Violent Behavior

[Guest guest]

I'm working with a caregiver whose loved one is in a nursing

facility. Velma is 75 and has been diagnosed with LBD in the last

year. She has been physically violent and defiant at times. Her

personality has been one of being in control for most of her

life, 'her way or the highway', so this is nothing new.

This has caused several visits to a behavioral unit that provided

more problems than solutions. There have been 'bad meds' prescribed,

but that seems to be resolved at the moment.

The nursing facility attempts to 'control' the violent outbursts with

injections of Valium, which doesn't always get the expected result.

She will be seeing a specialist this week that is outside the nursing

facility and is LBD savvy.

The family is concerned about their trip there and back to the

appointment. The family has received numerous phone calls in the last

week about violent outbursts. The nursing facility is frustrated with

the resident and family and just want this situation resolved or the

resident removed for the safety of staff and residents. This is a

crisis situation for all involved. Any words of wisdom are much

appreciated. A list of current meds is below. Thank you, Donna Jean

She has been tested for a UTI.

Seroquel; 50 mg every 8 hours

Aricept; 10 mg. daily (1 x daily....am.)

Namenda; 5mg. (1 x daily....am.)

Zoloft; 100mg. (1 x daily.....am.)

Syntroid; (thyroid medication....diagnosed since LBD began); .05 mg.

(1 x daily....am.)

Valium; 2mg. (1x daily at 4pm.)

Kepra; (anti-seizure med) 500mg. (2x daily)

Additionally she is taking something (I do not know what) for

increasing appetite, and medication for bowels (constipation)

too......

[Guest guest]

Hi Donna - don't cancel that doctor's appt. - it might be

difficult, but will be worth the trip.

That's a lot of meds. I'm no doctor, I'm no expert. But I would

question the Valium & the anti-seizure med. Why is she taking an anti-

seizure med? Valium has a serious side effect of agitation. It's a

benzo - not good for the elderly.

Also find out what the bowel med. is b/c that could be bad too:

http://health.groups.yahoo.com/group/LBDcaregivers/message/62093

I would highly recommend your reviewing these meds w/ a PharmD or

your local pharmacist.

It might be better not to give her a heads up about the trip. Not

sure what stage she's in but my mom would worry constantly before a

doctor's trip - keep thinking she'll miss the appt., that she'll be

late, etc. We learned to not let her know prior to the appt. so she

wouldn't get so anxious.

Good luck! And keep us posted.

PS - no meds should be stopped immediately - like when you start low,

go slow... you have to stop meds slowly too...

>

> I'm working with a caregiver whose loved one is in a nursing

> facility. Velma is 75 and has been diagnosed with LBD in the last

> year. She has been physically violent and defiant at times. Her

> personality has been one of being in control for most of her

> life, 'her way or the highway', so this is nothing new.

>

> This has caused several visits to a behavioral unit that provided

> more problems than solutions. There have been 'bad meds'

prescribed,

> but that seems to be resolved at the moment.

>

> The nursing facility attempts to 'control' the violent outbursts

with

> injections of Valium, which doesn't always get the expected result.

>

> She will be seeing a specialist this week that is outside the

nursing

> facility and is LBD savvy.

>

> The family is concerned about their trip there and back to the

> appointment. The family has received numerous phone calls in the

last

> week about violent outbursts. The nursing facility is frustrated

with

> the resident and family and just want this situation resolved or

the

> resident removed for the safety of staff and residents. This is a

> crisis situation for all involved. Any words of wisdom are much

> appreciated. A list of current meds is below. Thank you, Donna Jean

>

> She has been tested for a UTI.

> Seroquel; 50 mg every 8 hours

> Aricept; 10 mg. daily (1 x daily....am.)

> Namenda; 5mg. (1 x daily....am.)

> Zoloft; 100mg. (1 x daily.....am.)

> Syntroid; (thyroid medication....diagnosed since LBD began); .05

mg.

> (1 x daily....am.)

> Valium; 2mg. (1x daily at 4pm.)

