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    Scotland Avalon Member diteras's Avatar
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    Default Independent Nurse Practitioner's straight scoop on medicines

    My life as a pretend doctor. #1

    I make no apologies for being involved in psychiatric medicine and diagnosis. I had better qualify that before the hatred comes at me - I understand the hatred.
    I am an independent nurse practitioner non medical prescriber . I worked hard to be an IANP - my speciality is in older persons mental health. This includes the diagnosis and treatment of dementia - the classification of sub types and application of treatment - roughly 70% of my time is in ‘memory related work’.
    First thing to say is that I object that dementia is thrown in with psychiatry - it is not, in my opinion, a mental illness. If ones brain structure changes for organic reasons, you are not technically mentally ill- symptoms may be similar - but not the cause. That aside I understand why this is so. If it were left to many of my colleagues in medicine dementia would be a catch all diagnosis for anything including the non DSM or ICD listed ‘’awkward old bugger’ condition.

    The causes of reversible memory loss in aging which could ‘mimic dementia symptoms are many but commonly - B12 deficiency - hyponatremia - thyroid irregularities - infection (very common) and extended exposure to medications with anticholinergic/ antimuscarinic qualities - e.g.Bladder stabilisers, antihistamines and tricyclic antidepressants - amitriptyline is commonly used for neuropathic pain - because it's cheap - but plays havoc with memory.

    We also see many older people with ‘brain fog’ caused by treatments such as methotrexate for autoimmune conditions - and the old favourite prolonged analgesia use. ( opioid or synthetic opioid) -

    The lack of knowledge some poor folks have of their meds is staggering. The lack of knowledge we have sometime trumps them.

    Her is a little case study as an intro to my world of pain.

    - 85 year old lady - multiple medications - me- are you in a lot of pain? - her ( surprised )no --- me (pointing to one of her multiple medications on the GP’s referral letter)- - do you know what these are? Her - I thought they were for my blood pressure or something ----me - no they're not, it says you’ve taken them since 2006 is that about right? Her daughter --was that when you had shingles mum? --what are they anyway? Me - they are Tramadol capsules, (she was taking 300 mgs a day)which are prescribed for moderate/severe pain -,,,’’they are a synthetic opiate which is addictive and has a very bad reputation for side effects….some people experience long term issues which can be very dangerous but we can sort it out …..’’

    Now here I should say that this lady had multiple co morbidity and two of these were red flags for Tramadol - asthma and renal issues.
    Let's think about that two ways - These complications/contraindications were known in 2006 - so it might be that she didn't have the red flag problems then - so good - but when she was diagnosed with CKD and prescribed an inhaler surely surely someone would have checked? no ?……..so that is bad.

    Then there is the other view --- shingles can be bloody painful and can linger. So maybe after having gone through a number of alternatives the doctor settled on this as the only thing that worked? Still not good - why? Firstly the pain from long term afters due to shingles would be neuropathic -- therefore opioids are pretty much useless -- ask any of your friends who may suffer from something like trigeminal neuralgia - if any morphine helped? They will say no. If they say yes they did not have it. (1)
    So …. With option two we have total absence of basic physiological/pharmaceutical knowledge plus a failure to review a short term treatment and allowing it be repeated for eleven years. Note here that in addition Tramadol was re-classified as a (level3) controlled drug in 2014 (uk) due to high mortality associated. (2) So the community pharmacist was not exactly on the ball either then? It gets worse.
    This could have caused the Chronic Obstructive Pulmonary Disease and Renal issues. In my opinion it did. No question.


    The only issue which was remotely close to mitigation in the whole sorry mess was under ‘’allergies.’’
    I read that a buprenorphine patch had been trialled and withdrawn 2 years ago - due to an unspecified reaction. It is known as BUTRANS
    Buprenorphine is a partial blocker (synthetic opiate)It also is useful in addiction control - a partial blocker takes the sting out of heroin withdrawal without the buzz - a bit like non alcoholic lager if no one tells you? Best for my patients in pain control as a seven day ‘patch’ - for older persons an opiate bypassing the digestive system is a damn fine idea. Constipation can cause the most horrendous pseudo psychosis if left untreated and all things approaching that end. So she had been given this at least.

    There was no explanation of this trial- but this is how I read this info…. a locum or junior GP sees her at home ‘’one off’’ they realise this is bad and try to avert the coming disaster--- it doesn't work and by that time they have gone- so we drift back to doing nowt. But the allergy was clearly marked !! well done someone.

