Taking Dad to the doctor tomorrow

[cintinative]

Wow, I am so sorry. That sounds so frustrating. 

I am SO glad though that it sounds like his doctor genuinely is concerned and is putting you all in contact with the right specialists. Nowadays for a doctor to spend three hours with you is pretty unheard of--that's so great that he did that.  I would think that means you will have good support from him for referrals and getting your dad in as soon as possible.  

 

[sassenach]

16 hours ago, DawnM said:

I have had that EKG reading for 20 years and the doctors get all excited.   It isn't A-fib!

it is dementia.   It has to be.

My FIL is in kidney failure and the dr asked how long he has had high blood pressure.

FIL: I don't have high BP.

Dr: Your BP is elevated and you're already on one med for it.

FIL: They never tested me for it. They just put me on that medication for no reason.

Dr:  Your blood pressure gets tested every time you go to the doctor

FIL: but they've never officially tested me!

At this point I told the doctor quietly that she should probably just move on. 

FIL is surprisingly sharp, but also starting to slip. I don't see the above exchange as evidence of that so much. I think he has lived his life in denial of his medical issues and the part he plays in them. Ex: he has diabetes but insists it's not "that type of diabetes" so therefore he doesn't need to worry about his sugar consumption.

Every time you talk about your dad, he reminds me a lot of my FIL. I think they're at very similar stages. It's really hard to know where things will go from here. (((HUGS)))

 

 

[DawnM]

Thanks all for listening and responding.   It has been a long few days.   And work is very "extra" right now.  

It could be that he is in denial.   

I will update after his cardiology appt tomorrow.

[Harriet Vane]

With my loved ones, I found that being super chill and super laid back in demeanor while still inexorably moving forward with appointments and such was the only way forward. Just very business-as-usual-this-is-routine-no-big-deal.

Hope that helps--you know him best, of course, so of course you have a sense for what works or doesn't work with him.

[DawnM]

20 hours ago, cintinative said:

Wow, I am so sorry. That sounds so frustrating. 

I am SO glad though that it sounds like his doctor genuinely is concerned and is putting you all in contact with the right specialists. Nowadays for a doctor to spend three hours with you is pretty unheard of--that's so great that he did that.  I would think that means you will have good support from him for referrals and getting your dad in as soon as possible.  

 

The doctor didn't spend the full 3 hours with him,  It was off and on.  He ordered the nurse to do the EKGs, then dad went to the lab in-house to do blood work, then the X-ray tech did the X-ray, etc.....it just took 3 hours overall.

[DawnM]

He is INSISTING on getting a prayer letter out to around 300 people.   Most missionaries at his age stop their prayer letters.   

But he can't type anymore, so he painstakingly hand writes it and wants me to type it out.    He gave it to me Tuesday.   He keeps asking me every day when it will be ready.  Last night, after awards ceremony for the students, I tried to work on it.....I can't even read most of it.   And it makes no sense and is redundant.   

He mentions the girlfriend in his letter......that has GOT to come out.   It is ridiculous.  

[TravelingChris]

27 minutes ago, DawnM said:

The doctor didn't spend the full 3 hours with him,  It was off and on.  He ordered the nurse to do the EKGs, then dad went to the lab in-house to do blood work, then the X-ray tech did the X-ray, etc.....it just took 3 hours overall.

That is what I figured.

[mlktwins]

3 hours ago, DawnM said:

He is INSISTING on getting a prayer letter out to around 300 people.   Most missionaries at his age stop their prayer letters.   

But he can't type anymore, so he painstakingly hand writes it and wants me to type it out.    He gave it to me Tuesday.   He keeps asking me every day when it will be ready.  Last night, after awards ceremony for the students, I tried to work on it.....I can't even read most of it.   And it makes no sense and is redundant.   

He mentions the girlfriend in his letter......that has GOT to come out.   It is ridiculous.  

Does he need to see the typed letter or can you say they were taken care of at some point?  Is he signing them all?  Does he do the envelopes and stamps?  

I know you are not there yet (big hugs), but at some point you will be over feeling like you need to do all this extra stuff to appease him.  Only so many hours in the day and only so much of you to go around.  I know as I am living it.

