When I moved back to Glasgow eight months ago Dad was taking 42 tablets every week.
There was a Bridget Jones Diary style monitoring of the daily intake:
Aricept x 1
Antacid tablets x 2
Aspirin x 1
Senna tablets x 2
And then the extras, as and when required, lined up on his bedroom dressing table: inhaler, eye-drops, special shampoo, dry skin creams, and various other ointments and lotions for a range of conditions which seemed to come and go. The bathroom cupboard had its fair share of potions too; some on prescription, some bought over the counter, most of them passed their use-by date.
But it was one of the kitchen cupboards which housed the biggest stash – the bottles and sachets and packets and pills in the laxatives range. There were some other items for use in that department which I didn’t dare open.
A couple of months ago Dad started to refuse all medication. Without warning he just clamped his teeth firmly shut and shook his head. Only opening his mouth to say ‘bugger off’ or words to that effect. It was a 'no' to all medication, in whatever shape or form.
Was this a protest? A way of exerting some control? An irritation with the carers he didn’t like? He wouldn't say. I began a tango of persuasion and bribery: 1 tablet = 1 Maltezer – but even that lost its appeal after a while. So I made the decision to stop trying to give him any medication at all.
I told Lorraine, our lovely CPN and she said that, by now, it was unlikely the Aricept was helping Dad’s dementia much at all, but they like to keep people on it for fear of side effects if they stop taking it. The other tablets were not life-saving, more life-enhancing. So we decided it was fine for him to go without and to treat any indigestion or constipation as necessary.
During a routine visit one of the GPs asked Dad why, exactly, he’d stopped taking the tablets.
‘I’m afraid….’ Dad started, but didn’t get to the end of the sentence. I imagined that the closer was ‘…you’re trying to poison me.’ I set about reassuring him that no-one was trying to poison him.
Certainly some of the meals he’d been served up by the carers were pretty unappetising and might have given the impression that we were trying to slip something unpalatable passed him. Fish pie with a meat gravy sauce was dished up before I could intercept it. As a vegetarian I did wonder for a split second if this was a new Heston Blumenthal inspired culinary fashion! But Dad's expression soon told me it wasn't.
In fact, I now realise that Dad might just as easily have been trying to say: ‘I’m afraid …..the tablets don’t work anymore.’
And that what he might have meant is: ‘I’m afraid …that these tablets are surplus to requirements.’ In other words he knew, on some subliminal level, that he actually didn’t need all of them.
The aspirin is preventative. If you read some of the advice everyone over 50 should be taking an aspirin a day. But by now it’s unlikely that it will make any difference to Dad. And it might even have been irritating his stomach.
The antacid tablets aren’t any longer needed because Dad now has a diet which doesn’t give him heartburn or indigestion. And the same with the senna tablets and the various other laxatives.
Best of all, Dad has started to take the Aricept again; happily, without complaint - and he is noticeably better for it. I’m sure he knows that too.
The only disappointment this week is that Dad has got a cold and a brooding cough – inevitable really with all the people who come through the house trailing their different germs with them, - so the doctor has given him a course of antibiotics. He is taking them mostly without complaint, and without the need for follow-up chocolate.
So as of today the count is:
Amoxicillin x 3
Aricept x 1
And Paracetamol only if required.
It’s a bit one-step-forward, two-steps-back, but four tablets a day is still better than six. And in a few days’ time it’ll be back down to one.
Important to remember, I guess, that language isn’t the only form of communication. Particularly with dementia you have to read all the signs and then try your best to interpret what they could mean. I may not have got this one right, but the net result is good all round, so I’ll settle for that.
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