Dad, who was doing so well, has fallen and shattered his what?


Dad moved into an Assisted Living facility at the beginning of October after battling back from a congestive heart failure issue. He was doing so well, and just enjoyed a Thanksgiving Dinner at his AL facility. His table was the fullest, with 15 family members showing up to eat dinner with him. He was center of attention and loved it! Well, that all hour ago I just got a call from my brother. Dad's fallen and shattered his hip and is in the hospital. It's in the middle of the night and no orthopedic docs available, so won't know more till morning... He's in Texas, I'm in Arkansas... nothing I can do from here...

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Oh how sad--yet how wonderful he had a nice dinner with so many loved ones.
Sadly, a broken hip along with all the other health issues does not bode well, but you said he is a tough guy, so hope for the best.
In the very elderly, a broken hip (you said shattered!) is hard to fix, as there is only so much bone matter to deal with. I hope he can have this repaired and get strong again, but be prepared that this may not happen.
Sounds like a VERY loved man. He is blessed.
As fas as the anesthetic goes, few drs will perform this without a GA, as they need the patient really "cooperative". An epidural would not do this. (My DIL is an anesthesiologist and she says she has to make that call--often elderly people do not have the space in the vertebrae for an epidural--GA is the only option). I understand the dreaded catheter. It would only HAVE to be in place during the surgery and for maybe 12-24 hours post. He can use a urinal, pads, whatever. My hubby states to this day that the worst part of his liver transplant was the catheter.
Good luck--I hope we hear good news from you soon.
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Dustien, has your father had surgery yet?
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Barbara makes a good point. Spontaneous breaks have occurred after taking Fosamax, prescribed for osteoporosis. It's one of the dangerous side effects of that drug.

My father and I discussed both of his hip fractures and what happened. As best as we can tell, he had a near syncope episode, or blacked out momentarily and fell. If it's any consolation one hip was fractured when he was 94, the other hip when he was 95. At 98 he's still walking, sometimes with a walker and sometimes on his own. He's a very determined person.

He also had been taking Fosamax, because one of his doctors pushed it. .

The second surgery was accompanied by anxiety and reluctance from the treating (not his regular) cardiologist, based on co-morbidity factors. But as he frustratingly admitted, if he didn't give cardiac approval for the surgery, Dad wouldn't ever be able to walk again.

I've thought about this long and hard and decided if this scenario arises again, I'll draft a waiver of liability as to that specific decision so the ortho doctor can go ahead with the surgery.

Eventually Dad decided to D/C Fosamax b/c of the side effects. I'm glad he did. That was before he fell though, and I've always wondered if not suspected that Fosamax was a factor. It's been 3 years now since the last fall and even though there have been additional falls, there have been no fractures.

As to Thanksgiving plans, that as well as some other holidays are celebrated on designated days, and not always on the days on which the events originally occurred. You can easily redesignate your own day of celebration, perhaps after your father's surgery. There would be a lot to celebrate then!

If I understand correctly, your brother is in Texas geographically close to your father? If so, you don't need to fly to Arkansas. Assuming you're sole proxy under your father's legal and medical POAs, you can call the hospital and authorize your siblings to get information. I've done this before.

Then your brother can send out e-mail or text updates. You can respond with questions, or directions if necessary.

I probably should add that this kind of delegation doesn't necessarily have to arise from being proxy. In all the hospitalizations we've been through, it was only the several month 2 hospitals & 2 long term care hospitals plus rehab journey in which I was asked to provide copies of proxy authority.

You can still care for your daughter and granddaughter by delegating some information gathering to your brother. I think the key when multiple critical events happen is to determine how much you can delegate while still remaining involved.

But I can't imagine the anxiety and stress you feel, as if you're being pulled in several directions. From what you've read, you're fortunate that you and your siblings get along so well and work together, so that's a major factor in your father's favor.

BTW, if your father takes Warfarin, the hospital will probably have to make adjustments to get the PT/INR ranges w/I surgical parameters. Dad wasn't able to have his first hip surgery for a few days b/c of that reason. That WAS frustrating.

One thing you can do from here if you have the time is research rehab facilities in your father's area, if there's no rehab facility affiliated with his AL home. I checked Medicare reports, called and spoke with various people to get an idea how they approached potential clients, then went to visit. A few were eliminated immediately.

If you have Medilodge facilities, check them out. There are some in Michigan; the one I've taken Dad to is very good. A friend has said one in another location in our county is not as good.

