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Old 11-01-2015, 01:39 PM
 
Location: St Clair Shores, Michigan
200 posts, read 200,673 times
Reputation: 369

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~8 years ago my FIL (now nearly 75) had a double bypass and valve replacement. He physically recovered, but never did mentally recover. He had always been prone to depression, but it became much worse over the years since his surgery. He was, several years ago, diagnosed with severe depression and OCD. Numerous antidepressants were tried, none offering much improvement. Over the years since his diagnosis, he's been going monthly to a psychiatrist. This doctor has done nothing more than write a monthly prescription for Xanax (.5mg, up to 4 pills a day, which he takes his full dose, daily).

Since he was started on the Xanax, things have gone completely downhill. He won't leave the house (aside from his monthly appointment to this doctor), he hasn't bathed in 2 months, he falls daily (often multiple times a day) and is unable to get up without assistance, he can barely walk (although refuses to use a walker or cane), and has no memory to speak of. He sleeps 18-20 hours of each day.

My mother in law (who has always shown big time symptoms of ADHD but has never been diagnosed - their child, my husband, was diagnosed as a child) attempted to speak to the doctor once to tell him what is happening, however, the doctors only response to her concerns that my FIL wasn't telling him the true picture of what was going on was that he felt my FIL was telling it as "he saw it." No concern was shown to the falling or absolute lack of quality of life he now has since he was put on this drug.

My MIL is at her wits end, as she has always been more active and now cannot leave the house for more than groceries, since the chances that my FIL has fallen and needs assistance are high. She has a bad back, which obviously isn't being helped any by this situation. While I don't know their exact financial situation, she has indicated they must dip into savings every month and there is no money for sending him anywhere/getting someone to help, even if he would agree to such a thing, which would be unlikely.

The whole drug situation is sending off red flags to me. I'm concerned about that dosage, being given to an elderly person who is clearly NOT being helped by this at all, and him not ensuring he sees a geriatric psychiatrist or someone who clearly has more experience than simply writing scripts and collecting a monthly cash payment.

I have experience caregiving with my grandparents and own parents (and just got back from helping my mother after her double mastectomy), but, I have no experience with the elderly and non-Alzheimer's psychiatric issues. Should I report this doctor? I read the riot act to my grandfather on the walker issue when I lived with them, which prompted him to comply, but I feel uneasy doing it for my FIL, especially given his lack of mental health. Obviously, however, something has to change.

What would you guys do in this situation?
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Old 11-01-2015, 01:48 PM
 
6,319 posts, read 5,687,533 times
Reputation: 11932
They both should be in an assisted living facility.

4 Xanax is a LOT.
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Old 11-01-2015, 02:10 PM
 
Location: Wonderland
44,378 posts, read 35,877,934 times
Reputation: 62734
Quote:
Originally Posted by ultraviolet View Post
~8 years ago my FIL (now nearly 75) had a double bypass and valve replacement. He physically recovered, but never did mentally recover. He had always been prone to depression, but it became much worse over the years since his surgery. He was, several years ago, diagnosed with severe depression and OCD. Numerous antidepressants were tried, none offering much improvement. Over the years since his diagnosis, he's been going monthly to a psychiatrist. This doctor has done nothing more than write a monthly prescription for Xanax (.5mg, up to 4 pills a day, which he takes his full dose, daily).

Since he was started on the Xanax, things have gone completely downhill. He won't leave the house (aside from his monthly appointment to this doctor), he hasn't bathed in 2 months, he falls daily (often multiple times a day) and is unable to get up without assistance, he can barely walk (although refuses to use a walker or cane), and has no memory to speak of. He sleeps 18-20 hours of each day.

My mother in law (who has always shown big time symptoms of ADHD but has never been diagnosed - their child, my husband, was diagnosed as a child) attempted to speak to the doctor once to tell him what is happening, however, the doctors only response to her concerns that my FIL wasn't telling him the true picture of what was going on was that he felt my FIL was telling it as "he saw it." No concern was shown to the falling or absolute lack of quality of life he now has since he was put on this drug.

