Semi-Challenging Situation - Advice?

Olly_Bake

My father had hip pinning surgery first week of May. He did not get back to his baseline of being able to use a walker let alone stand up. In fact, he still does not want you to move his leg and he can’t/won’t put pressure on that leg (well very, very little). Had a bunch of x-rays done two weeks ago and still waiting on results as of today. However, doctor did prescribe Tramadol 50 mg. I’m trying half for now.

Dad, as of two weeks ago, has started wanting to get up and use the bedside commode. And if you don’t help him get there, he holds it in and kind of pouts. And of course, I don't want to see him get constipated or pout and of course guilt sets in for me. I have been able to get him there but not without a struggle for him and myself and a backache. The aid also is willing to help him when she comes in and if he asks. My sister that lives here just flat out says no. We can hand him the urinal and he can handle that part himself.

Sister has asked us to stop helping him get to the bedside commode because then he expects even her to do the same. I hate that he ask because it is hard on me as well but if I were in his shoes I would want someone to help me.

Monday night, around 12:30 midnight, my sister rung my phone about seven times until I got woke out my sleep to tell me dad wanted to get on the commode and made it to the end of the bed himself. Sure enough with a view of the camera, I see where if he had muscled up just a bit more strength and pushed one more time, he would had been out on the floor. I'm thinking of trying a bedpan. But if this is a pride issue (not sure right word), I'm not sure what to do. If a medical issue of enlarged prostate, he is already of tamsulosin. He was using the diaper but once he gained some memory back, that's when the change started.

We had a battle back when he lived with us for a year and was walking. He always wanted to stand up like a man he said and the aim would be off at times. Sigh! That's what make me think a pride issue.

PS: my nurse suggested a stool softener to his med regimen. Not sure of the purpose. Do you think the nurse figures it will just slip out while he is sleeping or something? I’ll have to ask for clarification once they get back next week.

I was reading on another person’s post on how they plan to use the lift and sling to get their LO to the commode. Well I have a love/hate with the Hoyer lift. I’ve mostly used the lift to raise dad to do a full bed change and it goes by so much faster doing it that way and I feel safe that if something goes wrong with the lift, he falls to the bed not the floor.

But using it for other things such as getting him out the bed in a wheelchair or on the bedside commode, I don’t trust the sling because it well slings (so much movement) and at times his butt area does tend to fall into the hole a bit more as I make the lift raise him up and it leans backward too much so you are trying to help your LO set up so you can let the lift go down and get them where needed. It seems more than a one person job or maybe I just don’t have the strength.

Any suggestions or thoughts?

caregiving daughter

I don't have any experience with a lift; however, at 57, I broke my hip. The injury was beyond painful. It also took a tremendous amount of upper body strength to reposition myself in bed and I had done strength training the six months before. Can you pull out the PT treatment plan and see what the documented goals were? To the extent the aim was to resume being upright with a walker, perhaps you could make the case for resumed home physical and/or occupational therapy. If you are able to utilize a professional resource, they could likely advise you on the safest protocols for using the commode.

JDancer

If the bedside commode (BSC) is placed next to where he's sitting, it's a simple stand and pivot. Physical therapy should have shown you the technique before he was released, I'm sorry if they didn't. Most BSCs have arms that can be removed, or lift out of the way. If the arm near the patient is out of the way, perhaps they can slide over. Maybe you can Google the proper techniques, or try it yourself to get the idea. If they didn't send a gait belt home with him, put a sturdy belt around his waist to hold onto. Use good body mechanics. Bend at the knees, move your feet, no twisting.

jmlarue

I've taken Tramadol for years for arthritis pain. It does not give a person a drowsy effect or make them unstable on their feet. His doctor prescribed 50 mg because he believes that is the level of pain meds he may need to feel comfortable to stand, pivot, and hopefully continue with physical therapy to recover. I'd give him the full dose. The sooner you get him back on his feet, the better. Pain control is a big part of that.

Olly_Bake

My phone has rung again this week with the same battle between my sister and dad. I expect there to be more if I can’t figure something double for overnight. I’m hoping to figure out a way to ensure he goes (the 2'nd before me or the aide leaves for the day but have absolutely no expectation this will work consistently because the body knows when it is ready to move.

Caregiving daughter – {Can you pull out the PT treatment plan and see what the documented goals were? To the extent the aim was to resume being upright with a walker, perhaps you could make the case for resumed home physical and/or occupational therapy. If you are able to utilize a professional resource, they could likely advise you on the safest protocols for using the commode.}

We are using the PT offered through the home health agency. It just got renewed and the first day was last week. I am going to request a copy of the PT treatment plan. Didn’t think of that the first round. My goal for him has probably changed from having him being upright with a walker to just bearing just a bit more of his own weight when we are doing transfer - I think? 

JDancer – {If the bedside commode (BSC) is placed next to where he's sitting, it's a simple stand and pivot. Physical therapy should have shown you the technique before he was released, I'm sorry if they didn't. Most BSCs have arms that can be removed, or lift out of the way. If they didn't send a gait belt home with him, put a sturdy belt around his waist to hold onto.}

The physical therapist team struggled also in trying to show the technique because dad is so frighten of falling now that he almost always trying to sit now rather than stand and then get this death grip on the thing you are trying to transfer him away from. So imagine trying to help him get up and then when you do manage to get him up, now you are trying to pry his hand away from the bed, wheelchair, or potty. Whatever he can grab a hold of. I didn't know they had bedside commodes with the removable side but his wheelchair does.

