To ask for investigation into GP?

[parmalilac]

Long story - sorry ! Had private knee replacement op last year. Am allergic to Codeine, this was duly noted in hospital. Came home 4 days later with lots of painkillers, blood thinners etc. GP visited me at home to see how I was, and I told him I wasn't sleeping due to pain. He looked at the meds and told me I could double the dose of 2 of the painkillers. Also gave presc. for sleeping pills, which I did not ask for and did not take. I doubled the dose of one painkiller that night and had severe anyaphylactic response, was rushed to hospital. They looked at all the meds and said it was probably the double dose I'd taken which 'tipped the balance' as that particular med was related to Codeine and I should not have been taking it in the first place. They looked at what I’d eaten and discounted food as a trigger, with 3 doctors saying it was probably the meds. Came home, continued to have anaphylactic reaction after adrenaline had worn off, was back in hospital twice more even though I'd stopped all meds by then. During this 10 days or so I was unable to do the physio which is vital after joint replacement. As a result I have not recovered properly (despite 6 months of physio) and am actually disabled now as I cannot walk without crutches.
Asked the private hospital to investigate why I was given those particular meds - they replied that basically as I had no reaction while I was actually there, they do not take any responsibility. Called a legal firm for some free advice about that, but they said the person responsible is the GP who advised me to double the dose. On researching this medication I also learned that it should NOT be taken with sleeping pills ... so now I am very concerned that the GP's actions were wrong. He did not ask me at any time if I had any allergies, but it is on my medical records.
Now I don’t know what to do and I wonder if it will negatively affect my future dealings with the Health Centre (it’s the only place in town). On the other hand, I think this GP has made a serious error, and it should be dealt with so it doesn’t happen to others. What would you do? I can't get my old life back but I think he should have to answer for this.

Forgot to add, apart from now being disabled, since the anaphylactic reaction have been unable to take most meds, as they say I am now 'sensitised', so can't imagine what will happen if I ever need another operation and can't take painkillers.

I would imagine as you had been given the meds in hospital and had no reaction the GP assumed you were not allergic to them after all. Lots of patients claim they are allergic to stuff which it turns out they aren't, (not saying that's the case with you as you clearly were allergic). I would say whoever discharged you with the meds you are allergic to is at fault.

If your medical notes said you were allergic to codeine then the hospital should not have prescribed you codeine related drugs. They are at fault, it doesn't matter whether you reacted at the time or later - anaphalaxis can be delayed.

What are these meds?

Oh dear I feel so sorry for you and can quite appreciate how dreadful the pain was, (I had both knees replaced during the course of last year and the pain once home was horrendous, however after loads of warnings from various family and friends I suffered the pain only taking Paracetamol and didn't take anything stronger as I have a weird reaction to codeine, and cannot take asprin. Did you pay for your treatment or were you allocated treatment in a private hospital under the NHS, if the latter I would contact PALs.
I am concerned at your lack of movement, have you been back to the hospital for X rays to check on the success or otherwise of your surgery? I would try and get further referrals for phisio. The more imobile you are the more you will stiffen up and the more it hurts.
If your surgery is shown on X ray to be successful it is down to you to push for any further treatment through your GP so I don't think it would be a good idea to allienate him/her.

When you say you are allergic to codeine, how did you discover this? As surely you would know yourself that if you've had problems with codeine you'll potentially have problems with any morphine derivative??

What drug were you given that you doubled the dose of?

I must say this all sounds a bit

I don't think blame can be placed with the GP. You had taken a medication with no adverse effect. If that Med was responsible you would have had a reaction eventually regardless, doubling the dose was reasonable. I think you need to bear in mind that all the other doctors said 'probably'. I also imagine a few of those were juniors and their evidence wouldn't be particularly convincing in court.

I think you need to see your surgeon with regards to how disabled you are.

