Help me with my dad

loricatus · Jul 19, 2008

He certainly sounds like he is in denial.

The only thing I can think of at this point is some shock therapy. Get some pictures of what he is in for if he continues the way he is going. You can also tell him that WHEN he loses the leg, he may just have to deal with removing the maggots first, because none of you are going to help him with that.

There is also a chance, if the infection spreads, of him dying from sepsis, which is not a pleasant way to go. Maybe you can tell him that he better start making out his will and get his affairs in order.

Sometimes tough love can work wonders to snap someone out of denial. I have been that route with one of my parents; and, I had to resort to what was considered cruel to wake my Dad up that he let cancer go untreated because of his denial that vitamins would work. My only regret is that I didn't try the tough love sooner because it was very hard to do to someone you care about.

I do know what you are going through; but, you have to remember that he is an adult and responsible for his own actions. All you can do is provide the information. It is his choice what to do with what you give him.

lsyorke, RN · Jul 19, 2008

Sometime you just have to be blunt..."If you don't take care of this, you WILL lose your leg below the knee".... Sound like cellulitis is already there with osteomyelitis not far behind.

Living with a type I diabetic I understand your frustration.

SunnyAndrsn · Jul 19, 2008

He sounds like my dad!

My dad hates to spend $$$ on anything related to medical costs for himself, yet of course for my nephew who is hospitalized with leukemia, he told our family "he'd take care of everything". For himself, nada!

Would you buying him the socks be an option? Or the bandages? Since it's your dad you could employ a little therapeutic lying and say "oh I just picked them up from work, we get them so cheap..."

Buy him the antifungal yourself, or ask your step mom to do it.

Even if you try all these tactics, recognize that if your dad is A&O x 3 he has the right to make bad decisions about his health and health care.

I've got a diabetic spouse and would have driven myself crazy if I didn't look at things this way.

I first want to say I am NOT looking for medical advice so I hope this post won't break any rules. I am not a nurse, I am waiting to get into nursing school but I know many of you deal with patients like my dad.
My dad is a diabetic (among other things) and he does not take care of himself. I mean he's doing much better with his diet, but when he developed a wound on his foot he did not seek medical attention for two weeks, until my step-mother dragged him to the doctor. She is about to graduate as an RN so she is very much aware of the risks of a wound on the foot, and she is very capable of of helping him with treatment. The doctor was alarmed at the state of the wound. He said my dad better take care of it or he's going to end up losing the foot. It is 5 inches by 3 inches spread across both sides and the back of his heel. He also has another wound starting on his toe and his whole foot is swollen. The doctor gave him a shot of antibiotics, some oral antibiotics, and instructions for home care until the cultures come back to show what's going on with the wound. The doctor also said to put an OTC antifungal cream on it, and a prescription antibiotic cream and to keep the wound covered with a kind of absorbent pad that will take in the weeping fluid but keep the wound dry.
My step mother called me frantic with worry and asked if I might speak to him. He apparently thinks the pads are too much much money to buy at Walgreens so instead he's using paper towels from the bathroom at work (!!) to wrap the wound, and because it's weeping a lot he has to change the paper towels frequently. He is using expired OTC antibiotic cream and antifungal ointment instead of what he is supposed to use on it. The doctor said to buy new socks and put a new sock on the wound daily over the bandages, but again he's too cheap and is using nasty old socks. He won't let my step-mother dress the wound, maybe out of pride or something.
What do you do with patients like this? Is there any way I can talk to him in a way that he will understand how urgent this situation is? He has a lot of money to spend on his hobbies so it's not like he's poor and can't afford the pads and ointment. He just chooses not to spend that money on himself. I suspect that he is in denial about how serious it is.

Tweety, BSN, RN · Jul 19, 2008

Denial and noncompliance in patients like this is tough. You can lead a horse to water, but you can not make it drink.

You're going to have to convince him that a little money spent now is money well spent. That when he goes into the hospital to have his leg amputated it's going to cost a lot more money. It already doesn't sound good at all.

Tell him about sepsis that he might get an infection that kills him if he doesn't take care of it. (opps...I just read the post above giving the same advice.)

