Lost in the maze of benefits

margaretclare

She is prescribed painkillers, Tramadol 8 a day, Paracetomol 8 a day and 10ml Oramorph as and when she needs it daily. On top of that she has heart tablets to bring her pressure down, anti depressants as she gets depressed a lot and water tablets due to fluid in her body.

As a former nurse and midwife can I comment on this, from some knowledge.

This is one sick woman and the husband's attitude is doing her no favours whatsoever. Nor is that of her GP. A different GP is what I'd recommend!

Tramadol is an extremely powerful painkiller. It mimics morphine in its action. 8 a day is a lot. That means every 3 hours day and night.

Paracetamol is a more commonly-prescribed painkiller but care must be taken with this because a build-up of it, or a combination with certain other medications (cough medicine for instance) can cause liver damage. Normally it shouldn't be taken as frequently as 8 a day. The ones we have say ONE or TWO four times a day, 8 a day being the absolute max. All those 3 painkillers acting together? Why?

Oramorph (oral morphine) AND tramadol? The only time I've ever heard of those two given together was under nursing supervision in, for example, a hospice.

Heart medication to bring down her blood-pressure? What, specifically?

And 'water tablets' i.e. diuretic tablets for oedema, fluid build-up in the legs one assumes?

Based on all that, the practice nurse at your GP's surgery should be able to write a pretty good assessment of her care needs on any application form for AA. Those are highly-dangerous and powerful medications and the GP should have them under constant review in any case.

Words fail me about your Dad. I won't even say what I think.

confuseddaughter_2

margaretclare wrote: »

As a former nurse and midwife can I comment on this, from some knowledge.

This is one sick woman and the husband's attitude is doing her no favours whatsoever. Nor is that of her GP. A different GP is what I'd recommend!

Tramadol is an extremely powerful painkiller. It mimics morphine in its action. 8 a day is a lot. That means every 3 hours day and night.

Paracetamol is a more commonly-prescribed painkiller but care must be taken with this because a build-up of it, or a combination with certain other medications (cough medicine for instance) can cause liver damage. Normally it shouldn't be taken as frequently as 8 a day. The ones we have say ONE or TWO four times a day, 8 a day being the absolute max. All those 3 painkillers acting together? Why?

Oramorph (oral morphine) AND tramadol? The only time I've ever heard of those two given together was under nursing supervision in, for example, a hospice.

Heart medication to bring down her blood-pressure? What, specifically?

And 'water tablets' i.e. diuretic tablets for oedema, fluid build-up in the legs one assumes?

Based on all that, the practice nurse at your GP's surgery should be able to write a pretty good assessment of her care needs on any application form for AA. Those are highly-dangerous and powerful medications and the GP should have them under constant review in any case.

Words fail me about your Dad. I won't even say what I think.

Thankyou for those comments which to be honest coming from a retired medical professional are scarring me!!


I've got mum's repeat prescription in front of me as I have started on the Attendance renewal form.


It reads:
Dosulepin 75mg - one at night
Morphine Sulphate 10ml every 4 hours when needed for pain relief
Paracetamol 500mg 1 or 2, 4 times a day (mum takes the 8 every day)
Tramadol 50mg 1 or 2, every 4 hours when necessary. Max 8 in 24 hours (mum takes the 8 every day)
Amiloride 5mg/Bumetanide 1mg 1 taken daily
Amlodipine 5mg 1 taken daily


Next review 5/10/14 (annually)

Mum has to take the pain relief daily as she cannot function without it due to the level of pain she is in.
As for the liver. She had an op last December to drain two very large cysts on her liver (one the size of a football the consultant said). This left her with an infection that took until Feb this year to clear up.
I don't exactly know what some are actually for other than the basics.
As for the GP report, the last one said that mum is more than capable of self caring. The GP reports for the DWP are completed by one of the back office girls from the medical records and signed off by any GP that is available. I know that as I know the practice manager who told me what the procedure is.
The practice nurse who is part time (1 day a week) doesn't get involved in these reports.
Dad just doesn't want mum (and mum agrees) to have to go into details with a stranger all about her medical problems and her inability to keep herself clean, dressed and presentable without his help. It's a pride thing that they have which I can understand as they are very private people.

