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October 24, 2016
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Know Your Parents' Meds

One of the "parents' business" items on our current trip to Virginia was a visit by a case nurse from an agency that is trying to get the Out-Laws additional personal and health assistance. While The Other Half's parents found her questions intrusive, they were reasonable follow-ons based on the OLs' current states of cognitive and physical health. One of the sets of questions was about their medications. A list of them was posted on the door to the den.

The case nurse assumed they were the Father-Out-Law's medications. Two were associated with asthma and COPD, one with GERD, another was a diuretic, a fourth was a potassium replacement, and the last one was unfamiliar to me (it turned out to have been a blood pressure medication). None of these are known issues for the FOL, whose current chronics are type 2 diabetes and some heart issues. The Mother-Out-Law and I had discussed her diuretic a number of times in previous years; it's one that requires significant potassium replenishment. From this, I was able to state to the nurse that this list was of the MOL's medications, not the FOL's.

I don't want to imagine what might have happened had a case nurse tried to administer these meds to the FOL.

Later that evening, the FOL uncovered a bottle of lisinopril with his name on it. Dated just over two months ago, it was set up for a month's supply of pills and was more than half full. Despite a previous stroke, the FOL's blood pressure is so low that it's a wonder he can stand up without getting dizzy. So why the lisinopril? I knew already that it was an ACE inhibitor (which has the side effect of preserving kidney function), but I wondered why he would be given a medication to lower an already-ridiculously-low blood pressure. Perhaps, based on the apparent "noncompliance", the doctor prescribed it and then told him to stop taking it? Based on some of the things I've been reading on my health groups, it wouldn't be the first time a pharmacist kept dispensing medications after a doctor ceased the medication (as long as there were refills remaining). Several hours later, it dawned on me: ACE inhibitors are on many diabetes standard-of-care checklists. Regardless of whether or not your blood pressure is ridiculously low, doctors are told to prescribe ACE inhibitors to every person diagnosed with diabetes. This is probably what happened — but I'm still not sure whether or not a ninety-three year old man should be taking something to protect his kidneys at the risk of dangerously lowering his blood pressure, and I don't know whether or not his doctors told him to stop taking it.

The moral of the story is, discuss your parents' medications with them while they are still young enough and coherent enough to have an understanding of what they are taking, and why — and maintain enough oversight to know what should, and should not be taking as their cognitive powers decline.

As people with diabetes, we already know how to look up medications, understand what they're used for, and ask questions. We do it for ourselves; we do it for our children. At a certain stage in life, we need to do this for our parents as well.

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