I take 6 classes of medication, and a daily total of 14 tablets. I don’t feel great most of the time.
No GP or Consultant has ever discussed with me whether this is impacting my quality of life.
Like many older people I have taken back at least a measure of control and stopped in my case my beta blocker. My breathing has improved and I am able to enjoy exercising.
I don’t want to live longer at the cost of enjoying the time I have left. I’ve also fallen off the wagon.
Evidence based medicine, algorithms and differing local protocols. A plague on all their houses I say.
What has happened to patient centred care, genetic profiling and personalised medicine?
Medication deprescribing is part of a medication optimization approach, that balances therapeutic goals with quality of life. This can be particularly important as we get older.
Unfortunately, many doctors simply add one medication on top of another and are more interested in metrics than side effects and quality of life.
Because of this, as a patient, you often have to be more active in your own care and ask for a medication review where you will candidly discuss both life goals as well as treatment goals.
Some doctors are more amenable to this than others and if yours isn't, then a second opinion is warranted. In this case you might seek out of geriatrician, who are often best equipped to optimize your medical treatment if you have multiple medical issues.
Thank you for your helpful reply. I like and respect my GP and wouldn’t want to offend him by asking for a second opinion. I have many medical conditions and I try not to bother him too much, and there’s never enough time to discuss an issue like this, when you’ve finally managed to see him that is, after 4 months because he is so popular.
I do like your suggestion of seeing a geriatrician, and if they offer such a thing, I would see them privately. I would probably be dead when I finally got to see one on the NHS 🙂🪦
I think basically I just need to get a grip and stop blaming other people for my woes. I’m perfectly capable doing something about at least some of my medical problems, well I think I am. I try to keep up with everything about AF and read the forum which has many helpful members.
You are a wise, well informed chap. I appreciate that you put so much time into helping members.
Most doctors are too far down the road of following protocols set in the main by organisations that are not thinking 'individually patient centred' and often treating too many patients to have the time to identify an holistic appreciation of what's needed.
Regrettably, I now find I have to do a lot of research myself, challenge them and make it clear in advance of any consultation that I am not a generic patient - all done very tactfully & respectfully of course.
The more drugs you are on the more dependent you become. However, it is never too late to change tack, one small step at a time.
I'm with you on this. Doctors seem for the most part to treat only the condition that's presented to them, usually with another drug. They might check for 'contraindications' with other prescribed medicines but can then add to a cocktail of interacting chemicals that might make you feel worse than the condition itself. If only they had the time/ inclination/ training to step back and look at the whole picture.I keep reminding myself it's my body and ultimately my choice what I put into it.
I thought my 5 daily and 1 x B12 nugget three times week was too much.
Bu I have had Ca Thyroid cancer, Af Rapid and persistent control as well as BP control, Clot control.
I tried to stop my BB Bisoprolol (Metoprolol made me breathless, fatigued with pauses at night) but restarted it for especially systollic control BP.
Always best to get your meds as low as possible.
I wonder if you are doubling up or you could change to a natural food instead.
Like kiwifruit /figs/ nuts for constipation, sardines/2 brazil nuts daily/beef liver for T3 or selenium and banana for magnesium and potassium.
Keep hydrated. Water best with squeeze lemon/orange/ in. Or A2 milk or UHT milk.
Changing your diet and exercising can be life changing. Weight loss is also a good one.
Be interested in your meds, the name and purpose of each one so that you can stay informed of their purpose.
I had only B12 Solgar nugget x 3 times week until 2019 when I had Stroke Embolic, AF rapid and Persistent and diagnosed with possible Thyroid Cancer - which was within 4 days in hospital via a scan for carotid arteries which were squeaky clean.
An ECG will show your Dr what happens if you stop your BB. Which one?
My main specialist is my General Surgeon to monitor thyroid Cancer return. Had a full thyroidectomy with 12 lymphs removed (2 infected). Also dissection of lymph node floor. Low risk but my 4th ultra-sound has directed me for tests CT/PET and MRI for check on cancer return. Nothing conclusive so repeat of cT scan November. I was discharged as outpatient cardio specialist back in November because I am stable on my meds.
I would call that 'personalised' medication at last! BBs did not much for rapid heart rate Day and my normally low Night H/Rate is 47avge.
On this forum sometimes we see folks with Af doubling upon say 2 CCBs. And we point this out. Later the poster gets back to us to say 1 of the same type gets dropped. Directions are not always understood.
How much for hydration? We get dehydrated overnight so a glass of water first thing in the morning is a must. If we feel thirsty in the day we are dehydrated because feeling thirsty is in a 'late' reaction. We should drink before this happens.
It is worst during hot weather or we are exercising and are hot.
