Paleobird's Next Big Adventure page 144

[Pebbles67]

Glad that Dad is out of the hospital and can now begin to recover. Paleobird, we've always known that you are an amazingly strong woman. This experience just proves it yet again.

Betorq I'm speechless. <3

[Paleobird]

woohoo, Betorq.

Indeed.:

Glad he's back home--I hope things improve for him.

Thanks, Owly. He's still weak and he gets confused sometimes but then other times is is perfectly lucid. He thinks having Betorq around is great. Someone to tell all his old stories to who, unlike my sister and myself, hasn't already heard them a thousand times.

Hi PB - I'm so stoked for you that your Dad is home again.

Seroquel is an atypical antipsychotic called Quetiapine. It has a blunting effect on mood, emotion and behaviour, and can be useful for reducing psychosis and maintaining mood stability. It's not commonly used in the elderly - very small doses accomplish a lot. I'd expect that he'd be on a maximum of 25mg, but he might develop a tolerance in which case it might be increased. The key to any increase is to do it slowly.

The side effect profile is mostly focused on the logically expected areas of being less articulate, trouble with balance and dizziness (especially if he gets up from a bed or chair quickly), sleepiness, and feeling kind of dull. In your Dad's case, they'll be using this med especially wanting this 'side' effect, rather than the main effect which is to manage psychosis. It's great that he's responding well to it, since quite a large number of elderly people get more agitated on it. It can also cause nightmares, but usually only in the beginning.

The other big risk is around metabolic syndrome, and this one is so common it's just an expected effect rather than a side effect (drug companies say it's not common, nurses say it's pretty much 100% of people). Weight gain, poor lipid profile, poor blood sugar control, hypertension - the whole range of symptoms with the usual consequences for cardiovascular health. I expect that eating primally will help with the metabolic syndrome, and with a lower dose than young people take, this effect might not be too bad.

Seroquel is metabolised by the liver, so if his liver isn't really healthy he could start to accumulate the dosage in his bloodstream. It's also been noted that the elderly metabolise it up to 50% more slowly than younger people anyway. It has a half-life of about 7 hours in healthy young people.

It seems to me that he's being treated for the troubling behaviour - Seroquel isn't doing anything to sort out the original problem. Not that that's a bad thing, if it enables your Dad to remain at home. If it was me, I'd be watchful for indications that he's feeling flat and disconnected, and use that as a signal to back off the dosage a bit. You want to find that fine line between helping to manage the fear and disorientation of sundowners without also getting rid of any pleasure in being alive. Also, though, it's important to know that some people have had really horrible experiences coming off it - nausea, panic, shakes etc. I'd have a really low threshold for asking for a blood test to check serum drug levels.

Hope this helps - I'm happy to send any sources to you.

Edited to add: Sorry if this seems very negative - I'm writing from the context of you having found a drug that's working for your Dad, which is fantastic. My notes were more to help you manage the ongoing use of it and monitor his wellbeing into the future. If it comes to this with my Mum, I'd want to stay with the medication but understand what its risks are and how to work around them.

Holy Crap! They sent us home on 100mg a night. No wonder my sister practically had to carry him to the bathroom in the middle of the night. We are definitely backing off of that dosage. Thanks for the warning about possible reactions to coming off of it. We will do it gradually. He seems to be settling in and really *knowing* that he is at home now and so I think that is taking care of a lot of the agitation issue already. We will see how 75mg does tonight (They gave 25mg pills and said tot take four.)

Good morning PaleoBird!!! Welcome back! Am so very glad to hear that your dad is back home. Yay!!!!!!!!!!!!!!!!!!!! Like you mentioned, am hoping that being home where things are familiar, where he can get as much uninterrupted sleep as he needs, and you can control what he's eating so much more easily will be just the thing he needs!

Am so glad that Betorq could stop by, what a fabulous thing, and Betorq, what a nice gesture! So very nice of you.

Jac, nicely said! I like informed decisions best, what you've provided will help PaleoBird and who knows how many other countless people searching for that MED on the forums to make the best informed decision she can.

Yep. I'm getting better advice from Jac than from the doctors around here.

I agree Lissee, what great support from both Bertorq and Jac.
PB hugs for you

Thank you, jacmac.

Glad that Dad is out of the hospital and can now begin to recover. Paleobird, we've always known that you are an amazingly strong woman. This experience just proves it yet again.

Betorq I'm speechless. <3

Me too.