    So far...
    We have created addiction and made someone worse in their health - we have as a side issue probably contributed to them being housebound and withdrawn and cognitively impaired- we have also not provided them with information and failed to effectively review dangerous medication even when it was reclassified - we have abandoned them to addiction and failed to explore ways to reduce the medication even when the person's pain symptoms have passed----- AND Then ---we have --- as a response to government prompts and demands from the ‘’court of public opinion’’ to sharpen up our dementia diagnosis rates ---trawled this poor woman up and had the unmitigated gall to refer her to a memory clinic with a letter which starts with ‘’I think this woman has Alzheimer disease ...and ends with ….would she be suitable for medication?’’
    HA!

    I made it clear that the memory impairment was drug induced and made recommendations to review - (I haven't even given the detail of the two other contraindicated meds which had been layered on top of this or that her grandson was a known opiate abuser.) I did not prescribe.

    What happened I hear you say? Actually if you are still with me well done -- you now probably hate me as much as say James May or maybe John Dean (watergate) hate themselves.

    Well I was off for awhile - and the nurse who was acting as care coordinator got jittery. You see I told you I was a reb (yeeehawww) She like many of her colleagues is steeped in the medical model.
    So when she reviews this lady she drags in a junior doctor. What we call a Foundation Year 2 .
    He writes a letter and is not aware of mine as the dictation was not yet on the system. He feels she does have Alzheimer's and prescribed medication - he also jumped on the Tramadol (so well done him)
    His recommendations - ‘’please reduce Tramadol and replace with a butrans patch ……’’ Lets be fair - he maybe couldn't read eh?

    What the actual ffffffff……... !!!!!!

    What happened - well she did have an allergy to butrans we established that - patch caused severe rash ...oh....so that's what it was.
    Medication for memory didn't work ( why would it as she didn't have AD?) caused side effects and was stopped after a week.

    I have written enough but there you are - just one person pooped on by the system and left to rot.
    I have a catalogue -this is just my opening shot so next will speak about the pharmaceutical lie in a way never seen by anyone before - I might be boring but I can try to convince myself I ain't. Indulge me. 3 ( I hate this band btw but best I could do.....


    1 https://www.cochrane.org/CD003726/NE...uropathic-pain

    2 https://www.mims.co.uk/tramadol-recl...rticle/1297952

    3 https://www.youtube.com/watch?v=TsdUcpkcWig

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    United States Avalon Member Whisper's Avatar
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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    just a short note :

    Alzheimer & Dementia and many other illnesses is often caused by metall storages in the brain. They found high amounts of metall (mercury and others...) in the brain of people who suffered from alzheimer....after they passed away. The information about this is suppressed.....

    Mercury (Mercury is the most toxic, non-radioactive element on earth) often used for tooth fillings and other med......., does collect other metalls in the human body and it often gets stored in organs or the brain..because it can easily pass the brain boarder. The human body can not eliminate mercury out of the body, so it gets stored somewhere..and causes damages by time. Even if you never had mercury tooth fillings...you could got it passed over from your mother while she was pregnant....there are studies about this also....(suppressed)....

    To drink 2 - 3 cups of plain gmo free coffee a day often helps the body to eliminate certain metals....which is helpful for people with alzheimer.....(Dr.med.Dr.med.habil Max Daunderer, toxicologist * 13. September 1943 in Landshut; † 7. Juni 2013)........

    Dr. med. Dr. med. habil. Max Daunderer died suddenly and unexpectedly in 2013.
    Last edited by Whisper; 5th July 2019 at 20:52.

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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    keep writing diteras, this is illuminating.
    thank you.

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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    Diteras,

    A thousand thank yous! I take very low doses of meds for neuropathic pain and anxiety. I am trying to go off everything but that will likely not be possible, so will keep meds to a bare minimum. It's the best I can do. I was taking antihistamines to help me sleep once in a while until I read the study that suggested certain antihistamines could cause dementia, or I guess, produce a state indistinguishable from dementia. So I quit flat out and won't take them again. I went through the list of drugs and the two drugs I currently take do not qualify as a dementia risk.

    I have a question for you. Do you think that some elderly people are medicated too heavily for high blood pressure? What are the impacts on the brain of having pressures that are artificially low. To me it seems that the elderly who may need slightly higher pressures to get blood to their brain may be at risk. It's like their brains are operating like a flat tire.

    Keep posting and thanks for all you are doing for the elderly. People like you are heroic!

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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    I will enjoy reading your thread here for sure, Diteras. I have been doing all I can to protect my own relatives and cohorts, as I see so many of them going down due to over-medications. It's scary!
    The older generation was so ingrained with trusting doctors and doing what they say, and many don't realize what the medical system has devolved into. I first realized this myself when my husband went through a major medical crisis 10 years ago and wound up with a grocery bag full of prescribed medications from the VA - prescriptions added for the side effects of the side effects of the side effects for the original med. It was ridiculous, and I just know in my heart he would not be here now if he had continued being a "good little patient."

