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I will contact our GP today and tell her the results of taking Judy off her gout medicine. Her foot does not seem to be any worse than it was when she was on the medication although just one day is not a good test.
Yesterday and today were the first days she was able to get through breakfast and lunch without falling to sleep in several weeks.
Her UTI symptoms seem to have vanished. It does not mean she does not still have the UTI.
She is able to drink again. I was having a difficult time getting her to get more than an ounce down her at a time because she would spit it up or just would not swallow it. I had added more thickener to her water and that seemed to help a little bit.
Her garment protector had more food on it that I had dropped than what had fallen out of her mouth.
Judy cannot get up by herself but she usually walks OK. She had not been walking well for a month and I had gotten her a wheel chair. I get the wheel chair close and get her up and I let her decide if she wants to walk or use the wheel chair. She has been choosing to walk about half the time.
To get back to the question, I feel it is an obligation of the caretaker to decide if the medication is helping or harming. I went through basically the same thing in the early 80s when a number of doctors had decided 100 units of insulin was appropriate for our 8 year old daughter and 10 year old son. It was a difficult battle then, and it is still difficult now. I can tell I am still tired because I am rambling.
Try to relax or she's going to put you in a home. Seriously, pick your battles and not very many. Reverse psychology will work better with her. She's a brat. You are a Saint:) xo
My mom was diagnosed in 2008 with Alz and has tried every med they would push on her. Last time I had her at the Neurologist I said NO they cause more anxiety and behavioral problems than they help. She was actually hitting me at times, and the bad mouth! She has been living with my husband and I for one year and I was very hopeful that it would be better for all of us to have her here. I tried vitamins and she had already been taken off all of her meds by her family care physician. I think he understood her desire to not prolong he days on this earth. I still do give her a multi vitamin, the b vitamin complex "Cerofolin" the neurologist prescribed and baby aspirin a day as she has a heart valve implant and it keeps her blood thin.She wasn't even taking that when she was in the assisted living. I now keep her clean, she doesn't remember to shower or even brush her teeth. Amazingly she is strong physically and makes her bed every day, helps me fold the clothes, and is generally pleasant....But there are times that do try my patience.
Last night my hubby was out of town with our sons and grandsons camping ... he so needed to get away and so something fun.
I decided we would have a girls night out and take Mom to dinner. We got right in which was good as she is not patient. The first words out of her moth were, "It is so d**** noisy in here. I told her maybe if she took out her hearing aids it would help to curb the noise for her. She didn't like that suggestion.
I explained it was dinner time and lots of people were eating and we would order quickly. She wanted a glass of wine and said for me to order as she like everything. I got some appetizers and a salad to split. I had to tell her that we were still getting a meal so she might want to slow down on the onion rings. She was snotty and said "I know what I want to eat and I am going to eat it."
I explained that she had a meal coming and she said" I am not going to eat anymore, I have already eaten." Her meal was a shrimp plate and rice and veg so was not large but she would not touch it. I told her I was going to eat my meal which I had to do quickly .We boxed hers up and I had to stop at a store to grab something quick so she insisted on staying in the car ...it was 84 degrees out. I said no and she said" Why the H*** not."
I was at the end of my patience at this point so I explained I was responsible for her and it was too hot and if we kept the windows down someone might bother her. She cussed again got out of the car slammed the door really hard. I then said, " No you are getting back in the car for acting like a 3 yr old and are going home to your room where you can spend the rest of the evening " She always says I don't need you to do things for me I can do them for myself...but she can't. I know I lost it and I know it just made her pissier, but I feel like when I try to do nice things for her it never works out anyway. When we got home (even though she does'nt need my help and can do everthing for herself) she wondered what that thing in her room was and why it was blowing and could I turn it off. I explained the air conditioning unit in her room and how I had set it to only come on if it was hotter than 70. She says Ok. 3 minutes later she comes down in 2 pairs of pajamas and asks me again about it. I turned it off this time and opened her windows which she then says "I can do that myself if I want it opened". I ask her if she is worried about the windows being opened (for security reasons), and tell her she is on the second floor and maybe a cooler night breeze would help to cool off the room. At this point her room was about 80 degrees. I know she doesn't get it but she fights me at every turn.I worry about her dehydrating and she drinks very little water and only likes coffee. I left with the windows open and she probably shut them as soon as I left. This after noon I am getting a care person in and going shopping even if it is just for TP laundry soap and a new lipstick hopefully to make me feel better. Thanks for letting me vent. Thankfully my mom is not incontinent for the most part has had a few accidents, where she hides the wet stuff in the closet, but I agree that having the body and no mind is just horrible for everyone!
