Too much Potassium?

Well, finally -- after three months of asking and asking -- I got my aunt's most recent blood panel results faxed to me. Her potassium level is still 4.7, on the high side. What if she had continued with the potassium supplements back in June? Apparently, her primary psysician was not aware that Lisinopril causes high potassium levels. And she probably is still not aware that the cardiologist had stopped the potassium. What if we hadn't flagged that issue back then?

My aunt also has a diarrhea issue from diverticulitis surgery in March, and that should have abated by now. According to the University of Maryland Medical Center: Side effects from potassium supplements "can include diarrhea and nausea. At higher doses, muscle weakness, slowed heart rate, and abnormal heart rhythm may occur." My aunt also suffers form atrial fibrilation.

Also: "A rise in potassium from ACE inhibitors may also be more likely in people with poor kidney function and diabetes." My aunt has been dehydrated and also has diabetes -- oy!

To be continued..

Does she have Parkinson's Disease or not?

Well, I returned from Stockton on June 30th -- having helped my aunt transition to a retirement community, with all the attendant issues of moving and downsizing. It was an education on so many levels!!!

Still waiting on an answer to the potassium issue. On June 18th, we went to see the cardiologist, who upped her Amiodarone dose -- but also stopped the potassium, pending upcoming blood tests. He agreed that my aunt's 4.7 potassium reading was too high considering that she was taking both potassium AND Lisinopril. We'll soon see...

On another note, my aunt was summoned to her neurologist's office yesterday as a result of drug chaos. In early June, he had said that her Parkinson's Disease was undertreated, and she did not have an "essential tremor." So try increasing the Mirapex; she could take a lot more daily if needed (see 6-2-09). We started to do that up to .375 mg three times daily, and she seemed to shake less. THEN when we went to get a new supply, HUMANA denied it! So she was switched a similar dosage of Ropinirole (Requip). Earlier this week, the pharmacy had given her 9 a day X 30 = 270 25 mg Ropinirole pills as it was time to get a new supply. This apparently triggered a drug inquiry from Humana, duh!

(BTW - the nurse asked my aunt to put all the pills she was currently taking in a bag and bring them to the office, even though we had given the doctor a complete list last time! She took her pills and her list.)

But the salient point was that the Requip was not helping diminish the tremors. So yesterday, the same doctor said that since the drugs didn't seem to help, he did not think she actually had Parkinson's Disease. My aunt -- who had recently attributed her coughing to the PD -- seemed quite pleased.

But just who the heck is on first?

Potassium

On Friday, we visited my aunt's primary doctor -- and had medication review to review the various med changes made since her leaving the rehab center. My aunt has had a potassium problem in the past, but she was given 20 mg a day at rehab and the doctor reaffirmed and renewed prescription. The next day, I read on article on gilbert GUIDE -- see below -- that cautioned that certain diuretics called ACE inhibitors can cause high levels of potassium in the blood (hyperkalemia). My aunt is also taking one of those, Lisinopril. Just leave as is, or question?

(NOTE: My aunt left rehab with a prescription for a Beta blocker, which she refused to take since it made her dizzy. The home health nurse said that the Ace inhibitor was then not needed as they went together. Both the primary care physician and her cardiologist said OK no Beta blocker, keep the Ace inhibitor. Who's on first?)

gilbert GUIDE: "How Aging and Medication Affects Our Bodies"

Progress?

My Aunt visited her neurologist today. He doubled her daily dose of Mirapex (Pramipexole) -- from .125 mg to .250 mg 3 X daily -- after examining her and stating that her Parkinson's Disease was undertreated. She seemed to pass all the other little physical tests like walking, squeezing his hand, touching her nose.

What if we had not made that appointment? She missed one of her quarterly appointments while in the rehab center, but no effort was made to follow-up far as I know. We were given the option of boosting the dosage further in week if need be -- up to 4.50 mg daily, can you imagine! The increase is supposed to improve balance and reduce tremors, with one potential side effect hallucinations. But no worry, not dangerous. Just cut the dosage back and it will be fine...Oy!

The doctor said it was definitely a Parkinson's tremor (3-4 shakes a second), and not an "essential tremor." He also was very pleased to be shown a list of all my Aunt's medications and kept a photocopy, but he did not ask for that info...One doctor down, two to go.

And it's not cheap, either.

Here's an article that addresses additional consequences of multiple morbidity:

"Burden of Common Multiple-Morbidity Constellations on Out-of-Pocket Medical Expenditures Among Older Adults" (The Gerontologist, 2007).

"Implications: Increasing rates of multiple morbidities in conjunction with escalating health care costs and stable or declining incomes among elders warrant creative attention from providers, researchers, and policy makers. Further understanding how specific multiple-morbidity constellations impact out-of-pocket spending moves us closer to effective interventions to support vulnerable elders."

It's called Multiple Morbidity.

For a few years now, I have been concerned by what seemed my 82-year-old Aunt's either over-medication and/or conflicting prescriptions by three different doctors. She had several health problems, and seemed to sometime walk around gingerly and in somewhat of a fog...was this the solution or the problem?

Various medications made her dizzy or otherwise did not sit well with her. She had regular appointments with her internist, cardiologist, and neurologist -- but often called to tell a doctor's representative that she had a problem. Often, prescriptions were altered verbally, which may or may not have helped and certainly caused some confusion when drugs were reordered with previous directions still on the bottles. "Oh, he told me to only take one a day."

Then came a couple of hospital stays, followed by rehab places. The primary doctor would prescribed a bunch of stuff, which she came home with; but those drugs did not jive with previous prescriptions even by that same doctor! Need I say more?

An article which appeared in The New York Times on March 31st affirmed my concerns and showed that there is much to be done before the issue of "multiple morbidity" (when a person has multiple medical conditions) is properly addressed: "Treating an Illness Is One Thing. What About a Person With Many?" Please read it and join the discussion!