My Mother and her family need to know whats going on with her. I’ll try to keep this short. Since July of this year for four months, she’s had a pacemaker put in, colonoscopy, endoscopy, and a CT scan of the abdomen. Her hemoglobin was low, while her kidney level was high (Aurora Kidney Failure). Both of those are now where they should be for an 81-year-old woman. Now her primary found out her thyroid is underactive.

Taking the following medication…
Acetaminophen (Tylenol) 325 mg
ALPRAZolam or Clorazepate (Anxiety) 0.5 mg
Bayer Aspirin (replace Coumadin) 81mg Daily
BuPROPion (Depression) 150 mg Once A Day
Darbepoetin alfa (Anemia Caused by Kidney Failure) 60 mcg (Injection)
Docusate or (Colace - Stool Softener) 100 mg Twice Daily
Levothyroxine (Thyroid) 50mg
Metoclopramide (Gastroesophageal reflux disease (GERD)) 5mg
Metoprolol (Blood Pressure) 25 mg. Twice Daily
Omeprazole / Prilosec (Stomach Ulcers) Twice Day
Pantoprazole (Acid Reflux) 40mg Daily
Rosuvastatin or (Crestor / Cholesterol) 10 mg

What she’s suffering with on a daily base is she’s tired, pain in her lower back, an upset stomach - feels like vomiting (sometimes she does), lightheaded and a sometimes a pain sensation back of her neck.

Her primary says the meds will make her feel like that, but she thinks something is going on and it’s being overlooked. Can you help her and suggest what else may be going on?

Medical History…
1. Aneurysm (AAA) 3.5cm/New MRI - Diagnose Approx 2000
NOT found in 2011
2. Diverticulosis
3. I.B.S.
4. Acid Reflux
5. Osteoporosis: Degenerative Disease & Scoliosis
6. Hiatal Hernia
7. Atrial Fibrillation - AFIB - Nov 2011
8. High Blood Pressure

Thank you for your time.
Scott (son)

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Blannie, good advice on a plant based diet. Our American diets have become so poor, so artificial and so compromised by unhealthy additives.

Veronica, I'm not sure what "off label" means. So I Googled it. Apparently Metoprolol is not recommended for A-fib, and is used in an FDA "unapproved use." So this would mean that Metoprolol isn't considered as an A-Fib med first. I noticed that the medical personnel immediately assume Dad has high blood pressure and is taking the Toprol XL for that. He's NEVER had hypertension.

He's been taking this for years, after his cardiologist switched from Amiodarone (but only after we learned that it could cause loss of smell and taste, which it did.)

The current cardiologist, who I like and respect, said that Dad should be on at least some level of Beta-blocker, and Toprol XL meets that need.
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GA The use of Metropolol for A Fib is an "off label" use

I was skeptical about Coumadin causing pericarditis but some people seem to think it does. Most Drs can't identify the cause but think it may be caused by a virus.

Along with all the other comments i would urge Scott and his family to do some serious research on each medication the mother is taking. They can make notes and be better informed with questions to ask her Drs.
I may have said this before but all the symptoms mum is experiencing can be side effects of the Metropolol. I also take Amiodarone which has many of the same side effects plus some that are even worse like hypothyroidism and severe shaking (shake too much to carry a cup of coffee)
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No disrespect to pharmacists, most of whom are fine and conscientious professionals, but it is their primary role to sell medicines. Pharmacologists, by contrast, study them - so it's a consulting or clinical pharmacologist you want on board.
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I would suggest three things. First, as others have suggested, a review of your mom's meds by a pharmacist. They can look for problems with interactions between the large number of meds your mom is on. Secondly, I'd immediately stop the cholesterol meds. I stopped them for both my mom and dad and my dad lived to 92 and mom lived to 97.5 years, both in pretty good shape to the end. My mom's only major issue was a lack of short-term memory, which I believe could have been caused by the Lipitor she was on for years. Thirdly, and most importantly, I would bet your mom is on the SAD diet (or Standard America Diet). That kind of lifestyle can cause or contribute to all of your mom's gastrointestinal issues. If she would be willing to start eating a whole foods, plant-based (NO animal products), and even no oil diet, she'd see her kidney function improve (kidney issues can come from too much protein from eating SAD), her IBS lessen or go away entirely, and her GERD disappear or reduce significantly. For the latest in evidence-based nutritional info about the healthiest way to eat, please search on nutritionfactsdotorg for each of her conditions to see the scientific evidence for what I'm saying. Good luck. You sound like a very caring son and your mom is lucky to have you as an advocate.
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Veronica and Shane are on the right track. I will comment on 2 items . Metroprolol will cause orthostatic dizziness when quickly standing upright. She is off of Coumadin presumably because of the fall risk. It was originally there for the A fib and now she needs aspirin. Either way she is at very high risk for a stroke. Your family needs to consider palliative or hospice and plan to treat symptoms rather than seek a cure
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IMO way too much going on with your mother for me to speculate.

