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My 67 year old sister lives with me, my brother and my son. She has a diabetic foot ulcer and now because of her bad circulation has 2 more sores on her toes. She is in constant pain and when they prescribe her pain meds, she finishes them too fast because they do not work.


She is waiting for an appointment with a doctor who will unblock the veins in her legs which will allow healing but in the meantime she was seeing a wound care doctor every week but the Caremore clinic she goes to have closed temporarily due to virus situation and sent her home with supplies for us to do the treatment ourselves.


The problem with her has been she does not take the doctors advice, for instance, the foot doctor told her to keep moving for circulation and actually wants her to walk around on her foot but she refused to do that because of the pain so the doctor suggested for her to do bicycle type exercises while sitting but she won't even do that. She will only do it if a physical therapist came over to make her do it which she had at one point with her previous insurance and as of January Medicare put her on an HMO Caremore which does not cover home health care.


Her regular doctor has instructed her to change her diet drastically to keep her sugar down which she did eliminate what she was eating before and lost 5 lbs but she is supposed to eat 3 meals a day and she just won't.


The problem I have with her is I cannot say anything to her about what the doctors told her to do or anything or she starts yelling at me telling me to quit trying to run her life and we end up in a big argument. She is exactly like our mother but worse. We have been living together for the past 10 years and I finally had to start staying in my room and not associate with her as much as possible but I have to take her to all her doctor appointments and pick up her prescriptions. Her health has been declining since 2014 and sometimes it is just too much to bear but I have no other choice. On top of it she is starting to have mental decline and does not remember anything I say so it is very frustrating.


BTW, my brother is 62 and bi-polar and is very difficult as well, and, my son is schizophrenic but gives me the least problems.


I just worry that the stress I have to deal with will cause me to have health problems and I never have time to go to a doctor myself. I got new insurance when we moved from California to Nevada in May 2019 for my job and have not been able to use it yet.


That is all, my venting is done!

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The mental decline you mentioned could be many things - uncontrolled blood sugars, kidney function problems, mini-strokes or even start of dementia.

If she won't follow her Doctor's orders there is not a lot you can actually do. It is very hard to watch people making bad decisions - especially in your house. I really do sympathize.

Quite a few diabetics land in hospital & require toe or foot amputation. Then rehab to learn to walk. Sometimes they refuse & go straight home, demanding to be waited on instead.

You DO have choices. You DO NOT have to be her full-time handmaiden. A nursing home would be valid direction at that stage, especially if the memory/cognition problems worsen.

Take care of your own health. There may be a very rocky ride ahead.
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NeedHelpWithMom Mar 31, 2020
I agree. Too much to deal with. Life is too short!
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Perhaps this stubborn sister, who is not taking care of her health, should find another place to live. You must take care of yourself!
Tell her physician what is happening before she loses her foot.
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Reply to Llamalover47
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Perhaps if you haven't done so already, contact her primary care physician and explain to them the issues. Since her feet are so painful and she is mismanaging her pain medications, I would suggest a consultation with a pain management specialist. Maybe if her pain was controlled, she'd be more willing to emulate to increase her circulation. If you can identify another person who she might listen to ,perhaps have them discuss the medical issues with her. Another way to communicate your concerns is to write her a letter. Letter writing will allow you time to think about what you want to say and gives her time to respond. I would also suggest that you visit a primary care physician for a physical to make sure you are healthy. It wouldn't be a bad idea to address your psychological and emotional well being by pursuing favorite pastimes as well as possibly joining in some community groups.
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It's very difficult to try to speak to a relative that you live with every day. Tensions have sometimes built up to an intolerable level. When you speak to one another, often one does not "hear" what the other says and it is an effort in futility.

I have not gone through this particular situation, but others that resemble it. I would suggest trying to write a letter and giving that to your sister. That way, she can either read it or not, but if she does, she may keep it and read it over and over, perhaps getting a benefit out of what you are trying to say and realizing that you are only concerned about her well being. She may be angry at first, but since she seems to be angry in any case, it should not make things worse in the long run.

