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My mom is 97. She fell recently and has a compression fracture of the first lumbar. Tramadol and Tylenol 3 have very bad side effects on her which led to two more falls resulting in three broken ribs and a nasty bump and a staple on her head. The pain has made her crazy but the pain meds have made her crazy and mean to the point of violence. She is currently in the hospital with restraints and occasional haldol so she can rest. What else can be done?? Everyone including doctors seem at a loss. Prior to this she had minor age related dementia with no diagnosis of dementia. Now she is full blown dementia with paranoia, hallucinations and violence.

I have the same thing. And been that the doctors are so scared, I use canbus for my pain. Does wonders
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Reply to Pelou56
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Oh no, your poor mother.

Well I am disabled with a spinal cord injury. My lower spine was crushed when I was 6 months pregnant. So severe my unborn baby suffered a traumatic brain injury. Although we only learned that after he was born.

My lower 5 vertebrae were crushed beyond repair. I had to wait months for surgery. 12 years later and I am still on pain management. I have gone through dozens of medications and too many horrid side effects and reactions.

There are a few less common drugs worth exploring and some nerve pain meds that might prove better for her.

1st with her age, some medications may be to risky. But a combination of muscle relaxers might help. Dilaudid, is a less common pain medication that works on different receptors. A very low dose of fentanyl patch is an option. My mother who died of breast cancer broke a vertebrae towards the end and used a 12.5 mg patch every 72 hours. ,methadone is a good one, but typically an ekg is needed first. Lyrica can be a stand in for some. Also ask about lidocaine patches over the hurting spot. Some OTC ibuprofen patches might offer some aid. Even a Tens Unit has benefits.

What would be great is if your mother could get into a pain clinic rather a regular Dr or orthopedics. They are run by highly trained anesthesiologist who can find the best solution. Even nerve blocks in the back can be discussed.

Miralax is great for keeping stools soft and not harsh to the aged body. 17 grams in 4-6 ounces of juice is all it takes. Also, diet sodas are he'll on bad backs. They increase constipation, which itself is he'll on broken vertebrae.

Another option is the resting back brand brace. They help too.

Is she getting any physical therapy? What type of bed is she sleeping in and is she avoiding sitting in hard chairs?

Life for me is harsh, pain wise. So I pray she finds comfort soon. If things don't improve get her to a neurosurgeon and spine place. Neurosurgeons are more highly trained than a regular orthopedics spine Dr.

17 years in the medical field have shown me over and over the best outcomes are through them.

There is one last thing I finally did for myself and my boys. We had the Dr do a DNA Profile on us to test which class of medication would be best for us. It proved life altering. Now we skip the guessing game and have those results to guide choices. Medicare and Medicaid both pay for this testing. Genetic Concept is the preferred one here, but your providers should have this available. Some places use the term Genocept for short.

I hope she can avoid prolonged suffering so close to her earned rest.