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    Scotland Avalon Member diteras's Avatar
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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    Quote Posted by Whisper (here)
    just a short note :

    Alzheimer & Dementia and many other illnesses is often caused by metall storages in the brain. They found high amounts of metall (mercury and others...) in the brain of people who suffered from alzheimer....after they passed away. The information about this is suppressed.....

    Mercury (Mercury is the most toxic, non-radioactive element on earth) often used for tooth fillings and other med......., does collect other metals in the human body and it often gets stored in organs or the brain..because it can easily pass the brain boarder. The human body can not eliminate mercury out of the body, so it gets stored somewhere..and causes damages by time. Even if you never had mercury tooth fillings...you could got it passed over from your mother while she was pregnant....there are studies about this also....(suppressed)....

    To drink 2 - 3 cups of plain gmo free coffee a day often helps the body to eliminate certain metals....which is helpful for people with alzheimer.....(Dr.med.Dr.med.habil Max Daunderer, toxicologist * 13. September 1943 in Landshut; † 7. Juni 2013)........

    Dr. med. Dr. med. habil. Max Daunderer died suddenly and unexpectedly in 2013.




    Thank you Whisper. Yes I have heard this. You are right of course and it is just another example of something which is a cause being not spoken of because it doesn't fit the paradigm -- who's paradigm I wonder?

    I guess in broadening the discussion the issue of weather/environmental control which allegedly involves ''chem trails'' with heavy metals links into this.They end up somewhere ---- in us. Water table.

    I also have seen one patient who had childhood (1950's UK)'pink disease' --see ref 1 below) he nearly died ---many did and for some reason this is not well known. It should be shouted about --don't you think?
    Isn't it weird how state supported horrors are not often spoken of - especially when multi billion dollar corps are behind these? Almost think their was a conspiracy eh?

    I guess when you refer to 'blockages' you are speaking of the post mortem beta amyloid tangles (2) which are found in some dementia patients?

    Beta Amyloid is a toxin which is created by us all the time --- now its happening while I think --- and is removed by the cerebral spinal fluid --- this is why a CSF check should be part of a proper diagnostic exploration -- that it isn't has many explanations which I hope you can bare with me to get to later.--- So when we cant, for whatever reason 'get rid', it builds up and you get what you get --(that is oversimplification but I hope it'll do for now)
    All the studies I have read inform me that sleep is the time when you process this - which is why a good natural sleep is so important ---maybe this is why Mrs ( I only need three hours a night) Thatcher got AD --(or maybe she was wacking up 'charlie'?-- what an image) ....sorry everyone....... Did she know John Delorean?-- I wonder.............

    As another aside --i have heard researchers propose that the 'black triangle' SSP UFO's work through creating a anti-gravity magnetic field by rotating highly pressurised mercury in their reactor thingie (thingie???-- oh yes eat my shorts Bob Lazar )
    Perfect eh? The pilots cant whistle-blow, because the exposure means that they basically cant remember where their ass is after a few flights?
    Is this why grey aliens are naked?-- they just forget to put their kegs on?


    1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173747/

    2 https://www.brightfocus.org/alzheime...illary-tangles

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    Scotland Avalon Member diteras's Avatar
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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    Quote Posted by AutumnW (here)
    Diteras,

    A thousand thank yous! I take very low doses of meds for neuropathic pain and anxiety. I am trying to go off everything but that will likely not be possible, so will keep meds to a bare minimum. It's the best I can do. I was taking antihistamines to help me sleep once in a while until I read the study that suggested certain antihistamines could cause dementia, or I guess, produce a state indistinguishable from dementia. So I quit flat out and won't take them again. I went through the list of drugs and the two drugs I currently take do not qualify as a dementia risk.

    I have a question for you. Do you think that some elderly people are medicated too heavily for high blood pressure? What are the impacts on the brain of having pressures that are artificially low. To me it seems that the elderly who may need slightly higher pressures to get blood to their brain may be at risk. It's like their brains are operating like a flat tire.

    Keep posting and thanks for all you are doing for the elderly. People like you are heroic!
    Thank you so much AutumnW and to Ayt who I have mixed into this reply- you are both too kind to me. I have never been described as 'heroic' before and am quite blown away....maybe you should speak to me ex to get a more balanced view?

    autumn w -I am guessing you are prescribed Lyrica or (generic) pregablin? Something like that--- maybe Carbmazapine /gabapentin?? or perhaps an old trycyclic antidepressant? The first three are used for seizure control (licenced) pain (sometimes licenced sometimes not) and mood stabilisation (ditto) depending on what you have. I can explain the concept of product licence to you if you wish? That is another topic.