> Kepra; (anti-seizure med) 500mg. (2x daily)

> Additionally she is taking something (I do not know what) for

> increasing appetite, and medication for bowels (constipation)

> too......

>

[Guest guest]

Dang, this takes me back - about a year, exactly.

My Mom went through a period of time of escalating behavior, as well. Well

- the whole season of Lewy was escalating behavior, of course. But from

April to July was totally wild. It started with her eating the WORLD -

taking food away from other residents at the RCF that she lived at, eating

two or three portions of EVERYTHING - several times a day. So not like her.

The doc did order an evaluation of her TSH and other thyroid levels - and

low and behold, they were skyrocketed through the roof - so adjustments were

made. That helped a little. She actually ended up going to an acute care

facility after a particularly out of control little season and was there for

a month. It was during that evaluation that they told me that her

escalation was advancement of the disease and that we'd do the best we could

to manage her outbursts. We finally found her a happy place. We were able

to get her back to her RCF. She did beautifully, and then just as the

evaluating doc at the acute care facility had predicted - she lived exactly

3 months to the date from her initial assessment longer.

Key to getting everything evened out: a recognized geriatric psychiatrist.

It really does look like she's got a polypharmacy thing going on - they

don't like to see people on this many drugs - there are so many interactions

and sensitivities that can be exacerbated when this much chemical is

happening. I'd certainly urge a qualified practitioner evaluate her meds -

thoroughly.

I don't know if she's violent because of needing to take meds, or stuff like

that - but that was certainly an issue for my Mom. We finally figured out

that if we gave her a chaser of her favorite candy - she'd happily comply.

Finding motivators that gave her a warm fuzzy was important.

Blessings,

Dina

Care Manager to Mom, aged 67

dx'd with LBD 10/2006

Home with the Lord 9/15/07

[Guest guest]

Donna,I believe some people cannot take Valium, nor Zoloft, and maybe

something else she is taking. Especially when the meds are mixed. I

would strongly suggest that one med at a time be removed to find out

if one is really the problem. But, then of course, if she has always

been that way, I don't imagine she will change now, with this

terrible disease playing havoc with her brain.

I pity all of them.

Love a lot,

Imogene

>

> I'm working with a caregiver whose loved one is in a nursing

> facility. Velma is 75 and has been diagnosed with LBD in the last

> year. She has been physically violent and defiant at times. Her

> personality has been one of being in control for most of her

> life, 'her way or the highway', so this is nothing new.

>

> This has caused several visits to a behavioral unit that provided

> more problems than solutions. There have been 'bad meds'

prescribed,

> but that seems to be resolved at the moment.

>

> The nursing facility attempts to 'control' the violent outbursts

with

> injections of Valium, which doesn't always get the expected result.

>

> She will be seeing a specialist this week that is outside the

nursing

> facility and is LBD savvy.

>

> The family is concerned about their trip there and back to the

> appointment. The family has received numerous phone calls in the

last

> week about violent outbursts. The nursing facility is frustrated

with

> the resident and family and just want this situation resolved or

the

> resident removed for the safety of staff and residents. This is a

> crisis situation for all involved. Any words of wisdom are much

> appreciated. A list of current meds is below. Thank you, Donna Jean

>

> She has been tested for a UTI.

> Seroquel; 50 mg every 8 hours

> Aricept; 10 mg. daily (1 x daily....am.)

> Namenda; 5mg. (1 x daily....am.)

> Zoloft; 100mg. (1 x daily.....am.)

> Syntroid; (thyroid medication....diagnosed since LBD began); .05

mg.

> (1 x daily....am.)

> Valium; 2mg. (1x daily at 4pm.)

> Kepra; (anti-seizure med) 500mg. (2x daily)

> Additionally she is taking something (I do not know what) for

> increasing appetite, and medication for bowels (constipation)

> too......

>

[Guest guest]

Valium is a MAJOR problem with my mother. She goes wild on it. As for

Zoloft, she's been on it for a year and a half with no problems.

