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My brother has extreme wounds on his legs that cause him excruciating pain. He will not keep the bandages on. Now the nursing home is sending him to the wound clinic. The results are amazing, but John still won't keep the wraps on. He has been in this condition for 4 years. My question is, is it appropriate to scold him? I am not sure he understands once the pain starts and he rips off the dressings and digs into the wounds. I am at a loss to help him.

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I doubt if scolding will help at all. Talk to the wound clinic. They may be able to cover the dressings with plaster casts that he can’t remove. Ask about pain control, too. Find out how long the wounds should take to heal – it may be possible to medicate him for the duration. How distressing, for him and for you!
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Reply to MargaretMcKen
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As a nurse and caregiver it is was demonstrated that one should not scold a person with Dementia. If the person is in pain the pain must be tested. If they itch and scratch the sensation is driving them to dig.
A few ideas.
1. keep pain adequately medicated. All pain is pain.
2. Keep nails short and filed smooth. Hands need to be cleaned thoroughly as digging spreads infection.
3. If Digging is happening at night. Soft gloves - mittens can be introduced as this will can decrease scratches.

that is a few
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Reply to LotusFootCare
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If they are using Unna Boot Dressings - my DH said they burned and felt like insects biting him and he made me cut them off.

Try asking your brother why he is removing the wraps. A lot of people are sensitive to them and yes, they will remove them. Ask the Wound Center to use Sterile Gauze Wraps instead. There is also a gauze sleeve that can be used - my DH never minded any gauze and left his wounds alone.
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Reply to RayLinStephens
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Thank you for the feedback. My brother is on methadone and other pain medications, anti depression and diuretics. I did ask the wound clinic doctor if they could put a plaster cast or sedate him until they heal and I was told no. I tried a new tactic yesterday and with the support of the wound clinic, nursing home staff it appears to be working. They are also monitoring him elevating his legs. I didn't mention that he picks and digs at the wounds too. I told him that I won't be able to take him out in the wheelchair once it starts to snow and ice - so - please don't take the uno boots off. We are on day 2. He did get some of the dressing off one leg, but the compression part is intact. I am so thankful that he has been able to comply this long. I know the healing will be amazing if he does.
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Reply to montanacmm
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I'm guilty of it. It doesn't work and doesn't do anything but raise your stroke level.
You can reward when they do something right, but don't expect them to remember anything.
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Reply to donkeehote
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It is absolutely NOT appropriate to scold someone with Alzheimer's Disease.

But it is also absolutely pointless.

Even if the scolding were to frighten him into compliance one moment, the very next moment he'd be at it again. You can't stop his doing this any more than you can stop him blinking. It's a reflex response to a source of discomfort.

Ask the wound clinic about techniques and (possibly, depending on all kinds of approvals) appliances that will help to prevent further harm.

I'm sorry, and I well remember how frustrating it is when someone you're responsible for does this (post cataract surgery, lip picking and hand scratching, in our case); but even if it worked scolding would not be justifiable. Please don't!
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Reply to Countrymouse
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Take a look at Teepa Snow videos on the web. She teaches posituve techniques for working with folks with dementia.
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Reply to 97yroldmom
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You can not scold someone that does not understand.
Can you scold an infant for spitting out food, or for letting their nose run, or not using the toilet?
You need to prevent the reaction he has to feeling the pain.
How often do you scratch a mosquito bite or scratch poison ivy when you itch even though you know you should not scratch. And often when you begin to scratch that releases feelings that make what you are doing feel even better so you scratch more. Same thing is going on in your brothers head. Difference is you realize what is going on he doesn't.
If there is a way to apply a numbing agent to the area so he will not have the urge to scratch that might work.
If there is a medication he can be given to possibly suppress the OCD feelings that he may have this might stem the urge to scratch. Once the wounds are healed the medication could be cut back or discontinued.
Possibly changing the type of pants he wears to ones that have a tighter cuff at the ankle (like sweat pants with the cuffed ankle)
Last resort there are mittens that he could be fitted with that would prevent this but not sure if this would be considered a "restraint" and it would have to be approved by a Doctor and he would have t be supervised and I am sure that there are a lot of other regulations that go with something like this.
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Reply to Grandma1954
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Is he able to wear soft athletic pants with knit cuffs at the ankles? Then perhaps a sock over the ankle cuff to reduce or prevent contact with the wounds?

How about distractions- are there any table activities that he could do that could keep him from reaching the wounds at least part of the time? Jig saw puzzles, modeling clay, painting, bead stringing, a ukulele or other simple musical instrument?

If you have access to a CERTIFIED music therapist, amazing things are now being done with OCD type conditions AND pain relief, using music as a tool. A therapeutic musician (a DIFFERENT DISCIPLINE) might also be helpful.

Finally, have any specific, structured rewards been tried? Your mention of his outings with you being a reinforcer is a VERY positive sign. Can you think of any more things that he LOVES and would potentially want to EARN by keeping his hands away from his legs?

”Scolding” is usually a pretty poor reinforcer, but “treats”, praise, and pleasant experiences usually have a better result. If you could get your brother to actually select some things HE might enjoy, so much the better.

It sounds as though you’re really an asset to your brother and he enjoys being with you, and that’s a positive reinforcer already!

I think you’re on the right track. Please post if any of these ideas work!
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Reply to AnnReid
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I see many reccomendations to properly medicate his pain and while that is a good idea today it's easier to play scrabble with a dementia patient then get pain meds.
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Reply to Quizario
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