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Quad heart bypass. Bi-Lat femoral arterial bioassay-stil smokes. Cardiologist says "don't fight this battle". He wants a cigarette about every two hours. Non-insulin diabetes but run sigh blood sugars. Candy demands, ice cream demands, green grapes, oranges, etc. "don't worry, just give them whatever they want". He's 83 - is this the way to play this? The alternative is constant arguing-trying to re-direct, offer alternatives. Help!

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What exactly did the cardiologist mean when saying: "Don't fight this battle?"
Is the patient terminal?

I have heard some say, let them smoke.  Did the cardiologist do surgery when the patient was a smoker?  (Asking for a friend, who needs to know.)
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He's a great doc and I really understand that the arguing that ensues over smoking and how many to allow may certainly not be worth the stress at age 83. He has tried so many ways to stop over the years -hypnosis, acupuncture, three different types of patches-but I don't think he ever really wanted to stop. But I worry because he sits and flicks the lighters over and over, burns holes in cushions,(outside). And how many "unhealthy" wants do we give in to to keep the agitation at bay.
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I would be worried about the cigarette lighter too.(cigarettes too as far as possible fires w ashes etc)

and smoking... and eating sugary foods, I guess if he wont listen. then it'd be hard to stop him especially if he is demanding. if the cigarettes and sugary foods causes his health to suffer, you shouldn't feel to blame. constant arguing is hard on both of you.

you say you offer alternative foods, but maybe you just have to accept he wont change? when you dig in your heels with dementia, they just push back even more.
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Hm.

He may be terribly bored. I guess you could try introducing to him to FreeCell or something, on one of the simpler handheld devices? That might substitute a new addiction and take his mind off the others - it sounds as if he's looking for stimuli.

But other than that, and oh my goodness the fire risk must make life a bit exciting, what's good enough for a cardiologist...

I think perhaps the way to look at it is, what are you trying to achieve? What are you hoping for for your father? And I have to agree that there is very little point in trying to get him to adopt healthier lifestyle choices if it's only going to make him miserable and you unpopular.
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Yup. That is how we play this. Give him what he wants.

This is your husband we are discussing, right, and he lives at home with you?

In my mother's nursing home I saw residents being wheeled to the patio to smoke, with large fireproof aprons covering them. Look up ~fireproof smoking aprons~ on Google. There are also similar lap blankets that could be used to help protect furniture. It makes sense to decrease the fire hazards as much as you can. But smoking is not a battle worth fighting at this point.

How high do his blood sugars run? What was his last a1C number? If his numbers get dangerously worse, perhaps he could start taking insulin. Or just live with the consequences of the high numbers. He wants an orange? That is just not a battle worth fighting. Give him an orange. Let him peel it himself, to spread the experience out. My husband's geriatrician told him to stop taking his blood sugar readings when he developed dementia, and to eat what he wanted. She monitored his a1C about every 3 months and told us she would let us know if it became dangerously high. It never happened.

The time you have left with your dear husband is limited, no matter what life-style changes he does or doesn't make. Constant conflict is bad for his quality of life, and yours, too! Try to enjoy each other. Cherish all the good moments.
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If you like reading, She, I suggest "Being Mortal: Medicine and What Matters in the End," by Atul Gawande. It has some good insights about Quality of Life decisions near the end of a life span.
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My MiL lived with us and was a HEAVY smoker, I was sooo worried about it but she wouldn't stop/ told everyone she was not going to stop, but she was terminal copd. One day she woke up having delirium and didn't WANT to smoke, we knew then that something had changed, she never asked to smoke again and 14 days later she passed.
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Desperate, it's SO good to hear from you. I'm sorry for the loss of your MIL. How are you and DH doing?
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Thank you all for your encouragement and reassurances. I so often feel that I am not doing enough to keep husband safe at home and there is no hope of placing him in memory care unless I can eventually get him enrolled in Medicaid. I do like the idea of a fireproof apron too. Every day/week is a new behavior or the repetition of one I thought was gone. Last night he needed the bedroom door closed because he was sure that someone would sneak in and stab him. He was truly afraid. Thank you all again.
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She1934,
So, he can have his cigarettes, but can you take charge of the lighter? Since you won't be nurse ratchet, answering his request to light up will always be met kindly, with no judgment, no comment.

