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JaneyFromChicago
Reply with quote  #1 
Mom is near 90 years and in a nursing home.  Her past history is that of valium use and other benzos in the 1960's and 70's (more or less an innocent addict, she went to the doctor for anxiety/depression, she never knew what she was getting into when he gave her something to "help" this.)  She successfully withdrew from it all in 1980.

Several years ago due to a bad time she was going through she ended up off and on ativan and then had several falls 3-4 years ago.  She was in and out of the hospital with each of these falls and because of stupid hospital mis-management and mis-communication she ended up on a very high dose of ativan and could no longer stay at her assisted living facility.

When she entered the nursing home they were aware of her problems with ativan (past addiction, extreme weakness, violent behavior, hallucinations, etc,) and agreed it was best she not be on any.  For some reason they started prescribing ativan as needed, then it went to once a day and now it is twice a day (.5 in the AM, .25 at bedtime plus .25 as needed). Some days she is getting just the AM and PM dosages, somedays she gets that plus two extra dosages.

Compared to a year ago (when she first went in to the home) mom is now extremely confused, imagines things going on that aren't, has an extremely difficult time remembering certain words, difficulty talking in general, poor memory, no longer goes to any activities, can barely walk as she is so weak, gets no exercise at all, we are told she has vascular dementia.  She sits in the same chair day after day after day with virtually no stimuation.  Yet on the other hand she still knows who her children are, loves talking with us and reads the newspaper every day. 

Questions - how does one know for sure if this is vascular dementia or if it is from the ativan?  Or is it even worth knowing at this point?  Should I pursue this with the nurses?  I have no support from my siblings on this, they assume it is the dementia that is making her this way and think removing the ativan will only make things worse.

My personal opinion is that the ativan is playing a stong role in her behavior and also played a strong role in the falls that she had which led to the nursing home admission, but at 90 years of age, is it worth it to take her off?  How bad would withdrawal be?  She has a lot of somatic complaints, aches, pains all over the place but they can't seem to find anything wrong.  Heart is good, no diabetes or other long term health conditions.

Any ideas anyone?  Anyone have loved ones that have been put on ativan or something similar and then deteriorated?  Is it common for the elderly to be put on ativan?

Thank you for listening, Janey
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Suzi
Reply with quote  #2 
Janey,

I don't know about Ativan in the elderly.
But I do know about Ativan from my perspective.  Since I also became additcted
to this medication when I was 26.  My heart started beating so fast all the time
and I went from doctor to doctor to try and find out why.  Finally after a echocardiogram
I was diagnosed with a prolasped mitral valve.  Also known as a floppy valve
The doctor that diagnosed me gave a blood pressure medication to keep my heart
from beating so fast when the blood was trying to get through the valve.
He also perscribed Ativan to me.  I had no idea what it was but the doctor told me
that it would help me not become so afraid when my heart started to beat so fast.
Never told me it was a transquilizer and I could become addicted to them.
Well a year later there I was taking 10 a day.  I was  a zombie from taking just
one every hour I take another. I tried to not take them but it was to late I would have withdrawl symptoms of being so weak, my stomach was hurting, I could not stand,
I was a mess.
I had to give my precious little daughter to my exhusband at the time because I knew
I could not take care of her like this. I had terrible panic attacks.  But Ativan
never helped me, it made me worse.  After I got off them I took classes to learn
how to deal with my heart beating fast and the doctor telling me it was a benign
condition but just very scary when my heart is trying to get the blood through that
valve.  

I finally realized I was addicted and called a doctor and he tapered me off of them very
slowly.  It took about 4-5 months.  After I was completely off of Ativan I felt like
a new person.   Ever since that day I never take anything unless I know all
about the medication never want to face that again.

I was able to have my daughter back and life was great again.  All of this because
of a pill that a doctor never told me could cause addiction.

If the doctor or your family decides to take your mother off of Ativan please
make sure they taper her off instead of just stopping them.   She might suffer
if they are just stopped. 

