MIxing Meds

[GVFD2-36]

Could anyone help me out with finding any indications of mixing nitro, with blood pressure meds and insulin. I have a family member who is diabetic, and such who is popping nitro like candy and refuses to seek medical attention...Also complains of chest pain and has been told of a possible blockage..anyone have any ideas on how to get them to get medical aid..etc...

Thanks

[FireMedic65]

www.medicare.gov would be a good start.

But without them going to see a doctor, your family member will most likely be denied coverage without a checkup.

[Chief1C]

Ahhhhhh... If they're "popping nitro like candy" because they're having chest pain, due to a blockage. I believe you don't need to worry about insurance to get treated in an ER, which is where they should probably be seen, soon.

Being the mean person I am, I'd just go ahead and call 9-1-1, then hope you get a puppy dog eyed responder than can talk them into going. Perhaps guilt them with talk of how much everyone loves them, and will miss them. Maybe cry a little? Or, you could just be honest " You are going to die."

[FireMedic65]

4c is right. Sometimes you just need a bit of the tough love.

[croaker260]

Could anyone help me out with finding any indications of mixing nitro, with blood pressure meds and insulin. I have a family member who is diabetic, and such who is popping nitro like candy and refuses to seek medical attention...Also complains of chest pain and has been told of a possible blockage..anyone have any ideas on how to get them to get medical aid..etc...

Thanks

Not sure your real question is about interactions of meds. Many diabetics (most eventually) will have HTN and CAD problems.

Your real question is how to convince a stubborn family member to get help...reality is often times you cant. But perhaps their spouse could. When you explain to them that frequent need for NTG is a sign of worsening CAD (AKA a crescendo pattern of unstable angina), and that NTG is not a cure for the issue (for many, when you take a pill, they no longer have the underlying problem...) maybe that will help.

Honestly though, having dealt with a stubborn relative (my grandmother who raised me) often tough love wont work. In fact it may make things worse. Especially if they are older than you and saw you in your diapers, there is NO WAY may people will be forced to do something by a "whipper snapper". Try the soft sell before you try the hard sell.

End the end....People have the right to make poor choices.

Edited November 27, 2009 by croaker260

[Mateo_1387]

Ahhhhhh... If they're "popping nitro like candy" because they're having chest pain, due to a blockage. I believe you don't need to worry about insurance to get treated in an ER, which is where they should probably be seen, soon.

Being the mean person I am, I'd just go ahead and call 9-1-1, then hope you get a puppy dog eyed responder than can talk them into going. Perhaps guilt them with talk of how much everyone loves them, and will miss them. Maybe cry a little? Or, you could just be honest " You are going to die."

4c is right. Sometimes you just need a bit of the tough love.

Be careful to not use coercion and scare tactics. Sick people do not need to be faced with 'you are going to die', especially when you do not know the end point of their demise. I would not want anyone to sell me something by coercion, not my care, and especially not my health care.

My suggestion would be to sell the idea to your family member that benefits them. This may be telling them about possibilities that may ensue from their unattended medical problem, selling them the idea that they will not have to pop nitroglycerin all day long, or that you love the person and want to see them around for years to come (of course if they are willing too, LOL).

Sometimes though, they may not want medical attention, and rather you are the one who wants them to be seen. Have you accepted that if they are happy with their current situation (after they have been informed) that you are happy for them? It may be something you think about.

[mobey]

Be careful to not use coercion and scare tactics. Sick people do not need to be faced with 'you are going to die', especially when you do not know the end point of their demise. I would not want anyone to sell me something by coercion, not my care, and especially not my health care.

My suggestion would be to sell the idea to your family member that benefits them. This may be telling them about possibilities that may ensue from their unattended medical problem, selling them the idea that they will not have to pop nitroglycerin all day long, or that you love the person and want to see them around for years to come (of course if they are willing too, LOL).

Sometimes though, they may not want medical attention, and rather you are the one who wants them to be seen. Have you accepted that if they are happy with their current situation (after they have been informed) that you are happy for them? It may be something you think about.

Yes, Yes, Yes.

Agreed 100%

For some reason, society nowadays is pretty quick to instill "tough love" and cram pills & guilt down peoples throats who are ready to die.

If I were in your places I would supply unbias information and offer love and support.

At 93 yrs old my grandmother decided NOT to increase her Lasix and Nitropatch dose to deal with her worsening CHF, she died 8days later of a pulmonary edema exacurbation.... exactly what she wanted.