Jump forward about 8 years. Judy did well (average life expectancy at the time was 4 to 8 years) when she ended up in the hospital. Because of her condition she had to see a neurologist. His first comment, "We both know the medication does no good for her condition.
A little over a year ago she started having urinary tract infections. I would take her in a week after the medications were done, she would test negative, a week later she would start showing symptoms again and I would bring her in for a urine test and another UTI.
I do not have a lot of faith in the medical profession but I do have a good relationship with our GP. Finally I asked her if she thought it would be a good time to maybe see a urologist. Probably the biggest mistake I have made in the past 10 years. He gave Judy a powerful antibiotic, plus a low dose of nitro fer mac, and Judy was having blowout diaarhea, blood in her stools, or else just little hard stools when she went into the bathroom. I was on the phone with the doctor's nurse constantly, and she finally told me the doctor said I should call the GP about the problems.
I talked to the GP and we found another urologist who said she was going to keep Judy on the same meds. 2 or 3 more UTIs and Judy ended up with C-Diff. One of the treating doctors said it was probably caused by nitro fer mac.
She is on her 2nd UTI since April. I took her into the clinic yesterday but they won't know until 48 hours. The nurse wanted to know why the nitro fer mac was eliminated and I told her it was the er doc or the hospital doc because they thought it caused the C-Diff. She suggested I give her one at supper and one at breakfast. I gave her the one at supper. When supper was over at 6:30, I didn't quite get her to the bathroom in time. I get her up at midnight for her thyroid pill and I could smell her as soon as I woke up. Clean up took about an hour and a half and when I went to sit down she was laying in bed crying. One of the results of CBD is the loss of speech. I lay alongside her in bed for a half hour and finally asked if she needn't to use the bathroom again. She can blink her eyes for a positive answer and when we got in the bathroom it was clean up 3 time. I finally got back to bed about 4 and an hour of channel surfing before I went back to sleep.
I woke up at 7:30 and was hoping the smell was an old smell. So clean-up 4 started. I had just put a gown on her and I was wishing it had wider shoulders so I could just pull it down over her body. Finally I put a couple paper towels over her head to keep the junk out of her hair, got her up and into the bathroom again.
This am I decided no more nitro fer mac and eliminated 2 other medications she is on for gout.
I was just going to send a nasty email to the urologist telling her what I did and if she did not want to work with our GP, I will just go back to letting the GP take care of the problem every month.
I think the nurse you spoke with about your husbands catheter and severe pain need a little further education.
Just because the catheter is in place and draining nice clear urine all is not necesarily OK. Patients with indwelling catheters often have severe bladder spasms which are excruciating. Vicoden can help but what your really need is something to stop the spasms so in this situation a call to your Dr or his on call service describing the problem ans suggesting bladder spasms will give them the picture and if you have an all night pharmacy they can call in the medication and everyone can sleep peacefully.
As you mentioned vicoden are his bowells being managed as it is very constipating. Anyone on this class of medication should recieve a stool softener every evening unless contraindicated and more agressive laxative and/or enemas if indicated. Severe constipation can also be very painful. Proper diet and fluid intake are also important. See if one of the nurses at your local hospice would be willing to talk to you about this kind of situation and others you may encounter on your very difficult journey. They are trained to anticipate these kinds to problems
That is very distressing, for Hospice to be so badly operated, that they mistakenly told you he was soon to die. But that unfortunately can happen...though usually not so badly as that.
Mom's last DH had a bad health episode that had ALL the medical professionals swearing he was gonna die the last weekend of September...heart bad, etc.
They SWORE he was about to die, imminently--that very weekend.
He didn't.