There aren't any other practices in the village. The nearest is 8 miles away and isn't taking on new patients. I checked that out after I found out what the GP had said to the DWP and I wasn't too happy and neither was the Social Worker and the OT.

margaretclare

OK, about what you've told me:

Dosulepin is a tricyclic antidepressant. Does your Mum see a mental health nurse, was she prescribed this by a psychiatrist? It's given for clinical depression.

Morphine, paracetamol and tramadol we've already discussed.

Amiloride is a potassium-sparing diuretic. That means that while wanting to get rid of build up of excess fluid, you need your potassium. It's a mineral which is crucial for life, for most bodily functions.

Amlodipine is used to treat high blood-pressure and angina. It's what is called a calcium-channel blocker.

If you look up e.g. Netdoctor through Google, you can find out a lot of this information.

I haven't seen your Mum but if I had seen someone with these level of medications when I was a district nurse/midwife, I would NOT have expected her to be able to do much for herself at all, and therefore I would have challenged any GP who said she is 'more than capable of self-caring'. The reasons why all those medications are given give the lie to that. Nevertheless, applications for AA focus on just what she can't do for herself in terms of the 'activities of daily living', just the very basics. You've said it, she can't get dressed or keep herself clean without Dad's help.

It's interesting to note that people can qualify for AA even if they live alone and therefore have NO one there to do the things that Dad does. It's also possible for both to qualify when both do these things for each other.

Well, it's fine being 'very private people' but carrying it to those lengths is not something I can understand. It's not as if that information is going to go anywhere except where it's needed, is it? It's not going to make the morning headlines unless Mum is a 'celeb' of some kind, like Peaches Geldof. Quite honestly, the people who deal with these forms deal with them all the time and your Mum will only be one of many. They're not going to gossip about it in the village, say 'ooh have you heard about...' It is simply not of any interest except to the people most concerned.

HB58

Margaretclare,

You might be a qualified midwife but that does not mean that you have up-to-date knowledge about chronic pain and the medication prescribed for it.

For instance, dosulepin (as you rightly said, a tricyclic antidepressant) is commonly used for people with chronic pain. Like amitryptilline, it helps sleep and modulates pain receptors.

Top doses of paracetamol are used alongside opiate analgesia as they help reduce the amounts of the latter that are needed.

Oral morphine is used for breakthrough pain if it is not controlled with the other meds.

People who take this amount of medication as a one-off would be totally zonked out. Those taking it regularly are likely to be tolerant to high doses. Whilst only in my 50's, I take similar medication in similar amounts and am pretty much self caring.

As an aside, I do think we need to be particularly careful about giving 'medical' advice on a forum like this.

margaretclare

As I said, all that information is easily-available. You may be pretty much self-caring, but this poor woman is not, as her daughter has said.

confuseddaughter_2

margaretclare wrote: »

OK, about what you've told me:

Dosulepin is a tricyclic antidepressant. Does your Mum see a mental health nurse, was she prescribed this by a psychiatrist? It's given for clinical depression.

Morphine, paracetamol and tramadol we've already discussed.

Amiloride is a potassium-sparing diuretic. That means that while wanting to get rid of build up of excess fluid, you need your potassium. It's a mineral which is crucial for life, for most bodily functions.

Amlodipine is used to treat high blood-pressure and angina. It's what is called a calcium-channel blocker.

If you look up e.g. Netdoctor through Google, you can find out a lot of this information.

I haven't seen your Mum but if I had seen someone with these level of medications when I was a district nurse/midwife, I would NOT have expected her to be able to do much for herself at all, and therefore I would have challenged any GP who said she is 'more than capable of self-caring'. The reasons why all those medications are given give the lie to that. Nevertheless, applications for AA focus on just what she can't do for herself in terms of the 'activities of daily living', just the very basics. You've said it, she can't get dressed or keep herself clean without Dad's help.

It's interesting to note that people can qualify for AA even if they live alone and therefore have NO one there to do the things that Dad does. It's also possible for both to qualify when both do these things for each other.

