Drug interactions - help!

[Mummaru]

Hello everyone. My name is Ruth and I'm 43 years old.

Before I begin, I must apologise in advance for this long post, but implore you to read on.

My family on my father's side are all afflicted with heart disease, and in the case of my grandparents, this proved fatal.

Two of my uncle's have had quadruple heart bypasses, another one has had stents, and my father suffered his first heart attack in 1985, has since suffered with angina and just last Thursday suffered another heart attack and was admitted to Papworth for an Angiogram with the expectation that he would either have stents or more invasive surgery. However he was discharged with the plan of managing his condition using only medication.

My Dad is a walking miracle if truth be told as he has a plethora of chronic conditions alongside the heart disease/failure and angina which include COPD, Asbestosis, pleural thickening (which have left him with severely impaired lung function), Asthma, rheumatoid and Osteoarthritis, type 2 diabetes, diverticulitis, hypertension, two knee replacements, and severe allergies to E102 and natural food colouring. This list is by no means exhaustive!

He is currently taking 15 different types of medications to manage his various conditions and Papworth have just added yet more, and I am extremely concerned about drug interactions and the damage this may do to his already poorly body.

Due to my Dad's lung issues and mobility problems, over the years, the weight has continued to creep on and he now weighs approximately 20 stone. Obviously he needs to lose weight, but he seems to be stuck in a vicious circle of being unable to be active due to pain, inflammation, breathlessness, chest pain and side effects of medications which affect his digestion and excaserbate existing conditions.

When he suffered the most recent heart attack, he was admitted to our local hospital initially, and when visiting him, I read his admission notes. There were a number of discrepancies in the information- for instance there were ticks on the "no" boxes for breathing difficulties, lung disease, mobility needs (able to stand from a sitting position without help), to name but a few.

When my Dad was admitted he had been administered 17.5mg of morphine over a 4 hour period and I assume these questions were answered by him at that time as neither my Mum nor i went with him to the hospital with him in the ambulance (at his request), but followed a little later on our own transport. I could not find a nurse with whom to discuss my concerns about the incorrect information on his notes, and had my young children with me at the time.

I intend to email the hospital to query this, as obviously these notes travelled with him to Papworth in the ambulance and again, he requested that myself and my Mum not accompany him at the time.

The staff at Papworth want him to begin excersising- which i fully agree with to an extent, but his other conditions are making this incredibly difficult. He is suffering chest pain and severe breathlessness from exertion on even just rising from his chair and getting to the toilet.

I don't feel that medication is the best route for him, and as I said earlier, the drug interactions are really giving me cause for concern.

I know it's a long shot - but has anyone else found themselves in a similar position as my Dad? I really am at a loss. I can't praise how lovely all the medical staff have been, but i am concerned that there may have been some oversights that may adversely affect my poor old Dad.

The photo I've attached is of his current medications and the ones with asterisks have been prescribed by Papworth.

Any advice would be appreciated.

[Fortepiano]

Do you know why surgery was decided against? I'm assuming it would be too risky given his lung problems and morbid obesity. If this is so, medication is the only route - and even with surgery / stents he would still be taking similar drugs.

It could be good idea for him to ask for a general medicines review. Some of his other drugs may be able to be reduced or discontinued. Interactions are generally minor and reduce or increase the drug's intensity. Often the problems are with non-prescription painkillers.

Papworth is a wonderful hospital and I would trust them. Can you talk things over with them? You may find you need a letter from your father giving permission.

Some of your father's troubles have probably been actually caused or at least worsened by his weight ( e.g. diabetes, osteoarthritis, knee replacement) so losing weight would obviously be helpful. Diet is obviously as important as exercise for weight loss - is there a way forward there? If your mother is the cook could she help? If he lost weight through diet he might find exercise a bit easier, and the vicious circle you describe could be turned into a virtuous one.

Above all what's needed is motivation for change, and that may be difficult given the situation is so long-standing. If your father is motivated I would try a fitbit with very small attainable goals at first, gradually increased, to help him be less sedentary. I wish you all the best - it's hard to see your parents struggling and often feel powerless to help.

Lastly, given your family history, I would say don't forget to look after yourself and your own heart health too! All the best

[Mummaru in reply to Fortepiano]

Thankyou.

Much of what you say makes complete sense, and some is already in place. My mum prepares very healthy, low far, low carb meals for them both (although she has none of my Dad's issues), and has done so for decades. The only thing that i think they are doing wrong is my Dad skips breakfast as his 13 morning meds often make him feel nauseous. My Dad doesn't overeat, in fact my 8 year old twins who are of normal weight and build eat more in one sitting than he does. I have wondered if in fact he isn't eating enough?