    The Lyrica 'catch all' medication is pretty commonly used for such symptoms as is gabapentin. The 'gaba's are originally an ant seizure drug which was expanded to other uses -- through the usual...''oh it does that too does it....hmmmm...well why not?'' experiential reality based work. It is a prime example of pharma gone completely ott too ---If anyone wants to look at how big companies ''work their thing'' I would recommend they have a butchers at this.... ref 1.... or this ref 2 ...or this ref 3.

    You get the drift.

    So yes, these things are as they say 'fraut with peril' But I don't know you and I can only give you general advice- you know you (and your hubby ayt) better than anyone, so do what you think/feel is right, having gathered all possible info is my best advice -- I am as likely to be wrong as the next man. If it does help you and clearly it does help some -- then great. Just be careful and be armed with some understanding - because quite often 'we' (medical professionals) base our understanding on faulty info -- my next post will cover this if you can stay with me.
    Are older people over medicated? Yes, generally yes ---- there are reason for this and I will try to get this over later (targeting post 3) but sometimes there is a need which I cant actually argue with - quality of life is the key -- if you are chasing quantity first and find yourself keep having to come back to medics to try and find the quality after that, then you could be disappointed.

    are BP meds overdone - in UK they brought out something called QOF (ref 4) a good idea in conception. In practice it encourages doctors to over use anti hypertensives to hit a target -- often by using one two or three from different groups - Now I am not saying that it doesn't work - but what I do know is that in reality what commonly happens is that every different med has a exponentially lower chance of making a significant difference and an exponentially higher chance of causing unwanted side effects --- that is true.

    So if you have a family history of stroke etc then please take them but also look at lifestyle and particularity salt consumption etc.

    The old adage about the operation being a complete success but the patient died springs to mind .....we are as much like mice in a maze as everyone else we just do not want to admit it

    Do what you think is best but please ask questions -- we should not be harvested by medical/pharmaceutical conglomerates and kept alive just to consume is my more radical thought here --- but that is mine. Everyone else should please themselves.

    thanks fr your support ---truly did not expect anyone to reply.. am amazed. love

    1 https://www.reuters.com/article/us-p...0RA1G120150910

    2 http://drugbaron.com/the-real-scandal-of-drug-pricing/

    3 http://theconversation.com/ambulance...res-why-106163

    4 https://digital.nhs.uk/data-and-info...-framework-qof
    Last edited by diteras; 6th July 2019 at 08:20.

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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    This is not boring. This is informative, with information gleaned by experience rather than simply by reading. Carry on, please. :~)

    p.s. ditaras, can I suggest that this thread be renamed? It will help with people searching forum titles for info. If you agree, what would you think would be a good title?
    Last edited by Dennis Leahy; 7th July 2019 at 16:21.


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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    Thank you for posting this.

    I'm supposed to be on BP meds right now but I'm somewhat at a crossroads. For 1 I have zero trust in my doctors considering my past experiences. I've had horrendous side effects in the past and I thank god they didn't end up sending me to jail or cemetery (lamictal or topamax, don't remember which one). I always asked about side effects but they more or less say to read the warnings which are more or less all the same. I've tried lots of other drugs to control the seizures and depekote seems to work the best for me. There was one other decent drug I can't remember the name of, but it made me sweat a ridiculous amount.

    The other thing with my BP is I could definitely improve my diet and lifestyle. It seems somewhat silly to not address those things and take drugs that allow me to continue a harmful lifestyle. When I manage to stay healthy, (basically sleep better, improve diet, meditate and exercise more) my BP improves dramatically.
    Just as every cop is a criminal
    And all the sinners saints

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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    Strat ive been given all sorts of BP meds. almost killed me. toprol slowed my heart to such an extent that i feared it might just stop beating altogether. my lasting memory of that week i took it was the night i awoke and did jumping jacks till i couldn't stand....i was certain if i stopped moving my heart would stop too.

    some meds *are* useful, as Autumn points out...but ugh, i would not recommend those bp meds to anyone.

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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    Quote Posted by Mike (here)
    Strat ive been given all sorts of BP meds. almost killed me. toprol slowed my heart to such an extent that i feared it might just stop beating altogether. my lasting memory of that week i took it was the night i awoke and did jumping jacks till i couldn't stand....i was certain if i stopped moving my heart would stop too.

    some meds *are* useful, as Autumn points out...but ugh, i would not recommend those bp meds to anyone.
    Have you looked into blue zones? In (I think) sicily they have an extremely high concentration of folks over 100yrs old who are active and yet they almost all smoke and have high BP.
    Just as every cop is a criminal
    And all the sinners saints

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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    gosh Dennis, thank you - truly ... if I had thought for one minute that so many folks would be so interested I would have tried harder with a 'hook'. I have no idea. You have just asked me the equivalent of the classic interview question ''so ..what do you think you are good at?''