The apron is a great safety feature.

About his fears....check with the doctor that he has meds for that anxiety.

So sorry that you are going through this. If you have a social worker, counselor, or therapist on board, this support can help you decide when he needs care that you won't be able to provide, and they will discuss the many options with you.

As well as caregivers here, can help you talk this out. Keep coming back!
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Keep us posted, She1934! I was thinking about you yesterday, hoping you are OK.
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Maybe he can try vaping to replace the smoking and an empty lighter with no flint or fluid to satisfy to need to fidget.
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Dear She1934,

It's so hard. After my father's stroke, he stopped smoking completely. I think it added to his unhappiness. I tried to make this up with food, but that was short lived. It is hard when people get into their 80s and 90s. I just don't know how aggressive us caretakers should be in reinforcing healthy eating and living. Those are life long habits and they are hard to break.

I know its hard to know what is right sometimes. I hope I made my dad a little happy to let him have his way.
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I would address safety issues. Also, does his second hand smoke bother others in the household. If it doesn’t I’d let it go. Sweets issue is much the same. If he doesn’t want to give up for his own health, don’t stress yourself into a health crisis.
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he must be very wealthy to be able to afford smoking.
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I'd like to second the recommendation for Atul Gawandi's Being Mortal. It helped me realize where the important battles were and to gracefully let go of the others. That was a valuable lesson. The bottom line is my loved one has a death sentence. Rigid diets and rules will not change that. If my goal is to make his remaining time pleasant and comfortable, my efforts make a difference. If my goal is to extend his days by a month, two, more, my efforts are for me and are selfish. I prefer him peacefully content and as happy as he can be, for however long he has.

I know She will make the decision best for the man she is caring for, that special individual who is himself and not the same as any other man. I am sure she is wise enough to look at safety issues as well. In the end we each do what we honestly believe is the best for our loved ones.
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Basically life is almost over. It is like a person that is dying of cancer but they won’t stop smoking. They have few pleasures and not much life left. Let them be happy. To late to worry about health.
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This is a very helpful thread to me. I feel I pushed for all the wrong things prior to my Dad’s demise. Now, with my Mom, I want to make better, more sensitive choices. Mom is tough one, since her discomfort is more emotional than physical. It may not be possible to give her what she wants...what she wants is all gone from this world except for myself and there is a limited supply of “me”. But I can perhaps avoid some of what she simply does NOT want, at least.
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I agree with the doctor. The battle simply isn't worth the stress. The man is 83 & has no desire to stop smoking. If it were my husband, I would let him smoke but under supervision so he doesn't burn the house down. I have seen some good suggestions here with regard to a fire proof apron, asking him to try an e-cig vs the real deal ... Perhaps you could interest him in something to busy his hands such as adult coloring books (my friend does this and she finds it amazingly relaxing). Maybe some sugar free hard candies to suck on to satisfy his sweet tooth and satisfy his oral fixation.
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My mother was in her mid 80's and the Dr. kept pushing her to eat more potassium rich foods. Just have her eat 12 almonds a day. We tried for a few weeks and she just wasn't interested. Finally bought her Hershey's dark chocolate kisses with Almonds and we could at least tell the Dr. she was having a few almonds a day. Maybe not the way the Dr. wanted but Mom was happy.
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Yes, I was told the same thing but about foods.

I can tell you this - when I tried to go "healthy" with my DH, he quit eating! I finally got him eating again and this time I let him have whatever he wanted.
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I’d like to echo what the others have advised. Please, please be extra vigilant when he smokes. A few years ago, our neighbor’s house burned to the ground due to his careless smoking. He didn’t make it out. The other neighbors and I were on the front lines, standing there helpless listening to him and his wife call for help, trapped in the house.