Pericarditis can be caused by acute renal failure as well, which could also explain her fatigue & poor appetite. Back pain could be from the AAA if it ruptures. This is unlikely; although I cannot diagnose her. 

A good idea would be to have a pharmacist review her medications for sure as stated above. 

Anything else is pure conjecture on my part.

Do you not have a good relationship with her doctors and feel they wouldn’t give you time to explain all this? Your mother is very sick. We don’t know her lab work, 

Good luck to you! 
Helpful Answer (4)

Hi Scotty13,
I'm sorry your Mom is uncomfortable and for all her health problems.
I know nothing about the kidney failure injection and cholesterol med, but I can tell you, I have IBS, Afib, and have had bad acid reflux myself and this is what I've tried:
(my meds are metoprolol, baby aspirin, sometimes Florajen3 and I've tried Prilosec, Bupropion and Alprazolam)
The problems they cause... metoprolol - a LOT of gas and bloating if Not taken with a full slice of bread, a pile of corn chips or a full meal. I do not lay down until After an hour of taking it. Aspirin, same, take with food! Prilosec really slowed bowel movement down way too much and constipated me thus creating discomfort, so I didn't stay on it long. Buproprion, also caused a LOT of gas. I was on it for a while and then it made my heart race way too much and raised my blood pressure. I am unable to take it again because of Afib. Alprazolam, same with the gas, upset stomach. This also caused burning in my feet and weird nerve pains, made Afib WORSE, and caused insomnia (and other withdrawal symptoms) on a tiny dose once a day - and over time that was just 2 or 3 days in a row once every 60 days or so. I gave it up.
Some of these drugs were just Great when I first started them and then I was Very Sorry to be on them because pretty soon the side effects appeared!
IBS causes my bowels to move in rounds like labor pains and on bad days I can be in the bathroom every 20 minutes for 5 or 6 hours - it is exhausting and dehydrating and only stops with Immodium. So, I eliminated most foods that cause gas, certain insoluble fiber products, and you can probably find a list online for those. I also have lactose intolerance, so I just don't even try to use Lactaide anymore. I can have yogurt and lactaide ice cream though.
If things get really bad with the IBS, I get Florajen3 (Walmart has it behind the pharmacy counter in a refrigerator and will hand it to you if you ask for it by name - no prescription). This is a strong probiotic my friend recommended to me because she was using it on chemo. It also causes some stomach upset but if I take it for 3 days, it seems to straighten things out again.
Your Mom has high blood pressure and afib, so the metoprolol is important. I have normally low bp, so it has been hard to live with and I'm on a pretty small dose, but it is most often the cause of my IBS - from messing up and taking it without enough food. The doc says it is not enough of a dose to be therapeutic for afib, but it took away "most" symptoms of chest pain and controls my heart rate.
I've read a lot of stuff trying to solve my problems. I had acid reflux so bad once after an antibiotic that I put the head of my bed up on blocks. That didn't work so well (I just kept sliding down!) Then I read if you have reflux, Lay on Your Left Side because of how the esophagus is arranged. Somehow the acid can't go back up that way. And that really works! So I trained myself to lay on my left side.
The problem with that is that is one of the most stressful sleep positions for Afib (I read this too, and it is true, stomach and left side, I have a lot more palpitations). You're supposed to lay on your back or Right Side for Afib. ; ) I make a choice every night, depending on how I feel. I also slept in a recliner chair for a while just to keep the acid down. Acid Reflux is a miserable thing to deal with!
One more thing... when I first got diagnosed with IBS, I was put on Fibercon and a tiny dose of Doxepin (antidepressant). 25 mg, I think. I couldn't believe it, but that really calmed down the whole system and the doctor told me it's because Doxepin acts on the nerves in the digestive system. It was also very sedative even though it was a tiny dose, so it helped with insomnia - but I think research on it shows a problem with it causing heart problems on larger doses for depression. You might ask whoever prescribed the Bupropion and Alprazolam if they would consider trying some different antidepressants/anti anxiety meds. I stopped the fibercon because I was choking on it trying to swallow that big pill. It's a choking hazard & can expand in your throat and you can't get it down. That scared me.
My mom is also on a lot of meds and I would like her to go to a geriatric doctor or someone to oversee ALL of it together, but I probably won't get support or cooperation for that. Good luck to you!
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Metoprolol is also used for A-Fib.
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My aunt takes a few of these meds. So I'm familiar with some of the side affects. Metoprolol causes the pulse to go down. I noticed my aunts pulse was in the 40s so I bought an oximeter and started recording it. She now only takes it when her pulse is 60 or over BUT with a pacemaker I'm not sure how that would work. Most (pacemakers ) are set to keep the heart at least at 60. (she takes two other BP meds as well)
The thyroid meds can do a real number. The thyroid is extremely important. My aunt was skipping hers so her STUPID primary upped her dosage from 80mcg to100! When she did take it she became constipated (didn't know she was) she wouldn't get out of bed, throwing up, not eating, not losing weight. BP going up. Temp going up. When her aid said her breath smelled like poop I took her to the ER. Her BP was so high they thought she was having a stroke. Turned out she was severely constipated. Dr mentioned she had too much thyroid on board. Next day after an enema symptoms started all over again. Took her to the medical center top hospital ER 2 hours away. Same thing too much thyroid. Still constipated. They requested that I take her to a gastroenterologist. I made her an appt with top guy at the med center. He looked at her blood work and tests Results I had with me. Poked around a bit said take her off the colace. Put her on polycarbonate glycol 350 (miralax) daily and the most important thing he said..., take her to a geriatric primary. Which I did all that he said. I then took her to the geriatric primary. They reduced the thyroid to .075 mcg from the 100 and made sure she took it 20 to 30 min before coffee with at least 4 oz of water.
I also started my aunt on probiotics daily. She feels fantastic at 91. I recommend that you start looking for a geriatric primary to manage her meds and look for a top gastro and cardio. 
It's worth it. Also I would recommend you read 'Being Mortal' by Atul Gawande. 
Helpful Answer (2)

