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My mom's doctor just emailed me telling me about her acute gout and getting xray but then also tells me she's been near impossible the last 3 days. She is refusing to take medications, accept her insulin, and probably just over all belligerent since he said the nurses are getting to the end of their rope. I'm not sure a phone call is going to be of any help as all she wants to do is leave the NH but dementia and health issues obviously are why she cannot. I hope they don't kick her out, can they?? I live in another country and there is no one there to take care of her! I'm in the midst of liquidating her assets, spending down, and getting her on Medicaid.
I dread calling, I'm dreading my next visit coming up next week because I'm the "jerk" putting or keeping her in there, and I'm already stressed out, now this! I just don't know what the best thing for her is, and I'm scared the NH will be fed up with her.

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((((((erica))))) hope you find some solutions for your mum. Mine spent over 9 months in a geri psych hospital before they got her medicated so she calmed down. Absolutely this is the best thing for your mum and you are NOT a jerk. You are a loving daughter dealing with a very difficult situation. Please let go of the guilt. Safety has to come first. You are doing all you can. Sometimes there aren't great options - just better or worse ones. or the best given the situation.
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Sue,
All they told me one time was she is on mood stabilizers. Every conversation ends and starts with "I want to come home, why can't I." She then gets angry.  No matter how I shut it down or try to turn the conversation she sticks with it sometimes and I know it is where she has to be and needs to be but she doesn't want to hear it. She's disowned me about 5 times but then doesn't remember. I do hope she does adjust at some point, but I feel at this point she never will.
My father had gout so I remember how much pain he was in. I will double check with doc to make sure he is sure it is gout. I swear that is the words he used in his email "nearly impossible." As much as I am at the mercy of this doctor, I'm happy that at least he emails me and keeps me up to date rather than just doing whatever and or ignoring because they have deemed her unable to make decisions on her own. I did send my friend who is a PhD in PT the email and she may go check on my mom and usually demands answers for me. She is my only source of help in NJ who also understands the medical field. By the way I also, am in the medical field so I'm not completely out of the loop.
I have put my big girl panties on because there is no one else who can or will deal with her or all her issues. Her neighbours are older than her, lots of her friends have passed on and other friends she alienated over the years with her attitude and nastiness.
I am trying to manage as best I can from where I am and I'm going back to NJ Wednesday to have in person meetings with the doctors and nurses as well as lawyer and other financial institutions. Trying to manage everything of hers at once plus my own family up here isn't easy. I am stressing out
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Erica,
I'm already mad. The doctor said, "She's near impossible"? A better way to professionally communicate her mood would be "She's not cooperating".
What's with her doctor?
Any jack a** knows that gout hurts like the devil. You can't move it, walk on it or even touch it without causing extreme pain.
That may be one reason she being unruly. Is she getting any gout medication to calm it down? (Colchicine) How about the daily medication to "prevent" attacks (Alopurinol)?

Just because she has dementia does NOT mean the doctor can dismiss any complaint of pain! Babies and old people are "overlooked" for pain assessments.

It doesn't sound like her anxiety is well controlled. Is she on any medications for agitation?

Wow, there is NO one to check in on her in the country where she lives? It's really hard to manage her care from another country. Could a friend or old neighbor check in on her? You really are at the mercy of what this doctor tells you. It would be better to have a second pair of eyes on her.

Erica, you've got to get your big girl pants on and take control of the situation. I know our moms have always been in charge, but now the tables are turned. You have to tell her how it is and take her wrath when she doesn't like it. You know she HAS to be in a facility. There is no reasoning with her due to the dementia. There is also no negotiating.
When she brings up the subject, say, "Mom, this is where you need to be." Then shut down the discussion.

Try to have them find ways to give her some control. They could ask, "Mrs. X, would you like to take your medication now or in 20 minutes?"
"Would you like to watch TV or go to the sun room to hear some music?"
She needs to be given "options" to feel like she has some control.

If this doesn't work, maybe an evaluation at the geriatric psych hospital can get her more stabilized. If dingy doc doesn't recommend it to you, you can recommend it to him!

My mom attacked me the first visit after I put her in the facility. It's sad that we need to do this. But, as they used to say to us, "it's for your own good".
She will calm down and adjust (especially when they find the right combination of meds).
Hang in there. It won't be this way forever.
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Erica, I don't want to sound harsh but forget all the background and the angst and for now just Google gout. It will (unless your mother is fantastically unlucky) be confined to a comparatively small joint - big toe is typical, in my mother's case it was further down her foot. They mustn't touch it! - and if they really, really can't avoid doing so, they must apply as little pressure as humanly possible.

So in this particular instance it isn't a matter of wondering how to make your mother behave herself. It's a matter of asking the NH how they are handling this acute and (God willing) short-lived crisis. I hope they get it under control very soon.
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She has already been on antibiotics for UTI and everything else going on. It's hard to stay away from her legs as she has CHF with moderate to severe swelling with weeping so I know they wrap her legs. As of right now he did mention he will also be getting psychiatry to come back in and meet with her. My mother has always had some mental issues (at least in my mind). She's a hoarder, but around the same time that started she also became angry and physically abusive, she's been manipulative my whole life, so my mom being difficult does not surprise me.
Also with her diabetes, I'm sure her kidneys aren't great as it has been uncontrolled for some time because before the NH she wasn't taking her medications/insulin. I don't want my mom to be in pain, and I know she's said she would rather die than be there, but yet she also tells me she thinks she's fine to go home and take care of herself! I'm just worried that they will kick her out. If she needs to be in a psychiatric hospital then so be it as well...I just can't take her up here to another country (immigration laws) and I can't move back and give up my life and family here but it doesn't mean I don't love her or want her safe, and unfortunately Id want her happy but what would make her happy would mean death for her.
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I haven't had it myself, but the pain of gout is infamous. Unfortunately, as I remember from my mother's happily brief attack, the medication for it (colchicine, sp.?) is not great in terms of side effects and interactions; but as my mother's emergency GP put it when I asked her if she was concerned about my mother's already poor kidney function: "I'm more concerned that your mother is in extreme pain."

So what is the doctor doing about it? Apart from the x-ray? (x-ray? Is he sure about gout or not?) The NH staff need to be aware that gout is incredibly painful to the touch and they mustn't go near the affected areas.
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Erica, email the doctor back and ask them (as FF wisely suggests) to rule out a UTI and for them to arrange a geriatric psych evaluation. Ask the doctor if he thinks transferring mom to a senior behavioal unit or psych hospital to get her behavior settled might be prudent.

Let the doctor know if this is long standing mental illness or "just" the dementia.

Point out that you are not the best person to make a phone call to mom, as she's angry at you.
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Erica, time for Mom to be tested for a Urinary Tract Infection as the symptoms in the elderly would be belligerent, angry, and hostile.
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