Non-compliance and physical therapy....a rant is coming....

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In addition to all of the other doctor appointments my mother always seems to have, her orthopedic surgeon has just added outpatient physical therapy 3x/week to the mix. The center is 20 minutes away from our house, & each session is to last an hour....due to the location, it's not enough time to drop her off & go run errands as nothing is around it.

The thing is, the physical therapy has been ordered because she hasn't been progressing well after her hip replacement. She refuses to follow the hip precautions & as a result she's already dislocated the new hip once. She was in a SNF for 3 months after the surgery, where she received daily physical therapy and if they didn't "make her" do something, she wouldn't do it. They finally said there's no more they could do with her because she wasn't improving, so she left the SNF the way she went in - wheelchair bound. Physical therapists that have come to the house work with her for a few minutes, tell her to do ___ number of exercises on her own, then they leave (waste of time, in other words, as she won't do the exercises...she's always got an excuse as to why she can't do them) She continues to bend past 90* to pick something up/put on her socks/etc., and then turns around & complains that her hip/leg hurts. I'll ask "do you think there's anything you're doing that's making it worse???" (KNOWING that it is what she's doing that is causing the pain) The answer is always no, or "i just bent over really quickly to pick up that _____" - Seriously? It doesn't matter how "quickly" you do it, YOU'RE NOT SUPPOSED TO DO IT! I just can NOT get that through her head!! I tell her everyday to call me when she's ready to get dressed - I'll help her with her pants & socks so she doesn't have to bend over...nope...she rolls on out of her bedroom fully dressed to the shoes.

Sooooo because my mother complained to the ortho about how she's "so upset" that she can't get around on her own yet, and is tired of the wheelchair, I am now going to be driving her 3 times a week to more physical therapy that is going to have the same result as all the others...she won't put in the effort, she'll make excuses for why she didn't do her at-home exercises, and we'll be back to square one again having wasted all of that time and gas for nothing. I expressed this frustration to her ortho and he said "well, all we can do is suggest she do them...we can't force her to do it." I wanted to bang my head against his office wall.

So I guess the 2 days a week I had "reserved" for myself are now being encroached upon (because some of the drs. are only open certain days of the week, etc.) and I find myself having to re-arrange my own appointments to accommodate her new PT schedule, which I am NOT happy about. Ugh.