He went to a relative's house with Mom, was signed up for Hospice, everyone knowing he was a goner.
Mom wanted him moved 2 States away--said she couldn't bear to stay where they were, and felt he'd have the best chance to survive if they moved in with us....THAT was a huge mistake, to bring them to our place, but I was trying to honor their wishes, as well as a promise made years earlier.....never thinking things could go worse.
HE lived 3 more months, with help of Hospice and our ministrations.
Mom stayed 6 years, while escalating her worst beaviors terribly, until arrangements happened to get her moved to another relative's.
We're still cleaning up Mom's messes 2 years later.
We continued to get billed for services rendered for HIM,over 1 year after he died--as if we were responsible parties--including threatened by bill collectors trying to get money from us [not blood relatives even].
ALL those agencies that swear they never sell contact/mailing lists, DO sell them we kept getting mailings from companies, non-profits and others, who'd gotten his contact info from those agencies--even the BoyScouts kept soliciting donations from the dead guy for over a year, despite my contacting them to get off their list, and, telling them he'd died, demented and impoverished as he'd lived.
The Hospice people were -generally- helpful,
However, it was pretty clear those who assess conditions, fail to adequately assess conditions and needs, unless a family advocate intervenes firmly.
Some workers sent to do home care are in such bad condition themselves, they should be on disability, certainly cannot adequately care for frail elders--I sent one of them home and just did her job myself--she moved as if she had a broken back. THEN I learned that welfare offices often force welfare recipients to work as home healthcare workers, to get off welfare--never mind they are incompetent to do so.
Home nursing agencies too often fail to adequately assess a person's true conditions. And/or, they recommend tests, labs, procedures, medications, etc. that a person in Hospice, dying, really does not need.
Sometimes it's really hard to figure if they would actually help quality of life, or, just prolong misery.
Pain meds can be a hard issue, as too many Docs still have a hard time balancing pain control meds; and, fears of addicting a person who is genuinely in Hospice dying, is ridiculous.
It's tough, no matter what, whether one is signed up for Hospice, or gets badly assessed in an acute hospital. Anyone in the medical care systems, needs good Advocates helping guide their best care.
We all need to be raising our own Advocates--those u=of us doing all the caregiving, ARE advocates--who will be ours?
It is so sad that your FIL got badly assessed. It sounds like there may also have been some medication errors as well.
How did who discover he was not really dying? Was it only because he lasted longer than 6 weeks? Other?
Not all persons in Hospice are on narcotics, or, the bulk of the pain relief comes from using Anti-inflammatory meds that are not narcotic, allowing them to "have a life" while they can.
Please keep us posted how he is doing.
Food and water are comforts.
Pain meds are comforts.
It is a wide variety of things people can pick from, to have, or not.
Choices.
It is very hard to tell what is going on with someone who is non-verbal...there might be cues, or might not be. Sometimes we just have to watch their behaviors, in context of what else is going on--like a catheter--which is a likely place for infection.
As it turns out, my husband did have a UTI and the folley cathetor was not correctly installed so it was causing him lots of pain. So hard to know what is really happening when they can't tell you. I try not to overact but if the pain keeps up, I know something is terribly wrong. Thank you for for your response. I learn from all of you and only hope I can be of help to others. When you can no longer communicate with a dementia patient, the next best thing is to pay attention to the symptoms.
Stuff like this, is what makes Advance Directives and POA documentation so important!
And even if you have these, some medical and nursing staff have a very hard time relinquishing control over whether an elder gets or stops medications keeping them alive.
Hospice is most appropriate if the person has conditions that will most likely cause their death in 6 months--
Do you or her Doc think that would that happen by withholding those 2 medications?
It is possible, too, to get an extension of hospice classification, under certain circumstances.
There may be classifications that allow hospice-like classification, to allow withholding meds like that, for some of the end-stage dementias or other medical conditions that will result in a person's death, but which last longer than the usual 6-months limit for Hospice.
Ask the Social Worker at the facility she's in, what classifications exist where you are, that might allow "comfort measures only"--then be prepared to have to put your foot down to say what those are for your family--food? water? Oxygen?, pain meds only? etc.