ETA:  Just speaking from experience, and everyone's experience is different of course, but the elderly and those with dementia can hyper-focus on something like the letter he wants to send out.  Like he forgets other important stuff, but dang it, that letter is going to get out.  I about killed myself the first year with dad trying to care for him (and all that came with it), making sure he was happy and got everything he wanted, etc.  That along with homeschooling twin 8th graders and big decisions about high school.  I was utterly exhausted!!!  I was not even working full time and it was too much for me to do alone.  After 3.5 years, I just don't anymore.  I make sure he is well cared for, I see him and am involved in his life, I tell him I love him, etc., but I will not go above and beyond for his whims anymore.  At this point though, his short term memory is so bad that he can demand me or pester me to do something, I say ok, and he forgets the next day.  It is what it is.  I have just started to figure out how to make it work for me.

You are at the beginnings of him needing more serious care.  It is good you are getting help in there.  My prediction is that soon, you will be needing longer than 10-15 hours a week - if he stays in your home.  Fight your battles wisely.  Let go of the little stuff.  Don't kill yourself trying to do it all.  I can almost guarantee that he has no clue how much of a toll his care is taking on you already.  If you don't find a balance for yourself, no one else will.  I wish I knew this 3.5 years ago when I was thrown into this journey.

Chin up and keep going.  You are a great daughter even when you are making choices for him he doesn't want or think he needs.  That is what he needs right now!  

Edited February 24, 2022 by mlktwins

[Hyacinth]

You’re a supportive, loving, and patient daughter (though I’m guessing you don’t always feel that way 🙂). Thanks for keeping us all posted. 

[fairfarmhand]

5 hours ago, DawnM said:

He is INSISTING on getting a prayer letter out to around 300 people.   Most missionaries at his age stop their prayer letters.   

But he can't type anymore, so he painstakingly hand writes it and wants me to type it out.    He gave it to me Tuesday.   He keeps asking me every day when it will be ready.  Last night, after awards ceremony for the students, I tried to work on it.....I can't even read most of it.   And it makes no sense and is redundant.   

He mentions the girlfriend in his letter......that has GOT to come out.   It is ridiculous.  

Can you write the letter for him.

"Dear friends and family, This is just a quick update on my dad. Insert pertinent information. I know many of you have been long time associates with dad. If you would like to get periodic updates, you can follow me on Facebook @ or email me at ____. "

 

When he asks, just say, "Oh I took care of that."

He can fuss and fume "I wanted to read it before you sent it out."

"Sorry, too late. Already mailed it."

You are allowed to leave the room when he starts getting fussy. I doubt he will chase you down to give you a dressing down.

[HS Mom in NC]

I agree with @Grace Hopper on palliative and hospice care.  If he's in significant decline, you need them involved yesterday. They're a godsend!  Most people wait months longer than is appropriate to get that care. If you're going to need a diagnosis to access that kind of care, do whatever it takes to get it.  If he has to scream and yell and wail and weep going to whatever testing is necessary, do it.  You have to stay in a long term/big picture mindset. It's tough for detailed, in the moment personality types, but it's necessary.  Palliative and hospice care are by far the best option for terminally ill patients. It's not even close.

Remember, you're dealing with someone who thinks and emotes like a child now. It doesn't matter what he insists on.  He's at the equivalent of a preschooler state of being.  We don't turn ourselves in knots over the details of preschooler demands, we decide what needs doing and how it needs doing, and the preschooler will just have to deal with it.  We'll be nice and sweet and hug them when they cry or, if appropriate, leave them alone to have a good cry.  We're all headed in that direction, it's part of the aging process in the last chapter of our lives. If you're looking for the action that results in giving him what he needs and being happy about it, sadly, it doesn't exist. Loving someone sometimes means doing and/or saying what they really don't want and like.

And I agree on white lies and modifications as necessary. You cannot put anything non-essential onto your plate now. He needs you to keep all non-essentials off your plate. If you decide the prayer letter is going out, write it from your perspective, not his, including what you decide is appropriate.  Keep it short and to the point as @fairfarmhand suggests.  If you think it's going to too many people, send out however many you think is appropriate. Don't ask for his approval by showing it to him first.  Just do it and tell him you sent out the letter letting people know he's seriously ill and asking them to keep him in their prayers. If you decide only some of the 300 should get it and he asks if everyone got one, say yes and move on. It's not like the male vs. female caregiver issue where he knows it's not a male, he won't ever know some or all of the people didn't get his letter. If you decide not to do it at all, tell him you did and change the subject. Let him be angry about not getting to read it first it if he's angry.

Edited February 24, 2022 by HS Mom in NC

[Ottakee]

Palliative care or hospice is wonderful.  I called them the day we got my MIL pancreatic cancer diagnosis.  Their care allowed her to live at home until the very end and have a better quality of life.   They helped with meds and equipment and even staffing for caregiving.

