My husband on it goes

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Well I have to say I am impressed with Eric's GP whom we saw on Friday. I had a call from the Geriatric Consultant at 5.30 yesterday. I had to put husband on as he was in the room and consultant was asking specific questions about the back pain. He said she had asked him to see husband urgently and offered an appointment on 20th. I am waiting for details and may well contact consultant by letter to express some concerns.Forgive me but given how husband reacted when GP whispered I cannot help feeling very scared and vulnerable doing this. I can try the 'open ended questions' such as ' can you please reassure me that the significant brain atrophy, even taking into account his age, and heavy drinking back in 2013, has not led to dementia'?

I may not go to the app as I do not drive and it is a £70 taxi as the ambulance service will not take me. It does sound as something has 'clicked' with the GP though. I shall not make too much effort to get him tidy either or write long notes about what medication he is on. If he is as clever as he tells us all he is then he should be able to remember his medication and what he takes it for. I have always written
everything down for him before previous appointments..

He is still mentioning that he is not happy with his GP but I think he would only move to one in the same surgery and his notes would therefore follow him! Would probably be a male partner if they would take him but just need to take it one day at a time.

I do know he would go ballistic if a memory clinic was suggested. However he might accept a scan if it were put forward as a follow up on the acute and subdural heamatoma.I do know they cannot make him go for further tests as my late further refused. I really dare not let him think I am pursuing the dementia route as although he is frail, he has been abusive and I cannot put myself at risk.

I did speak to the dietician today re repeat Fortisip and I did mention the d word. She did say the lack of self care and appetite were signs......

Thanks for reading.....not sure frankly a dementia diagnosis would help as he would still have 'mental capacity'.He has been threatening to see a solicitor to get it on file that he does not have dementia but I hand on heart cannot see how any solicitor would be able to do this as they do not have medical knowledge and taking into account his age, his history of heavy drinking which is on his medical file, and his heamatoma, would make it surely an option?
Helena, it's great you've got such a prompt appointment (for the NHS) with the consultant, and I think it is a sign of how bad your husband's GP thinks the situation is. In a way it's a shame you can't be there, but on the other hand, as you point out, it gives the consultant an opportunity to assess your husband 'true ability' (and inability....) to answer questions and so on.

That said, I would still write to the consultant YOURSELF, directly, expressing your concerns - including for your own safety, DO stress that, and say that is why you really, really, REALLY don't want your letter to the consultant to be made available to your husband, lest he reacts violently towards you for 'daring' to 'tell the truth' (or, in his view' untruths!') about himself. I suspect the consultant, as a geriatric specialist, will get the picture about your husband pretty quickly. I doubt much will get past him, ie, that your husband can't convince him he's mentally OK.....in fact, the more he 'boasts' about his mental ability, the better - sadly, it just proves the opposite. (Though, as I say, all of us would be fearful of dementia, and I can't blame your husband for being scared of such a diagnosis),

I would say, myself, in terms of a formal diagnosis of dementia, that the ONLY reason for doing so, and the ONLY point at which it becomes MATERIALLY useful, is if and when it reaches the point of losing legal capacity. THAT I the point at which your husband's wishes can be 'ignored', but until his mental deterioriation reaches that point, whether he knows, or is told, or is not told, doesn't really have any actual impact on what happens. He can go on refusing anything he wants to refuse until he he loses legal capacity......

On the other hand, it's useful if the consultant makes an initial diagnosis of dementia, as that 'starts the process' of reaching legal incapacity......

I would say it's perfectly reasonable in your letter to the consultant to be 'over-cautious' as in, saying in it just as you suggested 'Please assure us he does NOT have dementia, even though he ...etc etc' - that way even if your husband becomes aware you've written, he can't 'blame' you for 'shopping' him to the consultant! (and then take it out on you) (You could write two letters - one in the 'please assure me he does NOT have dementia' and the second one a 'covering' letter saying 'PLEASE don't let my husband think I think he's got dementia as he will react violently to me' (the consultant has to safeguard YOU, too, remember!).