If it really was the medicine you were allergic to, it shouldn't ever have been prescribed. GP way less at fault than the original prescribing doctor.

Not entirely sure you can link the lack of physio to being severly disabled ow - you need to get back to the surgeon for a follow up and on an intensive physio course now.

What was the medication that caused this reaction? Who diagnosed the codeine allergy and how? Was it simply based on your reaction to it previously, or did you have specific testing? I only ask as I wonder how it has been recorded in your medical records. For some reason the hospital gave you an opiate based medication despite having knowledge of your allergy.

As your concerns are now about the GPs care and treatment, you can make a formal NHS complaint. You can write or email the practice manager, outlining what happened, and what you want as a result. There will be an advocacy service to support you with this in your area if you wish (Google NHS complaints advocacy in your local authority). Unless the initial operation was NHS funded they will not be able to support you with this. You could also approach the GMC with your concerns about the particular Gp's fitness to practice, although they usually want you to go through the complaints process first. They cannot allow any complaint to impact on your current and future care.

Given that you had further reaction, even after you had stopped taking the meds, I cannot see how they are to blame really.

if you are determined to blame someone, its the prescribing Dr I'd have thought, although I really cannot see as its anyones fault really.

I don't think it is the GPs fault.

I'm confused and can't see where the GP is at fault here.

What drugs were you on? (Lots of medication are fine together even if the patient information sheet/drug licence advises caution, just like lots of drugs are actually fine in pregnancy or breastfeeding when the BNF says avoid.)

When you say you had a "severe" anaphylactic response, what actually happened?

What do you mean you are now "sensitised" to painkillers? Have you seen allergy consultant?

Anaphylaxis tends to start within seconds of administration. Rarely you can also get a delayed (biphasic) reaction but that's usually less than 12 hours after the first reaction.

If you had been on a codeine-related drug for 4 days without a reaction, it is surprisingly the idea that any anaphylactic reaction would have been due to that, and not an unreasonable idea to double the dose to suitably deal with your pain.

Also, lots of people say they are "allergic" to medicines when actually they have suffered normal side effects of that drug. ("I'm allergic to penicillin" sometimes means "it made me feel a bit sick", "I'm allergic to codeine" might mean "I got constipated on it.") Therefore it is important to know why a person thinks they are allergic to something to allow a sensible decision about whether or not it is safe to give.

(For example, about 10% of people believe themselves to be allergic to penicillin, when actually only 0.3-0.5% are, which severely limits good antibiotic choice in things like meningitis.)

What are the painkillers? How are you now disabled and you say you are now sensitive to other meds, what do you mean by that?

in my experience of allergies, anaphylactic shock is rarely delayed. However without extensive testing, their is NO WAY a hospital can discount anything just by looking at a list of food. You would need extensive tests to determine your level of sensitivity. As sensitivity can change throughout your life, nothing can be discounted without tests.

Likewise a med related to codeine would be unlikely unless you are allergic to a particular ingredient in those. Codine phosphate is the main active ingredient of Codine tablets. The other ingredients are lactose, magnesium stearate, pregelatinised maize starch, maize starch, stearic acid. Does the other drug contain any of these?
you need proper testing to find this out and most local hospitals are unable to do the tests required. We had to go to a specialist unit in London and the local hospitals were useless for information.

Were you given an epi pen? Have you been referred to a specialist?

Be careful that you have not developed an allergy to something else, i am aware of someone who had a sudden development of a reaction to limonene which is in a huge amount of things.

I think you need further investigation before looking to blame!

In not sure how the GP is to blame, all he did was change the dose of a drug you were already taking.

I think you are going to simply have to accept that this happened, rather than trying to apportion blame.

I had the same to an antibiotic in hospital this week. I also have severe allergies, but it was just one of those things. These things happen, they suck, but it's not your GP's fault if you were already taking them.

