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Old 11-08-2011, 06:14 AM   #1
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Question Mom fell and broke her OTHER hip

This is crazy. 7 weeks ago today, my mom, who is in the "early late stage" of alzheimer's/dementia apparently fell and broke her right hip. She had surgery and was released for rehab to the SN floor of the CCRC where she and my dad (who also has dementia) live.

Yesterday, I got a call that she'd fallen again (actually she's fallen a few times in the last 7 weeks) so they called the mobile x-ray company who finally made it out there around 5pm and faxed the report this morning that says her left hip is fractured.

The plan right now is to transport her on a stretcher to the surgeon who fixed her other hip and take it from there.

What happens now? Do any of y'all have experience with 2 broken hips within 2 months? We had just come to terms with the fact that she probably won't walk again, despite her trying to because she keeps forgetting that she is rehabbing from her broken hip. Now we know for sure that she won't.

Will this kill her? Should we put her though another surgery? Do we really have any choice? From what the NH nurse saw in the report, the fx is non-displaced, so that's better than displaced, right??

Unfortunately, we have been unable to locate any written advanced directives for either parent, but my brothers and I all know what her wishes are... don't keep me going by artificial means. Just keep me comfortable. A few years ago she decided against any more mammograms, colonoscopies, etc, saying,"I'm 80 for heaven's sake! If I get colon cancer, well, that's just what's going to kill me. I'm not going to take chemo, etc anyway!"

I want to honor her wishes, obviously. And I know that things are only going to get worse from here, and things are pretty bad. Any advice?

Thank you all for being here. I don't get online that much these days between daily visits to each parent, and my young children, my time is pretty well taken up. But I so appreciate knowing that I can come here and ask questions in a situation like this one.

Thanks,
Sarah
p.s. my brother and I are satisfied that there was nothing nefarious going on with the falls my parents have both had. It's just stressful taking care of all of this (as you all well know!) and we may have overreacted...

Last edited by SandwichLady; 11-08-2011 at 06:21 AM.

 
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Old 11-08-2011, 07:24 AM   #2
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Re: Mom fell and broke her OTHER hip

Sara,

I am sorry your Mom fell twice and broke her hips twice. I don't think you should give her another surgery. But of course they need to give her painkillers and make her comfortable. This may not mean that she is dying - it depends on how the hip can heal and how she can cope with the pain. Deb knows more about this issue. Borken hip is harder to heal, so I wonder how people can cope without surgery.
My FIL has not broken his hips yet. He also stopped walking this year due to the decline of AD.
If you are her health POA, you can tell the doctor no surgery. With the complications of the broken hips and surgery, she is more confused about her walking (she does not know why) and her struggle of wanting to walk. If she walks in this condition, she will fall again. So it is important to make sure she does not fall again by accident. (She could slip from the bed.)

Maybe you need to find her lawyer again to get the copy of advanced directive. I think for now, as family, you can tell the doctor not to give her surgery if you want to do that.

Take care,
Nina

Last edited by ninamarc; 11-08-2011 at 07:36 AM.

 
Old 11-08-2011, 07:48 AM   #3
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Re: Mom fell and broke her OTHER hip

Sandwich, I am not sure about your state but here in NC there are several ways to accomplish a DNR request which is different from the advanced directive or living will which must be done by the patient It is the actually orders signed by the doctor to facilitate DNR. The patient themselves can sign.... or the Medical POA can sign... or a list of others including children, siblings, parents. As your doctor or facility if there is such a form that can be filled out on your parents. Are any of you assigned Medical Power of Attorney? If so you may be able to process the necessary directives/living wills on their behalf. You might need to ask an attorney if this is possible in your state.