I hope others come and help you more.  Just wanted to let you know I feel
for you and your mother.  I don't know if her doctor seems to think your mother
needs Ativan.   But wanted to help that others have been through this also.
Maybe not at the same age but I understand your concern.
Years have gone by now and I hope doctors are more careful now and
at least watch a patient and let them know how addictive they are.
The body gets used to them and one doesn't work then two, then three
and on and on.  It was a nightmare!  My personality didn't change
on them just became well I didn't care what was going on around me.
Someone could have come up and slapped me and I would have sat
there like oh well. 

Please keep us posted on how you and your mother are doing.
I just felt to relaxed and a zombie on them.  But if she is being
watched carefully while taking then maybe she will be alright.
You don't say why the doctor thinks she needs them during the day.

Didn't mean to go on and on but I know how concerned you are.
Take care!

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Suzi
Reply with quote  #3 
Janey,

Wanted to say I'm in my 50's now so you can see how long ago that was,
so I do hope that doctors have come a long way since I went through this.
I don't know if Ativan is making your Mom feel or act differently but they
do relax a person to where you don't feel like doing much.
But I do hope her doctor knows and helps you to understand why
she is taken them.  
Take care!!

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JaneyFromChicago
Reply with quote  #4 
Suzi - thank you for your response.  I'm sorry you have had to deal with this in your own life but congratulations on getting off of it.  It was rough, I know.  I think doctors are way to liberal when they prescribe these drugs, but to them it is much easier to give a magic pill when things don't go right, than to work on the problem.

I don't know why they started mom on this again.  She was so much better without.  She can be a complainer, and a cranky one at that, so I think they may have thought just give her something to make her stop.

In the past she's had a difficult time getting off of this so I'm kind of hesitant about saying anything for that reason.  I've seen such a change in the last year and I just don't know if it is because of the ativan or not.

Can anyone tell me if the dosage she is taking is considered high or low -
AM .5 mgs
PM .25 mgs
as needed .25 mgs (some days takes nothing additional, other days one or two additional doses).

Janey
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Suzi
Reply with quote  #5 
Janey

I think those dosages are low.  But I'm pretty sure if she is ever taken
off of Ativan they should taper her off.  We as human's get used to
something in our system and at her age I just would not want her
to suffer from them being withdrawn on her without tapering her off.
What does her doctor think about the Ativan and her behavior.
She may need Ativan.  Hopefully her doctor is keeping a close
watch on her.  I would hope they are not using it to keep
her quiet.  Hang in there and hoping others will come and
help you out with their expierences.

Hope others will come and help you out further on elderly care.
I'm sorry I can't help you with that end of it.
((((((Hugs to you both)))))))
I can tell you want what is best for your Mom.
Keep us posted!!
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Mary E.
Reply with quote  #6 
Hi Janey,

My mother has been an Ativan user for years..  Her doctor prescribed it 20 years ago when she was taking care of my father who had had two serious strokes and was suffering from Vascular Dementia..  She couldn't sleep at all, was anxious, and begged the doctor for something to help..

Ativan is actually an anti-anxiety drug, but in someone who is suffering from anxiety and can't sleep it is used as a sleep aid.  My mother loved it from the beginning and used to say that it was the only thing that helped..  But, on her own, when she would have a tough day, would take a second one (I believe they were .5 mg).  Naturally, her prescription ran out too soon and she called her doctor, expecting that he'd just write another.  She was shocked and furious when he refused to and she had to go "cold turkey" until the time was up..  I think he must have explained to her when he prescribed it that she could not increase the dose on her own and this is why he was so strict and almost angry with her..  She had a rough 10 days or so - still not comprehending why it was dangerous to increase her dose..  But she had no choice.  When she got the next prescription, she made sure to take just the one a night..

But that was years ago, and she's still on it - now that she is 92, very frail after a stroke which has left her with short term memory loss and  some Dementia.  We've had mornings when she's hallucinating that she is someplace else.  She called one day and told me she was at a parade.  She had gotten herself up and dressed and believed she was with a friend who has been dead for 10 years..  I thought she'd had a stroke, but she came out of it when we pointed out that she was right in her bedroom.. It seems that she's still in a dream when waking, but it is strange because she talks and acts like she's awake.. 