My husband has congestive heart failure and even though I don’t buy cartons of cigarettes for him any longer, I do buy the occasional pack for him. I know he occasionally smokes during the night, as he’s already called me at 3AM to find a dropped, lit cigarette.

I agree with the doctor. If he wants a cheeseburger for breakfast, give it to him. It’s just easier that way.
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If he hasn't tried it yet, vaping might at least cut back on the fire hazard. Then, you don't buy the cigarettes and they aren't in the house. Cutting back on the vape might be easier. Just a thought.
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I will just chime in here, let him do what he wants in moderation. I don't know why, have been told its immediate gratification, but it seems people with brain damage crave sweets. The smoking does surprise me. My Dad was a chain smoker and when he had a valve replaced and 3 bypasses, he was told smoking would ruin everything the doctor did. My Dad stopped cold turkey.

I found the first thing to go with Dementia is reasoning and processing of information. Trying to reason with a Dementia patient is a lost cause. They also don't process what you are saying correctly. Let him enjoy these things. As his desease progresses, he may not be asking for these things anymore. He will go thru different stages.
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Once again, I am impressed with the thoughtful and supportive comments here, and it has eased my concerns. I probably won't try vaping, as I do not trust the whole thing, but I appreciate the suggestion. I do plan to look for an apron. Just like many of you, I question my judgement. Thank you.
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Has he tried vaping? It will allow him to get his nicotine without endangering anyone else.
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Once again, I am impressed with the thoughtful and supportive comments here, and it has eased my concerns. I probably won't try vaping, as I do not trust the whole thing, but I appreciate the suggestion. I do plan to look for an apron. Just like many of you, I question my judgement. Thank you.
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wow, what great answers. When I saw your question, She1934, I never even imagined the severity of the issues you were facing. Makes me feel lucky that my mom quit smoking 26 years ago. She is now 88. She sounds reasonable compared to some of the issues that many here are facing. Definitely diminishing cognitive capacity, which we are currently not treating due to the side effects of the meds. We're seeing the neuropsychologist this week, however, and will revisit this decision. I'm currently staying with her (I live 11 hrs away) for the summer (I was able to work out teaching for my university online) but will have to return home in mid-Aug. My sibs won't help, and Mom is in AL. But we all know that AL assistance is limited.

Got on a tangent. Here's how/why my mom quit smoking: my younger brother, who is severely disabled, was still living with her. He is now in a group home. She had home caregivers coming in to help get him up, in bed, and in the bath. One day she saw a cigarette size (full length) burn on the carpet. Had to be her, but she never admitted it. No one else lived there. All she could think was, "how could I get Steve out if the house started on fire????!!!!" She quit smoking right away.

The research on persuading people to change health behaviors does show that appeals to the safety of loved ones are more likely to impact people than are appeals to one's own safety. Is there anyone else in the family that your dad would care for enough to modify his behavior? Never worked with my dad -- he died at 58. But it did work with Mom. Praying for you!
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My moms doc said he wasn’t worried that she would go blind or lose a limb in the time she has left meaning: she will die before she has any serious issues with high blood sugar levels.
However, i wouldn’t allow him to run me ragged with his demands. I think a degree of reasonableness is necessary for both sides or he may make you crazy keeping him happy.
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Yes, that's how we play it at our home. We choose our battles carefully and his junk food eating isn't one worth fighting. Even at 69, he can eat what he likes just as he has done his entire adult life. He'd be miserable on a restricted diet and so would everyone around him. Thankfully, he's not a smoker so we don't have to fight that battle. We also don't fight over any medical procedure that isn't worth fighting for. For instance, His dentures are a bit loose but he refuses to go to the dentist and we're not dragging him to the dentist, by force. The results would only be a day of torture for all of us and all we'd get out of it, is a new set of dentures that he would then refuse to wear. After 15 years of this we've learned to let a lot of things go. My goal is to give him as peaceful and joy filled a life as I can for as long as I can.
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