Any medical trauma is going to set your Mom back. Anesthesia needs to be avoided if possible because many times they don't seem to wake up well. She is not going to be able to participate adequately in rehab nor remember that she can not get up and walk. Two trauma that close together is not good. But it is what it is Sandwich. Talk to the doctor and see what his recommendations are.... but be sure to explain to him that your Mom has dementia and what her situation is now. Hear what he says and then make the decision best for your Mom. If she is going to be in pain constantly from this fracture it might be best to have it fixed. If they are fixing it just so she can walk I would say no. Ask him how it is going to benefit her quality of life knowing that she can not participate in rehab effectively and has the potential of losing even more cognitive ability through the process. What is the recover time with and without the surgery. You want to opt for the shortest time! If it is a non-displaced then it may heal enough on it's on. With Mom's broken hand the first suggestion of the doctor was to do surgery and pin the bone. After a discussion of her dementia.. he agreed that we needed it to just heal on it's own. So be honest and forthright with the doctor about Mom's condition and situation

As I said in the beginning, any medical trauma will set your Mom back in her cognitive decline. You saw this with the first hip fracture. You can expect more of the same with this hip fracture. It has changed her world and she is not going to understand. Stress and anxiety is a demon of dementia. It does cause decline in itself. This is why any changes are hazardous to their cognition. The broken hip itself is probably not going to kill her... but the stress and trauma is going to make her journey more difficult and may shorten the time you have with her. You do need to prepare yourself for her to be non-ambulatory. She may not remember it but you know it Make plans accordingly.

Remember, you do not need to make an immediate decision standing in the doctor's office Give yourself time to think about the benefits and risk. And let us know what happens. Know my thoughts and prayers are with you and your Mom!

Love, deb

 
Old 11-08-2011, 10:06 AM   #4
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Re: Mom fell and broke her OTHER hip

Oh dear....this is a mess, isn't it?! My mom broke her hip and my nightmare was her breaking the other! Thank heavens it never happened but I was prepared for it if it did happen. After the awfulness of her surgery and rehab I talked to her doctor and the head nurse at her facility and we agreed ahead of time that if she ever did break the other hip, we would do nothing....but what they told me was that she would be in bed and be treated for pain and that eventually she would get pneumonia from being in bed all the time and it would be the cause of the end. She had such a terrible time with the first surgery and rehab...for weeks we had screaming, crying, hysterics, pleading for help....that we would never think to put her through it again. But..that was our decision.

What Deb has suggested is spot on...sit down with the doctor and get all of your options. The you can decide. In the meantime, I hope they can keep her comfortable at least.

My thoughts are certainly with you.

Love, Meg

 
Old 11-08-2011, 03:20 PM   #5
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Re: Mom fell and broke her OTHER hip

Hi Sandwich,

My mom fell and broke her 2nd hip just over 2 weeks ago, but there was a span of 18 months between the 2 fractures. She's in the late stages of vascular dementia.

I agreed to the 2nd surgery because this fracture was worse than the first (the top of her thigh bone was broken along with the femoral neck). The alternative was at least 6 months in bed, being treated for pain & seeing whether or not the bones would heal on their own. In Mom's case, that would be cruel and unusual punishment, because she was always on the go.

I felt that--for HER--it would be better if she died on the operating table or never really regained consciousness vs. being bedridden and in pain for months without understanding what was going on. I never thought she'd walk after the first surgery, but she surprised me, so I thought I'd give her the best chance I could to surprise me again

So far, she's doing well--they've got her walking about 85 feet at a time with a 2-person support team, but it hurts her tremendously. The good news is her dementia has progressed to the point where she doesn't remember how much it hurts 5 minutes later. She doesn't even remember that she's had rehab. It's going to be even worse when it DOESN'T hurt, because that's when she'll start trying to get up every five minutes. All in all, she'll be extremely lucky if she gets back to 75 or 80 percent of where she was before the fracture.

Don't get me wrong--I'm not recommending this for your Mom, just sharing my experience. You get to a point where all of the options stink, so you just have to do what you think is best & try not to second guess yourself.

Best wishes,
Kren

 
Old 11-08-2011, 06:49 PM   #6
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Re: Mom fell and broke her OTHER hip

Thank you all so much for your thoughful replies! Gabriel, as usual, you gave great advice! I took it and just spoke with the doc and didn't let him rush me and made sure he realized where I was coming from. He kept talking about mobility, and I thought that meant walking. But he meant even just being able to tolerate bending at the hip so as to be able to sit in a chair.