My MIL is at her wits end, as she has always been more active and now cannot leave the house for more than groceries, since the chances that my FIL has fallen and needs assistance are high. She has a bad back, which obviously isn't being helped any by this situation. While I don't know their exact financial situation, she has indicated they must dip into savings every month and there is no money for sending him anywhere/getting someone to help, even if he would agree to such a thing, which would be unlikely.

The whole drug situation is sending off red flags to me. I'm concerned about that dosage, being given to an elderly person who is clearly NOT being helped by this at all, and him not ensuring he sees a geriatric psychiatrist or someone who clearly has more experience than simply writing scripts and collecting a monthly cash payment.

I have experience caregiving with my grandparents and own parents (and just got back from helping my mother after her double mastectomy), but, I have no experience with the elderly and non-Alzheimer's psychiatric issues. Should I report this doctor? I read the riot act to my grandfather on the walker issue when I lived with them, which prompted him to comply, but I feel uneasy doing it for my FIL, especially given his lack of mental health. Obviously, however, something has to change.

What would you guys do in this situation?
Good grief, this is a terrible situation and I am so sorry your family is facing this. I feel so sorry for your mother in law especially! What a terrible lifestyle she has now - and it sounds like she's pretty active and able. She could be facing YEARS of this sort of thing, which would break even a stronger person mentally, emotionally and physically.

Can you and your husband meet with your mother in law either when her husband is sleeping or away from the house? (She could even call you when he goes to bed and you could go over there and just be really quiet, if she can't leave him alone.) This woman needs help and plenty of it, but if you are going to help, you need to know more financial information and she needs to LET you help.

This is very important - you have to have her cooperation, trust, and openness. If for whatever reason she won't allow this your options are very limited, because she is the next of kin and she sounds competent mentally. Any court or doctor or whatever will take her word over yours at this point and probably rightly so, considering that they are married and she's the main caregiver, and it's her finances and home and life in question moreso than yours. Not criticizing you at all, or justifying anything she's doing - just laying some groundwork for moving forward.

I think your concerns, however, are very legit. Try having a heart to heart talk with your MIL first, and see how that goes. I would recommend gathering some information on options first - maybe even taking the time to meet with an elder care attorney before meeting with her - not to fight or use against her, but to give her some hope, ideas, options. See how she responds before getting more aggressive with the next step. It will be easier to handle this problem with her cooperation rather than without it.
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Old 11-01-2015, 02:28 PM
 
Location: St Clair Shores, Michigan
200 posts, read 200,673 times
Reputation: 369
Thanks to both of you guys. My MIL is not at assisted living level yet (although certainly FIL is).

She has asked us for help - she doesn't know what to do about my FIL and his doctor either, at this point. FIL has always been somewhat hardheaded, and that hasn't changed even though he's constantly drugged up. I do not know if he's ever gotten violent, but she has alluded to mood swings and he flat out refuses to use a walker, even knowing how much he falls.

We cautioned her that she can't just flush the pills and refuse to take him to the dr yet, because he's been on such a high dose for some time now, so he can't just stop them cold turkey. She thankfully knew and said she wasn't, but honestly, I think if she could and there wouldn't be a negative health issue for it, she would in a heartbeat and I don't blame her.

She also has tried to make him do SOMETHING to help himself, but again, he refuses. He won't exercise at all (he's so weak he has trouble pushing remote tv buttons and can barely cut his own food) and she also will no longer do his laundry - she said he hasn't done it in some weeks, so she says he likely hasn't even changed underwear lately.

She needs help, she knows she does, but none of us know how to go about fixing the number one problem.
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Old 11-01-2015, 02:41 PM
 
Location: Wonderland
44,378 posts, read 35,877,934 times
Reputation: 62734
Quote:
Originally Posted by ultraviolet View Post
Thanks to both of you guys. My MIL is not at assisted living level yet (although certainly FIL is).

She has asked us for help - she doesn't know what to do about my FIL and his doctor either, at this point. FIL has always been somewhat hardheaded, and that hasn't changed even though he's constantly drugged up. I do not know if he's ever gotten violent, but she has alluded to mood swings and he flat out refuses to use a walker, even knowing how much he falls.