The one I chose is rural on one side, adjoining a forest in which wildlife are fairly tame and come down to entertain the residents. I saw sandhill cranes and a doe. Dad saw them as well as wild turkeys. The setting is so serene, and I think that's a major issue in anyone's recovery.

Checking out rehab facilities is exhausting though. Make sure you have a checklist, and go back again if necessary.

Good luck, and please keep us up to date.
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Do not do the cath. It is typically NOT necessary. Urinals and briefs should be fine unless the bladder does not empty. There is only one of you, so two of the three people who "need" you will have to take a number and get in line, unless they can come with you and help one of the other two. If you have medical POA or HIPAA permission, you can talk to his docs in TX, but letting one family member be the point of contact as long as they are good with medical stuff might be fine. Can you Skype with Dad? When it rains it pours...I feel ya!
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Dusten I had epidurals for both my hip and knee replacements. It was that surgeons standard practice with strong sedation. He said most patients can not tolerate lying on their side for so long. That is certainly true in my case with severe O/A. That drs practice was also to put a strong dose of morphine in the epidural at the end before they removed it so absolutely no pain meds were needed for the first 24 hours.
As far as the cath is concerned they do like to put one in for a couple days as it is too painful to stand and walk to the toilet. Mine was removed on day 3 when I could just totter.
A man coud probably manage with a urinal.
If he is not nodally incontinent after the inital 2 days he does not need a catheter and anyway they can put him in depends if it is so upsetting for him. Things like that can be refused anyway.
How long since your daughter's spine surgery? can she get around at all on her own? As long as she can get herself a drink and a snack she should be OK as long as there is someone available to do everything else for her. You can go or let your bro & sil deal with everything for the time being. I realize you have plans for Thanksgiving but you may just have to postpone it. Grand daughter will have to realize that sometimes we all have to make sacrifices.
none of these difficulties ar insurmountable it is Dad who needs the attention right now. blessings
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Churchmouse, sorry, missed that you also suggested epidural anaesthetic... I'm very hopeful now thanks to you guys!
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Barb...maybe they can do an epidural...that would be wonderful. Something to ask about, for sure. If he thinks he can get back up and walking and get the cath out, then I'm sure he'll keep fighting!
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Thanks for the nice words all. I've come to really feel as if you guys are a real part of my care giving team. I know it's my brother and sis in law who's on the front lines, but being as I'm POA for dad both for medical and financial, I've relied on this forum to help my brother and sis help my dad as much as I can. And you've all been a help in so many ways.

I'm so worried now though. Dad has so much against him...he has COPD, Diabetes, Congestive Heart Failure, Liver problems, Endema... I'm afraid with all this they won't even attempt a hip replacement and without one, he will surly never walk again and, worst of all, he will have to wear a cath. In September after a heart issue, they put in a cath and he only went downhill from there. The cath hurt him and only made him feel like he always had to pee and he was always trying to get up to go to the bathroom... we couldn't convince him he didn't have to go to the bathroom. One of the bathroom trips saw him fall and he just gave up. Finally he was hospitalized nearly comotose and we put him on Hospice. They told us he didn't have long, so we convinced the nurses to remove the hated cath..

Within 6 hours of removing the Cath he was singing Ole Suzanna to his Granddaughter and went uphill from there...three days later moving into the Assisted Living facility! Having to be Cathed again is going to kill him I'm afraid. He'll just give up if there's no hope of getting the cath out ever now, of that I have no doubt.
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Dustien, I'm so sorry that this has happened. I found, while my mom was in the hospital having her broken hip repaied ( she also has chf, they were able to do the surgery doing an epidual) that sometimes elders fall BECAUSE the break happens spontaneously. Not " she fell and broke her hip" rather " her hip broke, so she fell".

It sounds as though you are very much needed where you are. Brother has dad covered and you can consult by phone.

Find out if the AL he was at has a rehab wing. That would really be ideal, for him to be able to return there as a rehab patient. Let us know how this is working.
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Oh Dustien, this must be soooo hard for you! Being so far away and having to wait for more information is very stressful. Hang in there! No point in stressing out until you know the situation.

Be glad you had such a nice family event so recently.

Sometimes broken hips can be mended, the joint replaced, etc. Then there is rehab. In my mother's case nothing could be done surgically. She was wheelchair bound the rest of her life. While that isn't what any of us wanted for her, it had a silver lining in that she couldn't wander and staff could keep good track of her.

Whatever comes next you'll deal with it. I am sorry you are facing this now.
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