  

Gladys Stefany

Milford, Pike County, PA

Very Proud Daughter of Grace, age 76 - appears to be in between stages 3 and

4

Diagnosed with " probable " Diffuse Lewy Body Disease

Current Meds: Exelon Patch, Namenda, Nexium, Parcopa, Premarin, Synthroid,

Vytorin, Seroquel, and Zoloft

-- Re: Violent Behavior

Donna,I believe some people cannot take Valium, nor Zoloft, and maybe

something else she is taking. Especially when the meds are mixed. I

would strongly suggest that one med at a time be removed to find out

if one is really the problem. But, then of course, if she has always

been that way, I don't imagine she will change now, with this

terrible disease playing havoc with her brain.

I pity all of them.

Love a lot,

Imogene

>

> I'm working with a caregiver whose loved one is in a nursing

> facility. Velma is 75 and has been diagnosed with LBD in the last

> year. She has been physically violent and defiant at times. Her

> personality has been one of being in control for most of her

> life, 'her way or the highway', so this is nothing new.

>

> This has caused several visits to a behavioral unit that provided

> more problems than solutions. There have been 'bad meds'

prescribed,

> but that seems to be resolved at the moment.

>

> The nursing facility attempts to 'control' the violent outbursts

with

> injections of Valium, which doesn't always get the expected result.

>

> She will be seeing a specialist this week that is outside the

nursing

> facility and is LBD savvy.

>

> The family is concerned about their trip there and back to the

> appointment. The family has received numerous phone calls in the

last

> week about violent outbursts. The nursing facility is frustrated

with

> the resident and family and just want this situation resolved or

the

> resident removed for the safety of staff and residents. This is a

> crisis situation for all involved. Any words of wisdom are much

> appreciated. A list of current meds is below. Thank you, Donna Jean

>

> She has been tested for a UTI.

> Seroquel; 50 mg every 8 hours

> Aricept; 10 mg. daily (1 x daily....am.)

> Namenda; 5mg. (1 x daily....am.)

> Zoloft; 100mg. (1 x daily.....am.)

> Syntroid; (thyroid medication....diagnosed since LBD began); .05

mg.

> (1 x daily....am.)

> Valium; 2mg. (1x daily at 4pm.)

> Kepra; (anti-seizure med) 500mg. (2x daily)

> Additionally she is taking something (I do not know what) for

> increasing appetite, and medication for bowels (constipation)

> too......

>

------------------------------------

Welcome to LBDcaregivers.

[Guest guest]

Hi Donna -

& nbsp;

How wonderful of you to get involved. And it's no surprise this resident is

acting out. NH staff is creating at least some of the " problem " they don't like

by giving meds harmful in LBD. Best news ever is Velma will see an MD who knows

LBD.

& nbsp;

Valium is considered a harmful drug to those with LBD. Anxiety, combativeness,

terror, rages . . . As indicated, anti-seizure meds can also be a

problem: what is the clinical basis for this med? & nbsp;. Ditto certain certain

laxative. If the appetite stimulant is Reglan or another med in that class -

again ditto! Very bad in LBD.

& nbsp;

While it's true that most meds must be discontinued over a course of time (which

differs depending on the drug), certain meds must be stopped right away if they

are causing what's called neuroleptic malignant syndrome. & nbsp;This can be

caused by an intolerance to even low doses of a neuroleptic med like Seroquel,

or an overdose of same, or too many of such meds mixed together. I am not a doc

or nurse, but work with a gero-pharmacologist. I just gave him a quick call and

he recommends: get an immediate pharmacology consult on these meds. Valium in

LBD is bad news. It should not even be needed with the Seroquel. Re Seroquel: is

this an appropriate dose for the lady's weight, other medical issues, etc. Most

likely some of the other meds are interacting with it as well as being

potentially harmful on their own. Discontinuing the valium would be a good place

to start. He wonders about the names of the other meds, and asks what prompted

use of Synthroid at

this point. Many meds can affect other organs of the body, not just the brain.

& nbsp;

I agree with about announcing the trip. Too much cause for concern. If

the valium is C/D, and the Seroquel works as it should, she should be fairly

relaxed for the trip. Pleae keep us posted. Velma will be in my prayers.

