To be angry with my Mum's Dr.

[Frustrated123]

I'll try to keep this brief. My mum has had a bad leg for around 3 months. The dr has sent her for X-rays etc and diagnosed sciatica. He also prescribed painkillers, most recently a combination of naproxen and Tramadol.
Mum and the rest of us noticed that she was becoming very confused, finding it hard to formulate sentences and generally not acting herself. This seems to be since she started this painkiller combo.
So, last week she stopped taking the drugs but since then the confusion has gotten worse peaking mon and tues but seeming better again the last few days.
She goes back to the GP today with my father who explains about my mums confusion and the fact it seems to be since she started the pain killers. Without even asking any more questions apart from her name and dob and whether she ever leaves the oven on the Dr says 'I'm pretty sure you have dementia.'
And then sends her for more blood tests and a chest xray? Feel so furious that he seems to have made such a bold statement without any proper investigation.
Obviously, being told you have dementia is a life changing diagnosis. He totally ignored the fact this seems to have come on since he prescribed the painkillers. Posting for traffic really and also to see if anyone can offer any glimmer of hope that the Dr could be totally wrong and that these symptoms could be a side effect of the painkillers. Feeling very scared and don't know where to go from here.
Thank you in advance

YADNBU.

She may well have dementia, but the level of brain fog that tramadol can give you shouldn't be under-estimated (ditto that for chronic pain itself).

Is there someone else in the practice the two of you can go and see?

Definitely see someone else, you need a second, and thorough opinion.

Also, I'm just a layperson, but is it worth checking for a UTI? That can be a cause of confusion.

YADNBU. Firstly, GPs should not diagnose dementia. Secondly, he should do baseline blood and urine tests. I'd be really cross!

There has a big a massive change in the last year or so with dementia diagnosis, a big shift from secondary care to primary care and so GPs certainly can and do diagnose dementia - HOWEVER not like that! I too would be cross, can you make an appt with another GP at her surgery?

Has this started yet

www.bbc.co.uk/news/health-29718618

GPs being paid to diagnose dementia

I am not convinced about GPs diagnosing dementia at all and the above example is why.

Wow.

I'm an old age psychiatrist.

That's NOT how dementia is diagnosed, as I'm sure you're aware. GPs are perfectly capable of diagnosing it, but some prefer to send to secondary care memory clinics. I would request to see one of the other GPs and ask about the process, if you are concerned.

How long was she taking the pain meds for? If the confusion cane on suddenly it could be a uti

That's really terrible. A sudden onset confusion could be all sorts of things that aren't dementia related, such as a UTI. We were convinced my Grandmother had dementia, but she turned out to have pernicious anaemia! Easily treated and the confusion went.

First thing I thought reading this was UTI and pernicious anaemia and I see others thought those too. I'd go for a second opinion.

YANBU!

It's not only UTIs that can cause confusion. Dehydration can have the same effect. Also, if anyone suddenly stops taking Tramadol they go through really hellish 'cold turkey' symptoms.

Ffs, You could have been describing how I was on tramadol after a rta and I was 31 at the time ! YADNBU

Of course you're not being unreasonable if you are getting the full story. I'm a GP and I'd be amazed if it actually happened like that. Are you sure your Dad is relaying it accurately?

GP here. Agree with everyone. I'd be thinking medication, infection in the context of a sudden change and b12 deficiency if a bit more gradual. Dementia way down my list.

But agree with scrabble too- does this GP know your mum well? Could there be more to the story??

Yes Hedgehogging, this is the family GP who has treated my parents for over 30 years. I don't know him as don't live in the area and never had the need to see him before I left. I know that my parents and extended family have moaned over the years about his directness and lack of bedside manner but all in all he seems to be a good dr. I totally trust that my Dad is telling the truth about how it happened. My mum and dad are 'old school' in that a dr should be respected and what he says must be right! It is a small practice so the only GP there, hence making it difficult to get a second opinion. Thank you for all your comments.

Lots of other reasons! not unreasonable at all

Tramadol (and all opiate painkillers) are notorious for causing confusion.
This is called delirium and will resolve (although not immediately) on stopping the drug. Other common causes of delirium are any infection eg UTI or chest infection or things like low sodium levels in blood.
This is very poor practice to make a comment like that. Firstly because he is wrong (dementia has a slow onset over months or years) and secondly because of the way he did it.
If he really thought that it may be dementia he should do a cognitive screening test and blood tests refer her to a specialist.

I'm a geriatric doctor and see people in memory clinic. Sounds like (from the minimal info here) she has delirium which is different from dementia as it is reversible (generally) and has an underlying cause like infection. Naproxen can damage kidneys (sometimes) which can cause confusion. I never prescribe tramadol as it can make anyone confused but especially someone older. Definitely need a second opinion asap

I work for a charity supporting people with dementia. Our first line for people who are worried about their memory or any other common symptoms would be to check it out. People are so quick to assume it's dementia. Even stress can cause confusion. I would definitely ask for a second opinion and a referral to a memory clinic/team.

I just read yesterday that GP's were to be given £55 for every patient diagnosed. Don't agree with this at all. But I don't think GP's will be diagnosing patients for no good reason. Still the GP was far too blunt and should have asked more questions before suggesting it could be dementia. And taken into consideration the side effects of tablets.

This is the difficulty of having single GP practices, as you can't get a second opinion. Very reassuring that people with knowledge of memory problems have posted here. Your parents need to go back to the GP and insist on a referral to the local memory clinic. If the GP refuses, contact the local memory clinic and report what the GP has said, and that he is refusing a referral. My mum has dementia and before she was diagnosed, getting a referral to the correct service took persistence. I am not saying that I think your mum has dementia, I am just saying that doctors don't always refer readily.

MrsBB1982 "I never prescribe tramadol as it can make anyone confused but especially someone older."

That's interesting. My mother lives alone in her own flat (NOT sheltered accomm.) and is taking Tramadol. She'll be 95 this April. She was not warned of the consequences if she suddenly stopped taking them and went through the most horrendous 'cold turkey' withdrawal with no idea what was causing her to feel so ill, and as she was alone, quite frightened as to what was happening to her. It's interesting to know that, if you were her doctor, she would not be taking them at all.

I wouldn't be at all surprised if your dm's confusion is entirely drug related.
Tramadol really is rather evil. I have a friend who was recently prescribed it for back pain and has found the side-effects quite atrocious, especially on her cognition. She's come off it because she couldn't bear what she described as an endless and nightmarish journey down a tunnel of doom. Since she isn't given to flights of fancy, this description is indicative of the effects of tramadol on her!

I second what a pp has said about going back to the GP and getting a referral to a memory clinic. If she does have dementia then she'll need to get access to the right services. If not then she needs to come off the drugs!

I agree. I avoid prescribing tramadol for almost anyone but especially older people as it does so commonly cause confusion.