Let us know how she comes along. Thanks for taking such good care of her.
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Reply to OctoberAngels
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Give her CBD oil based tincture,3 drops of 350mg,under her tongue
WITH the pain meds.If you can get
THC/CBD oil tincture,get a 1:1 and
use 3drops under tongue.Increase
dose 1drop at a time for 4-5days at a time until desired effect...the 3
drops should be fine.Get 3rd party
lab tested CBD so u know exactly
what you're getting.
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Reply to dil9397
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CBD oil or medical marijuana are excellent for pain, with zero side effects. Although I’m sure the hospital will not allow such things since they work and put a huge dent in their bottom line. Maybe once you spring her you can give them a try?
They have vape pens that are an excellent delivery system for both.
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Reply to Snowcat60
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cetude Dec 29, 2018
NOTHING has zero side effects and pot will increase risk of falling. Especially for the elderly will increase likelihood of confusion and more falls.
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Have you talked to anyone about CBD oil?
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Reply to GratefulUriel
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Have you talked to any practitioners about CBD oil?
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Reply to GratefulUriel
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Have you tried a Chiropractor (I have a crushed lumbar 1 & 2 and a Chiropractor helped He also helped evaluate whether or not a TENS unit would help -- Believe me it does and relieves the pain enough that I can control it with Tylenol and Aspirin, Also try Lidocaine Patches, Menthol Patches (Salonpas), you can also get both in lotions and they work wonders.
They are not addicting and should not cause any mood changes. The patches are OTC (over the counter) I buy the Lidocaine Patches several boxes at a time over the internet to get the price below $1.50 per patch, the Menthol Patches are more reasonable -- I would say get a box of each and see which helps the most.
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Reply to Donna6149
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My dad had bone pain from metastasized prostate cancer. Doctors tried many pain relievers and relaxants that were ineffective and/or had horrible side effects. His behavior (dementia) was out of control from pain and drug side effects. He finally got relief both physically and mentally from the lowest dosage 3-day fentanyl patch. Occasionally he needed regular tylenol for breakthrough pain on the third day, just before the patch was changed.
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Reply to Elderdog
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Tramadol is nasty stuff, did the same to my mom. They shouldn't even prescribe it for elderly. Morphine seemed to help without too much other stuff going on for her fracture( my mom's). Gradually was able to use plain Tylenol.
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Reply to Friendtotheend
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My mother has had 5 compression fractures this year. I highly recommend a kyphoplasty for relief within a couple of days - otherwise the healing process is 2 to 3 months. If for some reason, kyphoplasty is not an option, the only treatment that really worked for my mom was a combination of regular Tylenol and Valium (for back spasms). Hang in there - compression fractures are very difficult to deal with.
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Reply to nycgal04
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You’ve gotten a lot of good suggestions here. If you find the docs are not open to hearing them from you, perhaps you could ask for a consult from a pain management specialist. If they don’t have one at the hospital, maybe there is a way for you to consult with one and then get the info from that doc to the hospital. I suspect a pain management specialist will suggest some of what you have heard here. But in my experience, sometimes docs are more willing to consider info if it comes from another doc. I’m so sorry for what you are going through. We had a similar experience with my dad after kidney stone surgery. It is both frightening and sad to see your loved one become a different person so quickly. As you navigate this try to take care of yourself as well, and try to remember that the nastiness is not for real (dad said some things to me I had to work hard at letting go of). Sending you good thoughts for strength, wisdom, and peace.
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Reply to MelissaPA2AZ
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Sorry to hear about your mom. My mom (81) recently had a lumbar fracture that she basically ignored for 2 months after diagnosis. She had taken Oxy and Tramadol with little relief, she got the most relief from 3 OTC ibuprofen. She has now been going to physical therapy 2x a week, wears a lumbar brace and uses a cane when she’s up and I have to make her lay down and rest her back 2-3 times during the day. She has greatly improved since we started this regimen about 3 weeks ago. She’ll take a Tramadol every few days because she thinks she should but still gets the most relief from ibuprofen.
I know the elderly tend to have a negative psychological reaction to a lot of different medications and it’s has to be worse for them when they are in pain and physically restricted. I hope the right combination of treatment is found soon. Hang tough!!...??? (I know it feels impossible sometimes!!)
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Reply to SusanW56
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The stay in the hospital is one cause for her change, not that it is a bad thing since she does need treatment. Perhaps there is a slow release medication in a patch they could try, this way there is a constant stream of it in her system. My father was put on a fentynal patch when he had fractured his femur, it is a strong medication though. I hope they can find something for her.
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Reply to Glendaj2
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Tylenol 3 used to make my mother hallucinate. Oh boy...the Haldol....not a good idea. "Haldol is not approved for use in older adults with dementia because of increased chances of death during treatment." And it can cause mood swings. they have other drugs they can use to help calm people than psychiatric drugs. They had my loved one on two black box psych drugs for treatment from a reaction to an MRI contrast (gadolinium). Oh, and even a UTI can cause psych problems - but I still don't think a psych drug like haldol to keep her calm is a good idea. (How about a plain old sedative, period?)They could find a more effective pain med. If her pain is that bad, it sounds like she needs something stronger. (An educated opinion and also based on what they put my loved one through.) Prayers for both you and your mother.)
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Reply to ItHappenedToMe
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There are a multitude of options to try for managing the pain and the hospital/doctors should be on top of this, it really concerns me that they aren't. It is so important that her pain get under control/managed so she can heal and get back to her baseline. Several good suggestions here, another option you could try is acupuncture and or homeopathic or Essential Oil and other Eastern, more natural remedies but they do take some time and due diligence. There are more and more doctors and hospitals using some of these pain management tools in conjunction with Western Medicine so it might be worth investigation there at the hospital. Otherwise if you do explore any of these make sure you find reputable info there are far too many advantage seekers out there now...however these can be very powerful, miraculous even remedies, I speak from personal experience.