Thanks for the responses - to answer the questions, I had a reaction to Codeine many years ago so that is on my records. I have never taken it since then. Never had reactions to anything else. During and after the op (private as we have insurance) I was given Tramadol, Nefopam, Oxycodone and Oxycontin. Came home with Tramadol, Nefopam, aspirin, Ibuprofen and Paracetamol. It was Tramadol which is suspected as that's the one I doubled (once only!). Yes, GP obviously assumed that as the hospital had given these, there was no problem, and indeed there hadn't been up to then. I developed the anaphylactic reaction within an hour or so, mouth and throat swelling up etc. DH was keeping a record of what I'd been eating as my appetite was poor, and we showed it to doctors. They all agreed it was likely caused by the Tramadol double dose (as per my OP) and said I should not have been taking Tramadol at all. After I recovered from the allergic reactions I was told, and since repeated by various GPS, that I should not take those meds again, nor should I take aspirin, nor can I take the blood pressure meds I was on for the previous few years.

My knee has not healed properly as during those 10 days or so I was in and out of hospital with this reaction, I was connected to heart monitors etc pumped with antihistamines and completely out of it, being covered head to toe with red itchy welts. I was not allowed to move around very much and exercise for the knee was the last thing on anyone's mind. Hence the non-healing, as adhesions formed around the joint capsule. I have had lots of physio, hydrotherapy, plus I walk, stretch, massage every day but my leg is 'stuck' at 75 degree bend, 25 degree extension (straightening). Physios say they can do nothing more. Have seen the private surgeon who did the op, she is completely dismissive and tells me that she did a good job and it's now up to me to get on with it.

Saw NHS consultant who says only option is redoing the op but it will not necessarily have a good outcome (I am in my 50s) so he would not recommend. If I pursued this with the private hosp. then I'm sure they would agree to redo the op as it means ££ income, so I trust the NHS consultant more on this matter.

So, I was very surprised when the legal advice was that the GP was responsible as he advised the change in dosage. He also prescribed sleeping pills which I later read are NOT to be taken with Tramadol. Thankfully I did not take them.

Forgot to add, yes I now have an Epipen, and as my knee has not healed properly it is constantly painful and hot. Effectively my life has been altered dramatically since this operation, so yes I'm angry if someone didn't do their job properly and it has caused this.

So what reaction did you have to codeine years ago?

I still think it is really, really unlikely that a double dose of tramadol would give you an anaphylactic reaction, especially after 4 days of tramadol, oxycodine and oxycontin. Also the half-life of tramadol is relatively short (6-12 hours) so that doesn't explain your apparent anaphylactic reaction 4 days later.

I'm also puzzled about why you are not allowed to take aspirin or blood pressure medication now.

It is difficult to tease out what's happened here without access to your notes so I would still very much recommend seeing an NHS allergy specialist for a proper assessment.

Cross-posted with this:

"yes I'm angry if someone didn't do their job properly and it has caused this."

Sometimes things just happen. Sometimes there are completely idiosyncratic reactions that end in odd ways. They couldn't be predicted or prevented.

It very much reads that you need someone to blame for this and that might actually itself be hampering your recovery.

But Tramadol is a synthetic opiate, it wouldn't trigger your allergy to codeine as it is not an opiate drug?!

This has absolutely NOTHING to do with your poor GP. He (safely) advised you to take an increased dose of a medication you were already taking, that he hadn't prescribed.

What part of that is his fault? None. He doesn't have a crystal ball and he didn't prescribe in the first instance. You're going to have to accept that thses things happen.

Codeine isn't tramadol is it?

umem.org/educational_pearls/578/

American site, but explains nicely that the oxycodone is much closer to codeine than tramadol, and that there is not normally any cross over in sensitivity. That said, if you have developed a new anaphylaxis to tramadol, of course people will now tell you to avoid it.
I'm sorry you've had a rough time, but I think you're looking for someone to blame, when you would be better served putting your energy into finding out what needs to be done to maximise your current mobility.