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My FIL, who lives with us, has been refusing meds like blood thinners (he has congestive heart failure and a-fib), beta blockers, blood pressure and an antibiotic for cellulitis and a severe infection in his teeth and jaw. He repeatedly says that he would much rather die than take meds. He insists that we're poisoning him and trying to kill him. His ankle was swelling and painful (cellulitis) again and he asked to go to the hospital, we saw his PCP Monday and, naturally, they told him he had to take his meds. But, he still refused. Yesterday, he also had to go for a CT scan of his head, and he kept trying to jump out of the car. So, we finally called his bluff and hubby took him to the ED last night. They ended up admitting him to Behavioral Health since he was a threat to himself. He told the Psychiatrist that my hubby puts saltpeter in his soda. I don't even know what saltpeter is! Anyway, I'm feeling pretty guilty for him being stuck in the psychiatric unit. Anyone else experience this?

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He's where he needs to be. His brain is clearly unwell. Would you feel guilty if he were in the cardiac unit for a heart condition?
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Wow, that is a difficult situation, but I can relate. My 88yo mom with mid level dementia has been refusing meds for a while, she doesnt even know what they are for and thinks I am making it up when I tell her, which eventually sent her to the hospital earlier this month, diagnosed with stage 3 heart failure, blood clots in legs, shortness of breath with mininimal activity, etc. We consulted with our local Hospice organization and are trying to grapple with the question of whether to stop offering her medication for heart health and allow her disease to progress to its natural end with the care and support of Hospice, or do we continue to offer it / fight with her, etc. Because of her dementia she doesn't make rational choices. She has stated the she has lived long enough, but...... We are still offering and she takes it maybe 60% of the time as I no longer want to fight. But we are still pondering this question.
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DebKlein Aug 2019
Also, the hospital was a a nightmare for both of us and I hope to never put us in that position again.
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https://www.thoughtco.com/saltpeter-or-potassium-nitrate-608490
Saltpeter is the natural mineral source of the chemical potassium nitrate, KNO3. Depending on where you live, it may be spelled "saltpetre" rather than 'saltpeter'. Before systematic naming of chemicals, saltpeter was called nitrate of potash. It has also been called 'Chinese salt' or 'Chinese snow'.  (Potash was used during WWII for ammunitions and bombs.  We had a bomb manufacturer in town during WWII and it was on "Potash Road". 🎇)

Saltpeter is a common food preservative and additive, fertilizer, and oxidizer for fireworks and rockets. It is one of the principal ingredients in gunpowder.  (I think that this is what your FIL was referring to when he said that your "hubby puts saltpeter in his soda"--he meant that your husband put gunpowder in his soda--to kill him.)

Potassium nitrate is used to treat asthma and in topical formulations for sensitive teeth. It was once a popular medication for lowering blood pressure. Saltpeter is a component of condensed aerosol fire suppression systems, salt bridges in electrochemistry, heat treatment of metals, and for thermal storage in power generators.

My Mom was hospitalized for back pain and refused to eat, drink, get out of bed, etc. because of Major Depression with Delusions in May 2017.  She was depressed because most of her friends had died and her younger brother died in March 2017 and her older sister died in April 2017.  She was transferred to the nursing home after two weeks and refused to do anything for almost 4 months until a niece came to visit and watch the Solar Eclipse with us in August 2017.  Mom "perked up" then, but she still had delusions and her mental thinking was impaired.

I'll write more later, I need to go to a doctor's appt. 😡
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MaryKathleen Aug 2019
Back in my day, when God was a child, it was thought that Saltpeter would decrease the sex drive in males.
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My uncle walked out of his Assisted Living a week ago looking for his wife (who had been taken to the hospital for a fractured femur and had just been moved to a hospice facility). The employee at the Assisted Living called 911. My uncle eventually ended up in the psych unit of the local hospital. Sadly, my husband went yesterday to tell him that his wife had passed on Monday (I was at the funeral home at the same time assisting my cousin with the plans for his mom’s burial).

Currently, we feel that my uncle is on a spiral down. It may be the affect of the massive amounts of medicines and the hospital staff trying to find the best “mix” for him, or it may be the fact that he was already physically declining—he is 91 and has had major heart surgery and lives with heart and lung conditions. He had been in another facility a year ago, and I’m not sure what medications from that stay were still being administered at the Assisted Living. Apparently they were not working since he went “ballistic” last week when the police tried to return him to the facility.

I do agree that people with mental health issues need skilled help. It is difficult to see your loved one going through these health complications. I have to trust that my uncle is getting the much needed care that his body has been missing for months. The other option could have been that he wandered out of the facility and ended up dead on the side of the street or in a vacant lot.

When/if he returns to the Assisted Living facility where he was living, he will be placed in the Memory Care unit. I am hoping that the care-givers (not necessarily RN's) will be able to handle him and keep him taking the medications that his body desperately needs.