    I am very new to this remarkable forum - I will (classic cop out here) be amenable to any suggestion your experience suggests.

    But once again ---thanks!

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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    Quote Posted by Mike (here)
    Strat ive been given all sorts of BP meds. almost killed me. toprol slowed my heart to such an extent that i feared it might just stop beating altogether. my lasting memory of that week i took it was the night i awoke and did jumping jacks till i couldn't stand....i was certain if i stopped moving my heart would stop too.

    some meds *are* useful, as Autumn points out...but ugh, i would not recommend those bp meds to anyone.
    There's a lot of politics in bp meds. The old diuretic types seem to work the best for most people. My husband and others I know had terrible reactions to the newer drugs. Husband and best friend, on one of the drugs, had pressures that would skyrocket and then plummet. Fortunately, I knew a bit about it, so suggested he TELL not ask the doctor to put him on the old class of drugs that are currently out of patent. They work FINE. I think they may deplete the body of potassium, so you take a pill and a banana! Perhaps they add potassium to the drug now. Diteras will know!

    Gabapentin not only eliminates muscle pain but helps me achieve stage 4 sleep, which is the recuperative phase of sleep, so when I wake up I feel like I have actually slept. Without it, I don't know, really hard to function. But am very aware of becoming too dependent on a high dose so am taking under the prescribed amount.

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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    Quote Posted by Dennis Leahy (here)
    This is not boring. This is informative, with information gleaned by experience rather than simply by reading. Carry on, please. :~)

    p.s. ditaras, can I suggest that this thread be renamed? It will help with people searching forum titles for info. If you agree, what would you think would be a good title?
    see above ----also not quite got the reply with quotes under control

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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    Quote Posted by diteras (here)
    Quote Posted by AutumnW (here)
    Diteras,

    A thousand thank yous! I take very low doses of meds for neuropathic pain and anxiety. I am trying to go off everything but that will likely not be possible, so will keep meds to a bare minimum. It's the best I can do. I was taking antihistamines to help me sleep once in a while until I read the study that suggested certain antihistamines could cause dementia, or I guess, produce a state indistinguishable from dementia. So I quit flat out and won't take them again. I went through the list of drugs and the two drugs I currently take do not qualify as a dementia risk.

    I have a question for you. Do you think that some elderly people are medicated too heavily for high blood pressure? What are the impacts on the brain of having pressures that are artificially low. To me it seems that the elderly who may need slightly higher pressures to get blood to their brain may be at risk. It's like their brains are operating like a flat tire.

    Keep posting and thanks for all you are doing for the elderly. People like you are heroic!
    Thank you so much AutumnW and to Ayt who I have mixed into this reply- you are both too kind to me. I have never been described as 'heroic' before and am quite blown away....maybe you should speak to me ex to get a more balanced view?

    autumn w -I am guessing you are prescribed Lyrica or (generic) pregablin? Something like that--- maybe Carbmazapine /gabapentin?? or perhaps an old trycyclic antidepressant? The first three are used for seizure control (licenced) pain (sometimes licenced sometimes not) and mood stabilisation (ditto) depending on what you have. I can explain the concept of product licence to you if you wish? That is another topic.

    The Lyrica 'catch all' medication is pretty commonly used for such symptoms as is gabapentin. The 'gaba's are originally an ant seizure drug which was expanded to other uses -- through the usual...''oh it does that too does it....hmmmm...well why not?'' experiential reality based work. It is a prime example of pharma gone completely ott too ---If anyone wants to look at how big companies ''work their thing'' I would recommend they have a butchers at this.... ref 1.... or this ref 2 ...or this ref 3.

    You get the drift.

    So yes, these things are as they say 'fraut with peril' But I don't know you and I can only give you general advice- you know you (and your hubby ayt) better than anyone, so do what you think/feel is right, having gathered all possible info is my best advice -- I am as likely to be wrong as the next man. If it does help you and clearly it does help some -- then great. Just be careful and be armed with some understanding - because quite often 'we' (medical professionals) base our understanding on faulty info -- my next post will cover this if you can stay with me.
    Are older people over medicated? Yes, generally yes ---- there are reason for this and I will try to get this over later (targeting post 3) but sometimes there is a need which I cant actually argue with - quality of life is the key -- if you are chasing quantity first and find yourself keep having to come back to medics to try and find the quality after that, then you could be disappointed.

    are BP meds overdone - in UK they brought out something called QOF (ref 4) a good idea in conception. In practice it encourages doctors to over use anti hypertensives to hit a target -- often by using one two or three from different groups - Now I am not saying that it doesn't work - but what I do know is that in reality what commonly happens is that every different med has a exponentially lower chance of making a significant difference and an exponentially higher chance of causing unwanted side effects --- that is true.