Sometimes these types of patients are in such deep denial that telling them the consequences of current actions is like beating yourself with a sledge hammer.

AmericanChai · Jul 19, 2008

Thanks so much for your support and advice. I think the sepsis angle might work. I'll look up some info on it today. We are going to see him tomorrow. I'm not supposed to know all that's going on so I can't bring the socks and dressing, etc. over just yet, but I will ask him what the doctor said to do. I will maybe say later, " I noticed you have some really old socks, I bought you some new ones to put on your foot." My stepmother suggested that he put maxi pads on the wound because it would be less expensive but still a whole lot better than paper towels from a public bathroom! He said no to that. Apparently they got in a big argument about it so she's turning it over to me to see if I can talk some sense into him.

In the end you are right, he's a grown man and has to take responsibility for himself. I just find it ironic that when my 80 year old grandmother had a wound on her leg that was slow to heal because of her age and some medicine she's on, that he was on her so much to go see a doctor. He pushed her to see a wound specialist and she ended up getting a skin graft to heal it. And yet he won't take even the simplest doctor's advice for his own care. Urgh!

locolorenzo22, BSN, RN · Jul 19, 2008

It's tough....sometimes parents and patients just really do not want to deal with it like it is...and the fact of the matter is that no matter how much you talk to him about it, he may not want to do it...or is in denial of how serious it is.

All you can do is discuss it with him, and if he chooses not to do it....that is his right...regardless of how you may feel about it.

FranNHRN · Jul 19, 2008

Just a couple of thoughts....does your dad have insurance? If he does, the insurance could be paying for his bandages. Also, I would recommend that he see a wound specialist. If he is draining that much he possibly could be a candidate for a wound vac. His wound would heal so much faster. As far as dealing with someone so noncompliant....it can be very difficult, but sometimes you have to be very blunt and state what his effects of his noncompliance will be. He is an adult and can make the decision not to take care of himself, but he should know what the consequences of his noncompliance will be i.e. getting his foot, or let amputated, or sepsis and death.

NeosynephRN · Jul 19, 2008

too bad I did not have pictures of the patient I had a couple weeks ago...wound on leg, treated at home for a year...awful!!! Ended up on a vent maxed out on pressor's because he was sooooo septic!!! Lost that leg and the other foot, has a trach now...just got off the vent, honestly we are absolutely amazed that he is alive..life will NEVER be the same for him becuase of a tiny wound ( at first)...bumped into the couch...or coffee table..

My dad used to be pretty non-compliant with the diabetes until I had a patient that had his member amputated from diabetic complications...told him about that and he has been good ever since...guess that scared some sense into him!!

nursejoy1, ASN, RN · Jul 19, 2008

I had a similar problem with my dad. It's a "male thing", I guess. He pushes my mom to go to the doctor when she is slightly sick. (COPD) But my dad had obviously decreased blood flow to his left foot,cold, gray toes with almost black spots. We pushed and pushed and he went after months. When the FNP he saw asked if he knew he had high B/P he told her no, and my Mom told her we had known for about 10 years. ( Sometimes as high as 220/110) Also discovered he's diabetic. Ended up having to have fem-pop bypass. He waited so long that he has nerve damage and ALOT of pain. He is young, only 58. He has always been active, but now has just now gone back to work as a construction worker after 9 months.( Really not physically ready) The only thing I can offer is to keep pushing. Tell him how important he is to you and that you don't want to lose him. I agree with the "shock" .I once told my dad after he had what I suspect was a TIA, that If he did not get treated, he would end up having a stroke and on dialysis as his brother did for 3 yrs before he died at 58, or end up in bed with us having to do all of his personal care. Good Luck to you!!

puggy232 · Jul 20, 2008

Maybe stress the cost if his DM becomes even more complicated, this disease is the worst, as you all have seen pts basically wittled away toe here, than a foot, then a leg- the noncompliance is frustrating esp. with a love one. Maybe his PMD has a pt he can talk to someone who is and amputee or has significant vascular problems around his age that can tell him what he is in for if he continues this way. He seems to be wanting to be self reliant-stress how that's hard to do if your blind an amputee or require dialysis three times a week, pt's having member complications will probably get his attention.