[Paleobird]

Well, my sister headed home today which has made the house considerably quieter. She is just one of those people that, everywhere they go, they carry around a cloud of fuss, noise, fluff, and fluster. I'm enjoying the calm and stillness.

Betorq is still here and is being very helpful, making sure that I don't forget to eat and taking the dog for walks around town. (That boy is a gooood cook). I'm getting a little jealous that the Wolf Cub will follow him around so easily, but then a bag of Trader Joe's organic dog treats wins hearts and minds every time.

Dad is still weak but he is determined to exercise and not let himself get flabby. He is walking around the house and yard as much as he can with his walker and sitting on the side of the bed doing leg raises and such.

He still gets very confused and doesn't realize what is going on sometimes. Other times he is perfectly lucid. So he really needs pretty much constant supervision at this point. I may have to hire someone to come in part time soon. Having Betorq here is nice because it allows me to take my time and pick out the right agency and not be rushed into picking someone at random out of the yellow pages.

[badgergirl]

Good news. Excellent on all fronts.

[Goldie]

Robin, my thoughts are with your dad and you every day.

And +++++ a million to Betorq!

[tomi]

Paleobird -- glad to hear things are on the upswing with your dad. And WOW to have Betorq stop by to stay a few days and offer such great help! What a true friend!

[Paleobird]

Good news. Excellent on all fronts.

Yes it is. Thank you. Each day is getting a little better as he gets the hospital drugs cleared out of his system.

Robin, my thoughts are with your dad and you every day.

And +++++ a million to Betorq!

Thanks, Goldie. Betorq is a dear. He makes his own yoghurt, kefir, coconut milk, sauerkraut, kimchi, etc. so there are interesting yummy things fermenting all over my kitchen.

Paleobird -- glad to hear things are on the upswing with your dad. And WOW to have Betorq stop by to stay a few days and offer such great help! What a true friend!

Yep, thing are definitely getting better. Dad is getting to the bathroom and back at night all by himself now. I think there is a certain level of personal dignity involved in being able to go to the bathroom without asking for help.

I have moved in at my Dad's place so I sleep on the pull out sofa in the living room so I can hear if Dad gets up. (Dad's house is 50's modern style with an open floor plan and dividing walls that don't go all the way to the ceiling.) Betorq is kind of house sitting at my place next door. I am still thinking of hiring someone to come in say once or twice a week but, at this point, I feel like I could leave for a couple of hours to go do the grocery shopping without being afraid that anything bad would happen.
This is a big improvement over even a few days ago.

Hey Jac if you're reading this: I took him back to 50 mg of the Seroquel last night with no problem at all after holding at 75 for two nights. I think I'll hold at 50 for another night or so and then back down to 25. The reduced dosage seems to be correlating with improved cognition and alertness in the morning. He still gets more confused as evening arrives (Sundowing) but it doesn't have the angry edge that it did in the hospital now that he is in familiar surroundings.

[Jac]

Hey Jac if you're reading this: I took him back to 50 mg of the Seroquel last night with no problem at all after holding at 75 for two nights. I think I'll hold at 50 for another night or so and then back down to 25. The reduced dosage seems to be correlating with improved cognition and alertness in the morning. He still gets more confused as evening arrives (Sundowing) but it doesn't have the angry edge that it did in the hospital now that he is in familiar surroundings.

That's awesome news! The anger and hitting out seems so logical to me - when people are afraid and confused, most of us will respond that way. Unfortunately it's often pathologised rather than being viewed as a healthy response. Deal with the fear and helplessness, the anger usually goes away. There's often a 'cascade of interventions' happening, meaning that one intervention, usually a drug, will have a consequence that seems to call for another intervention, then another, then another. In the end, all you see are the problems caused by the 'help'. It's always a struggle to find that balance between what's absolutely needed, and the point that tips over into preventable problems. Good on you for working out the balance for your Dad between being calm and safe, and being helpless.

[Sigi]

I'm glad things seem to be looking up, Robin. Give your Dad and Betorq a hug for me. And one for you too!

[sbhikes]

I feel bad that I turned down an invitation to meet betorq in LA. I thought it would be weird to say hey, let's go to LA and meet some guy from the Internet. Maybe if it had been a big party with everybody I would have done it. What do you guys think of the idea of when Mark has his PrimalCon thing in April that a bunch of us descends upon Oxnard on that Saturday and have a picnic on the periphery of his event? It's a public park, after all. At events like that, as much as I like the presenters, it's the meeting and hanging with people that sometimes is even more fun.