin Hedenmalm, MD

15 September 1995 | Volume 123 Issue 6 | Page 473

TO THE EDITOR:

Withdrawal reactions due to dextropropoxyphene have previously been reported in the medical literature [1-5]. Common symptoms are nausea, tremor, agitation, insomnia, diaphoresis, fever, and headache; however, confusion, psychotic reactions, and seizures have also been reported. I report a case of severe withdrawal syndrome due to dextropropoxyphene.

A 69-year-old woman had been receiving dextropropoxyphene (100 mg, 1 to 2 tablets as required) for a chronic pain syndrome. After surgery for a hip fracture, ketobemidone was administered for analgesia during the first 2 days after surgery. On the third day, the patient became increasingly confused, hallucinated, and sweated severely. She became unable to respond to questions and showed uncontrolled kicking movements. Despite treatment with dixyrazin (60 mg intravenously) and melperone (50 mg orally) during the night, her condition did not improve. In the morning, she was given ketobemidone (5 mg subcutaneously) and dextropropoxyphene (100 mg orally) and was transferred to the intensive care unit (ICU). After another 100 mg of dextropropoxyphene she became calm. Because of suspected dextropropoxyphene withdrawal symptoms, treatment with dextropropoxyphene (100 mg, 4 times daily, plus 1 to 2 tablets as required) was initiated. She was much calmer when released from the intensive care unit but was still confused.

Beginning on hospital day 7, dextropropoxyphene was reduced by 50 mg every other day. Her condition deteriorated, and on day 13 she was taken to the intensive care unit. She was stuporous and had dilated pupils; the Babinski sign was present bilaterally. Her temperature (42.3 °C) and heart rate (130 to 140 beats/min) were increased. She was placed on a respirator. Intravenous infusion of dobutamide was necessary when the patient's blood pressure decreased from 180/75 mm Hg to 80/50 mm Hg. Blood cultures, a pulmonary radiograph, and a cerebral computed tomographic scan could not explain her symptoms. A morphine infusion was initiated, and she improved gradually. On day 16, dextropropoxyphene was reinstituted at a dose of 900 to 100 mg/d and was reduced by 100 mg each week. No further withdrawal symptoms occurred. After 9 weeks, she no longer received dextropropoxyphene.

The patient had secretly consumed 1 to 3 g of dextropropoxyphene daily for at least 1 year. She had visited several physicians and manipulated her relatives to obtain these high doses.

This case shows that serious, nearly fatal withdrawal symptoms can develop after dextropropoxyphene abuse if initial symptoms are overlooked. Tranquilizers such as dixyrazine and melperone, commonly used for treatment of alcohol withdrawal, may be of little or no value for the treatment of opiate withdrawal. Dextropropoxyphene withdrawal symptoms can be prevented by slowly reducing the daily intake. Treatment with clonidine is an alternative [4, 5].

Author and Article Information
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Norrland University Hospital; S-901 85 Umea; Sweden

This drug is really a very poor pain reliever. It is quite habituating.
10 years on this drug? Seems like poor medical supervision. Often it takes a medical emergency to reveal drug dependence or bad choices of therapy.
I hope this situation is corrected, your mother tapered off the propoxyphene
eventually!

Lara

11-24-2006, 05:00 PM

I hope Janette reads and/or posts again this morning.
It's 8am Saturday morning where we are so she may be in sometime later.

We live in the same area and I'm very, very concerned about everything the more I've read and even more so knowing where she's being treated.

Jaycee

11-25-2006, 08:19 AM

Hi I'm back !!!!

It's 11 pm here and probably not a good idea to read all the information you have posted. My concentration is poor at present.

Lara, Tootsie & mrsdoubtfire - Thank you all so very much for your concern and very interesting info.

Mum usually goes to Pindara which I prefer to the Gold Coast Hospital but there were no beds available at the time.
I'm exhausted walking up the incline to the entrance of the GC every day especially with the ataxia. Oh well, I'm getting some exercise I guess.

Lara, I'm sure you will agree with me. Had thoughts of transferring Mum but at present she thinks she's in a hotel and therefore coping quite well.
Realize she cannot return home, this is going to be heartbreaking.