[DawnM]

11 hours ago, mlktwins said:

Does he need to see the typed letter or can you say they were taken care of at some point?  Is he signing them all?  Does he do the envelopes and stamps?  

I know you are not there yet (big hugs), but at some point you will be over feeling like you need to do all this extra stuff to appease him.  Only so many hours in the day and only so much of you to go around.  I know as I am living it.

ETA:  Just speaking from experience, and everyone's experience is different of course, but the elderly and those with dementia can hyper-focus on something like the letter he wants to send out.  Like he forgets other important stuff, but dang it, that letter is going to get out.  I about killed myself the first year with dad trying to care for him (and all that came with it), making sure he was happy and got everything he wanted, etc.  That along with homeschooling twin 8th graders and big decisions about high school.  I was utterly exhausted!!!  I was not even working full time and it was too much for me to do alone.  After 3.5 years, I just don't anymore.  I make sure he is well cared for, I see him and am involved in his life, I tell him I love him, etc., but I will not go above and beyond for his whims anymore.  At this point though, his short term memory is so bad that he can demand me or pester me to do something, I say ok, and he forgets the next day.  It is what it is.  I have just started to figure out how to make it work for me.

You are at the beginnings of him needing more serious care.  It is good you are getting help in there.  My prediction is that soon, you will be needing longer than 10-15 hours a week - if he stays in your home.  Fight your battles wisely.  Let go of the little stuff.  Don't kill yourself trying to do it all.  I can almost guarantee that he has no clue how much of a toll his care is taking on you already.  If you don't find a balance for yourself, no one else will.  I wish I knew this 3.5 years ago when I was thrown into this journey.

Chin up and keep going.  You are a great daughter even when you are making choices for him he doesn't want or think he needs.  That is what he needs right now!  

 

6 hours ago, fairfarmhand said:

Can you write the letter for him.

"Dear friends and family, This is just a quick update on my dad. Insert pertinent information. I know many of you have been long time associates with dad. If you would like to get periodic updates, you can follow me on Facebook @ or email me at ____. "

 

When he asks, just say, "Oh I took care of that."

He can fuss and fume "I wanted to read it before you sent it out."

"Sorry, too late. Already mailed it."

You are allowed to leave the room when he starts getting fussy. I doubt he will chase you down to give you a dressing down.

 

He wants the read it, then sent it to the printer, then when he gets them back, he writes a personal note on all of them.   It is over 300 letters.  I don't have time to do it behind his back and he is with it enough to know.

 

[DawnM]

He went to the cardiologist today.   He said, "Yup, you are in A-fib."   Dad says he won't take the blood thinners.

Again, WHY ARE WE HERE DAD?

 

[Kassia]

6 minutes ago, DawnM said:

He went to the cardiologist today.   He said, "Yup, you are in A-fib."   Dad says he won't take the blood thinners.

Again, WHY ARE WE HERE DAD?

 

I'm sorry, Dawn.  I wish you could get a break from all the stress.  😞 

[DawnM]

AND he wants to mention the possibility of getting remarried in the prayer letter!   NO, NO, NO!~

[Grace Hopper]

11 minutes ago, DawnM said:

 

 

He wants the read it, then sent it to the printer, then when he gets them back, he writes a personal note on all of them.   It is over 300 letters.  I don't have time to do it behind his back and he is with it enough to know.

 

He can’t do it without you, so no worries about it actually going out. I know it will drive you crazy that he asks daily, but that’s going to happen no matter what. 
 

Maybe y’all can reach a compromise - he writes letters to a couple of people a day and you mail them. Let him know that’s the best you can do right now. 
 

I’m sorry he’s fighting the doctor. But honestly, if the doc put him on Coumadin or Warfarin, you’d have to go in for bloodwork every couple of days until the proper dose is determined, so there’s a little something to be relieved about. 

[DawnM]

2 minutes ago, Grace Hopper said:

He can’t do it without you, so no worries about it actually going out. I know it will drive you crazy that he asks daily, but that’s going to happen no matter what. 
 

Maybe y’all can reach a compromise - he writes letters to a couple of people a day and you mail them. Let him know that’s the best you can do right now. 
 

I’m sorry he’s fighting the doctor. But honestly, if the doc put him on Coumadin or Warfarin, you’d have to go in for bloodwork every couple of days until the proper dose is determined, so there’s a little something to be relieved about. 