What she was doing recently that I think caused the Ativan to cause problems with her mind - was too begin to take it too early in the evening.  Her health aides give her her other meds at 4, but we were trusting her to take the .5 Ativan herself and told her to wait until 9..  Even though she is somewhat confused, this seemed do-able.  My brother and I would call to remind her.  But what was happening was that the minute the aide left at 4 or 5, she was craving the peaceful feeling the Ativan gave her and popping it in her mouth - maybe subconscously - maybe deliberately..  The result would be that in the evening - 5 until 9 - she was awake enough to answer the phone, but (to me it seemed) part of her brain was under the influence and she was unsteady, doing confused things like emptying the refrigerator into her walker basket with enough food to feed two people, dropping the phone, forgetting how to dial out, forgetting how to turn the TV off and on, etc.

This all can be the Dementia and the fact that the elderly with compromised mental status get more confused at sundown time and in the evening - but my brother and I were blaming the fact that she took the Ativan too early.  He stays with her overnight and he noticed that on the nights she had been most confused from taking it too early - she would then have trouble sleeping in the middle of the night (her Circadian rhythms were off)..  She would ask for another Ativan, which he'd refuse to give - she'd get angry - become more agitated, etc..The next day she'd be exhausted from not sleeping well in the sleeping time of night and be even more confused.

We decided to NOT let her have access to the Ativan.  Now either he or I go there and put it in her mouth.  Since we began this - she doesn't go to sleep until 11 or so, sleeps well through the night, is rested in the daytime. Everyone notices that she is more alert and less confused. 

The doctor said that as a person gets older - the liver and kidneys do not metabolize the meds as well and there can be a holdover of symptoms into the next day.  She advised trying to cut the pill in half so instead of .5 it would be .25, and thinks the results might even be better than they are with our time change.  We want to try it, but my brother thinks she might not sleep at all.. 

I think that in your mother's case - the fluctuation of the doses might not be a good idea.  When she's used to the .5 mg, if she seems to be agitated or unhappy and they are suddenly giving her the extra dose - it's not like adding another Ibuprofin (one is good two are better) - In the elderly it affects their moods and minds and activities for much longer than the subsequent 8 hours - your mother could be under the influence for the next waking day and acting strange - and then they give her the added dose thinking that will help - and then if her body adjusts to the added dose and they hold it back or give it too early - she will be agitated in withdrawal..

I think that in the elderly the Ativan must be given at the same time every night - hopefully after 9.  I don't agree with the added doses - I think the staff doesn't realize what is happening as a result.  (My mother weighs 110 lbs and takes the .5 mg and I think it's going to be that forever, despite our attempts to cut it down.)  We're with my mother every day and can see that it plays havoc with them..  Good luck and keep me informed.  We can compare notes!!
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JaneyFromChicago
Reply with quote  #7 
Mary E thank you so much for your response.  You wrote "It seems that she's still in a dream when waking, but it is strange because she talks and acts like she's awake."  So often that is exactly what I am thinking about my mom!!  It's as if she is having a dream but is fully awake.  And when I talk to her at the end of the day she will tell me what she did during the day.  I know darn well she doesn't do most of what she tells me (went out to lunch, went shopping, etc) but the way she says it, it is as if she really did it in her mind.  Sometimes I'll say are you sure you didn't dream that and she think and then say maybe I did. 

I want to at least be able to have the chance to see what she is like while not under the influence but it is hard as I don't have my siblings support.  They think it is fine she gets this and thinks it helps with her dementia.  I don't think the staff at the home is aware of how this may be affecting her, to them this kind of behavior is the norm.  But my mom certainly wasn't like she was when she entered the n.h. one year ago.

You make an excellent point about taking a consistent dose in both time and quantity.  I don't think this up and down is doing mom any good at all, probably just makes her crave it more.  And of course she totally denies she gets any ativan, which may be true because they have her on so many meds she couldn't possibly keep track of them all.  But it just feels to me that any time she is a bit ornery they give her another one without sitting down and talking about what is really bothering her.  So easy to give a pill, isn't it?

