My dad was always one of those guys who could eat anything and never gain weight...until he got older and was less active.. Then he began to put on weight and then even more when mom died. I believe he turned to food to take the pain away. For the last eight years, he's had a real love affair with food to the point it was the only thing (besides going to the casino) that made him happy.
Problem was, he was also a lifetime smoker and that, along with being a foodie, have left him with congestive heart failure, COPD and liver desease...three reasons he's not living alone anymore. A few months ago, being up to nearly 225 lbs (he's 5'10 tall) he had a real issue with gout that put him into the hospital, and his sugar levels were high, so they told him in front of my brother that he really should try to lose some weight and start watching his sugar levels closely.
My brother has always been a health nut and he's hated the way dad's been eating so he's taken this opportunity to put my dad on a very strict diet of few carbs, no sweets, no salt, and very small portions. At first that sounded ok to me, but now I'm not so sure. The last couple of times I've talked with him he just says how awful life is now that he's not allowed to eat. One of the problems is his dentures hurt him so he won't wear them and everything soft is "bad" for him. So he really is always hungry.
My sister in law, who is the main caregiver, confirmed that he's totally miserable and that when she tries to talk to my brother about it, but he refuses to listen, that he doesn't want to see dad die in pain like he was with the gout, not on his watch anyway.
So what is the answer here? In a few short month's dad's dropped back down to around 190. The way I see it is he's 87 years old with congestive heart failure and COPD... what more damage could this food do? I wonder if the metal anguish he's feeling by not being able to eat what he's loved all his life isn't worse then the physical problems the food might cause. At least with the physical he can take a pain pill...not much he can do about the misery. I did suggest antidepressants, but my sister in law says the Doctor is worried about how they would mix with some of his meds.
This is breaking my heart for dad, and yet I understand why my brother thinks he should eat healthier. but is that practical at this point in his life?? Anyone have any suggestions? Has this happened to anyone?
I know, this is not exactly the same thing, and yes, brother ought to ease up a bit, but unless you are truly talking about someone's last supper or their time in hospice care, it may matter very much what they eat! Maybe we need a Least Restrictive Environment approach to eating plans...whatever gives a person the most pleasure and choices without wrecking their health?
My patient was someone who too many people considered a short timer - happens not to be necessarily true - but part of the loss of health in the first place was misguided unrestricted eating (and drinking of sugary sodas by the 2 liters a day) born of the same kind of pity. And this guy probably does not want to get sicker and older faster than he has to, but like most people does not connect the dots.
As far as taking care of the gout with medicines, you can't always put out a fire while someone is pouring gas on it. We can treat asthma with every drug in the book, but until someone cleans up the mold and mildew and stops smoking in the house next to them, very little headway will be made. I doubt this guy really "wants" to stop all coaching and limitations on his diet if it means getting his gout back and maybe even becoming immobile. I doubt my poor grandma, really "got" it or really consciously thought that whatever extra pleasure she got from eating apple pie instead of apples every single time, was really worth losing her legs and her eyesight over - and dying of diabetic complications at age 60. But she did not have a coach, she had my mom, who pretty much believed the eat what you please thing. This guy at age 87 - could spend whatever time he has left, which could be a few years, getting fatter and sicker, hospitalized with his CHF or in pain most of the time, versus hardly ever; it really does matter what he eats.
Anyways, FWIW, it is good to hear that other point of view expressed by someone whose opinions I respect... it opens my eyes to the idea that a lot of the rocket-off-the-growth chart cases we see and feel frustration about because the problem is denied and no changes are made - are probably due to people thinking either black or white like this - either I eat everything I want whenever I want or I am miserable; or OTOH, either I restrict my eating totally to what someone else says I should and should not eat, some of which may be completely wrong, and rebel and resent the h3ll out of them, vs making reasonable choices and compromises.
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