An exploration of the UK unpaid carer's world

Letters to GP - account written on 1  9  2015                                                   hidden page

Update 2 9 2015   Email SP cc JL 29 Aug 2015 here 

Comment in this text

Typed letter to surgery 24 Aug.  Obviously, links have been added since.  GP unaware of the links.

Teresa and I need your attention please.  As this is likely to be one of numerous requests on your return, my needs are less urgent.  Teresa has been in fair health considering the sheer extent of her ailments. 

For several months until early July, she was able to be on parade c 1000.  This has regressed to 1330 and worse. A main reason is that she now (possibly) suffers from urinary hesitancy.   There seems to be more stops than starts.  She is generally occupied for an hour including once a night (sometimes twice).  No sign of constipation.  She drinks plenty of water.  GP advised stopping one her pills over several days. Seems to be working. 

    The dementia dimension seems fairly stable with only occasional lapses of memory and loss of FTD word-retrieval.  Hereford Memory Service has recently conducted an assessment. here

     However, I am worried about her weight.  She seems more frail.  You and I spoke in March and June re dietician advice viz Laura Samuels.  Still nothing   You have masses to do.  We leave for a second visit to a disability hotel on Weds 2 Sept returning Thurs 10.  It’s probably able to provide the correct scales. If not done before we return, can we please repeat the Ross hospital venture of weighing her?

 GP advised he was to follow this up yet again.  Yes - weigh Teresa at the hotel.

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Typed letter to surgery 24 Aug continues.

My OCD of 2011 may be said to be at a canter and the reins are difficult to hold.  There is overlap from Teresa’s problems.  As stated, she is commode-occupied for an hour once a night, sometimes twice.   During this time she constantly snorts.  Says she’s fighting for breath.  Such sleep-pattern ensures we are both exhausted.  No comment. 

     My suspected OCD manifests recently in the 2gether domain.  The Hereford Memory Service (HMS and Google here ) received a request from me in mid-July.  [here but too long to read now] It cited the Triangle of Care for Dementia in which carer, caree and HMS all work together for caree’s improved health.  Request denied via a third party.  [Since that refusal was made via SP, the Triangle page was created. here.]

The key issues are abbreviated as follows:

1. Lack of a proper response in early and mid-July 

2. No response until the recent intervention of a third party whom I had asked to be involved

3. HMS has communicated important information via the third-party - entirely unprofessional

4. Lack of thought and, more precisely, lack of proper investigation resulting from 2.  

5. I had resorted to demanding a meeting. Only very recently has this been recognised.   

     The new Team Manager is Mrs Jodie Thomas – 01432 845731.  Perhaps Vicki as carer lead could phone her.  Mrs Thomas can confirm that HMS has been inundated with web-pages.

      I say above my needs are not urgent.  That’s shorthand for nothing can be done until mid-September as two HMS managers to be involved in a meeting are on holiday. If the meeting is satisfactory, I hope to return to normal.  What is normal?  The Internet is full of carer stories like mine. Their authors suffer as much.

     The phoning-in regimen in HMS/CBT context will not be adopted now and I will wait for the outcome of the meeting. If negative, I hope to discuss if there is a need for yet more CBT or whatever.  If HMS may be involved a plus point is that it has further insight into my condition.  However, you might recommend an org or individual separate from HMS.

     The phoning-in regimen will not be adopted re Teresa as it sounds like a new prescription item.  I will phone on Tuesday morning re the dressing detailed overleaf [not included here]and request a nurse.  If you need to see the skin problem, do please write to that effect on the sheet.

The GP response is in this text above.  End of typed letter to surgery 24 Aug. 

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Hand-written compliment slip to GP on 27 Aug

Thank you for your call yesterday.  Will investigate Teresa's weight at the hotel.  It has sling-hoists.  Should Teresa use them with her hip socket problem.  

Paracetamol is being taken up to twelve per day.  I can't always keep track.

Max 8 per day - no mention of pain prob.

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Teresa complained her level was 9 yet again on 30 Sept.  I decided enough was enough. Could see another canalboat episode  here arising at the hotel.  Phoned 111 and a Dr Khan was most concerned about the level of paracetamol being taken alongside Codrydamol, itself containing more Para. Said he would send another Dr.

A Dr Singh came at 1000 and was very professional.  I took Teresa to A&E and we arrived at 1130.  A gruelling time for Teresa but no liver damage.  The Codrydamol was replaced by liquid morphine - Oramorph.

I have had concern over the Para equation since June but have had complete faith in Dr L.  I can't tell all the story and have sent the following by email.

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Dear Dr L

Teresa complained her level was 9 yet again on 30 Sept.  Phoned 111 and a Dr Khan said he would send another Dr.

A Dr Singh came at 1000.  I took Teresa to A&E and we arrived at 1130.  A gruelling time for Teresa but no liver damage.  The Codrydamol was replaced by liquid morphine - 100 ml of Oramorph 10mg/5ml - 2.5 ml 4 times a day. With the advice to use it on demand, I gave Teresa 1.5 ml at bedtime the same day - Sunday.

Today, Bank Holiday Monday at 1700, Teresa has not asked for the liquid.  We will see how that goes.

Your advice re the Mirtazapine may well be working.  The urinary hesitancy is less hesitant and of shorter duration. 

Teresa will take time to adjust to all this but a journey to the Porthcawl disability hotel on Wednesday is on her coping agenda.  She had been coping quite well with her own pill management and it is by far less certain that she was taking as many as twelve Paras a day.  

In the context of the Oramorph possibly being given less than max needed per day, we don't need to ask for a crate on the doorstep.  I will catch up after our return on 9 or 10 Sept. 

Thanks as ever.

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And if SP and pos JL are still awake, Thanks as ever.

PS  01 09 2015 to GP

pagetop here    for pasting       Letters to GP - account written on 1  9  2015  here

                                          Letter to former Bishop here.