Jim, as you seem to be concerned with the quantity of medicines you take, perhaps you could get an appointment with your Practice Pharmacist ? At my GP surgery, I get appointments with them annually, when they review my medications and discuss any concerns. Bisoprolol is a rate control drug ( which I couldn’t do without ! ) and although it doesn’t suit some people, if your heart rate is on the high side, it is helpful. However, you seem to feel better without it, so maybe a review of all your medication would be a good idea. Others on this forum have told you how GPs do tend to follow protocols. This is true. The doctors are not experts at understanding all medication - they couldn’t be, new medicines are arriving continually. But it is a pharmacist’s job to know all about them. I’m sure that if you spoke to one you would find it helpful. A Practice Pharmacist would be better than one on the high street because they would have access to your medical records. All the best.
Thank you Annie. I hadn’t thought about asking the practice pharmacist. Mind you in the 9 years I have been with the practice, she/he has never asked whether I needed any help with my medicines.
This is a true story. My late aunt became very ill and lost lots of weight. The family thought the worst, as did she. She was admitted to hospital where the doctors stopped all but one of her many medicines. She recovered her usual self and lived another decade or so, shuffling off this mortal coil in her 90s.
She did have to have a few of those medicines restored, but, still, there might be something for us to learn from this and your own story.
My mother in law in her late 80s started having blackouts and falls. One fall ended up with her in hospital where they also stopped all her medication. Turned out she'd been on BP Tablets for 40 years but had never had high BP. Her then GP had diagnosed after one reading at the surgery. The tablets were dropping her BP far too low hence the blackouts. She wsa taken off ALL medication and lived to be 99.
What a story. And isn’t life strange? Coincidentally, I have been put on similar tablets despite having normal BP, but I have been told that they protect my heart.
Well, yes - I assumed the tablets would but it's been generally okay until recently when I was told to try doubling my dose of beta blocker, and that seemed to take it too far.
After my HA I was put on bisopralol for the same reason but my BP had been perfectly normal and they dropped it so low I couldn't function; slept all day and felt like a zombie so they were stopped. Now, 6 y ears on my average BOP is 124/69. I can't cope with it any lower. It's getting a balance between quality of life and protection.
Indeed and well said. I seem okay with the top going well down, even to 100, but the bottom is like you, best around 70.
My sister-in-law had a heart attack at Christmas and was quickly treated with two stents. She is much better but she told me she has stopped her bisoprolol for just the reasons you explain. I told her she should have spoken to her doctor before doing so, however, and still think she should.
Absolutely. I would never stop any medication without G P agreement. I also had two stents so was on ticagrelor but the side effect of making me feel I couldn't breathe was unbearable. GP wouldn't change it or speak to cardio. I was going for another angiogram in 4 days so I stopped it until I could speak to the cardio. He went up the wall and did immediately change it and I needed a big dose of the alternative clopidogrel e before he could do the angiogram but I just couldn't tolerate the gasping for breath and no one was listening. That's the only time I've done it though. I knew what ticagrelor was but had no idea why I was taking it. Patients are rarely told why they are given medication and what it does so I think everyone should ask. They just might stick with meds if they knew why they had to take it. It's like statins- most think they are just to reduce cholesterol but they do far more than that.
Thanks ; mostly fine. I just wish I could get an appointment for two referrals to find out why I'm so breathless. Lungs tested fine but the wait time for all referrals here is 12 months.
That is too long. What if you took yourself off to A&E, claiming it was worse? A £200 private consultation would likely not be much benefit without paying for extra tests although if the doctor deemed them urgent, I suspect they would be done on the NHS.
MY G P's secretary says they can't get anyone fast tracked no matter how urgent. I do have one GP trying hi s best. After the HA the second angiogram found 2 blockages in LAD At 64%; not bad enough to stent. I do wonder if they've got worse so am pushing for a CT angiogram. Still the first referral done by the acute medicine dept at the hospital was last October so only 2 more months to go - maybe.
Although there is information about interaction of two different medicines there is no data on effects of taking several medicines at once because nobody has yet studied it properly. There have been small experiments in deprescribing for older frailer patients and the upshot has generally been an improvement in quality of life. Some people are far more sensitive to the side effects of medication and ALL medicines have side effects though some are more damaging than others. I am quite relaxed about taking my thyroid meds and small dose of transdermal oestrogen as I look at them as just replacements for what my body is no longer making enough of . But I hate taking the rest especially the Apixaban . I have reduced the Nebivolol to .65mg and am thinking of taking it as PIP only. I only take a quarter of the dose of Symbicort as that controls my asthma well enough . I might have to up it to two puffs a day when autumn comes as my allergy to mold always worsens then. But the prescription says 4 puffs a day - day in day out. I am very against one size fits all medicine, reckon I know my body better than any doctor having been in it for 72 years and am the picture of the non compliant patient.
With asthma, the evidence used to suggest that if there is a particular drop in overnight peak flow (I seem to recall 20% but am not sure now), then steroid treatment must be increased. Home use of PF meters seemed, back then, to be the way forward.