[Richard B the EMT]

Admittedly a bit of a side step, but why didn't I find out about the side effects of Viagra/Ciallis and Nitro from my agency, and instead, find out as a part of a bit in a Jack Nicholson movie?

[HERBIE1]

Yes, Yes, Yes.

Agreed 100%

For some reason, society nowadays is pretty quick to instill "tough love" and cram pills & guilt down peoples throats who are ready to die.

If I were in your places I would supply unbias information and offer love and support.

At 93 yrs old my grandmother decided NOT to increase her Lasix and Nitropatch dose to deal with her worsening CHF, she died 8days later of a pulmonary edema exacurbation.... exactly what she wanted.

Well, I would say there are 2 different scenarios. As a responder, I have no problem trying to "guilt" someone into going to an ER. Tell them the worst case scenario, tell them they may die (if appropriate for their condition), tell them their family is worried they may lose them. If all that fails, and they meet the criteria for a refusal of transport, then you've done all you can, and you need to respect their wishes. Yes, it seems our society has become far more likely to know what's best for someone else- regardless of their expressed wishes or their refusal to comply with seemingly common sense advice/treatment/care. Like you alluded to, since when did making your own decisions become a bad thing?

As a family member of someone who may not be doing what you feel is in their best interests, well, like you said, give them the straight dope, make them understand the possible consequences of their decisions, and then support and love them unconditionally. Is it hard- of course. Nobody wants to see a loved one hasten their demise or live a quality of life you feel is not adequate, but ultimately it's not YOUR decision, it's THEIRS. As long as that person is of sound mind and body, you must respect their wishes. That is what love is all about- doing what THEY want.

I'm sure that most people struggle long and hard with their decisions to forgo treatment or care and don't come to these conclusions easily. They accept their situation, understand the probable outcome, and are OK with it.

We've all had patients who completely frustrate their families(and us) by refusing care, being noncompliant with their medications, or simply do not take care of themselves as we think they should. They made a choice, and we must accept that choice- as unpleasant as it may be.

[Mateo_1387]

Well, I would say there are 2 different scenarios. As a responder, I have no problem trying to "guilt" someone into going to an ER. Tell them the worst case scenario, tell them they may die (if appropriate for their condition), tell them their family is worried they may lose them. If all that fails, and they meet the criteria for a refusal of transport, then you've done all you can, and you need to respect their wishes. Yes, it seems our society has become far more likely to know what's best for someone else- regardless of their expressed wishes or their refusal to comply with seemingly common sense advice/treatment/care. Like you alluded to, since when did making your own decisions become a bad thing?

Using guilt to indirectly force a patient to accept medical care is coercion. This topic reminds me of a quote by DwayneEMTP in his thread he started about treating diabetic patients. I think the quote applies to this case. DwayneEMTP said "Now, I'm comfortable that my treatment was strictly patient advocacy based, but do we have the right to advocate for patients against their properly mentating wishes? Or to withhold the opportunity to properly mentate, when it's within our power to give it, so that we can gift them with our advocacy? (Yikes, sounds terribly arrogant when put that way, doesn't it?)" ( found on this thread http://www.emtcity.com/index.php/topic/16244-moralethical-dilemma-concerning-a-pts-right-to-refuse/page__st__20 ) The bold section of the quote is what I am in reference to with this discussion. Although his discussion was about an unconscious diabetic patient, I want to ask the same question (although modified) for this thread. Are we being an unbiased patient advocate and informing our patients of their choices, or are we using coercion 'so that we can gift them with our advocacy'?

As health care providers, we, IMO, have a duty to respect the individual rights of our patients when they form a decision about their health care. Informing a patient that their condition could worsen and possibly result in death is completely different from cramming 'you are going to die' down their throat, in hopes they will go to the hospital. Although sometimes difficult to do, as patient advocates, it is the duty of the health care provider to respect their wishes. We should, in a non-coercive way, inform our patient about their medical condition, as limited by our knowledge. Patients should not be lied to, made to feel guilt, scared, or threatened to accept medical care.

Better ways are available to talk to patients that are more compassionate and productive. One example would be to try and understand why the patient is reluctant to refuse care. Stating to the patient, ‘I am here to respect your wishes, but I would like to talk with you about your reluctance to accepting medical care, would you please explain why?’ shows the patient that you are their advocate and that you are interested in the thought process behind their decision. After the patient explains why they do not want to go to the hospital, you may be able to take a different approach to ease their possibly unfounded reasons for not accepting medical treatment.