It is up to the family member[s] who have legal authorization over a sick person's care, how this get handled.
Otherwise, a Doctor is mandated to keep providing standard care, to avoid being accused of "patient abandonment" and other terrible charges.
It all needs to be in writing, Legal, authorized by whoever is legally allowed to speak for the patient.
There is nothing inhumane or crazy about stopping meds that extend a life that has lost all quality, which the person living it would never have wanted for themselves when they had their brain intact.
But proper policy and procedure must be followed, to avoid anyone thinking there was anything done wrong.
In working for an in-patient hospice, one of the strongest persons I knew, was a patient who consciously chose to let life go.
There was no quality left to her life. All her systems had been failing for some time, related to many chronic ills.
She couldn't take it anymore; there were no treatments or meds to fix anything, and meds only sustained the total misery she was existing in.
Her Doc, her family, the Hospice, her extended family, all supported her choices.
She was admitted to Hospice, supposed to get pain meds and basic comfort measures--she got to choose some on that--she chose no food, no water or other fluids--only rinse mouth.
She wanted to be turned.
She had a choice of pain meds, which could be adjusted as needed.
Very quickly though, I learned even some nursing staff had issues surrounding this, as did any on-call Docs not familiar with Hospice.
Nursing staff routinely charted "comatose", never administering pain meds.
On-call Docs feared addiction to narcotic pain meds, so refused to change the prescription--nursing staff who cared enough to get pain meds going right, had to work around those Docs until her Doc was available.
Each day I came to check on her, she lay in bed, eyes closed, not moving--it hurt too much to cry or respond.
But she DID respond to my requesting she squeeze my hand if she needed pain meds....which I charted and gave, and passed that information on to next shift....as if they would follow up on that...they didn't.
Only one other nurse over that entire time, followed up on that information.
It took her 2 weeks to die in that situation.
During the time she was supposedly "comatose", about 10 days into it, I answered the phone at bedside from one of her relatives back East, who spoke loving words in her ear, and to which the patient DID try to respond verbally, though it only came out as soft sounds. I had to listen in, to know when to hang up the phone. The call lasted several minutes.
The patient tried to respond verbally several times.
All of us were crying--the caller, the patient and me, by the time it was done.
The fallout from charting all that?
The director of nursing of the unit, mandated that I better re-chart my notes, to make sure the hospital didn't look questionable--I had to make the notes more generic, and less apt to cause a lawsuit, she said.
She was not worried the patient got improper care, only how it made the hospital look.
The take-aways of that:
==Hospice makes a Big difference--it can be very helpful.
==Each patient is an individual, with their own twists on similar diagnoses--so care for one does not always equal care for all with same.
==Even demented people pretty far gone, have some shreds of awareness left, and often try to act on them, even if clumsily--if you know the person and their history, you can better figure out what they are trying to communicate or do..
==The staff in the hospice makes a difference--hopefully, they are trained for it.
==Patients still need strong advocates to keep care properly administered, whatever that care is.
I hope things work out more smoothly for you and your Mom.
an antidepressant and a pain pill. We also have her on hospice but I imagine she will live longer than 6 months. I would think a discussion with her physician that you want a palliative approach would be appropriate.
The moral of those stories is just 1. YMMV and 2. Side effects can suck big time...but so can the diseases the meds are trying to help with; refer to #1.
Mom no longer knows me, where she is, nothing.....but yet she is as strong as an ox. Not one health problem does the woman have other then dementia. We stopped the aricept because it was no longer working. My mother's only meds are for anxiety. I would not allow meds at this stage even if she were to be diagnosed with something.
I'm not saying that it was all about money, but the timing of the nursing home staff being suddenly agreeable to removing the meds was pretty interesting. We're glad our relative is now at peace.
Is it possible to get home medical care from a visiting nurse or Physician's Assistant (PA)? Kaiser "prescribed" home nursing/physician's Assistant visits for dementia patient because they determined that the dementia made him "homebound" when it came to going to the Dr., (it was a bit of a fudge, since he could walk a mile if he wanted), but what was relevant was that he was mentally incapable of going to the Dr.s office due to his disease. It did make it MUCH easier to get medical care for him.