So, with him saying the surgery would be for comfort and "mobility," we agreed to it. At this point, she is still talking, and recognizes my brother, my dad and me, although she sometimes thinks she's had a conversation with my deceased sister. She is in the early late-stage, but she is still communicative and I believe that if she could move faster to the bathroom, she'd still be continent (although she'd need direction to complete the maneuvers). I guess what I'm saying is that if she were already bedridden and noncommunicative, it would be a different story.

And like Kren, mom is very active and in speaking with her nurse at her SNF, the nurse was dubious that we'd be able to keep mom sufficiently immobile to let the break heal. Also, mom tolerated the last surgery pretty well. Luckily, she had an easier time than others.

It's interesting though... when the hospitalist came by to talk about her medical issues to clear her for surgery, he was talking to me about it all, and mom piped up and said,"to what end? all of this... to what end is it being done?" My jaw dropped! But I have to say that it made me feel better about even considering not doing the surgery because while I thought I knew how she felt about "extraordinary measures" and etc., I had started to second guess myself. But both the ortho and the hospitalist said they would not characterize this as extraordinary measures, unlike say openheart surgery, or cancer treatment. this surgery goes to her ability to be comfortable. But mom saying that let me know that I wasn't being ghoulish by asking those questions... she had the same questions!!!

I'm not concerned if this leaves her further down the dementia road because that's coming anyway. Our goal now is to make her as comfortable and content as possible. And if something happens to her on the operating table, I'll take it as a sign that God was merciful to mom and allowed her to not have to go through any more suffering. Being philosophical!

Thank you all again for responding so quickly!! Once again, y'all have come through for me!!!

Love,
Sarah

 
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Old 11-08-2011, 08:45 PM   #7
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Re: Mom fell and broke her OTHER hip

you did good Sarah!! There is no easy yes or no answer to these questions. Each situation is different and you have to go into it with a clear head and the right questions. You have to know what your purpose is. You have to know the consequences of each answer. Then you weigh your options, make an informed decisions, and do what you feel is best.

I laughed when I read what your Mom said. They will drop those clarity bombs at any time.... and usually when we don't expect them. Yes, your Mom was asking the same questions you were and validated what you were doing. In her way she was telling you that questioning is ok.

When is the surgery? I do hope it goes as well as the last one. Know I will keep you and especially your Mom in my thoughts and prayers. Please let us know how it goes

Love, deb

 
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Old 11-08-2011, 09:48 PM   #8
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Re: Mom fell and broke her OTHER hip

Dear Sarah,

Just wanted to add that my mom is originally from Alabama--and 'Bama Girls are TOUGH!

Seriously, I'm glad you've reached a decision that you're comfortable with, and I would say that no matter what you decided. We're all just doing the best we can for the people we love.

And I wouldn't characterize asking those questions as being "ghoulish"--I think you were being a realist, which seems to be a rare trait these days.

Quote:
Originally Posted by SandwichLady View Post
I'm not concerned if this leaves her further down the dementia road because that's coming anyway. Our goal now is to make her as comfortable and content as possible. And if something happens to her on the operating table, I'll take it as a sign that God was merciful to mom and allowed her to not have to go through any more suffering.
This really sums it up for me. I got into it--yet again--with the Physician's Assistant at Mom's nursing home. She had scheduled a follow-up appointment for Mom with the orthopedic surgeon. Mom is still bedridden most of the time, not yet able to sit comfortably in a wheelchair for long periods, and is so anxious when we take her out of her comfort zone that she hyperventilates until she returns to the nursing home. So I told the PA that mom was not going. She got all huffy and puffy and finally said, "if you don't follow my advice, your mom could DIE!"

I couldn't help myself--I laughed and said "Darlin', if there is one thing I can guarantee you, it's that Mom is going to die. Sooner or later, she's going to go. But if it's sooner, I'd rather it was in her bed than in the back of a wheelchair-accessible taxi." And then I called and cancelled the appointment.