Hi Scott, Mum has a significant disease burden, more than we can begin to advise on this forum.
I will focus on some of the medications.
Metropolol can have side effects that meet all her complaints.
Aspirin may help prevent blood clots and heart attacks and strokes but can also be very irritating to the gut and cause bleeding. There are newer medications to replace warfarin but they are incredibly expensive whereas coumadin and aspirin are very cheap.
Does she also have osteo arthritis in addition to the scoliosis and osteoporosis?
Tylenol is usually but don't know if this is the case with kidney failure
Does she really need to be taking something for cholesterol?
I would also question the need for two proton pump inhibitors.
Given the disease burden your Mom is carrying I think the most important question to ask her Drs is what her prognosis is. I think the family needs to think about Mom's end of life care and focus on comfort rather than curative treatments. Kidney failure in itself is something that leads to death sooner or later. I don't expect this is what you wanted to hear but from what you have written this is the conclusion I see and should be presented to her MDs probably not in her presence. She will work it out for help eventually so giving her bad news will only add to her burden
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What a mess.

Just off the top of my head, and claiming no pharmacological expertise but having come across them before, these two for example:

Omeprazole / Prilosec (Stomach Ulcers) Twice Day
Pantoprazole (Acid Reflux) 40mg Daily

are both proton pump inhibitors, which work in exactly the same way, and if you look them up you will immediately see that they are, I quote: "not normally taken together."

I wonder how many of the other meds that applies to?

All I can say is, if it were my mother I would want to put that whole px in front of a pharmacologist and ask for comments. Then take the comments back to the primary and ask for a review with a strong focus on quality of life.

Poor woman. She must rattle.
Helpful Answer (4)

Prilosec is an acid reflux medication. I see she receives Metoclopramide for Gerd which is a acid reflux problem. Maybe one of the meds can be cut out. Your Mom has a lot wrong with her that could cause pain.
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Hiatal Hernia will cause pain too. My Dad had a wedge under his pillow when laying down to keep him elavated. More pain when laying flat.
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If shes got significant scoliosis and osteoporosis, would that explain her neck and back pain. And shes got significant stomach issues. Are those being treated?

Is the anxiety med only when shes feeling anxious? Or is the geripsych prescribing it to be taken regularly so as to get ahead of the anxiety?
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You can also take all of the meds to a pharmacist to assess possible interactions and what the best schedule is for taking them. I too have hypothyroidism. The doctors must start you out on a low dose of medicine and test in 3 months. Dose is often changed at that point. Being tired is a symptom of that disease. But many people don't know how important it is to take that medicine on its own, on an empty stomach and then not eat for an hour! I had to fight the nurse in my Mom's memory care facility to get that med administered properly. And things like grapefruit make many medicines useless.
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Diverticulosis, IBS and Acid reflux could all contribute to her stomach problems. With the colonoscopy I guess they found that her Diverticulosis has gotten worse that she needs an operation.IBS will cause pain if they are feeding her foods thay irratate it.  My daughter can't eat eggs or drink milk.  Spagetti sauce can do a job too.  I would check the aspirin.  My mother was sensitive to it and it made her sick to her stomach.  Coumodin causes internal bleeding.  
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Scott, this is an incredibly complex situation, with a LOT of meds. What did the doctors say? They're really the only ones who have access to the records, especially the tests and bloodwork, and can give you a precise answer.

Your mother's had a lot of medical work in the last 4 months. That alone could wear her down, especially the anxiety preceding the tests, and the nature of the tests themselves (endoscopy and colonoscopy), which are uncomfortable to say the least.

Is the PCP doctor coordinating the care, or do you have specialists for the cardiac and other issues?

I feel badly for your mother; she must be so uncomfortable, but I really do think you or others in your family need to have a sit down discussion with some of the doctors. Was anyone from the family present during these various procedures and tests?
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