Our Primary Care Physician is a lovely young woman, fairly early in her career and, I feel, quite on top of every day medicine but, on the flip side, while very sympathetic, I don’t feel she is all that skilled and/or knowledgeable about AZ/Dementia.
I asked for and received a referral to a Gerontologist. We went to the appointment however, both our Son and I did not feel comfortable with this person and observation of my husband, during the appointment, indicated some discomfort. I think he not only upset but also confused my husband – just by his (the doctors’) demeanor, briskness and hurry-up attitude.
Reading several postings on this forum I am now wondering if I would be better off requesting referral to a Neurologist. While a Gerontologist is one who specializes in medicine for the elderly and some even tend to have a tendency to lean towards Alzheimer/Dementia care I’m really asking if a Neurologist would be a better choice for an all ‘round care provider for my husband.
THANKS for your input …. I have an appointment with our PCP tomorrow afternoon to discuss this with her so would appreciate some suggestions..
I think it may depend on "where" your husband is on the AZ path. Mine is probably mid-stage and is taking Aricept & Namenda. Neurologist just asks "How are you"? Of course my hb always says "fine." Doc wants to talk about leg pain my hb has had for years as a result of a botched heart cath. Doesn't seem interested in his dementia. At the moment I don't plan to go back because there's really nothing to be done further--now. We're coasting for now. Reading all you can about AZ, reading this blog helps deal w/issues and problems that come up. However, there is a discussion re leaving the neurologist that also gives a different perspecitive; so I'll leave it for others who receive value from the neurologist where they are. Sorry for the babbling.
My DH sees a geriatric psychiatrist who manages all his "mood meds". DH also has some psychiatric stuff from before the AD, so we would have continued with that route anyway, but we moved and were establishing with new drs., and this one was recommended by the new neurologist we had seen. Added bonus is that he is on the staff of local psychiatric unit. DH has had 3 admissions in the last year and he could consult/share records and this has been helpful. Since the mood/behavior meds are his specialty, he is best for us in adjusting/combining meds.
The psychiatrist has also suggested going with a group geriatric practice instead of the PCP we are currently seeing. He feels they would be better for the main issues DH has (dementia, diabetes 2), since family/general practice has experience in a lot of "kid stuff" that is not applicable to DH. Haven't checked it out yet.
When I first started noticing symptoms of my husband, I had him see his PCP. She is an internist and she did tell me that she felt he had some type of early onset dementia (turned out to be FTD) and did not have the expertise to fully diagnosis. She had us see a neurologist. On our first visit I wasn't sure about the neuro as my husband was very scared and I thought he was a bit arrogant. As time as gone by I have found the neuro to be quite easy to talk to and my husband says he likes him too. Personally I feel that if the doctor gets along well with you and your husband, it makes it a little easier. The neuro sends all test results to his PCP so she is kept up to date. My husband sees his PCP for cholesterol and any illness but the neuro handles all of the meds and testing related to the FTD. He also sees a psychiatrist to regulate his anti-depressants.
My impression from reading here is that it's all over the map, and very much dependent on the individual physician. You might try getting a referral from the ALZ association locally as to who they deal with. They encouraged me to go to the neurologist we currently go to, and our PCP, who is sympathetic but it's not his speciality, said go ahead. But a lot of neurologists are interested in epilepsy, parkinson's - but not dementia. You might google anyone you have heard of; a lot of time their specialities are indicated..
I am in a dilemma here also. I asked our pcp to take over dh and he has been doing so. All the Neuro does is ask him how he is, glance at his chart, ask if we need any prescriptions and that's it. Last time as he exited the room dh commented to me "pill pusher". That about sums it up. I think I am cancelling upcoming apointment and tell them I will reschedule later and make an apointment with the Dementia Specialist at WVU. once a year along with our pcp.
My DH sees a neurologist in a group who specialized in memory disorders. Everyone there is exceedingly nice and available for consults and questions. The doctor spends as much time with us as we want and there is a social worker available as wanted. DH's PCP never noticed anything and my PCP will soon become his as well. (Insurance issues mostly.) Boy, I guess I am lucky because I feel that we are in very capable, warm and caring hands!!!!
Our Neuro-Psych Dr. is with the Alzheimer and Memory Disorder Clinic . He handles all the Psych and mood meds. Our PCP handles the enlarge prostate issue, the pain med, the plavix and lovastatin, and Potassium--and any eneral injury /illness issues. Both coordinate and both are approaching his care on an event driven basis. We are lucky.
THANKS everyone for so generously sharing your various situations. All of a sudden, reading your various postings, it struck me that I may be totally missing the boat here in my own area so using that trusty search engine *google* I've been able to find an Alzheimers Disease and Related Disorders Clinic right here under my nose ! I'm going to ask our PCP for a referral tomorrow ...... there is, from what I read on line, about a 6 month waiting list but, as I've been on this journey for 5+ years already, another 6 months isn't going to hurt anything.
Bar-bra, I don't think the specialty is what matters, it's the individual doctor, his level of experience with dementia, and his level of comfort working with them.
In my experience, it takes forever to get an appointment with a neurologist. So while I think a highly qualified neuro is an important part of the team, I would not have one as the PCP.
Also, as briegull says, neuro's specialize, so you need to check into what type of work they prefer. My husband's first neuro specialized in migraines ... which might be great for migraine patients, but didn't do much for my husband.
Geriatrician would be my first choice for PCP an older patient. There are sooooooo many other things that can and will go wrong, besides the dementia. And, typically, they like working with older people and are more patient and compassionate (but not always!!!) But this is a fairly new specialty, and it can be hard to find one, especially if your husband isn't in a nursing home. (Many of them limit their practices to nursing home patients.) So if you can't find one of those you like, my next choice would be Internal Medicine.
The university here has a top-notch medical center / hospital, and also a top-notch AD research center. My husband's new PCP is a geriatrician associated with both, and he also has a new neuro associated with both. Both are great.
BUT !!! we have run into a couple of jerks working at the research center. So you still have to find the right person there. Even though that's their specialty, that doesn't mean they like AD patients or know how to deal with them. (I had to "deal" with one of them! He upset my husband dreadfully. So he is now on the list of researchers who are not to come anywhere close to my husband.)
Note: when we see the doctors for medical care, it is NOT actually through the AD research center. They have private practices. We also participate in studies through the research center -- scheduling those sessions can take a while.
our geriatrician is marvelous...she's very kind and courteous and gentle, quite familiar with dementia, also very realistic about how much care (and which care) really makes sense.
i agree with sunshyne - it depends so much on the individual doctor...we've been to a geriatric internist that is just a rubber-stamp for whatever the ALF wants. doesn't even look at the current meds before writing another script. worthless and dangerous....