To ask for an urgent second opinion ? Unwell 90 year old

[AnOnne]

My mum is 90, with a number of health issues (type 2 diabetes, under active thyroid, kidney disease, heart failure, obesity and more.) She has been on mounaro for her diabetes for over a year and has lost 6 stone and was generally feeling a lot better for it. Recently she has started suffering hot flushes, dizziness, agitation and generally feeling wrong/unwell. Her weight loss has suddenly accelerated to 6lbs a week which seems a bit alarming. I think it started to scare her (she is a long time GP avoider) since she checked her BP herself Thursday and noticed that her heart rate was in the 30s. She made a GP appointment, which was yesterday. The GP was apparently dismissive, disinterested and had little to say. He booked her bloods and an ECG for 10 days time, and when pushed by my 90 year old mum agreed that maybe she could reduce her thyroxine dose in the meantime. AIBU to ask to see another GP Monday? Surely there shoud be a bit more urgency when a 90 year old has a HR in the 30s? (He did take her HR which was 45 in clinic.) Any advice would be really welcome.

If she has a really show heart rate and feels dizzy, she needs to go to hospital, urgently.

Wouldn't hurt to see another GP but low heart rate is quite common with interactive thyroid so that's probably why GP wasn't concerned. Combined with dizziness, though, that would be something to investigate. Did your mum give full account of her symptoms to the GP or just low HR concerns?

Hi OP, you say she has heart failure and has put 6lbs on in a week - this would be a red flag for me that it is oedema. Has she become more short of breath? What about leg swelling, is she coughing more or bringing up any sputum? Is she under a heart failure team? I think with a heart rate that low they would be looking at her meds - is she on many to control her heart rate? I would go back if nothing else to leave bloods for 10 days time with those symptoms and weight gain is not acceptable in a 90 year old.

The first 2 replies sum up my problem - A&E versus not really a problem!

I disagree, with hospitals being so overwhelmed these are tests that can easily be done in the community where she is not going to sit in A&E for days. 10 day wait though is not acceptable.

@SUUUUUUNNNNN No she has lost 6lbs a week for the last 2 weeks. I agree that she needs her meds checked, she is still on the same doses as when she was 22 stone

For a 90 year old I’m surprised mounjaro was prescribed as the risk vs benefit is high, some side effects are brutal even in younger patients.
My advice would be to go to a and e but be prepared for a long wait.

The system is totally broken. We used pharmacy first for a health issue once... The first pharmacy told us to go to A&E. The second told us to watch and wait!!!!!

She’s lost 6lbs, not gained it

Well reducing the thyroxine could slow the pulse even more. Check her pulse again. If it still in the 30s, consider A&E or 111. Did GP stop other meds? For heart failure she could be on lots of rate slowing medications like bisoprolol which could easily be reduced or stopped.

So sorry I read it as a sudden weight gain (teach me to read an op properly). Yes it could be they are metabolising differently now she has lost so much weight. I too would be worried but she really needs the bloods they will tell you so much - it could be a tweak of the medications that will sort it all. 10 days is not acceptable go back Monday and if she deteriorates over the weekend head to A&E.

@StormySpanielz But she is on the same dose of thyroxine now as she was when she was 22 stone - she is now 16 stone. Given the hot flushes, agitation and extreme weight loss I think its a valid concern that she is being over treated for her underactive thyroid now. But I confess, Im not a medic

Is she still on mounjaro too ?

She needs ED if her pulse really is in the 30s with those symptoms. It could be lots of thinks but she needs to be seen urgently, have bloods and an ECG at least. I'm a doctor btw.

@neverReallyasleep Yes its her diabetes medication

@rainingsnoring Well this is the problem, the low HR is intermittent and was 45 at the clinic yesterday and my mum (who likes to shoot herself in the foot) is now saying 'Im fine!'

A&E may be appropriate here. Or you could discuss with a 111 clinician whether she's suitable for an urgent community response services assessment today

Yeah, I’m surprised at that too.

Speak to 111 but A&E isn’t somewhere I’d take a 90yr old unless absolutely necessary. There’s too many germs for her to catch. I definitely wouldn’t wait the 10 days though, I completely understand your concern.

Have you actually seen your Mum or is this all via the phone?
It's very hard to advise without her full medical details available but I would definitely be concerned by what you have described with the medical details given and would suggest what I said above.

Yes but it may need reducing or stopping has the dose been adjusted at all in the time she’s been on it ? Has she been monitored ?

The impact of monjaro and significant weightloss can have different effects on the other medications.

I would suggest speaking to 111.

I'm on monjaro for diabetes. My levothyroxine had to come down but my warfarin has had to go up.

I am not a specialist but my daughter did see a thyroid specialist recently for an under active thryoid and the specialist did say some of the symptoms you mention could be a sign of too much thyroid meds. But I wouldn’t just drop her meds without medical advice. 30 hr sounds terribly low I would seek a second opinion.

If she has lost 6stone then she absolutely needs to have her thyroid meds adjusted - the dosage is calculated according to weight so when I lost 6st I became hyperthyroid and was rather unwell. That said a HR of 30bpm is alarming. Mine is a little lower than most peoples bit nowhere near that (58-62 on average, but I am late 50s). Below 60bpm needs monitoring. I’d call 111 and get her seen again today.

Mounjaro at 90? I’m surprised. She needs to stop taking it, she’s too old to be losing that much body fat so quickly ☹️