I would reiterate that I care. Especially I would try to make her realize that she could wind up having to have her foot amputated. This is a powerful deterrent to most people. It COULD change her attitude.

Worth a try?
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Reply to Janus12
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Sometimes people reach a breaking point and they don't want to push through...they get tired and want to give up.  As much as you want your sister to live, she has to want it.  Depression and health issues go hand in hand.  If she isn't already on an anti-depressant, maybe she should be.

You definitely have your hands full.  Just remember to take care of yourself first because without you, it all falls apart.  My only advice is to strongly suggest an anti-depressant to your sister and stay positive in front of her as best you can.

Take care of yourself Mesmereyes.
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Sorry you are going through this. I see it is difficult and I have no advise to offer other than things will change at some point and it will be for the better, it just may be awhile. Just try to hang on till then. Try to stay healthy and best of luck to you.
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Seems your sister remembers her doctors' advice but does not want to follow it. Do what you can to follow a healthy lifestyle : diet, exercise, sleep... Invite all your family members to join you, but don't push. She and each family member is responsible for his or her own choices and outcome. I know she hates the pain, but pain is an indicator that there is still some live nerves and living tissue. If she doesn't eat right, get enough circulation in her foot, and blockage repair, she will probably end up losing some toes if not the whole foot.

Since you are caring fro folks with mental health issues, you need to take extra good care of your own mental health: develop good friendships, pursue fun activities you enjoy, daily times in fresh air, and maybe develop a spiritual life to stay centered on God and not the situation.
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This is all good advice. All I would add is I hope your massager is not just some vibrating foot pad or vibrating foot bath, because those can do more harm than good to diabetic feet. Avoid fast speeds and high heat, and back away from that train wreck in process.
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Isthisrealyreal Mar 30, 2020
SF, if it is the body rub foot massager then it is approved for diabetics. My dads podiatrist and gp recommended he use it to avoid vein surgery in the future because of diabetic neuropathy.
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Sorry you have so much going on! Whew. Now, let's take a breath and set some boundaries.

Once you have touched on a topic with your sister, let it go. You can't make her do the right thing and take proper care of herself. Unless and until she is deemed incompetent, she is responsible for her healthcare choices, not you.

I have had to do this distancing with my mother too. She should take MUCH better care of herself and could be feeling so much better if she would do certain things, but she's not interested. I was soooo angry for awhile but now I just have to leave it be and accept the lousy fact that she is not going to do the work. It seems like your sister is the same way. We can not make them do what we KNOW they should be doing. And we have to find a way to deal with it. It's frustrating but it is what it is.
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Mezmereyes Mar 30, 2020
Thanks, I know, she is just like our mother and she just doesn't care what happens to her. She is just so tired of her misery that she does not care if she dies. She ran out of pain meds and pops Tylenol like candy trying to ease the pain but it does not work on that pain until she gets her circulation fixed and my brother tells her about the warning on the bottle that taking too much will damage her liver and she just screams "I DON'T CARE IF IT KILLS ME"! LEAVE ME ALONE! I give up, I just go to my room and don't associate with her, that is all I can do, I am going to stop worrying and just let her be. The thing is, she used to criticize our mother for being the way she was and not listening to the doctor but she is just like her and I tell her that and she just gets mad so fuck it, I am through!
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I know I’m telling you what you already know, but I’ll say it... you need a respite!
I live in Virginia and there are opportunities for respite through grants and different programs. The best way to find out about them are to contact your local area’s Agencies on Aging, or The Alzheimer’s Association.
Good luck!
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Mezmereyes Mar 30, 2020
Thanks, I will check into that.
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My aunts pt says if she doesn't do the excersices on her own, there is no reason to come back.. one day a week isn't going to do the job.. my aunt has dementia/ALZ... so he was right, it didn't work..