The knee issues and arthritis began long before he began to stack the weight on ( when he was around 13 stone), and of course their symptoms have increased his decline into obesity.

When I called Papworth to check on Dad, his nurse informed me they had decided against surgery as his arteries were not as obstructed as they had initially suspected. My Uncle had the stent surgery at Papworth less than two months ago following his second heart attack, and this has helped to alleviate his COPD (he was previously on oxygen therapy it was so bad), and it has helped him to lose weight as he is now much less sedentary with less breathing difficulties.

I've checked some of the drug interactions from his extensive prescriptionlist, and there is one major interaction between two drugs he has been taking for some time that can cause hyperkalemia - which can seriously disrupt or slow heart rhythm. When Dad was being attended by the first responded paramedic, his heart beat was all over the place - there was no regularity whatsoever to it. I'm going to ask his GP for his latest blood results to check potassium levels and see if this correlates at all.

I really appreciate your feedback, so thanks for taking the time to reply. It most certainly is a worry as parents get older!

(Oh, and for the record, I was diagnosed with hypertension just last week - I had a 24 hour study completed 2 years ago as I was suffering blackouts, headaches and dizziness but it was not followed up and my symptoms reduced significantly. I've been suffering severely with migraine over the past year (I had to give up my job because of it), and had experienced a hemiplegic migraine, so BP was checked again and it was far too high. I've now been prescribed ramipril daily.

Thanks again!

[stevejb1810]

Hi

I am not in your position, but I do have some experience in this area. The problem with the NHS, great though it is, is that all too often people get treated for one condition, then the next and then the next and end up seeing one consultant after another, each with their own speciality. Rarely does anyone have time to manage the whole person.

From your description, your father is not a well man and the meds he is on may well be what he needs but if you have concerns about drug/drug interactions, my advice would be to start with your pharmacist (most have a small consulting room for just such conversations), and then go to your GP if you are not getting the information you need. Keep the discussion going until you have the answers you want but be prepared that some of the meds your father is taking may well be to manage unwanted side effects of others (it is almost inevitable that the more meds you take the more likely you are to have these unwanted side effects).

Steve

[Mummaru in reply to stevejb1810]

Thankyou Steve, I think that's an idea I shall act upon .... understanding the various meds will help us no end. I've just retrieved the list from my Dad and he is on 5 different medications to protect the heart and lower blood pressure amongst the 17 he has to take daily!!!! I'm very befuddled by it all!

[MichaelJH Heart Star]

My late mother was having issues with multiple medications at one stage. I researched the various drugs and then requested a review with her GP (he was also mine). Some drugs are given to counteract the side effects of others so changing the first can remove the need for the second. In the end her tablets were halved.

I agree with the earlier comment about treating a condition and not the person as a whole. In the past I have had to point out that a drug is unsuitable for name because of... At times I have felt like my own medical project manager!

Yes, your father does need to lose weight. I know of one person who weighs 50% more than your father and now needs multiple surgeries that currently carry too much of a risk. O know people who have come off (Type II) diabetes medication and others whose joint problems have been much reduced by losing weight. GPs sometimes are willing to refer people for slimming and exercise classes where they show they are motivated to improve things.

[Mummaru in reply to MichaelJH]

Thank you, it really is a minefield and i know that in the past my Dad has had to remind his own GP (who knows him very well) that a certain medication she has suggested is not suitable for him, and she has sought alternatives.

I think the main issue is the fact he has only 60% lung function, which obviously has a huge impact on his ability to be more physical - as i said, currently it's a miracle that he makes it through each day!

My kids and I are desperately trying to encourage him to come swimming (during very quiet periods), but he is reluctant because he is embarrassed of his size and operation scars (And I know this is a feeble excuse, but i do understand why he feels do sekf-conscious) however, i concur wholeheartedly that he does need to do something!

Thanks again

[MichaelJH Heart Star in reply to Mummaru]

Yes, swimming would be an excellent start as the water is supportive. Even if he did not swim movement with the support of the water, and also its resistance, would help start his metabolism. If he goes a few tomes he might see other seriously overweight people and feel less self-conscious.

Drug interactions and/or intolerance to a drug can be a real problem. I gave up on a large chain of chemists when an out-of-hours GP sent them a prescription for me. Unfortunately it was for a drug I cannot take and yet they dispensed it despite their database recording the issue. When I asked why they did not query it with the GP I just got blank looks. It seemed to me they were just collecting information (for marketing?) rather than making proper use of it!