Hugs to your family. This is not easy, but keep apprised of his mental/medical condition and if you have questions, ask the professionals, if they can’t or won’t take the time to answer them, you may need to find another place for his care. Please don’t try to do it at home!
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Isthisrealyreal Aug 2019
He was looking for his wife, of course he went ballistic. How sad he never got to say goodbye.
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I sympathize with your decision to at last put him where he's safe and others are, too, from him. The trying to jump out of the car is especially tough to hear about.

About saltpeter, it's used for many things, but the myth is that it's also put into Army food to diminish sexual urges of the population of young, virile men, per my 20 year Army man stepdad (1922-2005). Stepdad thought it was true, and honestly, I do not know. If the FIL is of a certain age and heard this story, then maybe he's blaming the effects of aging on the sex drive on an agent such as saltpeter. I might be way off in this train of thought! But saltpeter in the soda is a strange accusation.
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You don't mention whether he has a living will with medical directives or what his wishes are for end of life care (these thoughts have to be expressed when someone can think logically and preferably when someone is not in pain or already ill). Speak with a social worker about what his (and your) options now are. The hospital should have a social worker.
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Palliative care. Why force him to take medicine that will not cure him of what is a fatal disease (dementia)?. Let him go out on his own terms. Comfort care only.
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BrielleD11 Aug 2019
His meds are for his atrial fibrillation and congestive heart failure. He has expressed fear of having a stroke - that's why we want him to take those meds.
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People get to a point where they have had enough. Why make him take the meds?
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cetude Aug 2019
because loved ones have to watch him die...rather slowly at that..or if he has a stroke from non-compliance..still alive. That's why. IF the psychiatrists rule him competent better do advanced directive in WRITING, so when he strokes out and can no longer take in fluids you can let him die with a clear conscious -- very slowly-- of dehydration. It can take 3 weeks to die of dehydration. Death is rarely fast or easy.
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Saltpeter often joked about in high school that it caused impotence, at least on a temporary basis. I bet that is what grandpa is concerned about.
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If the psychiatrists rule he is competent, then he has the right to refuse treatment and medications. It is appropriate to get him hospitalized if any doubt, and check for infections and UTIs. I would not just "let him do what he want" until you know all bases are checked. You are talking about his LIFE so you better be sure and NOT GUESS.

IF he is ruled competent by psychiatrists, then get in WRITING advanced directives forbidding feeding tube, so he can sign his own death warrant. So when he has his stroke due to non-compliance and unable to take in food or water, the loved ones can watch him die of dehydration which can take 2 to 3 weeks' time, with a clear conscious. Death is rarely fast and easy. Even under hospice it can take weeks to die of dehydration because it is illegal for the nurse to overdose the patient because that is assisted suicide and is illegal in most states.

It is easy to say "let him do what he wants" but loved ones have to watch him die. So let him be ruled competent and sign his own death warrant with advanced directives. Ask ye shall receive.

Nobody--even evidence based research--talks about death by dehydration because they are against feeding tubes for end-stage Alzheimer's. But let me assure you it is a very slow, agonizing process.
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Isthisrealyreal Aug 2019
Cetude, with his medical conditions he is far more likely to have a massive heart attack than a stroke.
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Many meds have side effects that may cause more problems than they are supposed to cure. Depression and hallucinations are just a couple of them.
Some meds also cause constipation and a general lethargic feeling. What’s the end result? You live longer and feel worse. It’s understandable why the aging don’t want to take them. The end is going to come anyways. No one should be forced to take medication.
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jacobsonbob Aug 2019
I suspect the main purpose of feeding some of these drugs is to prevent a blockage in the tube going from the patient's wallet to the medical establishment's "accounts receivable" office.
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I'm not an expert but I'm guessing the doctor felt he needed to be accessed by the behavioral health department because he seems to be behaving irrationally. It sounds like he has some level of paranoia. For him to accuse you of trying to poison him with meds makes him sound paranoid. Accusing your husband of putting saltpeter in his food is certainly paranoid. It was a common joke (and myth) that the military put saltpeter in the soldiers' food to decrease their sex drive. It was commonly believed in WW II and the expression carried over to civilian life as well.

A rational person does have the right to refuse medical care, but it's important to know that they understand the consequences and and are making a rational decision. Your father-in-law seems like he may not be rational. He was so afraid of a CT scan that he would risk his life jumping out of a moving car? He'd rather die than take meds because the meds will kill him?

I recommend keeping in communication with the behavioral health department. Ask them what their concerns are, what their assessment is, and what options you have. Keep asking questions until you feel you understand.
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madhatter632 Aug 2019
The myth was back in the day they used saltpeter to keep men under control from sexual desires in the military and Jail it supposedly was to keep the male organ from becoming erect.
This is probably what her FIL is referring to as it was seen as a form of punishment.
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Infections can cause some wild behavior. Don't feel guilty for trying to help.