What do you mean no worries about it actually going out?

[Grace Hopper]

1 minute ago, DawnM said:

AND he wants to mention the possibility of getting remarried in the prayer letter!   NO, NO, NO!~

Again, he’s not able to accomplish any of this without your assistance. 
 

I also realize you need to vent!!! 
Elder care is hard. I don’t mean to imply otherwise. But I do think you should remain in control where possible. You can’t force him to take meds. And he can’t force you to assist him in sending out that prayer letter. 

[Jaybee]

It seems to me like you have several options (none necessarily good) as to the letter. First, send it just like he wrote it, and let people figure it out (if you can figure out what his writing says)--or copy it as written because you don't have time to type it anyway. Second, just get firm with him like some have said, and tell him you do not have the time to deal with it--then deal with the tantrum. One way or another, it sounds like you are going to have to take a hard stand. You may be concerned that people will think ill of him because of the incoherence of the letter. I don't know what you do about that. But I don't know that you have the emotional energy right now to edit the letter enough to both keep him happy and make it coherent. I'm so sorry you have all this on your plate.

[Grace Hopper]

1 minute ago, DawnM said:

What do you mean no worries about it actually going out?

Is he capable of taking them to the post office in bulk? If he is mailing things himself, that’s not a burden on you. If he’s not able to mail things himself, you don’t have to get them all the way to the post office, iykwim. 

[fairfarmhand]

22 minutes ago, DawnM said:

 

 

He wants the read it, then sent it to the printer, then when he gets them back, he writes a personal note on all of them.   It is over 300 letters.  I don't have time to do it behind his back and he is with it enough to know.

 

Sorry dad. I don’t have time to do this. 

[Katy]

This sounds like the perfect thing for a former medical missionary to help him with. With explicit instructions to leave out the girlfriend or future marriage talk. 

[prairiewindmomma]

Sending out letters, a new marriage, attending church and participating in fellowship—those are all things someone with a vibrant retirement life and all of their faculties does. 
 

I am not sure whether you are dealing with someone in deep denial or dementia or both, but either way I am sorry you are dealing with the stress of it all.

I think the dementia eval might bring clarity for you and give you peace on how to make decisions and move forward. (I don’t know that he would accept the results.)

[Catwoman]

18 minutes ago, fairfarmhand said:

Sorry dad. I don’t have time to do this. 

I think the problem is that this is something that is very important to him, so it’s not easy for Dawn to say no. 

[fairfarmhand]

13 minutes ago, Catwoman said:

I think the problem is that this is something that is very important to him, so it’s not easy for Dawn to say no. 

And I get that. But one only has so many hours in the day. And when the time is taken up by more important things, it’s gone, no matter how important it is to dad. 
 

(maybe he could ask his new girlfriend to do it?)

[freesia]

I’ve been thinking about this. I totally get where you are coming from, Dawn. I wonder though if you should go the path of least resistance and just type the letter as he has written it. I would maybe fix it a bit. Then I would read it aloud to him to make sure it’s what he wants to say. He might hear the problems. I wouldn’t even edit out the girlfriend part. I’ve read mysteries by favorite authors who’ve aged that are rambly and a bit incoherent. Somehow those books got published. I shrug it off.  If I got a support letter from an elderly missionary like that, I’d do the same thing. I’m not sure what the harm would be. 

[DawnM]

5 minutes ago, fairfarmhand said:

And I get that. But one only has so many hours in the day. And when the time is taken up by more important things, it’s gone, no matter how important it is to dad. 
 

(maybe he could ask his new girlfriend to do it?)

He sent it to her 5 weeks ago and she agreed to do it and then never did it!

[freesia]

5 minutes ago, fairfarmhand said:

And I get that. But one only has so many hours in the day. And when the time is taken up by more important things, it’s gone, no matter how important it is to dad. 
 

(maybe he could ask his new girlfriend to do it?)

Oh that’s a good idea!

[DawnM]

35 minutes ago, Katy said:

This sounds like the perfect thing for a former medical missionary to help him with. With explicit instructions to leave out the girlfriend or future marriage talk. 

We are trying to find someone!

[fairfarmhand]

3 minutes ago, DawnM said:

He sent it to her 5 weeks ago and she agreed to do it and then never did it!

I wonder if he's bugging her about it? 🙂

[Catwoman]

6 minutes ago, DawnM said:

He sent it to her 5 weeks ago and she agreed to do it and then never did it!