Janey
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Molly-Tx
Reply with quote  #8 
Hi Janey
My mom died in Apr 2009 after a heart attach in Dec.  They put her on Ativan.  It was horrible.  They tried different dosages.  She imagined all sorts of things, such as people breaking in the door, things on the ceiling, etc.  We finally had to take her off of it.  She had a low tolerance to drugs and it just did not work with her.

Good luck with what is going on.

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JaneyFromChicago
Reply with quote  #9 
I talked with the social worker and they are going to do a psych evaluation on mom this week.  But another problem has come up and she has to have some medical tests done.  If this turns out to be something bad I guess we may skip getting off the ativan.  sigh
Janey
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Trixi
Reply with quote  #10 
Janey, I think Ativan is bad news. My mom received a diagnosis of Alzheimer's while on it.  She took 1 mg a day for years - sometimes 1.5 mg or 2 mg (with doctor's approval) - but as she got older it made her act very strangely.  She also took a low dose of Trazodone for sleep, although that medication is used for anxiety too.  She received that diagnosis after an 8 (!) hour neuro psych evaluation and we were all sure it was an accurate diagnosis.  I believe we did it over 2 days.  My mom was really angry about the diagnosis, but her behavior was so erratic we figured she was in denial. 

About a year later, when she got off the Ativan by accident, as she lost her meds on a 3 week trip (how scared was I when she took that trip with my father, you can only imagine)  she came back to pretty much her old self again.  I told her how much 'back to herself' she was without the meds, and thankfully she really heard me and didn't start them again the rest of her life.  She wouldn't agree to stop them before and the doctors were so certain they were not such a contributing factor to her behavior.  

I have heard since then from more than a few people that Ativan and the elderly are not a good combination in terms of taking it regularly.  I realize our story is not representative of all, but I had to share our experience with you, especially when you are about to have her evaluated.
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Caregiver1928
Reply with quote  #11 

Hi Janey,

I am so grateful that you wrote about the use of Ativan and talked about (Vascular Dementia). My Mom is 81 years old and I have been caring for her for over 8 years. My Mom had a mild stroke many years, we did not know about it until 2006 after she had alot of test done, and a brain scan. It was determined that she may have had mild stroke a year or two prior to us finding out in 2006. My Mom has been on (Clonazepam) for about 30 plus years. It was a medication that they used to use for anxiety disorder and falls into a class of medications called benzodiazepines. This type of drug was ideally supposed to be used for a short period of time, however the doctor she had been seeing for many years just kept increasing the dosages. Mom has been taking 0.5mg 4 pills a day sometimes up to 5 in a day. It was not until August of 2009 that my Mom started to have severe panic attacks and she would describe them like having a heart attack and feeling severe chest pains. Needless to say I became very concerned, and took my Mom to see her doctor which my Mom had started with back in 2000. My experience over the next few months was an ordeal in it self!

We saw a “Generalist” she ran test on my Mom but before she got the results of those test, she put my Mom on heart medication (nitro-glycerine) and informed us that my Mom probably had angina of the heart. First it was the spray and than it was the pill. My Mom became very weak and she was still having the chest pains! We went back to the Generalist and she decided that my Mom should see a Cardiologist. We waited for a few weeks until we got an appointment. When we finally saw the Cardiologist he immediately advised that after close examination of my Moms test which had been extensive MRI’s, my Mom did not have a heart problem at all! In fact he said, sometimes the MRI’s can give a false positive of a heart condition. I was shocked, upset, and yes pissed off! The Cardiologist suggested that my Mom go to a (Pain Management Centre) to help her deal with the chest pains because in his expert opinion my Mom had arthritis in her bones around her ribcage centred near her chest. So back to my Moms doctor and we advised her of the Cardiologist diagnosis. Again there where forms to be completed and a requisition needed to be done by the doctor and sent to the PMC. Still my Mom was suffering and the panic attacks would last for a few hours to the worst end of the scale and last for a few days!

