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Mom drug her left foot, lost her balance and fell on both replacement knees last Sept; left knee was bruised and healed completely while right knee suffered a simple fracture just above the prosthesis which worsen when PT tried to push through a plateau earlier this year. PT has been discontinued for at least 3 months to give the bone a chance to heal, but doctor recommends she keeps walking daily but not to the point of pain. The latest assessment is that Mom will never walk normally again regardless of how well the bone heals because her spinal stenosis has finally impaired nerve function enough to imped walking. She now drags the left foot when using the walker (as she has throughout PT); she has more than enough strength to walk, as we see in her sit to stand and balance tests, but she can not lift that left foot well when standing. I've known for over two decades that Mom would probably end up in a wheelchair if she lived long enough and it seems we are nearly there now.


My challenge in this transition in managing (1) how many steps she takes a day so the simple fracture heals and does not cause pain and knee swelling and (2) how to prevent swelling in her feet from vinous insufficiency compromising her walking stability and possibly causing blood clots. When Mom goes to adult day care in her wheelchair, she doesn't walk at all except for a few steps in the bath room (rolls the wheelchair w her feet). The nurse puts Mom into a recliner for at least an hour in the middle of the day care day, but she still has some significant swelling when she arrives at home. When she tries to walk on the swollen feet, she is very unsteady (going from a medium to a high fall risk). I think it might hurt to walk on the swollen feet so we use the wheelchair to visit the bath room and then get into her lift recliner with minimal steps.


The problem is some days Mom wants to get up almost as soon as I get her feet up. Experimentation has shown that a minimum of 90 minutes (120 is much better) is needed for Mom to walk with her fairly stable new normal. Most days, I settle her in the chair with a snack and the paper and she's fine for a couple of hours, often taking a nap after she's done with the paper. Other days she wants up and out of the chair so she can walk with the walker to the bathroom because she wants to pee (even though she did that less than 5 minutes before). And then she wants to go again in 10-15 minutes, and sometimes again in another 5-30 minutes; she does have almost no short term memory and MCI. If I give in and help her up every time she asks I not only need to hold my breath and pray she doesn't fall again right in front of me, but we end up stressing the knee enough that it starts swelling too and hurting. For some reason she refuses to use the wheelchair for most of these repeat trips. Needless to say, the deposit from these close timed trips is almost non-existent (1 tsp to maybe 1 tbsp).


My current solution is unplugging the recliner so she cannot get out of it by herself and placing the bed side commode by the chair the first time she asks for an early bathroom visit. I give Mom the choice of using the commode or the incontinence panty she wears overnight and to day care (almost always dry when she comes back from day care). Often she tells me to never mind and at the end of 2 hours when she gets up the incontinence pantry is still dry. Since she doesn't have a UTI, I'm assuming this is MCI or maybe an early dementia behavior.


Any suggestions for how I could manage this balancing act better? There's a part of me that really hates telling her no when she wants something as simple as getting up to go to the bathroom but the larger part right now is screaming that we need to avoid another fall if at all possible. I can care for Mom at home as long as she can help with her transfers; with my own spinal stenosis problems, I not sure I can manage without her help even with some kind of lift system.

Ahmijoy, maybe this is really about me getting accustomed to telling my mother "No we're not going to do that" when she wants me to do something. I haven't had to really do that before. I guess I want someone to tell me that's OK. Maybe that's really the big step in this transition.
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Ahmijoy May 6, 2019
I know that’s one of the most difficult things to do. If we try, to ourselves we sound mean and nasty. I always thought small steps were the best. “Tomorrow, you can try to comb your own hair.” Ive finally gotten to the point where I don’t jump to my feet whenever my husband wants something. When he issues ten orders at once, I’ll repeat, “I’m not Edith Bunker!” (Remember how she never walked, she ran?)

You have the determination to do this. Remember, small steps. (((Hugs)))
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My sister-in-law had an AFO after a series of strokes but I'm not sure that will help Mom. She's holding the ankle in the right position for walking, she's just not picking the entire foot up enough to clear the floor, apparently from the knee. Nerve problems have been below the knee until this last nerve function assessment; now the impairment is to mid-thigh. The foot drags and she doesn't even have enough sensation to even know the foot is dragging. When I ask her if she can hear the foot dragging across the floor she says yes and will usually take 1-2 good steps before dragging it again. I will definitely ask the doctor if an AFO or some other brace might help at our appointment next week.
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I’m not quite sure exactly what your question is. I do know there is no magic solution to stopping a fall other than the person remaining sitting down. You could try making the bathroom trips a shorter walk by wheeling her wheelchair to the bathroom doorway and then helping her up. But, there is no way to stop a fall once it’s in the process, so to speak. My husband, while in rehab for his lack of mobility, fell out of a lift with three aides standing right there. It’s dangerous to everyone helping to try to stop a fall. Everyone could be injured.

Btw, there is no way to “sense” if someone has a urinary tract infection. They present differently in everyone. Some people have such a negative change in behavior, they’re impossible to deal with. Others might have frequent urination, a fever, feelings of always having to “go”, etc. The only way to be certain is a urine test and/or culture. I can also say that my mom’s roommate spent 23hrs and 59 minutes in the bathroom each day. She’d come out, lay down in her bed, immediately get back out of bed and go into the bathroom. This went on all day, every day.
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TNtechie May 6, 2019
I have had Mom tested for a UTI every week for the last month; two at PCP and two at a walk in clinic. Mostly because since my father's death she has starting occasionally thinking she's living about 30 years ago when she was caring for my grandfather. She wants me to drive her to my grandfather's house because she has to take care of him. Its really strange because when she was taking care of Grandpa, she drove herself. So she knows she needs me to drive her now, but still thinks she needs to do things she was doing years ago. I also wonder if it is some kind of displaced guilt because she wasn't caring for my father when he died. Mom is really having a difficult time since Dad's death in early March. I didn't expect that since she hadn't been directly taking care of him or even seeing him very often since he went into MC 3+ years ago. She was helping me cook for him and packing up his weekly care package I delivered on Sunday.
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Find out if she can be fitted for a brace for the Drop Foot. The brace will help keep her from dragging the foot she will have to lift it up though.
If she can handle the brace, it was a bit uncomfortable for my Husband, at least the one he had but there are many and there might have been one that would have worked better for him.
the braces are called AFO short for Ankle Foot Orthosis
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