Are my dad's doctors making him sicker?

September 25, 2011 4:00 PM

This is my first Ask MeFi question, and I'm asking on behalf of my parents. My father is in reasonably good physical health but poor mental health, which may be related to the meds he's on and the "quality" care he's getting in the American "system". Are there some kind of additional resources for me or them to help make their way through the bureaucrat-ese and get some better care? And maybe some additional health care (or heck, elder care in general) resources I could find for them?

My father has some kind of dementia condition that is causing him to have some loss of mental faculties, but I'm not totally clear on exactly what. He had been diagnosed with both Parkinson's and restless leg, but I think he's not showing any signs of Parkinson's currently. He is on a host of medications, some of which seem to make him drowsy all the time (including, I'm now made aware, both morphine and oxycodone, to which he may be addicted), and he's showing obsessive and compulsive behaviors that he wasn't previously. I'm thinking it's something to do with the combination of meds he's on, but I don't have the resources to determine what.

My dad is a military retiree, and used to be on Kaiser Permanente coverage -- in fact my parents have been on Kaiser for pretty much their entire lives, until a couple of years ago. They were paying a lot in premiums and switched to Tricare, which I understand does a lot of Medicare supplemental coverage and for which they pay a lot less. But now they're in the wonderful United States health care "system", where clinics are all over creation and doctors don't talk to one another. The ideal situation for both of them would be to be back on Kaiser, where information is in one place, care is in one place, and if you need a specialist they have all of your records on the same system and it's all covered. They're in Salem, Oregon, and we've always had great Kaiser facilities around here.

posted by no relation to health & fitness (9 answers total)

I don't have any specific recommendations for your area (this is from what I know from my home state in the MidWest/South) but they could probably still find a network of doctors that will have their medical records connected. Look for a set of clinics all under one hospital's name. Chances are they will be connected to other clinics that share that same name. You may also want to seek out a gerontologist (specializes in elderly)...that person would be the one who will most likely know all of the resources available to your parents. They may also be able to coordinate care (some offer "case management" services where they get all of the records from different doctors and makes sure everyone is on the same page).

I know how frustrating this can be. My grandmothers see a bunch of different doctors and sometimes I think they wind up getting medications just to handle the side effects of other medications. I do know that my grandfather was diagnosed with Parkinsons and the medication for that did make him drowsy. He had to find the right dosage that kept his symptoms where he wanted them to be while also not making him sleep through the day.

Good luck!
posted by MultiFaceted at 4:17 PM on September 25, 2011

Your dad is a military retiree - are there any veteran's organizations or retired military organizations near you that can help?

Also: Link to State of Oregon Department of Aging and Adult Services - try contacting one in your area.

FWIW, my dad has Kaiser, and has some of the same problems as your dad. His PCP referred him to a neurologist, who brought in a pharmacist to review ALL his current medications (including over the counter meds, vitamins, etc.) and check for drug interactions and side effects. Your dad being on opiates might entail some gnarly detoxing if he needs to go off them, OR he might legitimately need them for intractable pain. I think a neurologist would be a first line of contact for you if you can get a referral to one.

Good luck!
posted by Rosie M. Banks at 4:49 PM on September 25, 2011

I would recommend the VA medical system. It's integrated, has one of the most complete electronic records in any system (meaning all of his providers would have access to his medical records). It can take a little while to get into the system, but it's a really great quality of care at a relatively low cost. It looks like there is an outpatient center in Salem, and a Parkinson's specific center in Portland. Contacting the local VA will let you know what you need to do to get services there.

Tricare is like an HMO for the military, providing coverage to outside providers, meaning that coordination of care can be tricky.
posted by goggie at 5:13 PM on September 25, 2011

Check your MeFi mail.
posted by neuron at 6:27 PM on September 25, 2011

My grandmother has Kaiser coverage, the entire premium is paid by Medicare and the coverage has been nothing but incredible. You might want to give your local Kaiser facility a call and find out if such coverage is available in your area. She's now in end-stage Alzheimers and Kaiser has bent over backwards to give her the best of care throughout the entire journey. As her caregiver throughout all of this, I've been continually impressed by Kaiser's level of care.
posted by buggzzee23 at 8:05 PM on September 25, 2011

Thanks everyone -- I'm passing information along as we speak.
posted by no relation at 8:43 PM on September 25, 2011

Also, just for your personal reference, you can check drug interactions on drugs.com. Might help you stay informed when/if you talk to the docs your dad finally sees.
posted by enzymatic at 9:10 PM on September 25, 2011

I can recommend the VA system, but be aware that if he's not already receiving care at a VA for something, it can take a long time to get into the system. Go for it for sure, but plan on having a couple months waiting for an appointment. Lots of new vets and a budget crisis equals long waiting lists.
posted by gilsonal at 9:12 PM on September 25, 2011

Does he, by any chance, get short-winded easily, with very little exertion? I think he should have a workup of his heart and pulmonary function because what you're describing is very common in people with underlying lung or heart disease that causes a reduction in oxygen saturation. Another thing that could be causing the drowsiness and confusion type business is underlying diabetes - that too should be thoroughly checked out.

Doctors can be quick to fall back on "there's a dementia that's part of Parkinson's - I'm sorry, but that's probably what he has," and etc. and etc. - they can blame everything on his Parkinson's - or if he's overweight, everything's because of that, or if he smokes, it's all because he smokes, etc. They're not necessarily bad doctors, but they are trained to box everything up in neat little boxes and they often miss things they shouldn't. Your father is fortunate to have you advocating for him and I encourage you to keep at it until you get some solid answers.

If he's on medication for his restless legs, check into the type of medication and its side effects. I have Parkinson's (17 years) and restless legs, COPD on oxygen for 9 years, depression, osteoporosis and a few other things I don't pay much attention to. I take a benzodiazepine for my restless legs, but it has a powerful effect on me and I can only take a half of a (very small) tablet at a time and that will knock me out for about 6 hours. If I took a whole tablet, I'd be, at best, only semiconscious most of the time and confused for sure. I take my half tablet right before I want to go to sleep and never during the daytime. Some doctors prescribe antidepressants to help with the restless legs, but they didn't work at all for me, though I'm very glad to be on Lexapro - an SSRI antidepressant - because it keeps me from focusing on my misery all the time. I'm also on codeine in the form of Tylenol #3 and I take plenty of it because it keeps me from coughing and the coughing is something I simply cannot do with my end-stage lung disease. So yes, I'm addicted to codeine, a morphine derivative - ask me if I care. I would question, though, if your father needs to be on the very strong painkillers he's on or if he could be having some problems with his consciousness due to the morphine. Maybe he needs it - if so, that's the way it is - but if the strength could be backed off a little without causing him problems, it might help bring his alertness and cognition back into a better place. The Parkinson's itself is a bitch - nothing else can describe it. It's like trying to walk and talk and move around in liquid glue. And the meds have some incredible side effects - they vary from pill to pill, but they can cause hallucinations and confusion, sluggishness - or all the way to Michael J. Fox's thrashing around, which is called dyskinesia.

I'll stop now - I'm not a doctor, but I'm just trying to jump in there with experiences of my own. Thank you for the kindness you're showing your father and bless you for keeping at it even though it's a long, hard fight. I wish you and your father the best.
posted by aryma at 10:40 PM on September 25, 2011