Her GP doesn't visit hospitals ??? but I contacted her previous doctor (for 30 years) who has a heart clinic and he was very helpful. He feels Mum should overcome her symptoms, may take a few more weeks. So fingers crossed.

Please forgive me as unable to answer all your questions but will return tomorrow.

Braintalk is a godsend and I thank everyone !!!!

x Janette

Lara

11-25-2006, 03:53 PM

I contacted her previous doctor (for 30 years) who has a heart clinic and he was very helpful. He feels Mum should overcome her symptoms, may take a few more weeks. So fingers crossed.

I'm glad you were able to contact that doctor. Let us know how she's doing. Take care of yourself as well.

Jaycee

11-26-2006, 09:00 AM

Hello All,

I'm so worried I just can't sleep.
Thought Mum had slightly improved but she was very confused and paranoid today.
All these things keep running through my head and I'm quite sure the ceasing of Capadex has everything to do with Mum's symptoms.
I advised the ambulance men what her meds were and a nurse and the hospital contacted her GP who too advised the meds.
Instead of Capadex they were administering a paracetamol.
I spoke to a medical doc. and she seemed horrified that the correct med wasn't used and said she would correct it but 2 days later nothing had changed.
The nurse said they don't have Capadex in the Pharmacy and I should bring it in myself ??? which I did but 9 days postop !!!

Reading the article on mrsdoubtfyre's post about withdrawal of Dextropropoxyphene it's very very possible this is the problem but when I brought this up today at the hospital a nurse said they think it's alcohol withdrawal. RUBBISH !!!! Mum did a drink or two but her symptoms were far from alcohol related, the signs were just not there - the DT's or whatever it's called etc.

Feel there is a big cover up and no idea what I should do. Just forget it, NOT I !!!!!

Thanks for listening, really appreciate it.

NOT HAPPY JAN !!!

x Janette

Tootsie

11-26-2006, 05:54 PM

Hi Jan,
You have so many things to think about and consider, I almost hesitate to bring up anything more.

However, the hospital is probably wondering if your mother may have been drinking more than you or anyone else, knew or anticipated. There are forms of dementia specific to alcohol use, and it may be one of the things that is being considered. It is important that everything that may be causing the difficulty be evaluated.

You might inquire about the blood tests that have been done to test her liver. Since the medication and alcohol are both metabolized in the liver, that might be the source of the chemical toxicity that would produce the confusion and other mental symptoms. Cheerio.

Jaycee

11-26-2006, 08:14 PM

Hello Tootsie

Hope you are well.

Thanks again for all your help.

I live with Mum and she was only having 2 scotch & sodas a day prior to hospitalization. Regarding the blood tests, have asked many times for a copy of the liver one but their copier wasn't working ? and anyway I would have to contact the Doc. There have been so many Docs seeing Mum probably due to the public system as previously she went to a private one where there's usually one treating doc.
Just found out yesterday the doc who I should be speaking too being the surgeon so have to track him down which isn't easier.

Oh Tootsie, have you heard the saying "Don't know whether I'm Arthur or Martha" - well that's me !!!! running around in circles.

Huhs

Tootsie

11-28-2006, 12:24 AM

Jaycee,
I hope that you are able to find some answers soon, as it is so very frustrating to have to worry about your Mom and deal with all the anxiety and difficulty with the professional staff also. Cheerio.

Jaycee

12-02-2006, 06:06 PM

Thanks Tootsie,

Good Grief !!!! I could say much more (and I don't swear).

Latest news regarding my Mum:-

I moved Mum from the public hospital to a privare one last Wednesday.
Still haven't got over the fact that she went cold turkey off the Capadex for 9 days before I realized it and mainly that the withdrawal symptoms would cause confusion and dementia which Mum has now & looks permanent.

I just presumed Mum would be getting her usual medication in the public hospital as they were well aware that she took Capadex but failed to do so because of the lame excuse not having this med in their pharmacy.
Is the hospital at fault? I asked the liason officer on Thursday to look into this matter & I :confused: should hear back in a few days.
Am so angry I want to take this further !!!!