Through out all of these pain staking and frustrating experiences my Mom was taking between 4-6 Clonazepam in a day to try and get some sort of relief. Unfortunately the problem became compounded and my Mom was either sleeping mostly and /or starting to have falls and become weak in her legs. It was now April of 2010 and we were no where near to getting any positive results or answers! When we finally got into see a doctor at the PMC (Pain Management Centre) it was a total waist of time! In fact he was very surprised that we would even be referred to him from the Cardiologist. Again I was at this point extremely frustrated as was my Mom. She was being passed along like a hand me down and each time she was becoming more depressed and her anxiety would increase. As her son and caregiver, I felt I had to take matters into my own hands and if I did not help her who the hell would! I turned to the internet and started to research. I Googled and Googled for any thing I could think of in relationship to underlining symptoms and causes related to medications and drug interactions. I spent hours and hours researching, I made notes and cross referenced my notes and than I finally decided based on all the research I had done perhaps what my Mom is going through is some sort of depression. A few years ago back in 2002 my Mom had been taking welbuturine to help her with the depression of my Dad passing away in Feb 2002. He passed from Cancer at the young age of 67 years old. And prior to that my sister passed away in 1998 she had been very ill for many years.

My Moms brother passed away in 2001 and than her Mom passed in June 2002. There was no doubt about it Mom had suffered a lot and grieved a lot, which ended up in her becoming very depressed. Unfortunately in 2006 as I mentioned early in my email here, Mom had suffered a mild stroke somewhere between 2003-2005 this only compounded the health issues she was experiencing. 2006 was a HELL, my Mom was having memory problems, and was hallucinating in addition to these health issues she had personality disorders and would either be very pleasant or incredible irritable and argumentative. I turned to the internet and began researching on symptoms of mild strokes in seniors, and found that these symptoms are stroke related in some people and there is nothing you can do.

This was hard to digest and I would have to consider looking at placing my Mom in a senior home facility. However my partner came home one day after work and presented me with an article named Aspartame Poisoning” I would be glad to share this article as it was very informative not to mention eye-opening. Aspartame is in diet sugars and my Mom had been putting diet sugar in her tea and cooking with it for over 30 some years. One of the main symptoms of “Aspartame Poisoning” is MS (Multiple Sclerosis) but more underlining are the following symptoms. Tinnitus and fibromyalgia. If you are using ASPARTAME (NutraSweet, Equal, Spoonful, etc) and you suffer from fibromyalgia symptoms, spasms, shooting, pains, numbness in your legs, cramps, vertigo, dizziness,  headaches, tinnitus, joint pain, unexplainable depression, anxiety attacks, slurred speech, blurred vision, or memory loss you probably have ASPARTAME poisoning! I immediately took my Mom off the diet sugar and within a week we noticed great improvement and she started to be like herself again! Why am I including this in my letter when one is probably thinking what does this have too do with taking Ativan/ Clonazepam and it’s effects on a senior. My point is that there can be other factors involved that may cause health issues and are just not medication related. My suggestion Janey, do what ever it takes to get your Mom off the Ativan! Even though she is 90 years old, I would do what ever I could to get my Mom back to some sort of quality of life! And I am sure you love your Mom so much as I do mine, you probably feel helpless yet responsible to do what ever you can to help your Mom. NEVER GIVE UP! In fact after reading your blog I am having second thoughts about looking into placing my Mom into a nursing home. Her falls seem to come and go and I have been so involved with her medical requirements over these past years plus having to fight ever step of the way to ensure she is not being brushed off by the medical community and doing what ever it takes to give my Mom the quality of life she so rightfully disserves. I am wondering if any senior home even if they are the best! Would have my Moms best interest at heart. It has taken me a good few weeks now to get my Mom down to just two Clonazepam a day. Also I had done so much research and had decided that after we took my Mom off the wellborn in 2007 and other meds, my researched turned up facts that my Mom suffers from GAD (General Anxiety Disorder) which is brought on by depression. So with the new anti-depressants available today we had my Moms doctor prescribe Cymbalta 30mg which has helped a lot with her symptoms. Mom is more manageable now and I would just hate to see all our hard work and painstaking efforts flushed down the drain by placing her in a home. I hope my long response has brought some comfort and support to you, along with giving you a boost start to aiding in your decision to get your Mom off the Ativan. I would like to know how you make out and keep us posted. All the best to you and your family.