    So if you have a family history of stroke etc then please take them but also look at lifestyle and particularity salt consumption etc.

    The old adage about the operation being a complete success but the patient died springs to mind .....we are as much like mice in a maze as everyone else we just do not want to admit it

    Do what you think is best but please ask questions -- we should not be harvested by medical/pharmaceutical conglomerates and kept alive just to consume is my more radical thought here --- but that is mine. Everyone else should please themselves.

    thanks fr your support ---truly did not expect anyone to reply.. am amazed. love

    1 https://www.reuters.com/article/us-p...0RA1G120150910

    2 http://drugbaron.com/the-real-scandal-of-drug-pricing/

    3 http://theconversation.com/ambulance...res-why-106163

    4 https://digital.nhs.uk/data-and-info...-framework-qof
    Thanks diteras! Am not on bp meds but did note a few years ago that the info radiating from drug companies suggested we ALL aim for 110/70 rather than the decades long ideal which was 120/80. It was around that time that my mother, in her late seventies had her bp meds increased. I have wondered though, since that time, if they lowered her pressures to the point that she developed ischemia from a lack of blood to her brain. I suppose it is a dilemma as a little too high can break vessels and capillaries.

    I take the lowest recommended dose of prozac for anxiety. If I could exercise more this would be completely unnecessary, but I can't so stress is something I have to watch and medicate. And meditation doesn't work. Anyway...way too much info...sorry!

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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    [/QUOTE]

    Thanks diteras! Am not on bp meds but did note a few years ago that the info radiating from drug companies suggested we ALL aim for 110/70 rather than the decades long ideal which was 120/80. It was around that time that my mother, in her late seventies had her bp meds increased. I have wondered though, since that time, if they lowered her pressures to the point that she developed ischemia from a lack of blood to her brain. I suppose it is a dilemma as a little too high can break vessels and capillaries.

    I take the lowest recommended dose of prozac for anxiety. If I could exercise more this would be completely unnecessary, but I can't so stress is something I have to watch and medicate. And meditation doesn't work. Anyway...way too much info...sorry![/QUOTE]

    Please....do not apologise. You are most certainly not alone. I am sorry your mum has been a worry too . The business of control of hypertension is (in my opinion) just that. I would never suggest for a second that people shouldn't take medication if they have a condition which this may modify, but when drug companies make suggestions, there is a little fire engine which starts doing circuits in my head.
    Now here I have to say that this is my observation - but....who benefits from lowering targets and by implication lowering treatment thresholds? If you take 10% off the lower gateway what does that mean in terms of treatment volume ....?

    My other observation would be - if you are lowering bp with multiple meds and run towards hypotension - or postural hypotension/hypertension the most likely outcome is a fall. If you expose an elderly person (especially if they have a degree of memory impairment) to trauma and a procedure which requires surgery and inhaled anaesthetics,(fractured femur is most common) then there is a pretty decent chance you will press the 'fast forward'on any condition they might be vulnerable to (see ref 1.) There is - what I would loosely term ' a lot of academic obfuscation' about this atm - studies which say ....'more info required' and 'possible multiple issues affecting'....I will stick my neck out here - if there is a vascular problem it will make it worse - and there is another issue.
    The systems (worldwide I guess) are increasingly driven by pathways and standards --- so if you are older and less resilient your recovery time is measured against that of a 35 year old. Anyone see the problem with that? So if you cant make a recovery in around the expected time .....then you block a bed ...if you block a bed then you are a problem.....if you are a problem then someone will have to apply a solution. I would NEVER agree to assess anyone for dementia who had recently had such difficulties. It happens though. You bet. Injustice isn't just a occasional event - its an everyday occurrence.

    Fluoxitine? (prozac) like I said AutumnW - whatever gets you through the night. You are on it and you are informed. I am not sure it would be my first call for anxiety, but I don't know you so that's not a fair judgement. It works fr you and really that's all that matters

    thanks


    ref 1 https://www.neurologyadvisor.com/top...-there-a-link/
    Last edited by diteras; 7th July 2019 at 21:58.

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    United States Avalon Member Dennis Leahy's Avatar
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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    Quote Posted by diteras (here)
    gosh Dennis, thank you - truly ... if I had thought for one minute that so many folks would be so interested I would have tried harder with a 'hook'. I have no idea. You have just asked me the equivalent of the classic interview question ''so ..what do you think you are good at?''