Now, back to Pindara - The day after her admission I spoke to the Sister regarding further rehab & possible nursing home & she said wait until until Monday or Tuesday to make an appointment with the Discharge Manager.
Yesterday Mum told me she was coming home Monday ???? The Doctor told her all being well she can come home.
This Doc is only treating her for the broken elbow, surely he MUST realize she is not well enough to come home, for goodness sake !!!!
On Friday I asked the Sister for the Docs phone number/office number & she said she couldn't give it to me. I explained I wanted to discuss Mum's ongoing care but she just wiped me off.
I then went to the main reception & there was the Discharge Manager, when I told her the Sister wouldn't give me the Docs number she said SHE SHOULD HAVE. By this time it was 6PM and I couldn't contact the Doc anyway.
Yesterday the Sister told another fib & said the Doc wouldn't have been in his office anyway because he was operating but he WASN'T - anyway his receptionist would have been there.
I think I have a right to be upset !!!!

What's happening with the hospital system ????
Surely I have a right as being the daughter & having power of attorney to speak to the Doc ???? The same thing happened in the public hospital, I'm still waiting !!!!

So, here's Mum all excited about coming home. I can hardly turn around & say "NO MUM I WANT YOU TO GO INTO A NURSING HOME" which is where she belongs. She can hardly walk & is very weak. I'm not going to be much help with my ataxia.
She will never talk to me if I take action.

I mentioned 'DUTY OF CARE' and the Discharge Manager came back with 'Injury of Chance' ?????

Any suggestions please !!!!

Losing patience !!!

Jaycee

Lara

12-02-2006, 06:57 PM

Just sending you a private message with info. regarding G C Hosp. staff contact details.

Jaycee

12-02-2006, 10:14 PM

Thank you so much Lara,

Read your PM.

Mum has been ill since 2 nights ago. Left her yesterday evening when they sedated her but just phoned & she hasn't improved. Her bed mate advised me NOT the staff.

Have more to tell but like you cannot post here.

I REALLY want her home now.

x
Janette

Lara

12-03-2006, 01:04 AM

Dear Janette,
The way you are describing how your mum has been deteriorating is very worrying indeed. I just re-read the whole thread from the beginning. She's 85, has had a couple of bad falls, with this last one requiring surgery and general anaesthetic just recently. She was on long-term painkiller and that was ceased abruptly. Suddenly she's deteriorating again...

Have you been able to at least sit down with one of the nursing staff or one of her doctors at either place and asked them what they think is going on? Heck, I'm not a doctor, but the whole situation has been complicated by taking her off the capadex like that. In your situation, I would be wondering if she's had a Stroke, or perhaps having Transient Ischemic Attacks, small strokes. Can she walk around at all? Does she have any problems speaking or numbness or is it all mental confusion only?
How confused is she?
Have they looked into why she's deteriorated so quickly?
Have they done any blood tests or urine tests? How're her kidneys working... all that type of thing. Any head scans or MRIs taken?
Is she eating and drinking?
If the only doctor who's visiting her where she is at the moment is an orthopaedic surgeon, then I'd be asking for a consultant or someone else to evaluate all that is going on apart from her broken bones. I think you can arrange that by phoning your GP. To them it might not be an emergency, but from what you're saying, I'd be wanting some of your questions answered yesterday.

Sorry that she's doing so poorly. I am hoping she'll pick up and get less confused and stronger as each day passes.

GUMBY

12-03-2006, 02:36 AM

Find out her liver function. With anesthesia and Morphine there may be injury due to above. Is there any jaundice? Just a hunch, reading through this.With the age and increased confusion it may be a possibility. If there is any liver impairment according to your Mom's blood work, do not let them continue meds that may impair liver function any further. I wish your Mom and yourself the best. It's just a hunch. Good luck

Jaycee

12-03-2006, 06:03 AM

Hello Gumby

Thank you for your concern it is much appreciated.

Have asked and asked for the liver function tests but for some reason they wouldn't give it to me ???

When Mum was discharged from the 1st hospital I asked again and the clerk said she would send the results with the ambulance that transfered Mum to the private hospital. Everything was rushed & I followed the ambulance but after checking the file on arrival there were NO tests in the file ???
I have the clerks name so will contact her tomorrow and ask again.

Don't like to say this but the more I think about things it appears there is a cover-up, however perhaps the file MUST remain at the public hospital. Surely I am able to obtain same, if not, her present Doc. ??

It's very possible Mum has liver damage at her age, actually I'm quite sure as remember her GP mentioning same last year.