losing a leg, or dying.. what's it worth:? At least try the foot messager, then take a walk, hunt for the next pain med.. can yo imagine if you actually tried the scavenger hunt? She would be screaming, and you would need to tell her to find the next clue on her own.... maybe not a good idea... kinda
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Reply to MAYDAY
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Look into weightwatchers. perhaps, both of you can try it, or other types of diets.. Maybe small portions more times than 3 times daily.. which means, yo need to watch every mouthful of stuff you stuff into your mouth.. My kid sdaid I just had 3 meals when I got home from work...went from one snack to the next,... and I don't know why I am not losing weight? Yikes. In between meals,, how about some almonds or other diabetic source of snack? I really don't know, sure I am becoming diabetic.. bring in ensure, or the other one that is better for diabetics, that may help... BOOST?? not sure of the name..

And for the next issue.. Get some zip lock bags.. put a pill in it with a note of a hint where the next pill may be located... But the next spot will be just a note.. for her to find a clue to where the next note may be at... Scavenger hunt...at least she may get more steps in for exercise... ??? :) She is 64... does she work? Maybe get her to volunteer somewhere? well with this virus, that may be hard.
Get her meds mailed to the home or po box.
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I’m sorry you are living this nightmare .Caregiving for just one is overwhelming . Could you and your son possibly move out , to a small apartment , maybe ? Your health and well being is very important .
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Mezmereyes Mar 30, 2020
Believe me I would love to move out but financially not possible for us or for her and my brother who does not have an income. She would only be able to pay for rent and nothing else and my brother would not want to be left alone with her to take care of. Thanks for the suggestion though.
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Its time to find everyone help.

First, Medicare does not put people on HMOs. Medicare allows you to go to any doctor you choose. But it doesn't supply a prescription plan. I think your sister is on a Medicare Advantage plan. This is not really Medicare, as such. Which for some people, it may not be good. I would go to the Office of Aging and see if they can help your sister find a plan suited for her needs. Depending on her income, she maybe able to get Medicaid as her supplimental then she will have a prescription plan and other benefits like transportation to her doctors. Going back to regular Medicare.

Your brother...by SSI do you mean Supplimental income or Social Security?
If he doesn't have Social Security, he can apply for it at 62. If SS is not enough to live on, he maybe able to get Supplimental Income too. He also should be able to get Medicaid for health insurance.

Your son...he can get Social Security Disability. With that comes Medicare and Medicaid. You can see a SS lawyer for this. He cannot charge your son to help with applying or any appeals. He gets his payment from SS, when son gets Okd, from any retro money due.

Now, I am assuming that none of what I wrote is in place. Once it is, then you can change ur living arrangements. Maybe sister and brother can stay together. There are resources out there for them Food stamps, help with utilities. Moving to HUD subsidized housing.

Then maybe you and son can move in together sharing expenses and applying for help with utilities, etc.

You are not responsible financially for anyone who is an adult. Between Office of Aging and your Social Services everyone should be able to get some help.

Your sister is old enough to realize that by not doing what needs to be done, she will lose a leg or two. At that point, she will probably need Long term Care. These sores are just the start of things to come. I would ask her "You do understand by not doing what the doctor says could mean amputation or death". If she says yes, then tell her then your will honor her choices and not say anything more. But to realize, you will not physically care for her. So if it comes to that, she will need to go to a NH with Medicaid paying. I would make that clear to your brother too. If something happens to ur sister, he is on his own. You are getting older too and your only responsibility is your son. Lay it out and stick by your guns. Set boundries. You cannot take care of 3 people and yourself.
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Mezmereyes Mar 30, 2020
My sister has Anthem Blue Cross Advantage Plan (Caremore) HMO and Medicaid. My brother has Medicaid and will apply for Social Security Income. My son has Medicaid as well.