    I am very new to this remarkable forum - I will (classic cop out here) be amenable to any suggestion your experience suggests.

    But once again ---thanks!

    New title for thread.
    OK, how about:
    Independent Nurse Practitioner's straight scoop on medicines
    (or maybe someone will come up with something better)


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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    #2
    My compatriot Richard D Hall who is an independent UK journalist of some conviction, always closes his items with the following statement ‘’remember, believe nothing that you hear and only half of what you see’’
    Now you might not agree with many of his positions - but he does - in my opinion -put them forward with total sincerity. A man who travels the UK in a sparse little van on a shoestring production budget,(when he is working) urinating into a tupperware container, is committed.

    There is a very good point made in his closing mantra. He is right. Many people suspect he is right and a lot of people who share those views here know he is right. How you shift the perception from suspicion to knowing is a journey which has many paths - and can have many restarts - The system is (any system, for I believe they are all the same) a maze with many false ends - which never seems to resolve when you are in it. Closer = more confused.

    Eventually you come to see that everything is connected. Everything.

    When I prescribe medication I am by implication endorsing something. Geopolitical world view of disease and disease as a concept? Probably. The perception of disease and the limitations we impose upon our response to it? Definitely. These issues are not dissimilar to the SSP v white space program or fossil fuel v free energy (same thing) discussion.

    In a nutshell, whether it's deliberate or not, it is obvious that there aint no profit in curing anything - and - in terms of management by fear - again, deliberate or not - a lot to be gained.

    The ways disease is arrived at as a concept is interesting. If anyone wishes to know how ‘new’ diseases are arrived at I suggest they ‘’weaponise their curiosity.’’ as Mr Corbell would say. Articles on the DSM/ICD ‘meetings’ are widespread and all find a route back to pharmaceutical mega corps through associations - but you know this. If you look at the numbers……(see ref 1) it will all make sense…...you can carry some ‘opinions’ with that wonga eh? But these are businesses and the world is a capitalist economy - so really whatydya expect? - ‘’here lies the last altruist -died of loneliness in poverty. ‘’ Ask Tessla...

    This is not meant to be me being yet another little voice dissing ‘big pharma’ - no point.
    Been done better by better men.

    I wanted to give just one practical demonstration of how this is can be easily seen. Even by numpties like me.

    I went to a University where ‘evidenced based practice’ was a biggie in the course. Most people hated this and I thought I would too - but I did not.

    So I do look at recent developments as often as I can - I note some interesting trends.
    1 - generally even quite major developments are not picked up by mainstream media until there is a potential to ‘sex it up’ (or an agenda) ...vaccines, new cancer treatments, drug ‘fails’ (see Lyrica in my opening shot) Sometimes years pass before research is pushed up - maybe on slack news days?

    2 - when these things are made front and centre they are done so in a way which is either ill informed - deliberately or - (being generous) borderline patronising. I say this because most people who have a problem quickly become experts - they know, they are ‘on it’ every day - So stories about (for e.g. trazodone being a cure all for dementia ref 2) are at best based on no real evidence which has practical implications. --- Example from practice ---I do use trazodone to manage low level challenging behaviour in dementia --- bad drug if there is an unknown subdural haematoma (falls are common and unseen falls happen which are not attributed as causal if someone already has dementia -won't ref this but I can) certainly is a sedative (but not always) and certainly is likely to make anyone with a history of falls a higher level of risk. We can also list increased confusion as ‘likely’. So if you have a brain you have to consider and make known the risk v benefit ‘tension’ to all. So in reality where is the benefit?

    I am droning on. (again) ….sorry

    So recently I was confronted by a review of services which was focused on diagnostic rates. This badly written piece of nonsense used the expression ..’’benefit of treatment’’ so many times it was nauseating. Now I am not against treatment. But again from a practical point of view I would have to say that ‘’modest effect’’ is being generous. Why?
    Ok. -We have four drugs licensed to treat Alzheimer's disease. We are told that 6/10 people with dementia will have AD. There is no licenced treatment for Vascular dementia UK and only limited value in using one of the above four in Lewy Bodies disease. There are many many other breeds of dementia but the first two are the ones we see most of. (allegedly says DSM/ICD)

    The drugs- three - donepezil. Galantamine - rivastigmine (put simply) work by blocking the action of the substance which clears acetylcholine from the brain - so if you work on the theory that AD is a deficiency in the regulation of this neurotransmitter then Bob’s your mothers brother. These are called acetylcholinesterase inhibitors. - mild/moderate conditions
    The fourth (memantine- moderate/severe) is a glutamate blocker - it prevents excessive glutamate from damaging cells - in US is also licensed for vascular conditions - why for I know not.