Maybe she sees that the writing isn’t what it should be, but she doesn’t want to hurt his feelings, so she just keeps delaying getting it done for him?

[mlktwins]

15 minutes ago, freesia said:

I’ve been thinking about this. I totally get where you are coming from, Dawn. I wonder though if you should go the path of least resistance and just type the letter as he has written it. I would maybe fix it a bit. Then I would read it aloud to him to make sure it’s what he wants to say. He might hear the problems. I wouldn’t even edit out the girlfriend part. I’ve read mysteries by favorite authors who’ve aged that are rambly and a bit incoherent. Somehow those books got published. I shrug it off.  If I got a support letter from an elderly missionary like that, I’d do the same thing. I’m not sure what the harm would be. 

Since he is demanding it be done, this is what I would do!

Edited February 24, 2022 by mlktwins

[kbutton]

23 minutes ago, freesia said:

I’ve been thinking about this. I totally get where you are coming from, Dawn. I wonder though if you should go the path of least resistance and just type the letter as he has written it. I would maybe fix it a bit. Then I would read it aloud to him to make sure it’s what he wants to say. He might hear the problems. I wouldn’t even edit out the girlfriend part. I’ve read mysteries by favorite authors who’ve aged that are rambly and a bit incoherent. Somehow those books got published. I shrug it off.  If I got a support letter from an elderly missionary like that, I’d do the same thing. I’m not sure what the harm would be. 

If you do this, make it on condition that every letter you send is a day he takes his meds? 🙂 

[melmichigan]

I hope the neurology appointment is coming up soon so you can get clarification. My guess is that if he has a decline in kidney function it is causing cognition impairment and/or dementia.

[DawnM]

10 hours ago, melmichigan said:

I hope the neurology appointment is coming up soon so you can get clarification. My guess is that if he has a decline in kidney function it is causing cognition impairment and/or dementia.

Neurology will be coming up, but the doc wanted to get his heart stuff taken care of first.

[DawnM]

My friend and I have a running joke about Dad.   Every time he isnt agreeable and I am telling her about it, we both say, "Shady Pines Pa, Shady Pines!" 🤣

[Pawz4me]

10 hours ago, melmichigan said:

My guess is that if he has a decline in kidney function it is causing cognition impairment and/or dementia.

I'm not sure if you're thinking that if he has kidney cancer that would cause a decline in function, or if I missed something that was posted that indicates his blood work is off. But FWIW --kidney cancer in and of itself doesn't typically cause a decline in function. That becomes a worry if/when a nephrectomy (full or partial) is done and the patient is living with less than two kidneys.

[itsheresomewhere]

34 minutes ago, DawnM said:

My friend and I have a running joke about Dad.   Every time he isnt agreeable and I am telling her about it, we both say, "Shady Pines Pa, Shady Pines!" 🤣

I say the same thing to my mother.   “Shady Pines is in your future.” I tell her. 

Edited February 25, 2022 by itsheresomewhere

[DawnM]

5 minutes ago, Pawz4me said:

I'm not sure if you're thinking that if he has kidney cancer that would cause a decline in function, or if I missed something that was posted that indicates his blood work is off. But FWIW --kidney cancer in and of itself doesn't typically cause a decline in function. That becomes a worry if/when a nephrectomy (full or partial) is done and the patient is living with less than two kidneys.

I haven't checked the bloodwork, but his urine had protein and blood in it and that made the doctor take note.   Dad had about 3/4 of one of his kidneys removed in 2013 due to kidney cancer.

Last night I talked to Dad more about his cardiology appt and his kidneys.   I said,

“Dad, why won’t you get a kidney scan?”  

He said, “Don’t need one.”  

I said, “yes you do, the doctor would like you to get one.”  

He said, “I didn’t hear that.”  

I said, “Well, he is concerned about your protein and blood in your urine and would like a kidney scan and you told him no”.  

Dad: “I did?   Well, I don’t need one, The kidney is old news, I already had that cancer.” 🙄

[LifeLovePassion]

He might also have SOMS with a side of denial (stubborn old man syndrome). My dad insisted there was nothing wrong and Doctors couldn't figure anything out and didn't know anything. After he passed we got his clinic records and saw that there were definite diagnosis. He was not a good medical advocate and liked to keep his business private so even my mom didn't know some of it. His personality was such that he thought he knew better no matter the issue, so that didn't help. 

Hang in there Dawn and vent as needed.  