Jmlarue – {I’ve taken Tramadol for year for arthritis pain.} Thanks for your comment. My only concern with the full dose was the warning that Tramadol can slow or stop your breathing. And dad has severe COPD which we just got a bit under control. So I and the nurse were okay in trying half along with Tylenol Arthritis. However, if pain management does not improved, I will go ahead and try the 50 after informing the home health nurse.

JDancer

Next time you see PT, ask about a slide board and a BSC with a removable arm. Standing can be eliminated.

quartlow2

You might consider OT for him. Their job is to help him learn how to do daily living tasks with his current capabilities. You can tell the company of the issue and ask OT and PT to coordinate therapy. Maybe giving alternatives "until he's stronger".

​fesk

I second quart's recommendation for OT. They should be able to evaluate, provide suggestions on the best way to proceed, and work with you to achieve the best outcome.

Olly_Bake

Update to this post. 

I’m still trying to convince my aide to allow dad to bear some of his weight and to use the lift. She feels picking him up and getting him there is quicker but I can see the struggle from the camera and from firsthand. The OT & PT fired themselves after one day of the renewal just telling us to use the lift for everything and we do the exercises shown on their sheet. I know the more we do that, the weaker he will become.

What I’ve been doing since last week that I’m trying to improve upon is using the standard lift. I place the bedside commode right up against the bed to sturdy. Kind of like arm to arm and close to the head of the bed. Then I bring in the lift and turn it sideways a bit (legs of lift almost underneath the bed with the handle within reaching distance of the commode and bed. Once he starts standing, I help him quickly grab the handle on the standard lift and I turn his hips as he pulls himself up just enough to clear the bedside commode handle.

Future plan is to get the bedside commode where the handle comes up if I see where he gets where he can no longer clear. Didn't know they existed until this post.

Thankfully, he can still tell us he needs to go. But I did have to get a bed alarm like the ones they use on the wheelchairs for use at night. Sister and dad are still having rounds about the bathroom (but not as much). I moved his tamsulosin to mornings and started using a half of laxative/softener combo to try and make sure he goes before I or the aide go for the day.

I got the bedpan. Nope he would never go in it and said it was hurting his backside and hips. I took his word for it after making several attempts and went back to the bedside commode and the lift. And lots of self-talk.

That's where we are on this issue for now. White flag waiving!

Jo C.

Olly, what were the results of the x-rays?  If you do not know, it is important to contact the physician's office to have it read to you.  If anything is amiss, then one would need to speak to the physician who may not have seen the result report or something else may have fallen sideways and been missed. 

As for stool softeners; do take the physician's advice on how often and how many to give. Tramadol can be very constipating; about 45% of persons taking that med develop that problem.   It is not just about not being able to go; it is about dreadful exceedingly hard stools that one feels they need to pass but due to the hardness are not able to.  Patients suffer very real distress when that happens, so prevention is important.

J.

Olly_Bake

Reply to Jo C

The primary doctor just stated DJD in hips and knee. I got both reports and it says for the left hip and pelvis the gamma-nail is still in place in the proximal aspect of femur, faint fracture in the left intertrochanteric region, and mild DJD. The report on the knee says severe DJD with osteophytic lipping, joint space narrowing, and arterial calcification.

You are so right about the Tramadol [it is about dreadful exceedingly hard stools that one feels they need to pass but due to the hardness are not able to]. Poor dad keeps saying feels like he is trying to pass rocks and feel sore now in that area.  The home health nurse checked on us today and told me to replace the other stool softener with Miralax and she will visit tomorrow. I am going to pick some up on my way to his home tomorrow. Right now we are using one vegetable laxative and stool softener. Hoping the Miralax makes it even easier.

May flowers

Olly, Miralax  has become apart of our daily regimen. It draws water into the colon and softens stools. We do a capful daily unless it gets too loose and we do 1/2 capful. Hopefully, he is drinking enough, that helps too.

I hope you will get more comfortable with the lift, once you have used it consistently it really does become second nature. I have taught 5 caregivers now with the lift and all of them can now do it without any assistance. This is a very good video, and covers how to help them sit upright when lowering: https://www.youtube.com/watch?v=MI1CMip07tA 

I have not had a sling “sling around” so I am not sure what is happening there. Maybe keep one hand on his feet to steady him while you are pumping it up or rolling. Also, moving slowly helps. It is VERY safe when done correctly, much more so than stand and pivot when their legs are weak, and much easier on caregivers. We switched to an electric lift (paying out of pocket), but well worth it.

As for the bottom hanging out, this happens to us as well. My FIL is in between size u-slings, so we have to go with the larger slings and it means his bottom hangs down. It looks precarious, but it really isn’t. We even do diaper changes while he’s suspended - clean his bottom, put on cream, and then lower him down onto his clean diaper in the bed. So much easier than rolling him around in the bed, which he hated.

Hope that helps!