I Cured Her
Elderly Vietnamese lady with diabetes, hypertension, new dementia and what her family was certain was depression. She wouldn't eat, was losing weight and was plagued with diarrhea. She'd been hospitalized within the last year for emergency surgery for a small bowel obstruction, so her GI workup was recent and negative.
She spoke no English, so her wonderfully attentive children did all the translating. (No, I don't have access to any other source of translation. Yes, I considered elder abuse-type scenarios and ruled them all out to my satisfaction.) I was very hesitant to treat her for mental issues without being able to communicate with her directly, and even found a relatively nearby Vietnamese FP. The family refused the referral and pleaded with me to treat her.
I went over her med list and recent labs. Noticing that her A1C was 5.7 on metformin only, I figured her diabetes was under pretty good control. Certainly good enough that stopping the metformin for a bit wouldn't be immediately fatal, so that's what I did. At the family's insistence, I also gave her a tiny dose of antidepressant, warning that I thought she'd find the side effects troublesome.
Saw her back the other day: All better.
Appetite back; no more diarrhea; she was even brighter and chattier as she walked into the office unassisted vs. clinging to the son or the daughter's arm, as she had the last few visits. No more "dementia"; no more depression, and yes, they had discontinued the antidepressant after only a few days because of side effects.
I love curing people by stopping meds.
For you diabetes purists, yes, her blood sugars rose from 120's-130's to 200-220, but I gave her a smidgen of glimiprizide (Amaryl 2 mg.) and asked them to keep an eye on her sugars, as well as hypoglycemic precautions. And yes, I know it can cause weight gain. As it is, she's a whopping 109 lbs, and could stand to gain back some of what she's lost over the last few months.
I still get a kick out of paring med lists.