My sister is aware that amputation or death is a possibility but does not care and she pretty much takes care of herself and has told me that if it ever comes to the point where she cannot do anything for herself that we put her in a nursing home.

Thanks for the advice.
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I just looked up senior rentals in Las Vegas. They have several there. The rent is reasonable! Tell them to move then you and your son will have your apartment back to yourselves again.

Your sister qualifies. Looks like the apartments for seniors are ages 55 and up.

I have no idea how that works. I guess everyone living there must be a senior. Is he 55?
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Mezmereyes Mar 30, 2020
Thanks I will look into it. Yes for senior apartments everyone has to be 55 and up. We all qualify except my son who just turned 29.

It is just a difficult situation because if my sister and brother get their own place, my brother would have to do all the cooking and everything and he is 62 and they do not have transportation and he does not want to live with her alone.
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Can I recommend that you check out a "Body Rub Foot Massager".
My dad has one and he just has to put his feet on it and punch a button to get the foot massage that increases his foot circulation. He says that it is a tremendous help for his neuropathy pain and he feels better. No effort on his part is key.

You can not care more than your sister does, period. If she chooses not to help herself then you can step back and know that you can not force her. The whole leading a horse to water thing. I have a rule, everyone is entitled to make their own choices, but that includes me. So anyone that has options for getting better and deciding that they would rather suffer doesn't get to use me as a blasting board for all their woes. I will tell them what they can do to make it better, I will tell them if they CHOOSE not to do anything about it they LOSE the right to gripe to me about it. Then I just ignore the complaints or walk away if they escalate it.

You can set boundaries and find other resources for your sister. I for one would find out how to get her on the public transport in your area and make her call and schedule a ride for her appointments, you can call the department of transportation and they will tell you what options are available and how to get her signed up. I would make her use pharmacy delivery or mail order, I would not prop up her bad choices by being her personal assistant. She doesn't have to change anything because she knows that you will step up and take care of her, that perception needs to be corrected. She needs to participate in her own wellbeing as much as possible, not as much as she wants.

Best of luck, this is a tough love situation.
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Mezmereyes Mar 30, 2020
Thanks I have one of those massagers, I forgot I had it. I will try that but I have a feeling she is going to say she doesn't like it. She is the type of person who finds fault with everything but it doesn't hurt to try.

Thanks for the suggestions. I actually need to be present at her doctor appointments because she does not remember everything they tell her and right now the medical center she goes to has shut down for now so the wound care has to be done at home for the next 4 weeks!

She has an appointment next month with a doctor to unblock her veins and once that is done and her circulation improves then her foot will heal, it's just a matter of timing.
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You are the victim of a False Dichotomy.

You feel as though you have only two choices and must pick one or the other:

1. Succeed in persuading your sister to follow health guidance.
2. Stay in your room and refuse to associate with her.

But these are not the only available options!

It's not your foot. It's not your eyesight. It's not you with the blinding headaches and feeling of general malaise. If your sister makes... what do I say... ill-advised choices, it's she who suffers, and not you.

The reason you *are* currently suffering from her choices is that you are "owning" her problems. Hence the frustration, anxiety and anger when she resists or even resents your support.

I appreciate that when you have been in this position before with other loved ones it is really, really hard to step back just enough. But you mustn't be so close she hurts you, and yet you can't distance yourself altogether by walking away.

Suppose there were a diabetic nurse on the premises. How would you expect her to interact with your sister?

I also appreciate that this seems like an unfair question: no doubt your sister is much more cooperative with her wound care nurse and her physical therapist, and rarely if ever tells them to stop trying to run her life.

But believe me, those professionals will also have encountered many patients who are argumentative and self-destructive. And when they do: they will offer the advice, explain the information, continue to make the treatment available. But if the patient won't play ball - those therapists do not go home in tears about it.

