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.

She needs to get assessed immediately - an ECG by paramedics or A and E.
If her heart rate and BP are that low, she may need medication or a temporary pacemaker put in to increase her heart rate.

Do you have a minor injuries unit near you? I would ring 111 today and say you don’t feel happy with gp not doing further tests after heart rate of 30 and ask for gp appt at minor injuries (that’s what we are told to do in our area if need be).

I'd see what the online symptom checker suggests https://111.nhs.uk/triage/check-its-not-an-emergency .

My DH has used it in the past for an infection which seemed to suddenly get worse at the weekend. A doctor called him back and got him an appointment at an out of hours clinic. Are you able to go to an appointment with your Mum and advocate for her. If she tends to down play her symptoms and you get a dismissive doctor, you may need to be the squeaky wheel. I would also imagine her meds need to be adjusted to reflect her much lower weight.

For her diabetes. It is a diabetes drug (originally).

You need all your medication reviewed when you lose that much weight and a repeat HbA1c. I lost a large amount of weight and had to come of all my meds including my diuretic furosemide as it started making me feel horribly dizzy and drained.
I ended jp coming off everything and found my diabetes was reversed.
Book an appointment with a pharmacist. I think a pulse of 30 is very worrying.

You need proper medical advice. See a different GP.

Are you sure the pulse of 30 was accurate ? Perhaps an error ? Was it manual?

Another Dr here. HR in 30s suggests heart block. Needs urgent assessment. My FIL had this and needed a pacemaker.

It’s the low heart rate that needs to be seen. All the other symptoms could be high thyroid meds dose but that would cause high heart rate, not low. Also thyroid meds have a long half life so even if she’s dropped them it could take up to 6 weeks to feel better.

Can you go and see her and check her HR yourself?

I thought it had to be taken with caution after 75. Hopefully she’s ok

@Clairey1986 Yes, she is nocturnal so wont be up til midday so I will head over then. I think I am conflating 2 issues, the low HR and the thyroid meds, but as you say, the HR is the main concern just now. If its still low today I will have to call 111 though I susect they'll say A&E and mum will refuse

Pharmacies are not always very helpful . I went to one for a blood pressure check because I was getting headaches at the gym . My blood pressure was fine and he just said gyms are noisy .

@Jane143 I really dont think the mounjaro is the issue, it is her diabetes medication that happens to have also helped her lose weight. She has been fine on it, no side effects. She is only on the 5ml dose and has been losing weight steadily but not particulalry fast until a few weeks ago. I suspect the rapid weightloss may have another cause.

What's her HR normally? So last month? Last year? Is low normal for her?

@BlueMum16 Yes it is normally on the low side, mid to upper 40s. GPs have never been concerned by it, but 30s seems another level of low. But Im not a doctor so who knows!

She’s far to old to be on weight loss jabs. Im not suprised.

I have had low thyroid since 1993. I've lost over 6 stone but my meds haven't been reduced?
They are monitoring.
I don't take WLJ or have diabetes.

I'd get you mum to the walk in centre at your local hospital.

Another person wondering if her other medications are now at too high a dose. If her pulse is below 50 and she feels unwell please take her to ED - really needs an ECG.

@WeepingAngelInTheTardis It is a diabetes drug (that has been found to be effective for weightloss) she is on it to control her type 2 diabetes since other diabetes meds werent proving very effective at controllling it

@EricTheHalfASleeve thats what I think tbh

Can you tell us her other meds. If HR is routinely in the 40s and GP not worried, seems very likely she is on rate slowing medications for her heart failure.

Her HR probably went up because she was nervous seeing the doctor - white coat syndrome. My mum had a pacemaker fitted when her HR went down to 40. I would insist of her being seen urgently OP if you can. Which might mean A&E unfortunately. Call 111.

Is it a private MJ prescription? What does the prescriber say?

Call 111 and get her an OOHs appt. Polypharmacy in the elderly is well recognised and may be the issue here. However it may not be.

Dial 999 now, unfortunately there are a lot of useless GP s around