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.

Ten days is a long time to wait for someone so old. Heart rate 30 is v low and rapid weight loss would make me worry ab cancer. I’d say A&E, except the risk of picking something up while waiting would worry me. If DM deteriorates then I think A&E where you’ll get ecg immediately, well after a long wait.
ETA it’s annoying when doctors are more blasé with someone old and in poor health.

It doesn't matter if her HR is 30 or 45. It's still way below the normal resting HR of 60-100. You need to get her seen. You can't assume that it's her thyroid medication. She needs a full evaluation by a doctor. I would say that A&E is entirely appropriate given that she's symptomatic (dizzy and faint). They can do a full set of obs, bloods, and an ECG. That will either be reassuring or point to either a new medical condition or over medication of existing conditions.

The other thing to point out is that our heart rates drop at night, so if she really is hovering between 30-45 in the day time, her night time HR is likely to be very low indeed.

10 days time included 2 weekends, so I’m guessing it’s booked for a week on Monday. If she was saying she felt fine, perhaps didn’t share the weight loss and had a heart beat higher at the gp then a weeks wait for an appointment seems proportional. Gently op, do remember she’s 90 you say with lots of medical issues do even if they diagnose something there may not be a cure available, be prepared. We were in a similar position minus the weight loss and there wasn’t anything really to do, mil simply didn’t wake up one day.

Haven't rtft, but my mother was diabetic and suddenly lost loads of weight (she didnt take her condition seriously sadly even though she took her medication) went from quite overweight to underweight. She was fobbed off for months by her GP because the weight loss was seen as a good thing and her pain was ignored. Her diabetes medication was never adjusted and it led to spinal nerve damage which wasn't diagnosed until she had a mri scan.
My point is that your mothers diabetes medication may need to be changed/adjustedto take her weight loss into account and it may well be the cause of her symptoms (could also be other things as well but I would take her to A&E if her GP won't take her seriously)

Heart rates can be low if on certain meds, unless the “heartbeats should be at least 60” brigade are gps or geriatric doctors please don’t make assumptions, mils was in the low 40’s for years due to medication and my dads is late 40’s always has been because he’s so fit, still is at nearly 80! The gp will know about the heart rate vs medication situation.

Op's mum is on it for diabetes not weight loss so via NHS.

I'm a private GP and I see a fair number of patients like this - complex, frail, on multiple medications. If there's a decent private GP service locally (a traditional practice, not a health check/screening factory) then you may wish to book an appointment there if you have the budget. It's very difficult to advise further without knowing the full medical history, what medication she's taking, and her normal functional status. In some cases a patient like this might need A&E but in other cases managing in the community would be perfectly appropriate.

Hopefully you can get an OOH appt to avoid a&e. And then get her admitted if necessary. I would phone 111 and go from there.

A&E should be the option. However they have people waiting for hours on end and it’s not a suitable or acceptable environment for elderly unwell people.

It’s completely fucking disgusting.

OP ring an ambulance at least that way your mum will be lay in a bed and not sat in A&E.

much love to you. I lost my mum in January xx

Also a doctor here. I'd be seeking further medical help today from what you've said here. A heart rate in the 30s with dizziness etc needs checking - and no posters here know exactly what happened in that GP appt, might be absolutely fine but if she's still feeling unwell ask for help.

Pulse of 30 needs urgent review. Her heart won’t be effective at this rate

She recorded her own pulse with a home bp machine. It may not be.accurate but with her medical history, medication and symptoms she needs an ecg, bloods , meds review and medical review. She may be on heart meds that affect her pulse. I'd at least call 111.

Can you use Martha’s law to ask for a second opinion?

Id be getting her to hospital. That low heart rate suggests her heart is under enormous pressure. She needs to be seen.

You don't need to. You just call 111 or take her to hospital.

@AnOnne please follpw the advice of the doctors on the thread. I'd also get cracking and get her to A&E asap, and before the Saturday sports injiroes arrive. I'd get her to a full, main hospital A&E, even of ot means a longer drive. One where cardiology is on hand.

She's not on "weight loss jabs".........she's on medication for her diabetes!

The fact that the diabetes medication is used to lose weight is secondary and not relevant in this case.

Except the main issue seems to be 6lb a week weight loss

I think a lot of people are getting confused by the mounjaro because they have no medical knowledge.

Rapid weight changes are not a good sign with known heart failure, plus she has other complications with her thyroid and diabetes where rapid weight change is a red flag.

I think she needs to be assessed properly and asap, if you can go with her to ensure she is able to get across what is happening I suspect that would help.

I'm a nurse. I would take my mother to a&e if she was feeling unwell with a heart rate in the 30s.

Good advice I’d consider getting a smart watch to monitor heart rate too. I’d call 111.

Losing 6 stones in more than a year is not too quickly for someone whose starting weight was 22 stones. The 6lb weight loss in 2 consecutive weeks is a concern and not necessarily related to mounjaro. This lady needs to be properly checked out, have bloods and an ECG and all her medication reviewed. So no, 'stop mounjaro' doesn't really cut it.

Not read all the replies but when I lost a lot of weight on Mounjaro I had to have my thyroxine dose reduced because the dosing is based on weight.
edit: sorry not solely based on weight, obviously bloods as well! But definitely weight is a consideration

That's a common misconception. If paramedics deem it non-urgent, arriving by ambulance is not going to automatically mean she avoids sitting in triage.

Ok I stand corrected, just seemed a shock to the system of a 90 year old to me. She’s done well to get to that age at 22 stone so I hope she’s ok