Greg

Toronto, Canada

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Mary E. # 2
Reply with quote  #12 
Very interesting reading - very suprising that Im dealing with this today.   My dad is in his late 80's  and recently diagnosed with poor kidney function. I have a very similar  situation. I feel your care b/c I am youngest of 5 siblings - however the diagnosis of alzhiemers 5 yrs ago and recently the kidney have been taken lightly by siblings, but everyone holds on or deals with reality differently; so I won't speak negative of them. I only say today I spoke with hospice just for some help with minor in home care - to take care of me so I can take care of dad. To my suprise I was told the first thing they will recommend is ativan "so that I can get more rest at night" when he's sun downing. Is it really that serious??? I don't think making him a  zombie or addictive is what my heart feels right now - to add to that I didn't know it was addictive. I did let them know that my daughter who is a RN told me earlier not to give it to him at this age, however the hospice worker tend to disagree & reports  that it really works well for them.  soo...
All I can say is THANKS FOR THE INFO (I saw some of this in working as social worker recently) the increased weakness and 'out of it" mood. 
HANG IN THERE I HAVE BEEN TOLD BY TOO MANY PEOPLE WHO DON'T EVEN KNOW ME THAT WHEN WE CARE FOR OUR PARENTS - THE RETURN OF GOODNESS AND SPECIAL BLESSINGS WILL BE HUGE.  I say it will be worth it.   My WWII Vet would have done the same for his baby girl.      
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Concerned
Reply with quote  #13 
My brother-in-law's mother had to go into an assisted living/extended care facility because of multi-infarc dementia.  While there, she developed anxiety and they treated it with an Ativan patch.  One day, they found her "unresponsive" and rushed her to the hospital, where it was discovered that the poor woman had ELEVEN  patches on her.  Apparently the aide who would put on the new patches didn't bother taking the old ones off.  And apparently whoever assisted her in bathing wasn't concerned about that, either.  Who knows how much Ativan was leaching out of the old patches?  No wonder she was "unresponsive".  After a few days in the hospital "drying out", she was doing fine, but the assisted living facility refused to take her back unless the family hired 24-hours-a-day nurses for her.  Now, mind you, she was "unresponsive" and overdosed because the facilities' employee(s) didn't do their job, but now they wanted the family to pay for extra care.  It took one call from an attorney's office and the facility changed their tune and took her back.  The family kept her there only long enough to find another facility.  Ay-ay-ay....
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florence
Reply with quote  #14 
My mother was on ativan and i thought she was loosing her mind we even had a MRI on her brain to see if something was going on and they said her brain was clear so i took her off of it and her mind cleared up and then they put her on ambein and it too made her crazy so i put her on melatonin and she is sleeping  better and her mind is clear
sorry about the boldness of my type but it the only way i can see what i type
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Tina
Reply with quote  #15 
Wow, this topic caught my eye. My Mom is a 94 year old ativan/lorazapam ab(user). Story and conclusions very similar to Mary E., so I won't repeat what's been said. I will say that it becomes harder as they age to separate side effects from dementia. What I have witnessed is that the over dosing and under dosing both have behavioral symptoms and sometimes they are similar. Inability to find a word(to the point of tears) along with inability to speak and associated agitation and dry mouth usually points to underdosing(which means they ran out of oills earlier by taking too many). Difficulty rosing them from sleep and then looking at you and saying "I can't hear you" or being 'out of it' and crying usually points to overdosing. What makes it so bad is that they think it doesn't effect them and they take them like Pez candies. Trying to control the pills(unless you can do it daily in person) is difficult as they will swear that the pill dispenser wasn't filled, or the person giving it to them didn't,etc. My mother has a 7 day 4X /day dispenser and will take Blood pressure pills and put them in it to fool me into thinking she didn't take as many as she actually did ! (Anyone who can think that strategically most likely does not have dementia!).
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