I see you are already thinking and investigating UTI, good because it is very likely more than one thing going on here now, so often any hospital stay at an advanced age now means several rabbit holes to follow...the cognitive decline/signs and symptoms being common which is why it is so helpful to have someone that knows them well around to advocate for them a lot. This is not always because the hospital is a bad one or the wrong place for them even it's just a fact of life for the aging I think and yes some hospitals and facilities are not great places to have to be many of them are very good too but still new surroundings and any imbalance in their bodies are things our minds just don't deal well with as we advance in age.
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Reply to Lymie61
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Let me add that she has been tested for a UTI and found only with trace bacteria but was put on a round of antibiotics.
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Reply to MAFlatt
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Lymie61 Dec 27, 2018
My mom has been tested twice (we were sure based on her change in behavior she had UTI) so early I guess the test came back negative or at least the rapid one did but the next day (or two) or the longer term test came back positive. My point being sometimes when it behaves like a duck (UTI) it is a duck even if it doesn't test as one the first time. It was one of the first things that came to mind as part of what might be going on anyway as I read your post. Good for you!
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We went through a similar thing with my mother last year. Your mom needs a kyphoplasty or a vertebroplasty. And quickly - Medicare won't pay if it's been more than 3 months since the event, as the benefits of the procedure decline as time goes by. We were fortunate to get in to a neurosurgeon just before the time ran out, and Mom's back was better instantly. However, then we had to detox her from the opioids she had been taking. Plus, she got something called "ICU dementia" (I'll leave that to you to Google), and it's taken about a year for her to recover from that. The kyphoplasty is a quick, minimally invasive procedure - the pre-op took longer than the procedure. Good luck! ETA: Here is a place in your city that does such things: https://txspineonline.com/territories/midland/
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Reply to LarkInTN
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cwillie Dec 26, 2018
I first read about those procedures here on AgingCare - more than one person has had a loved one with similar psychosis that was the result of poorly treated pain and medication side effects.
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Has she been tested for a UTI? It sounds like there is more going on here than untreated pain.

Tramadol was a Godsend for my mom, obtw.
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Reply to BarbBrooklyn
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This is a tough situation. She could be allergic to the codeine in the Tylenol 3.
Maybe ask for hydrocodone or oxymorphone which are synthetic forms of codeine which may not have the same adverse effects as codeine in her case.

Also a lidocaine patch to the area or a low dose fentanyl patch may work.

There are many other meds to manage pain other than Tylenol3 which is first level & often doesn’t work with conditions such as a fractured vertebrae.

Try repositioning too. The less she sits or puts pressure on the area the better.

Her bones are quite fragile at her age. I would try to avoid any extended movement to prevent further injury to her lower back. ALWAYS arrange for someone be with her if she gets up to walk to the bathroom.

Ask for a lumbar brace she can use when she is ambulatory and have it available to use at your fingertips.

This is so sad to me as I really get bothered when someone is in pain & medical providers don’t take it seriously. A body in pain won’t heal quickly. This whole opioid “crisis” withholds pain medication for people that really need it.

But bottom line she can just as well be allergic or sensitive to any new pain medication synthetic or not, so proceed with caution. Low dose first.

Good luck to you both.
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Reply to Shane1124
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Tramadol should be banned, it is a terrible drug with wicked nasty side effects. I cringe every time I hear someone has been prescribed that poison.

I would not let them tell you she needs to be placed in a memory care facility. She needs her medical issues addressed. This is a tough time to be in hospital. I would request a spinal specialist and a pain specialist. I would also request that they rule out any type of infection.

I had to be a raging b!÷@h when my dad was in hospital to get his medical needs addressed, I don't know why they think people are there, holiday I suppose. You are dealing with the bottom of the barrel when you are dealing with hospitalists, these are the doctors that can't have their own practice because patients meet them once and run the other direction. Stick to your guns and get specialists called in.

Best of luck and may God give your mom pain relief. That can make a person crazy beyond belief.

She needs her pain dealt with, maybe something topical to get it calmed down.
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Reply to Isthisrealyreal
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Tramadol is not good for the elderly. It causes hallucinations. My Mom had it too for a fractured vertebrae. A guy I know, in his 50s, had the same problem with it.. He took one and said no more.
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Reply to JoAnn29
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It sounds like the pain meds are causing psychosis. Cwillie mention a nerve block that might be a good call.
Does mom have an infection? Infection of the menings can cause this" although rare, can still happen. Also has she be tested for a UTI? I know you are probably thinking what one has to do with the other but the body is one system made up of many systems. UTI can also cause this type of behavior in older people. I am just throwing more ideas out there.
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Reply to Shell38314
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I'm just tossing out some ideas...

Ask about surgical options - vertebroplasty or kyphoplasty.
People have mentioned pain patches rather than using oral analgesics
Medical marijuana?
Nerve Block Injections?
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Reply to cwillie
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She is in the hospital. Work with the doctors who will try different treatments. Has she been seen by a spinal specialist? Can she get a PCA pump. Many people feel that cures or treatments are easy to fix. This may take A while. A spinal injury is complex. Through trial and error a specialist and not a bunch of caregivers will find an answer
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