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@mynameisprivate - that is really true. My mom's favorite phrase is "I'm not an exercise person." - then she can't figure out why she's not walking? oy. She's also diabetic (has been for over 40 years) but eats nothing but carbs with a few veggies thrown in for show. Funny thing is that she used to work in the diet office of a hospital...you think she'd know better. I am slowly but surely changing her diet - i don't buy the "cup o'noodles" or the boxed mac & cheese, etc. anymore - I just won't do it. She has digestive issues that I KNOW are related to her diet and her diet alone, yet she just wants the doctor to "figure this all out" (i.e. give me a new prescription because it just CAN'T be caused by the food she eats) - doesn't matter that when I make her dinner and "forget" to add a potato or rice she's not in the bathroom all night long...it's not the food. (shaking my head)
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The therapist came today - this time around it's a woman. She went through the usual list of maladies, meds, etc. that they have to do on the first visit, then she "got down to business" and wanted to see what my mom could do on her own. She watched her transfer from her chair to the bed, toilet, etc. then had her use the walker to walk a few steps. Immediately she saw that whenever she swings her right leg forward (the hip replacement was on that side) to take a step, her right leg goes towards the center/left foot. She told her "move your leg to the right", so she did...this went on several times to where each step my mom took, i heard the PT say "keep your leg to the right" "stop putting it in the center" "you're going to trip yourself" etc. - my mom finally said "THAT'S JUST WHERE IT WANTS TO GO - I CANT HELP IT!" so the PT stopped her and said "YOU can control that leg and where it goes - your muscles are weak, but they are still working - YOU need to make them listen to you." I thought to myself "FINALLY!!!!!" Here's hoping this PT will be able to get through to her!!
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This sounds like my mother. She does 3 or 4 reps of something she is supposed to do 3 sets of 10 of, and calls that "doing her exercises". People of our parents generation were not raised with the understanding of the role exercise and good diet plays in keeping you healthy. Medical problems "just happen", and when they do, you see a doctor, who "fixes you" with medicine or surgery. She had the surgery, she should be "fixed", right? ;) Good luck. Maybe you will have better luck with your mom than I have had with mine.
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There is obviously something more going on here and it is important that you talk to her primary doctor about her behavior. I have some of the same issues with my husband. He doesn't want to do the at-home exercises he is supposed to do that he has learned at PT. I push as hard as I can, but sometimes, I have to back off and try again later or tomorrow. I am learning patience, patience, patience...which I know I have very little of. I try to remember that I, too, may be in his position someday, and I hope someone will treat me with patience and kindness even when they are at wit's end. It's the hardest lesson I have had to learn. I pray and pray and vent here when I have to. Hang in there! This isn't an easy job, but it is one which will teach us more than we ever thought we needed to know! Take care and God bless.
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The orthopedic surgeon agreed with the PT and they are going to set her up with a PT to come to the house again....not that it will do much good unless my Mom finally pulls her head out & realizes it's all in her hands. What is really infuriating is when I have to take her to a doctor appointment & she says stuff like "I can't wait until I'm able to walk down those front steps again, so you don't have to wheel me down that ramp..." or "I wish I could get out of this damn wheelchair and just use my walker again..." HELLO!!!! YOU HAVE TO PUT IN THE WORK to get there!!!! I'll never be able to get that point across to her, so I don't even try anymore - all I get is frustration and excuses. Ugh.
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My husband is the same way. Won't do anything at home but he puts on a big show for the PT-ist. He always has an excuse as to why he can't do the exercises. I'm tired of arguing and being told I'm the one who is arguing and being miserable. It's the same way with his meds. I'm at wits end and my journey has only just begun. I really don't know what I'm going to do.
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Good luck on the home PT!
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I took her to the P/T appt. today. The P/T assessed her condition, and told her (and me) that her muscles were extremely weak, and that to expect her to build them enough to where she could walk again is probably an unrealistic goal. She noted that she had 3 months of daily physical therapy after the hip replacement surgery & said if that didn't do it, then the limited number of therapy visits medicare would cover now probably wouldn't do it either. Since she has been in a wheelchair for over a year,she has lost a lot of muscle mass so the PT wants her to instead concentrate on keeping the muscle strength she does have so she doesn't lose her ability to transfer herself, etc. The PT said she was going to talk to her ortho surgeon & see if she could get him to authorize home-based PT again (she was only allowed 4 visits when she was discharged from the SNF...and the guy that showed up was not effective - i will NOT let them assign him again) so we'll have to see how it goes.
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I so get it. I'm a PT n deal with these situations all the time plus my mother won't follow any suggestions I make to help her neck n back. You need to set boundaries n tell her how it's going to be ( as nice as possible). The doc is trying to make his life easier by complying to her request to get better. U can't make her do exercises but u can tell her if she doesn't n her mobility declines u will not be able to physically help her n she'll have to go to a NH. Talk with the PT sometime alone n tell them she's noncompliant n for them to tell her they will give her 2 wks. N if she doesn't improve they will have to discharge her. It's true too. They can't fix her 2-3 hrs a week. She has to take responsibility and ask for ur help as needed with exercises. How many weeks post op? 6 wks or so hip precautions don't have to be so strict but depends in Doc they all have different rules. You'd think she wouldn't want to dislocate it again. Try not to harp on her bc she dig her heels n harder. Don't do anything for her she can do for herself. Don't feel guilty you can only help her if she chooses. Easy said but u have to take care of ur own needs n stay sane. I've gone thru this with my dad n now my mother. I told my dad I wouldn't take him to therapy but he wasn't a good candidate. The PT's u got at home were not doing there job. They need to have mom do exercises n activities while they r there. Call agency n tell them u want another therapist one who can be firm. If she does go to out-patient see if someone else can take her. A sitter can n u can get a service for a usual minimum of 6 hrs a week. Good luck! There is a fine balance between caregiving for ur mom n for urself n fmly. god Bless!
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Hey Chris, in view of her age/other issues, is it possible she needs a mood elevator? Perhaps she is depressed. This would contribute to her 'non-compliance' with PT. Is there a friend/neighbor/member of a church group that would take her to some of the appointments? It would give you more time.
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