I get a lot of funny looks at the home

Wishing you and your mom all the best,
Kren

 
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Old 11-08-2011, 10:39 PM   #9
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Re: Mom fell and broke her OTHER hip

Kren... I have to get to bed because I have much to do tomorrow and it is late but I had to say I just belly laughed at what you told the PA. I am sure you did it with such a sweet smile I sound like something I would say!! Yep, with a smile and then do exactly what I intended to do in the first place. Bless their hearts... they just doesn't know what to do with a good old southern gal hehe

Love, deb

 
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Old 11-08-2011, 11:07 PM   #10
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Re: Mom fell and broke her OTHER hip

Sweet Dreams, Deb

Glad I could give you a good laugh--Lord Knows you've earned it!

Keep smilin'--it throws them off your track

Love, Kren

 
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Old 11-09-2011, 04:10 AM   #11
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Re: Mom fell and broke her OTHER hip

"Clarity bombs!" I love that!! And that's what they are!! (Mom also told me out of the blue that I need to curtail my spending.... which I'm sure my husband would appreciate!)

Deb and Kren, thank you for your words of support! And Kren, I think that your exchange with the PA is hilarious!! Duh! Death from lack of follow up appointment?!?! Puh-leese! And you're right, we 'Bama girls are tough!

The surgery is scheduled for around lunchtime today. I'll keep y'all posted.

thank you again for all of your advice! And I am going to call the lawyer who prepared their wills to see if he has any advanced directives... it would surprise me if they hadn't made them because the wills were drawn up a few months after my sister died from breast cancer (she had cerebral palsy and lived with them) so it seems natural for them to be thinking about that sort of thing. We'll see.

Love,
Sarah

 
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Old 11-09-2011, 07:58 AM   #12
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Re: Mom fell and broke her OTHER hip

Sarah,

That is right, you have to do anything to make her comfortable - surgery or not.

Although my FIL never had such major surgery after he got sick with AD, he had some minor same day surgeries. Hernia twice and this microwave therapy for his enlarged prostate. Well, it was not pleasant. Not for sure. Some caregiver even wondered why bothered with this microwave therapy when he was screaming for 30 minutes for letting him go. Well these same day surgeries were successful and they don't bother him so much now. He still has some residual urine in his bladder but he is much better now and does not need the catheter all the time.
Some surgeries are important for comfort care. That is true. Even if some procedure could speed up the death, I think comfort care is number one goal.
Now we don't really want my FIL to use the walker because he may fall. The home is saying let him walk as much as possible. Well, walk? he does not walk anymore!!

Hope your Mom's surgery will help her a lot.

Hugs,
Nina

Last edited by ninamarc; 11-09-2011 at 08:07 AM.

 
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Old 11-09-2011, 08:02 AM   #13
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Re: Mom fell and broke her OTHER hip

Sarah, you and your Mom will be in my prayers today.... for a good quick recover.

"Clarity bombs" are exactly what they are. Mom lost her ability to communicate with consistency in May of 2009. Most of what we hear from her is jibberish, scrambled words combined with random sounds. But every once in a while she will put together a statement that makes you stop and go HUH? Like the day I was walking with her and stopped by the Facility Director's office to complain. He was giving me "excuses" and Mom pipped in.... "You talk too much!" Yes, I HAD to laugh!!

Kren...yep we have to keep our sense of humor and we have to laugh at the absurdity around us. It keeps us sane!! And I thank you for that one.

Love, deb

 
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Old 11-09-2011, 08:11 AM   #14
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Re: Mom fell and broke her OTHER hip

Nina, You are so right about comfort care! Even if it shortens their life...I know I'd rather not live a long time in discomfort/pain! I know what you mean about them encouraging hyour FIL to walk...you probably feel like that's a broken hip waiting to happen! My mom was so used to being on the go, and with no short term memory, she forgets until it's too late not to walk! I'm just shaking my head at the thought of what this second surgery it's going to do to that situation. Sigh...
Love,
Sarah

 
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Old 11-09-2011, 08:15 AM   #15
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Re: Mom fell and broke her OTHER hip

Deb...I LOVE that story! It's like when your kids are with you and say something truthful, but embarrassing! Did he laugh?! I hope for his sake he did! :-)

 
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