[DawnM]

2 hours ago, LifeLovePassion said:

He might also have SOMS with a side of denial (stubborn old man syndrome). My dad insisted there was nothing wrong and Doctors couldn't figure anything out and didn't know anything. After he passed we got his clinic records and saw that there were definite diagnosis. He was not a good medical advocate and liked to keep his business private so even my mom didn't know some of it. His personality was such that he thought he knew better no matter the issue, so that didn't help. 

Hang in there Dawn and vent as needed.  

I will be honest.   My dad does not know that I have his online medical chart set up.    He doesn't do anything online so if it were up to him, he not only wouldn't have it, but even if he did, he could no longer figure out how to use it.   So, I can see ALL of it.   I also do have medical POA.

[sassenach]

18 hours ago, Grace Hopper said:

He can’t do it without you, so no worries about it actually going out. I know it will drive you crazy that he asks daily, but that’s going to happen no matter what. 
 

Maybe y’all can reach a compromise - he writes letters to a couple of people a day and you mail them. Let him know that’s the best you can do right now. 
 

I’m sorry he’s fighting the doctor. But honestly, if the doc put him on Coumadin or Warfarin, you’d have to go in for bloodwork every couple of days until the proper dose is determined, so there’s a little something to be relieved about. 

There are some great, newer generation anticoagulants that don't require frequent blood testing (xerelto, eloquis).

[Acorn]

7 minutes ago, sassenach said:

There are some great, newer generation anticoagulants that don't require frequent blood testing (xerelto, eloquis).

None of the newer ones were said to be suitable for my mom with one kidney. The 2-3 times a week testing has been a pain to deal with due to winter weather and other health concerns as she no longer can drive.

[sassenach]

I'm going to second or third the idea of seeking palliative care consult. I'm actually doing this with FIL next week. He also had kidney cancer and his remaining kidney has declined to the point of being in failure. It's starting to throw off his potassium, blood counts, etc. He doesn't want dialysis (I don't blame him) or insulin for his diabetes, so everything is just declining. I asked for palliative because I can tell he's getting tired of all the blood tests and diet changes, and I just need a doctor to walk him through his options. The specialists just keep throwing more tests and treatments at him and I'm not sure that's what how he actually wants to live right now. I do get frustrated at his lack of self care, but at the same time I feel for him. I think palliative will help us figure out a North Star so as we're navigating the options, we have some sort of filter to make decisions with.

 

[Scarlett]

13 minutes ago, sassenach said:

There are some great, newer generation anticoagulants that don't require frequent blood testing (xerelto, eloquis).

And Pradaxa which is the one dh is on.  But with a frail elderly patient fall risk is a real concern....

No good answers really.

[sassenach]

Just now, Acorn said:

None of the newer ones were said to be suitable for my mom with one kidney. The 2-3 times a week testing has been a pain to deal with due to winter weather and other health concerns as she no longer can drive.

Good to know. I didn't realize that it was contraindicated with renal insufficiency. My son is just wrapping up 3 months of lovenox (injections) because that class was incompatible with one of his seizure meds. We went with the injections because getting blood draws is extremely challenging with him. Can't wait to be done.

 

[sassenach]

1 minute ago, Scarlett said:

And Pradaxa which is the one dh is on.  But with a frail elderly patient fall risk is a real concern....

No good answers really.

I think that's another +1 in the palliative consult category. If he doesn't want to treat the a-fib, he should just be really clear on what kind of interventions he wants in case of a stroke. It's a legit option to leave it untreated, but I wouldn't want to do that if there isn't a DNR/DNI in place.

[Jean in Newcastle]

A man talking about a quick new marriage sounds more like a man in denial than a man who is wanting to die without interventions. . . .

[Grace Hopper]

54 minutes ago, sassenach said:

There are some great, newer generation anticoagulants that don't require frequent blood testing (xerelto, eloquis).

IME the newer ones weren’t compatible with CHF. And as someone else mentioned, as the elder becomes more of a fall risk as time goes on, one must do a sort of risk-benefit analysis on what may happen should someone on a blood thinner take a hard hit on the way down. 
 

Also, ime, hospice is wonderful, a caveat for enrollment was that they did not manage warfarin/Coumadin blood levels, so the patient had to be willing to discontinue that drug. In our case it went hand in hand with it being too risky due to frequent falls, but for some it might be a harder decision since it increases the chances of other things, especially if one has serious Afib or a pacemaker. This is my understanding based on personal experience, perhaps there are better options currently. 

Edited February 25, 2022 by Grace Hopper