Assuming your FIL is aware that discontinuing his meds may lead to his demise, he has the right to refuse medical care. My mother had CHF and other problems and decided at age 88 to just stop fighting. Hospice took over at that point and the wait wasn't long.
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my2cents Aug 2019
If he is accusing them of trying to poison him, it sounds more like a dementia issue. He may no longer understand what the meds are for or be able to make his own medical decisions. Right to refuse surely includes the 'ability' to make a sound decision.
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Haven't been in your situation, but wanted to comment on the saltpeter. You used to be able to buy it at the drug store (not sure if you still can) and it was said to be used on men to reduce sex drive. I seem to remember it was common to use in prisons or other situations where men isolated from women. Some women, who had a bunch of kids, chores, and 24/7 work chores used it secretly to avoid their wifely duty!! Heard about this years and years ago!
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I understand your feelings as I went through it with my mom too, but just know you are doing absolutely the best thing for your FIL by having him assessed by the behavioral health unit. I agree with Laura, it does sound like he's exhibiting some paranoia, and obviously has a high degree of anxiety about his meds and health. He needs to be assessed for cognitive impairment/dementia, and there are meds they can give him too that might help the anxiety and paranoia depending on the cause. It does sound like he's not thinking rationally and is a danger to himself without treatment.
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Saltpeter is a reference to a substance to decrease male sexual desire. Your FIL definitely needs to be in the psychiatric unit if he's refusing to take meds and endangering himself. Don't feel guilty. You are doing the best things to help him through his final years. Also, rational patients refuse meds because the want to die rather than live with suffering. Perhaps back there in his rational mind, he's ready to leave this earthly life behind.
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The myth was back in the day they used saltpeter to keep men under control from sexual desires in the military and Jail it supposedly was to keep the male organ from becoming erect.
This is probably what her FIL is referring to as it was seen as a form of punishment.
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Jean1808 Sep 2019
My mother who has likely always been crazy used to tell me that in her nursing school back in the day they put salt peter in the young ladies food.
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How did he feel about it before the dementia? Any living will, DNR etc?
My father had no dementia but some mild/moderate brain damage due to a head injury where he could no longer care for himself and decided he’d had enough and refused treatment. By law you are allowed to refuse treatment. You don’t say( or I didn’t see if you did) how cognizant he is but imo if he’s done he’s done. If you are POA that’s your decision, if not it’s his. Not sure why you feel it’s important to forestall the inevitable.
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BrielleD11 Aug 2019
Yes, living will...he wants meds, but not CPR, feeding tube or life support. He certainly has dementia, he has been diagnosed.
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The infection in the tooth is deemed a medical emergency. Any infection if left to brew could turn septic. It's good that he is in hospital.
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BrielleD11 Aug 2019
Thank you Llamalover, I appreciate you.
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You have allowed what is best for your loved one by letting him go to the hospital and agreed to the psychiatric unit for treatment because that's what it sounds like you're loved one needs to get the correct help they need. My husband had Alzheimer's and I encountered a similar situation while he was in a memory care unit he had to be admitted to the psychiatric unit downtown at the Nix and I was just broken broken over it but it turned out to be the best treatment and got him on a smoother Road to live out the rest of his life than what he was experiencing. Trusting in others to care for our loved ones is a tough thing to do but it's most often for the best. And you as a caregiver can only do so much and I know you're doing the best you can. Do not feel the guilt that some others want to put on you perhaps because you are doing the best for your loved one.
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Yes it's happened to my 93 yr. old Mom twice. She fell at her Assisted Living Facility and had been refusing her meds. So she went to hospital for 6 days for other complications and she was hallucinating and confused. The ALF said they couldn't take her back. While there she was diagnosed with a mood disorder and was started on two meds that helped. I think she's had an anxiety disorder most of her life but she stayed away from doctors and medicine. She walks with walker pretty good and still eating well and we still have some laughs. I'm not quite ready for Hospice. She signed a form that named me as Healthcare Proxy but the hospital had some problems accepting it so my husband and I got dual guardianship of her. Took a lawyer and $1700. I'm sorry you're having to go through this. After another try at a ALF we finally had to go with a skilled nursing facility or nursing home and I've been relieved she's getting more care. Good luck.
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Yes, with any suicidal ideation this is where it will go. This is of course a severe dementia now it is sounding and there may be placement in memory care needed. This also could be a thing where you are allowed to go palliative care, no real treatment and hospice if truly you believe that your FIL would rather die. The CHF is not a good thing with the Atrial Fib. Either the cellulitis in leg or infection in gums could go systemic and kill very quickly. It is going to be time to ask for a palliative care consult. The CHF can cause breathing difficulty and poor oxygen exchange and can lead to just not enough O2 to the brain. I doubt you will be able to take him home unless he truly already HAS an infection going that is responsible. You don't say how much of a change this is. They will try a medication cocktail, but again, you are between devil and deep with trying to keep someone comfortable and not agitated but now snowed to sleep all the time.
I am so sorry. You could be looking already at a raging infection. I hope they find a reason for this change, if change it is--or an answer to make him more comfortable. How old is your FIL Brielle. Please update us and good luck.
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