Finally, although your husband is, I would suspect, unlikely to tell you what 'actually' happened in the consultantion, and simply to tell you something like 'The consultant confirms I don't have dementia, that I'm one of the cleverest people he's ever met, and you are simply fussing over nothing!'.....what the consultant ACTUALLY thinks will be sent to your husband's GP. That is the usual drill.

Your husband's GP will get a letter saying 'Dear Dr x, at your request I examined Mr xxxx on xxxx, with your concerns about xxxxx. My finding is that xxxxx' (etc etc). Now, a letter such as that is USUALLY send as a copy to the patient (my bro gets them from his cardiologist,ie, a copy of what his cardio sends to his GP, to plot my brother in), but given your husband's mental state that might not happen (eg, if the consultant should say 'I find signs of significant and progressive dementia'....). If that is so, I wonder whether the GP/consultant would let YOU see that letter 'privately' (ie, without your husband knowing it or being party to it).

The whole issue of 'disclosure' to someone with dementia/psychosis etc is very tricky, and I'm sure there are strict guidelines. (eg, would a patient who is suspected of being a criminally violent psychopath ever be TOLD that he is????? It would be too dangerous, surely!!!!!)

Anyway, the main thing is that your husband has been 'moved up a notch' by seeing the cosultantant, and that HAS to be good.. Good all round!
Helena, while your husband is in the ambulance you can ring the hospital appointment section and ask if you can speak to the consultant, either before or after the appointment, to express your concerns. Then you know your husband won't be able to overhear what you are saying! Make sure you escape the house for a while, to blow the cobwebs away.
Helena
I think it's perfectly reasonable, given that you cannot be at the appointment, that you send a letter in advance (ie not with hubby) listing what medications hubby is prescribed and which he actually takes.
I also think it reasonable you include the signs you see that worry you, and express the hope that there is some simple cause that will be easily remedied. Also ask that you be given details of any new medication prescribed so that you can ensure it is administered correctly.
Any consultant worth his salt would read between the lines, and even if he cannot breach confidentiality would find some way of replying.

So glad you have this opportunity, and so quickly too.
X
MrsA
Thanks ladies. I have written to the GP today and will post first class. I have expressed my concerns re the heamtoma and the considerable brain atrophy going back to 2013.

I am still waiting for the Consultants paperwork re the appiontment. We have 2 hospitals in this area and my husband is not sure which one his appointment is at so we are waiting for the letter.

I have expressed my worry re the lack of self care, appalling diet and the denial in the letter to the GP. I have also suggested if she feels she needs to speak with me alone, that she send him to give a urine sample, not as silly as it sounds given the amount of UTI's he has had plus blood in the urine. I may still write or try to contact the Consultant but time is ticking by.....

Thanks for your support. He is still going on about how sneaky the GP was and also how she smirked when using the word Geriatric'. I have said to me, Geriatric is just a word for specialists who work with older people in the way that pedeatric is used for people who work with children. At times I need the patience of a Saint............ Unfortunately, I am not a naturally patient person.
Nor me Helena. My son's keep telling me "Patience is a virtue" to which I reply "which you know I don't have much of!" On the other hand, I'm sure it's that impatience/drive which has kept me going when things are tough, so it's a double edged sword really.
I've just googled "brain atrophy" and found that there should be regular brain scans. That made me wonder how "regular" your husband's have been? I have enormous respect for your efforts to cope with all this.
Thanks BB. I did google brain atrophy and dementia but soon got out of my depth. I think it depends which part of the brain was affected? I do not think he ever had a follow up scan after the heamatoma. I thought there would be but he was treated at a Nottingham specialist unit where as we live in Leicestershire so I wonder if it got lost int he system as he was transferred back to a Leicester hospital after the operation . I was told that dementia diagnosis could not be progressed until at least a year after the heamatoma. He did have a scan when he fell last September at A and E but I had no paperwork.F

So yes if the Gp thinks there is a risk of dementia then she may be able to sell it to him as a routine follow up.