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by thaumaturgy 2807 days ago
I suspect it's pretty common. I recently corrected a prescription / dosing issue with my 89-year-old grandfather that was largely the result of the people involved not sanity-checking what was going on.

I'm still of the opinion that most people are better off letting doctors and nurses do their job than trying to manage their own health based on stuff they've read on the internet. There's a lot of bad information out there and sorting through it takes practice. You have to enjoy reading medical literature more than blogs.

The specifics: he's in a home hospice care situation as a result of severe aortic stenosis along with some complicating factors. Hospice is designed to provide "last two weeks" care for their patients, and they have a specific drug cocktail for that, but he's been on home hospice for over a year now because his body just isn't done yet, and there is no death-with-dignity law in his state (nor available providers in the neighboring state).

The drug cocktail is an opioid, usually morphine, along with a benzodiazepine, usually Lorazepam (generic Ativan). Taken together, they help relieve anxiety, reduce respiratory distress, and lower blood pressure. That last is important, because the morphine/benzo cocktail is specifically cautioned against in medical literature for elderly patients who are still ambulatory, because it creates a fall risk. They go to stand up to use the bathroom, and there isn't sufficient blood pressure to stay conscious, and they pass out and hit the floor, hard.

And that's exactly what happened to him. The third time, it hospitalized him and, because his speech had been slurred and his consciousness had been altered before the fall, I suspected his medication wasn't right. I went out there and carefully went through everything, and sure 'nuff, that's what it was.

The doctors just prescribed whatever hospice asked for, and hospice just asked for their usual recipe. It took an annoying number of meetings with staff before a younger visiting physician dropped in to one of the meetings and followed up with the literature I was citing. The next morning they started reducing his dosages and he began recovering, including getting his mental faculties back.

He's been back home for a couple of months now, doing well.

Physicians aren't magic. But, they work in a field that's totally alien to most of us here on HN, and trying to navigate the field as a layman can easily lead you into some pretty woo-woo nonsense. Trust, but verify.

2 comments

Medicine isn't alien if you spend enough years caring about it. The problem is, most people are of the attitude that they shouldn't pay any mind to the science, because the doctors will take care of it. This leads to total dependence on the infallibility of these professionals - and we all know that no professionals are infallible despite their title. The main jig docs have over polymathy knowledge-driven intelligent folk is first-hand sight/smell/ and feel for conditions by seeing patients day in and day out. Drugs though? Most of everyone can understand what would look sketch as fuck in terms of dosing. It pays to have some semblance of heuristics on what competent care and pharmacuetical administration looks like.

The populace would be far better off if we all stopped feigning lack of interest for the things that truly matter. Like medicine/biology. It's the study of us. Sure, delegate decisions to those in the day in, day out - that is diligence. But don't just accept to hear jargon. Learn what's going on. Be active. Knowledge isn't agnostic to specific fields..especially when its about your body itself. That is human knowledge. And everybody who is living should at least be half competent in knowing whether 38 pills of an antibiotic makes any goddamn sense. If this nurse had been a knowledge worker first, and a robotic nurse second, she probably would have caught the issue. Over specialization creates idiots following scripts. Meh..

I’m sorry I usually try not to do this but this is some seriously dangerous advice.

It took me literally 30 seconds to find the interaction you’re talking about while tapping about on my phone. Being informed about side effects and interactions needs to be the patient’s (or their family) job.

The space may be alien but we have people who we are paying to help Sherpa us through it. Ask questions. Ask why. If you don’t understand don’t blindly trust - ask your doctor. Seek second opinions.

I’m just a dev, I have 0 medical training. But I know the FDA publishes side effects and interactions. I always understand these before taking anything. Yeah I don’t understand the gibberish in pharmacology sections of things but I can read a list of effects and ask a doctor about them.

TLDR - if you don’t understand your care ask. If the provider won’t explain find another provider who will.