    Problems -
    (my opinion) the premise of 6/10 is wrong. WHO figures would support this at least to some extent.
    In practice - the symptoms associated with AD, especially in the early phase are pretty much identical to those of cerebrovascular disease which (when you think about it from a lifestyle- age-span extended pov) should be much more common.
    So….
    Miss-diagnosis is common in my experience. --- you have treatment fails almost built in because of the paradigm we use.
    And again-
    Does anyone believe that the most complex acknowledged structure on this planet - the human brain - is, when in decay, the victim of one disease process? It might be. The Lord of The Rings might be a documentary too.

    Getting to the end now…
    I look for evidence to try to support ''treatment'' to the extent it is being pushed - I find this ( ref 3) hmmm.... very positive …. I say where did this come from?….Well it came from here…(ref 4) I have linked a summary but have read the full report - this is a meta analysis review - one of the biggest ever done - and well done too (thank you AGS) I will quote their conclusion verbatim... Nb they do find donepezil marginally better than t'others but the effects are small - very small.

    ’An exhaustive review of the literature involving 142 studies demonstrated that cognitive enhancers in general have minimal effects on cognition according to minimal clinically important difference and global ratings. The drugs appear safe, but this must be interpreted cautiously because trial participants may have less co morbidity and fewer adverse effects than those treated with these drugs in clinical practice’’


    So the authors conclude that effects are tiny and risks are possibly greater for real people due to the construct of clinical trials.
    Spin is everywhere.

    There is also a balanced view here (ref 5)

    Game over.

    I could go on and on - and already have said too much. I hope I pitch this right for everyone - happy to give more detail but fear I get too involved.
    This is my brain every day of my life.

    Thanks for reading.

    PS Denis how the heck do I change the title????









    1 https://www.marketresearchreports.co...arket-turnover

    2 https://www.nhs.uk/news/obesity/two-...ight-dementia/

    3 https://psychcentral.com/news/2017/1...on/126844.html

    4 https://www.ncbi.nlm.nih.gov/pubmed/29131306

    5 https://www.cochrane.org/CD001190/DE...eimers-disease
    Last edited by diteras; 11th July 2019 at 11:09.

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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    Thank you for this thread diteras. I’ve been an explorer of alternative ideas about health and wellness for some years and it’s interesting to read your insights, thoughts and views here.

    In your explorations of different ideas about health and wellness, have you come across the work of Ivan Illich?

    Illich was an Austrian-Croatian philosopher-priest, both a conservative and a radical, and he had some remarkable insights on health and criticised what he termed “medicalisation”. The book in which these ideas are covered is Medical Nemesis, later published as Limits to Medicine:

    A copy of the book is here: https://ratical.org/ratville/AoS/MedicalNemesis.pdf

    Here is a brief summary of his ideas:
    Quote In Medical Nemesis, Illich challenged the fundamental premise of medical progress, arguing that institutional medicine is overwhelmingly pathogenic and actively sickening.

    Health, argues Illich, is the capacity to cope with the human reality of death, pain, and sickness. Technology can help, but modern medicine has gone too far launching into a god like battle to eradicate death, pain, and sickness. In doing so, it turns people into consumers or objects, destroying their capacity for health.

    The concept of medicalization is attributed to Ivan Illich, who first wrote on the subject in 1976. He proposed that modern medicine had become detrimental to society, by amongst other things, "launching ... an inhuman attempt to defeat death, pain and sickness".[5] By doing so, he argued, medicine had deprived individuals and societies of their ability to cope with sickness and death.

    According to Illich, "iatrogenesis cannot be understood unless it is seen as the specifically medical manifestation of specific counterproductivitiy." Illich sees three levels of iatrogenesis. Clinical iatrogenesis is the injury done to patients by ineffective, toxic, and unsafe treatments. Social iatrogenesis results from the medicalisation of life. Cultural iatrogenesis is the destruction of traditional ways of dealing with and making sense of death, pain, and sickness.
    From here: http://naturalhealthperspective.com/...an-illich.html

    If you enjoy Illich’s ideas, David Caley has some radio programmes recorded for CBS in Canada on his website: https://www.davidcayley.com/podcasts...ry/Ivan+Illich
    *I have loved the stars too dearly to be fearful of the night*

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    United States Avalon Member Dennis Leahy's Avatar
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    Default Re: Independent Nurse Practitioner's straight scoop on medicines

    Quote Posted by diteras (here)
    ...PS Denis how the heck do I change the title???? ...
    Done. I hope that helps to give this thread the attention it deserves. -Dennis


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