We cautioned her that she can't just flush the pills and refuse to take him to the dr yet, because he's been on such a high dose for some time now, so he can't just stop them cold turkey. She thankfully knew and said she wasn't, but honestly, I think if she could and there wouldn't be a negative health issue for it, she would in a heartbeat and I don't blame her.

She also has tried to make him do SOMETHING to help himself, but again, he refuses. He won't exercise at all (he's so weak he has trouble pushing remote tv buttons and can barely cut his own food) and she also will no longer do his laundry - she said he hasn't done it in some weeks, so she says he likely hasn't even changed underwear lately.

She needs help, she knows she does, but none of us know how to go about fixing the number one problem.
An elder care attorney would be familiar with this scenario and your options. Also, a social worker could probably help as well. Your mother's doctor should be able to give her some people to contact, but she's going to have to do it.
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Old 11-01-2015, 07:10 PM
 
Location: Southwest Washington State
21,590 posts, read 14,200,956 times
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I think your MIL needs to call the doc for a phone consult. She needs a list of concerns, and she should insist that he hears her out. He needs to know that she fears for her husband, and that he continues to be depressed, in spite of taking an antidepressant. She needs to go down the list of concerns. If necessary, put the call on speaker, and have an adult child with her, to make sure concerns are addressed.

Something is amiss, and the doc needs to understand this. If he wants to pull FIL off the med, he will know how to do it.

Good luck!
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Old 11-02-2015, 07:10 AM
 
2,477 posts, read 2,515,030 times
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Quote:
Originally Posted by silibran View Post
I think your MIL needs to call the doc for a phone consult. She needs a list of concerns, and she should insist that he hears her out.
Good luck!
That really helps. I have people write their concerns, or the chronology of an illness in bullet point format. Only the most important things, and try to keep it to the objective info. Then they hand it to the doctor.

Doctors seem to respond well to this. It's partly a time factor, and partly that it gives them the most relevant information. When many try to describe what the problems are, it is so personal and impacts them so greatly, that they end up talking more about the emotional effects and don't describe the issues.
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Old 11-02-2015, 09:00 AM
 
7,917 posts, read 7,245,545 times
Reputation: 6263
Hopefully, he's being seen by someone else besides the psychiatrist. You can probably get a GP doctor to write out a referral for therapy and a walking aid. The frequent falls would be cause enough and refusal to use walking aids would be added cause for concern. Maybe your FIL will respond more positively to suggestions when it comes from an outsider with medical credentials. Medicare will pay for the home physical therapy visits. A nurse will also visit to evaluate the information that you've provided. He's probably on some antihypertension drug since the heart attack and this will contribute to depression. The sudden dementia-like symptoms are probably a resut of the Xanax.
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Old 11-04-2015, 08:18 AM
 
3,455 posts, read 2,297,678 times
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Very complicated situation. It sounds like he is overmedicated on the Xanax, but what needs to be teased out is overmedication versus depression versus dementia -- or all 3 in combination. I treat a lot of geriatric patients and honestly, four 0.5 mg Xanax a day would not be sufficient to make the person as debilitated as you describe. Increase in falls, yes. Increase in apathy, could be (although that is true of dementia and depression, too). But all the severe weakness, the lack of attention to personal hygiene, etc. -- that's not typical of taking 2.0 mg Xanax total per day.

Your FIL needs a complete neuropsychiatric work-up, preferably with someone who is experienced in geri psych and/or geriatric neurology, including dementia. If that is not available to you, is there a PCP who specializes in geriatrics in your area? I don't know where your FIL is in relation to U Michigan, but if you are near U Mich, I would call them to see who they can recommend. I know they have a geriatric specialty division of their internal medicine program; patients are seen in Ann Arbor.

It sounds to me like his depression is not being treated at all at this point -- is that true?
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Old 11-04-2015, 04:21 PM
 
Location: Canada
3,869 posts, read 2,707,628 times
Reputation: 5055
Quote:
Side effects of Xanax (alprazolam) include drowsiness, dizziness, insomnia, memory problems, poor balance or coordination, slurred speech, trouble concentrating, and irritability.
Side Effects of Xanax (Alprazolam) Drug Center - RxList

It looks like to me that Xanax has created problems rather than solving them.
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