Well, it's fine being 'very private people' but carrying it to those lengths is not something I can understand. It's not as if that information is going to go anywhere except where it's needed, is it? It's not going to make the morning headlines unless Mum is a 'celeb' of some kind, like Peaches Geldof. Quite honestly, the people who deal with these forms deal with them all the time and your Mum will only be one of many. They're not going to gossip about it in the village, say 'ooh have you heard about...' It is simply not of any interest except to the people most concerned.

Thankyou


Confused I am but you are certainly full of old fashioned wisdom and knowledge.
I have learned more about my mum and her problems from you (I have always known that they both keep some things back from me) than anybody else. For a start I didn't know that she could have challenged what the GP told the DWP, I didn't realise the potency of the drugs she takes and I didn't really know what her problems are given the extent that she is prescribed these drugs.
What you seem to be saying is logic. How can anybody deny including the DWP that she must be in a state if these drugs have been prescribed in the first place. You make out quite rightly that the repeat prescription alone is a powerful piece of evidence.
I feel more empowered now in being able to explain more about her on the form and what to question her about as plainly she isn't telling me half of what her problems are.
Naïve as I am, it's about time that she started to open up a bit more instead of me just going along thinking 'well she is old so by that fact alone most people of her age are taking similar medication as the norm'.
To answer your questions and this makes me upset to realise it, she does have depression but refuses to accept it saying that she just gets fed up. I did in the past get her to see a private counsellor, which seemed to help. I think now that she has learned how to keep it better hidden from me for fear of me pushing the subject again. No she hasn't seen anybody to do with mental health. Personally I can't imagine mum accepting that she needs to see a psychiatrist. The GP gave her this medication (in fact about 6 months ago suggested increasing it to 150mg from 75mg). She has the prescription somewhere but has never used it so the GP kept it at 75mg.
I think they fear that they will be looked at as being incapable and ready for the care home if they told someone outside of the family.
To be really honest I know that mum needs dad more than she admits to. She relies on him for everything. If that is really true, I can understand her fear. My main worry with all of this information is can dad cope? He is not a well man himself. He has problems both physically and mentally. He himself has a DLA award being middle care and high mobility. He is bad on his legs, has major abdominal problems (being tested for more), is on blood thinners for thrombosis is under the consultant for mental health and is awaiting the results of why he keeps having siezures. Mum's repeat prescription list is 2 pages long - dad's is 5!


Still I must sort mum out first as her situation is more important with the possibly of them losing so much money if she doesn't get awarded the Attendance this time round.
Once again many thanks for your time, you certainly have made a difference to a less confused and more knowledgeable
daughter.

Ali_Leith

Confused daughter, I was very moved by your posts, and by the replies. You are clearly a loving and involved daughter. Please do consider contacting a carer's support group- i have found they are a wealth of knowledge about navigating the jungle of welfare rights and social work services. Best of luck, Ali

margaretclare

Confuseddaughter (or are you Pauline, as someone else said?) there's an old saying that those who live longest will see the most, and I've had a full, busy, long and active life in this wicked world.

I must be careful not to 'give medical advice' but here goes:

Depression is very very common in older people. I once had a conversation with a consultant psychiatrist (this was after widowhood coincidental with redundancy) and she said that there are some situations in life where it would be more abnormal NOT to be depressed. Many people in our generation have lost a lot of what made life worth living. Not only youth, but health and strength. Being in constant pain. That's extremely depressing. The humiliation of e.g. not being able to put your tights on yourself, do up your own bra because your arm muscles have got too weak.

I am married to a man who lives with constant pain but he accepts that as a trade-off for having the 2 legs his Maker gave him and not having had an above-knee amputation. That was entirely his choice, made in discussion with his consultant orthopaedic surgeon. I would not dream of making those choices for him unless it had been absolutely life or death (which it nearly was).

I must emphasise that, while many of us are taking medication of one kind or another, it is NOT the norm for older people to be taking the kind of cocktail of powerful medications that your Mum is taking.