& nbsp;

Lin

& nbsp;

From: & lt;octoryrose@... & gt;

Subject: Re: Violent Behavior

To: LBDcaregivers

Date: Monday, June 16, 2008, 4:47 PM

Hi Donna - don't cancel that doctor's appt. - it might be

difficult, but will be worth the trip.

That's a lot of meds. I'm no doctor, I'm no expert. But I would

question the Valium & amp; the anti-seizure med. Why is she taking an anti-

seizure med? Valium has a serious side effect of agitation. It's a

benzo - not good for the elderly.

Also find out what the bowel med. is b/c that could be bad too:

http://health.groups.yahoo.com/group/LBDcaregivers/message/62093

I would highly recommend your reviewing these meds w/ a PharmD or

your local pharmacist.

It might be better not to give her a heads up about the trip. Not

sure what stage she's in but my mom would worry constantly before a

doctor's trip - keep thinking she'll miss the appt., that she'll be

late, etc. We learned to not let her know prior to the appt. so she

wouldn't get so anxious.

Good luck! And keep us posted.

PS - no meds should be stopped immediately - like when you start low,

go slow... you have to stop meds slowly too...

& gt;

& gt; I'm working with a caregiver whose loved one is in a nursing

& gt; facility. Velma is 75 and has been diagnosed with LBD in the last

& gt; year. She has been physically violent and defiant at times. Her

& gt; personality has been one of being in control for most of her

& gt; life, 'her way or the highway', so this is nothing new.

& gt;

& gt; This has caused several visits to a behavioral unit that provided

& gt; more problems than solutions. There have been 'bad meds'

prescribed,

& gt; but that seems to be resolved at the moment.

& gt;

& gt; The nursing facility attempts to 'control' the violent outbursts

with

& gt; injections of Valium, which doesn't always get the expected result.

& gt;

& gt; She will be seeing a specialist this week that is outside the

nursing

& gt; facility and is LBD savvy.

& gt;

& gt; The family is concerned about their trip there and back to the

& gt; appointment. The family has received numerous phone calls in the

last

& gt; week about violent outbursts. The nursing facility is frustrated

with

& gt; the resident and family and just want this situation resolved or

the

& gt; resident removed for the safety of staff and residents. This is a

& gt; crisis situation for all involved. Any words of wisdom are much

& gt; appreciated. A list of current meds is below. Thank you, Donna Jean

& gt;

& gt; She has been tested for a UTI.

& gt; Seroquel; 50 mg every 8 hours

& gt; Aricept; 10 mg. daily (1 x daily....am.)

& gt; Namenda; 5mg. (1 x daily....am.)

& gt; Zoloft; 100mg. (1 x daily.....am.)

& gt; Syntroid; (thyroid medication....diagnosed since LBD began); .05

mg.

& gt; (1 x daily....am.)

& gt; Valium; 2mg. (1x daily at 4pm.)

& gt; Kepra; (anti-seizure med) 500mg. (2x daily)

& gt; Additionally she is taking something (I do not know what) for

& gt; increasing appetite, and medication for bowels (constipation)

& gt; too......

& gt;

------------------------------------

Welcome to LBDcaregivers.

[Guest guest]

Hi, Leona! I've been wondering how's your husband doing. You mentioned that he

was having some other health problems. Did the doctor find the cause? How is he

doing now? I've been checking the digests for new information, but I have not

seen any news from you and Ray. Please let us know. You are in my prayers every

day.

What this doctor said about REM Behavior Disorder is very familiar to me (it has

been mentioned before in our group) -my husband started having that many years

ago, even before the memory and balance problems. He would start kicking and

throwing punches to the point of hitting me a few times until I wised up and

even in my sleep would catch his hand in mid-air and started calling his name to

wake him up. Several times he knocked the night stand with everything on it and

several others he fell out of bed, sometimes hurting himself. Interestingly, now

that his LBD has advanced, these episodes have somewhat subsided -he has the

jerking movements but not so violently as before.

My best wishes for you and Ray. Love,

Raquel