Cheers
J.

pab

12-03-2006, 06:47 AM

dont know the aussie legal system.,,,but since you have power of attorney, maybe a nicely worded letter from an attorney+ the power of attorney, SHOVED IN THEIR faces, is the way to go?.....emphasizing that you have tried the nice way, now it is your way, or the court way.....good luck

Tootsie

12-03-2006, 05:41 PM

Jaycee,
I think most of us here in the USA are confused over many of the things you have described, because there is such a difference in the health care systems involved.

Here, there is more likely to be a problem with a multitude of tests being done, to avoid any hint of malpractice, and thus a law suit. In a national health care system, the things you have described, seem to be a lack of accountability, for any specific individual.

You may be able to handle your mother's care at home if there are sufficient home care services available to you. Actually, there needs to be a very comprehensive evaluation done, by skilled professionals,who will consider your health needs and limitations, and the physical facilities of your home. Decisions about discharge planning should encompass all of those things.

If you are forced to tell you Mom that she is not able to come home, you could use your own limitations as the reason. I am a frequent poster on the Alzheimer's Forum and respond to questions and concerns there. One thing that we all learn to do, is lie to our loved ones, to avoid any anxiety producing worry or concern that they express. It is a fact of life, that for someone suffering from dementia, reasoning is not an option. They have lost the capacity for rational discussion and only makes them more upset. Cheerio.

GUMBY

12-03-2006, 06:50 PM

I am sorry for this kind of care. Well there is more than one way to skin a cat. Maybe, what you can do in the meantime is, have where your Mom is placed now, draw a panel of liver function test. This way in the meantime you will know what is what and will give you some time to obtain the old results to compare. If the results are elevated, it is important not to be on anything that can impair function. This way you can discuss this with her doctors as what to do. It's just a hunch. Again, I am sorry for this type of care, sometimes you do what you have to do. I wish your Mom and you the best and the strength to keep pushing on.

Jaycee

12-07-2006, 12:14 AM

Thanks Gumby

I don't have the liver function test from the first hospital where Mum wasn't given her usual med Capadex but have Ultrasound Abdomen Clinical Notes from the 2nd hospital which were done mainly because she was vomiting for two days (cause unknown) but all it states:-

The liver is diffusely homogeneous measuring 12.8 cm.
My brother had asked the doc for a copy of the liver test but to date not received anything.
May have to go to our GP for her to contact the medical records departments of both hospitals to compare results.

On Sept 30 I phoned the Liason Officer of the public hospital & today received a reply letter stating:-

'Capadex is not used in Queensland Health Hospitals as it is not on the hospital approved drug list. *The information that you were given regarding this was accurate. While there is some evidence that suggests that patients who have been on Capadex for long periods may experience some psychological dependence on the medication, it is believed that there is no evidence to support any relationship between Capadex withdrawals and dementia'.

My brother who is a dentist and studied medicine and is still studying and many of his friends and colleagues are of the opinion that Capadex withdrawal can cause dementia.

Mum has improved but still confused and doesn't remember much of her stay in the hospitals.

Once again THANKS EVERYONE for listening.

Comments would be appreciated.

* I believe this statement was that they DID NOT have Capadex in the pharmacy.

Jaycee

12-08-2006, 05:43 PM

Hello beglobal

My mother has been taking the same meds for years i.e. high blood pressure, cholesterol, reflux. I presume the usual ones for an 85 year old.
Would you like the brand names?
Sorry, I realize some of our meds have different brand names in the US.
Where are you beglobal? Please don't answer if you wish not to.

The doc who operated on mum's spine 13 years ago (Laminectomy) which wasn't a success prescribed Capadex and said she would be in a wheelchair in 5 years. Well, she's at that stage now so she has done well. He said she could take a max of 8 per day but she has taken a max of 6.
Since then her 3 doctors over the years kept giving her Capadex & Panamax to cut down on the Capadex.

Now where were we? Please forgive me but I am a little 'foggy' this morning, not much sleep again.
I bought one of those baby monitors so I could hear Mum if she needed anything during the night and have been listening to her grunting and groaning and snoring which is quite funny when you think of it - baby's don't snore do they? Well maybe some but Mum sounds like a pig.

Thank you beglobal for your interest.

Regards