Take just one part of this - the foot. Your sister won't walk on it because it hurts. She won't do her "cycling" exercises (and frankly that was a dumb idea from the doctor - what does he think you pedal with?) for the same reason. So, a bit of imagination is called for. What you want is mobility and improved circulation: how do you get that foot moving without putting pressure on the sore bits?

Massage. Use a nice smelling lotion to break the ice and see if she'll take to the idea - and whatever you do *don't* be hurt if she doesn't. Remember: this is Her Foot Not Yours.

Or, how about ballet-on-your-back? Go to https://www.youtube.com/watch?v=_IPThrrJr-8 and watch just the introduction (I have no idea why that young lady's hair is not properly tied back! - but never mind). There is no reason on earth why those foot stretches and ankle rotations could not be done perfectly well in the air by a 200 lb lady lying on her bed.

Would that be just as good as walking and cycling? No, of course it wouldn't. But oh so much better than nothing!

These are just quick ideas, you'll have better ones of your own, and if they're nice and they're fun go right ahead and suggest them.

Your role is to encourage your sister in any way that helps her. It is not to force her to take advice, and God forbid it should be to break your heart if she won't.
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bigsispjt Mar 29, 2020
You are helpful while providing comic relief. Thank you.
My son is diabetic and experiencing swollen legs and feet and now has trouble walking. His wife said they took the dog for a walk. My son had to sit while the dog played. The photo of the dog playing just sent me into a crazy headspace of what ifs. Every time I say it's time to call the doctor immediately, they shut down.
My friend, wisely, tells me there's nothing I can do. He's my only son, (not that it matters), and I'm so afraid for him. I only see kidney failure ahead. A nurse with 20 plus years with kidney patients says he already is in renal failure.
On another post I shared about my self-absorbed mother thinking of nothing but who can bring her diet coke to the senior building where she lives. Once I take this batch of cases, I need to find a way to say no.
I'm tired y"all. Just mentally. I've been in bed all day.
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So sorry you're going through this.  You've become everyone's caregiver, except your own.  And you're neglecting yourself not seeing a doctor, etc.

Time to have conversations with sister and brother that they have to find another place to live and hire caregivers as needed or live in a facility that provides care. 

Research facilities (Not places Close to you!), and give those to them. Make calls to those homes on their behalf to get them moving .. whatever's needed to get them out of your home and into their own homes. 

Give them a deadline.  The Coronavirus is going to be an obstacle right now, but as soon as it passes, be ready to send them right away to wherever you found.

Good luck.
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Mezmereyes Mar 30, 2020
Thanks.
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Wow! You certainly have a lot on your plate. I am so sorry.

I just read your profile and you are in a bind. All of you truly do depend on each other. At least for now. Your living situation may be possible to change with some research and planning.

I don’t even know where to start. I am sure that you are emotionally exhausted by all of this.

I can see why you don’t want to be near your family. Your sister is skating on very thin ice with her diabetes situation. I took care of a sibling too.

My brother died in 2013. He also had diabetes and a host of other issues. For my own sanity I had to stop caring for him. It’s tougher for you because you are roommates.

If you don’t mind me asking, how old are you? How old is your son? How old is your brother?

My brother lived in a senior apartment with controlled rent. The rent was based on his income. Could either you or they move into an income based rent controlled apartment?

I don’t think you want to live with your siblings. Your sister is not willing to listen to reason. She will wear you down eventually. Your brother is difficult too. At least he does clean.

Of course, you are concerned about your son. Your son takes priority over your siblings. Are there group homes that are available for his future? I know that isn’t ideal but it may be your only option. Start researching group homes in your area.

Best wishes to you and your family. Vent anytime. We are here for you.
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Mezmereyes Mar 30, 2020
Thanks. I will be 60 in June. My brother is 62 and my son is 29. My brother has no income but will apply for SSI.

They have no transportation and yes we all do depend on one another. If they moved out then my brother would have to take care of her which would be difficult for him.

I will check into a group home for my son's future. Thanks.
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