As a family member of someone who may not be doing what you feel is in their best interests, well, like you said, give them the straight dope, make them understand the possible consequences of their decisions, and then support and love them unconditionally. Is it hard- of course. Nobody wants to see a loved one hasten their demise or live a quality of life you feel is not adequate, but ultimately it's not YOUR decision, it's THEIRS. As long as that person is of sound mind and body, you must respect their wishes. That is what love is all about- doing what THEY want.

I'm sure that most people struggle long and hard with their decisions to forgo treatment or care and don't come to these conclusions easily. They accept their situation, understand the probable outcome, and are OK with it.

We've all had patients who completely frustrate their families(and us) by refusing care, being noncompliant with their medications, or simply do not take care of themselves as we think they should. They made a choice, and we must accept that choice- as unpleasant as it may be.

So, I have a story to share with you.

Some of my family members, including my grandparents, which this story is about, have a very negative view on allopathic health care treatments. To a degree, their opinions make sense, but it is taken to an extreme at times. Most folks would probably call them nuts for their opinions (and my oh my, there are some interesting ones, PM me if you’d like to hear) but I love them anyways.

So, on with the story. My grandparents are 77 and 81 years old, they both have high blood pressure, and grandpa is a diabetic. Grandpa is a stubborn ol’ man, and certainly difficult to talk with. Grandpa when first diagnosed as a diabetic did a great job of controlling his diet and checking is glucose levels. About a year down the road though, he fell off the wagon. That is where it all started.

I would confront grandpa with all my wonderful medical knowledge (sarcasm) and try to, in essence, coerce him to take care of himself. With his stubborn belief that allopathic medicine does not work, combined with my poor attitude and even less experienced view on life, we would lock horns. It was certainly uncomfortable for us both to reach that point.

Recently, I was visiting with the grandparents and was looking for a yogurt container in their refrigerator. Grandpa informed me that I could have his beer in the refrigerator. Screech ! In my mind, I am thinking wtf? Grandpa does not drink alcohol, although he used to indulge back in the day, he quit back in the 80’s. So, I had to ask, ‘why do you have beer in the refrigerator’? He informed me that my father bought it for him, because he asked for it. After asking why he wanted one, he informed me that he could not quench his thirst, and that he would drink the beer to quench that thirst. I was shocked. This seemed very out of character for my grandfather.

T

hen it hit me. I looked at him and said ‘Grandpa, I bet you 10 bucks it is because you blood sugar level is high, no scratch that, I bet 200 bucks. You drink this beer, it may help for a small amount of time to quench your thirst, but it will cause your blood sugar to raise and your thirst to become worse.’

This conversation was going to lead to one ending, we were going to lock horns again. It was bound to happen. That is when I gave him the choice, I asked him ‘do you want me to explain it, or do you want me to shut up?’. His reply ‘Shut up’.

I could handle being told to shut up, what I could not handle was that my grandfather was suffering from his diabetes and doing nothing about it. This really bothered me. It also made me do a bunch of thinking.

I wanted to bring the discussion back up with my grandfather. That is how the spider web of thought started. I had to question myself about why I wanted to bring it up to my grandfather. I realized why, it is because I wanted him to be treated for the diabetes. I wanted him to be around for years to come. The reasons were purse selfish in nature. I ended up talking with a friend of mine about the situation, which made me think more.

My friend and I discussed that it is difficult to watch a family member not take care of themselves when faced with a medical problem, especially when we know what should be done. We also discussed how the treatment or lack of treatment will affect his happiness. Grandpa may feel like he is being restricted at his age from enjoying the privilege to eat what he wants, when he wants, and through gifting him with my advocacy, he may place that blame on me. A person’s vice may be drinking alcohol, smoking, using drugs, unsafe sports, and the like, Grandpa’s vice just might be eating what he likes to help him enjoy his later years of life. I had to ask myself ‘am I willing to push him to unhappiness to fulfill my personal agenda?’.

In short, the answer is no. As Herbie said, I show him my love when I respect his decisions. My friend recommended to me that I approach him with the follow;

1. That I love him.

2. That I respect his decisions and happiness.

3. That I am there to answer any questions I can about his health.

4. That I will help him in any way possible if he decides that he wants to make a healthy change.

Those three things are what my grandfather needed to hear. That I love him, that I respect his happiness, and will be there for him. Although initially difficult to comprehend at first, I am happy that my Grandpa is happy. In the end, that is most important.

Good luck to the OP ! I hope this helps…