I am green with envy that you have even a small dose of oestrogen. I had a hysterectomy 36 years ago and my word, do I feel he lack o f hormones but my G P absolutely utterly refuses to even consider it. I would happily take any risk to heart to have even a small dose of progesterone b ut he won't even consider it. NICE says no. I'd much rather have quality of life over quantity. I'm only 4 yrs older than you. How on earth did you manage to get it? I got the stipulated 10 years HRT after the hysterectomy but it was then stopped.
I had a total hysterectomy aged 48. I moved to France when I was 49. My GP has never suggested I stop and I would argue strongly against any such suggestion. My patches are only 25mcg . You can buy progesterone cream online. If you are in the UK you can probably buy oestrogen patches from online pharmacies in the US though they might be very pricy. You can also go to a private menopause clinic though I think it is unlikely they would prescribe after such a long gap. The latest thinking on HRT is that if you are just taking transdermal low dose bioidentical oestrogen you can stay on it till you die. Don't expect NICE to be up to the latest thinking though. You must have been young when you had the hysterectomy so you should have got it till you were the age for normal menopause ie early fifties.
I was 41; 6 months after my son was born. TOtal hysterectomy. I got HRT for 10 years which was about right but back then it was insisted that you stop after 10 years. All our GPs are insistent that if yo u have heart disease you must not take it.
It’s so sad that they stopped the HRT for you. It’s only been really this past couple of years, that all the studies they did on HRT years and years ago, were proved to be not valid. We’ve still got a long way to go thiugh in the UK. If you were to start taking HRT today, after a hysterectomy, there is no reason that you couldn’t stay on it, but as Auriculaire says, you would struggle now sadly, as there’s been too long a gap and they are very cautious for commencing after 60.
You really would sadly. You may be able to get systemic oestrogen for ‘down there’ ( as it were) - a cream or pessarie ( prescribed for VA - vaginal atrophy) ) that isn’t absorbed into the blood stream. Taken for VA - you can start that at any age, or should be able to and can take that for life. A lot of women don’t know about it, it doesn’t give you anything like a patch would though, as not absorbed but can prevent UTIs, which a lot of women, who have VA get. You’d have to have symptoms of VA…sadly a lot of women don’t even know they have and ‘put up with it’ thinking it’s normal ageing..
That’s a shame it’s no good for you…there are a few different ones, or perhaps you might need to use it more often? I use it every other day as twice a week not enough. Which have you tried?
It doesn’t get absorbed into the bloodstream as you probably know so you so no benefits of oestrogen anywhere else in your body.
Most of the early studies were done in America on the horse urine oestrogen combined with a nasty artifical progesterone. It was the latter that upped the breast cancer risk. Bioidentical transdermal oestrogen has a very low risk profile. But the bad publicity has stuck in the minds of doctors.
It’s very tragic what happened. I’m on body identical Oestregen ( I have a spray - Lenzetto) and have a Mirena coil for progesterone and I want to take it for the rest of my life. Both my parents had osteoporosis too, so I really want it for that protection too. I belong to a couple of FB groups and forums and some women are still really struggling to get HRT, despite all the latest news about it. Their GPs are still confused. I had to go to a orivate menopause specialist to get mine sorted out,
Quite frankly I think it should be the woman's choice. All menopausal women ( except those with breast or other oestrogen sensitive cancers) should be offered a trial of HRT to see if it gives them a better quality of life and if they want to stay on it any risks should be explained. But doctors need to be informed about the true risks not those touted in old , poorly conducted studies using products that are way out of date. I was lucky in that I was given transdermal oestrogen from the start by the menopause clinic at Birmingham QE - in 1993. But pill form is still being prescribed by useless ill informed doctors despite the disadvantages. I consider it a form of misogyny that older male GPs are often so useless when it comes to "women's ailments", There is evidence that oestrogen helps protect against colorectal cancer and dementia as well as osteoporosis. I'm lucky with my GP - he has never suggested I stop it though I know he would be unhappy about me taking a higher dose.
Well said ( as always Auriculaire)….it should be a woman’s choice. You’ve hit the nail on the head regarding ill informed misogynistic male doctors. Sadly, I have also got an ill informed forty something female GP at my surgery ( the ONLY female there) who is outwardly anti-HRT and woe betide anyone who tries to ask her for it. She will attempt to recite all the old wrong studies results and all the incorrect risks as if they were imprinted on her brain to any poor female who will listen and then feebly say “I’m not anti -HRT but…” I smile to myself that she may change her mind about it in a few years, but I now avoid her as much as I can.
I have to bypass her for the only forward thinking, level headed, middle aged male GP there who does most things I ask (thankfully). I don’t know what I’d do without him…which is a worry in itself, it shouldn’t be this hard. Yes, I too was given pills when I first was put in it…I soon changed that after two months and being more informed and researching.
With Qualipop, I have heard there are some minor risks with starting it over 60, but I daresay they may still be very small, I’m sure more will develop on that.
Ah, a woman after my own heart. With your bold and brave approach, I am sure you will live to at least 92, assuming of course that you want to. What a lesson for us all.
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