Can I just ask how old your Mum is? It's intriguing to me that so often I get this 'oh she's old..' and it turns out that the person is younger than me. I don't think of myself as being old. I don't know if I ever will.

What you say about your local GP's surgery is shocking, but it does make me realise how fortunate we are in this little market town on the edge of a conurbation. We have practice nurses, some who work part-time, but there's always one, as well as the team of 5 or 6 GPs.

I can understand your Mum's fear at possibly losing your Dad. He sounds to be a very sick man himself and maybe that's why he seems so inflexible and dogmatic about seeking help.

Thank you for the kind words. I hope you manage to get through to your parents! Forewarned is forearmed.

confuseddaughter_2

margaretclare wrote: »

Confuseddaughter (or are you Pauline, as someone else said?) there's an old saying that those who live longest will see the most, and I've had a full, busy, long and active life in this wicked world.

I must be careful not to 'give medical advice' but here goes:

Depression is very very common in older people. I once had a conversation with a consultant psychiatrist (this was after widowhood coincidental with redundancy) and she said that there are some situations in life where it would be more abnormal NOT to be depressed. Many people in our generation have lost a lot of what made life worth living. Not only youth, but health and strength. Being in constant pain. That's extremely depressing. The humiliation of e.g. not being able to put your tights on yourself, do up your own bra because your arm muscles have got too weak.

I am married to a man who lives with constant pain but he accepts that as a trade-off for having the 2 legs his Maker gave him and not having had an above-knee amputation. That was entirely his choice, made in discussion with his consultant orthopaedic surgeon. I would not dream of making those choices for him unless it had been absolutely life or death (which it nearly was).

I must emphasise that, while many of us are taking medication of one kind or another, it is NOT the norm for older people to be taking the kind of cocktail of powerful medications that your Mum is taking.

Can I just ask how old your Mum is? It's intriguing to me that so often I get this 'oh she's old..' and it turns out that the person is younger than me. I don't think of myself as being old. I don't know if I ever will.

What you say about your local GP's surgery is shocking, but it does make me realise how fortunate we are in this little market town on the edge of a conurbation. We have practice nurses, some who work part-time, but there's always one, as well as the team of 5 or 6 GPs.

I can understand your Mum's fear at possibly losing your Dad. He sounds to be a very sick man himself and maybe that's why he seems so inflexible and dogmatic about seeking help.

Thank you for the kind words. I hope you manage to get through to your parents! Forewarned is forearmed.

Thankyou for being so nice to me. I don't know anybody called Pauline?? My name is Sandra but I prefer Sandy. It seems that as you get older things do wear out unfortunately. You both sound like strong minded people. I have this image of you as a District Nurse & Midwife, strong personality, you don't suffer fools gladly, yet you are kind and understanding inside. I would love to have you as a nurse at my GP surgery. Someone to turn to when all else fails.
My mum is only 70 and dad just turned 65 this year.
Dad is a very proud man, too proud for his own good it seems. He's not in good health but he will not give in to it, he has mum to look after and care for. You could say that he is a little bit Victorian in his ways and takes his vows he gave mum 44 years ago very seriously.
Onwards and upwards I suppose. I am working my way through the form and trying to explain how mum really is and how she copes (or doesn't) which is more the truth.
Thank you once again for being so helpful

margaretclare

I am sorry, Sandy, I seem to have got a bit mixed up. Someone called you Pauline on another thread. Sorry about that!

Thank you for the very kind words. Your parents are not what I think of as 'old', not at all. DH and I both worked until we were 67, different work from what we were used to - he worked in a call-centre and I did office admin for the local authority. We were married in our mid-60s. I think what makes a difference is a lifetime of having to stand on our own feet and make our own decisions/choices. And also, do responsible jobs in which we had to make decisions and manage other people. We're now approaching 80, at least he is, and I'm only a few months behind. We still don't think of ourselves as 'old'. What we're doing now is being trained as volunteers to do roadside speed checks in conjunction with the local police. I'm also transcribing 17th century wills for a family history project and DH acts as a facilitator for older people who want to learn about computers, at the local library. There is always something new to learn and to get involved in, even though physical capabilities have lessened.