Medical appointments

VeeM

Hello! My mom has pretty advanced Alzheimer’s with behavioral disturbances. She is aggressive, combative, and wanders. We have been working for the past 3 months to find some type of medication combination to help make her more manageable. She lives with me and other family including my dad. At home, we do our best to setup a more calm environment for her however, it does not help much but we deal with it. The problem we are having is we cannot even get her to doctor’s appointments. She needs multiple follows up that we’re first delayed by COVID and now because she is aggressive and refuses everything. We took her to get labs done, she hit the phlebotomist and couldn’t get them done. We took her to see her neurologist and my sister had to walk out with her mid appointment and me follow soon after because she wanted to take off in the parking lot and t[refused to get in the car. Most recently, we took her to a dentist appointment and we couldn’t even get inside the building because as soon as s she got out of the car she tried to bolt. We had to restrain her to prevent her from leaving (very busy street) that obviously upset her, she hit me, cried, and refused to get back in the car. I’m pretty sure three is a video of this out there. BTW all of these attempts were made after several medication adjustments that led us to believe she would do better. She is currently on 50mg seroquel twice a day and 5mg lexapro once a day. I am questioning whether that is working but decided to give it a little more time since she hasn’t been on this dosage for long. In the meantime, she needs to get these appointments but I’m not sure how to do it. Anyone else struggle with this? Any suggestions?

M1

Without trying to be flippant, I would suggest rethinking your definition of necessary.  It may be time for if it aint broke, don't fix it, and letting sleeping dogs lie. Have you thought about a palliative care or hospice evaluation? Many palliative care practices will make house calls.

VeeM

You right in the sense that there are some appointments she does not need and I would not try so hard to get her to those appointments. Her dental appointment she does need because has has a broken tooth that got infected and would want to treat before reinfection. Pain and discomfort are my concern. I would like her to have labs because the way I see it it’s not that I don’t want time to follow it’s course, it’s more that I’m concerned that she will develop illnesses that she doesn’t currently have but us borderline that will make her time left and our caring for her more difficult. She is fairly healthy so I don’t think hospice would be appropriate but I will look into palliative care.

​fesk

I would speak with the dentist's office and see if they can offer any advice. For the rest, I would hold off until you have found a medicine that works well enough to allow your mother to handle the appointments better. Hopefully that will happen within a month or two. I would also see if there is a doctor's office or service that would come to the house for lab work. This is something we have been able to arrange.

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MN Chickadee

Who is prescribing the medications? She likely needs a geriatric psychiatrist. When there are extreme behaviors and aggression a geriatric psychiatrist is the best trained to tinker with meds.  It can take some trial and error, but there may be the right cocktail to make care easier and her quality of life better. Everyone reacts differently to drugs and sometimes the dose needs to be changed. Sometimes a PWD even needs an inpatient setting to get the meds right. There are such things as geriatric psych units. A PWD usually stays there at least a few weeks to get the meds right. It is staffed by doctors and nurses highly trained in dementia. In such a medical setting other things may be able to get accomplished as well such as blood draws once they get her stable. In my area the closes geriatric psych unit is a couple hours away but worth it for many families to get their PWD the help they need. I wouldn't attempt any regular medical appointments until you get her stable on the right meds. And echoing others, think about which ones are truly necessary given her terminal disease of Alzheimers. If it affects pain and comfort is one thing, but if it is to prolong life you might rethink and consider more of a palliative care approach either formally with hospice or just in your own thinking.

jfkoc

Please go to a site like drugs.com and check side effects and interactions. There is a major interaction with these two drugs that you will want to evaluate.

I was given Lexapro and it had a paradoxical effect. I was so anxious I could barely function.

I agree with thinking about what appointments are neccessary.

Kibbee

Contact all of her physicians and see if they offer virtual visits.  Also find out if they can make a referral to a home health agency that will dispatch a nurse to your home to draw the labs and check vitals, and get the updated information into her chart.

Due to my husband's mobility issues we have switched to virtual visits whenever possible.  Yes, the in-person, hands-on aspect is missing, but if updated labs and vitals are in place in the chart, then much of a physician's evaluation and diagnosis is verbal, ie he or she asks questions to understand symptoms, triggers, what is/is not working, etc and from that will determine the care plan going forward.

VeeM

Thanks everyone for the advice. 

Yes we have switched most appointments to virtual or phone. We took her to the neurologist because we thought she could handle it, we were very wrong.  But most of the follow ups she’s had with her have been virtual. Labs and dentist were the ones we were trying to take her to. Labs I’m not super concerned about but the dentist I wish we could do. I will have to look into home health coming to do labs. 

All the medication adjustments have been done by her neurologist but will also look into a geriatric psychiatrist. 

Hopefully we can figure this out soon. 

VeeM

Just wanted to give you all an update. We figured out that  mom was having a bad reaction to seroquel and instead of helping was making agitation and aggression worse. We took her off it and started doing better or at least was back to baseline. She is now on lexapro only and it seems to help with anxiety more than sertraline did. She still have agitation and aggression and the next recommended med to try was respiradone but Ive decided not yo try it at this time. She already had a bad reaction to seroquel and some years back when hospitalized for sepsis to haldol. Seeing that she’s had a bad reaction yo 2 antipsychotics I’m afraid to try a new one. I am trying to take her to a geriatric psych but the soonest appointment I could find so far is until March. In the meantime, I’ve started giving her CBD tincture which seems to work but it’s hard to administer under the tongue as suggested, to administer the some dosage, and still trying yo figure out which dosage works best for her.

M1

Glad to hear the update and that she’s better. These meds can be so tricky.

King Boo

Schedule the March appointment.  You will most likely need it, and at the very least it is advisable to have her establish specialist care because she can get in much more quickly if she is already a patient for future needs.

With these behaviors, there is too much at risk not to see the 'go to' professional for this class of medications.  Her care needs, her wellbeing, your sanity, etc.