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Dad is having muscle soreness in his back/side/hip area, which he has had before. He uses a walker and this afternoon, he was in a lot of pain, so he took a Tramadol (which he very rarely takes) and walked back to the bedroom for a nap. He got up a couple of hours later and went to the den to sit in his recliner. An hour or so later, he decided it hurt too much to stand up, and in the hours since, has convinced himself he cannot stand. I'm the caregiver, my mom and sister are disabled, and I literally cannot lift or carry my dad. Because of the coronavirus, I am hesitant to call 911 unless it's an actual emergency. Dad has CHF (and undiagnosed dementia) and my mom and sis are diabetic, so everyone is high risk. I told Dad he can either get up or sleep in his recliner tonight. I am at a loss. Any suggestions?

Today Dad had a video visit with the primary care doc. After a couple of questions re: symptoms, the doc said he was prescribing a muscle relaxer 3x daily. I asked about Dad being a fall risk, and the doc said start with one at bedtime and if that goes well, increase dose.

Long story short, the prescribed drug (Cyclobenzaprine) should not be given to patients with CHF and arrythmia, of which Dad has both. So we are sticking with Tylenol and heat, and if things aren't better after the long weekend, I'll call the doctor's office and request a muscle relaxer that doesn't have cardiac side effects.
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Reply to texascares
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I just noticed that one of your post DOES say that your father has dementia. I'd check out the mobility issue with his doctor for sure, but, also inquire about the dementia. One of the things that happens is loss of the ability to walk. It's not something that he came up with, but, a real trait of the disease. For some it comes in the later stages, but for others, it's not that late. This happens with people who have dementia, even if they have no prior issues with their feet or legs. My LO lost the ability to walk rather early and the wheelchair really gave her back the ability to get around. While he's trying to get around on his own, I agree with you about doing all that's possible to avoid a fall. It's quite common and almost unavoidable in many situations.
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Reply to Sunnygirl1
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Well, last night was difficult. Dad was able to sleep in his bed as opposed to the recliner, but my sister woke me at nearly 4:00 this morning, saying Dad needed help. He had gone to the bathroom and could not get up from his seated position. We had a yelling match as he insisted he couldn't get up and I stressed that I would not be able to pick him up if he fell. Eventually I was able to help him to a rolling office chair (very carefully) and back to bed. I went back to my room and sat in bed, heart pounding, until 6:00 a.m., when I finally got a little sleep. Today I told Mom my biggest fear during the ordeal was that he would fall and I'd have to call EMS. Today I went to Walmart and bought a 5-inch commode riser with hand rails. So far it has worked, and I'm praying it will work tonight.

As far as his pain, it still only bothers him when moving a certain way, and he is better when he gets up and walks every now and then. We'll see how tomorrow goes, and call the doctor if needed Wed.
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Thank you, everyone. Yes, we will be having him evaluated once it is safe to do so. So many assisted living centers here have cases, and I think I heard that half of Texas' corona-related deaths are in living centers. Very sad.

Dad has had peripheral neuropathy in his feet (non-diabetic) for decades. The neurologist thinks it was from many years on hydrochlorothiazide for blood pressure. As a result, he has had balance problems for years, and coupled with the back issues, he is very much a fall risk. We have stressed that he use his walker everywhere, not just when he leaves the house (which isn't happening now). He has gone to physical therapy for balance, and was going last year before stopping due to his CHF diagnosis and subsequent (but unrelated) hernia surgery. About the time he decided to go back to therapy, this virus hit. He does have gentle at-home exercises they gave him when they discharged him, so maybe when his pain lets up, he can resume those.

Re: hallucinations with prescriptions -- back when Dad was still working, the doctor gave him codeine for a bad cough. Dad tried to fire his boss. I was given Periactin when I had a bad ear infection when I was 2, and my parents said it made me think I was a tiger.
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Tramadol does cause confusion and hallucinations. We had to take Mom off of it. I was told by a doctor that the elderly should never be put on it. I had a friend in his 50s who took it and had hallucinations. He only took it one time.

I found with my Mom that she overexaggerated her pain. Like a little kid. Just doing her BP with a cuff she would say it hurt.

When this COVID thing is over, you may want to get Dad re-evaluated.
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Do not be afraid to use a hospital for non COVID reasons. They are generally quiet. COVID suspects are pre screened and separated. So are hospital staff separated.
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If the dementia is causing his inability to walk, I’d discuss what that means with his doctor. A loss of varying abilities is common. Some lose this ability late in the progression, but for some it’s early and it’s not a matter of being stubborn, but of brain damage. I’d discuss it with his doctor though because they may need to rule out other causes.
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Update -- Dad has twice gotten up and taken his walker to the bathroom. Mom and I suggested he put on sweat pants, since he was complaining about fastening his belt with the khakis. During his second trip to the bathroom, he changed into a pair of "pants with pockets" that were hanging over the shower rod because he HAS to keep a comb with him at all times.

So we have now learned that stubbornness can be stronger than pain.

We are starting to think that our biggest mistake was letting him stay in the recliner all evening, then sleep in it. He is doing much better each time he stands up and moves. We'll make sure he can sleep in his bed tonight, and if the pain is no better tomorrrow, we can do a video appt. with the primary care doc.

We'll also try to keep his pain manageable with a heat patch and Tylenol. The Tramadol is only 50 mg, but we are wondering if it may have added to his confusion and agitation. Several years ago, he was given Vicodin for a severe kidney stone, and even though he'd taken it as needed for years, it caused him to hallucinate and become very belligerent. I called an all-night pharmacy and learned that opiates can cause such behavior in seniors, and the older we get, the worse the reactions can be. So it may be that even though he could tolerate the Tramadol a year ago, maybe it now is a problem. We also try to avoid opiates whenver possible due to stomach/lower GI issues.

I hate to say this, but he has always been a big baby. If he gets a paper cut, you'd think his finger was cut off. It makes it hard to know when there is something really wrong. And the dementia has made him horribly self-centered. For a man who has always gone out of his way to help people, it's hard to see now that he only cares about himself.

It is comforting to find so many people here in similar situations. As a single woman, I never had the experience of running a household. When Mom had her stroke, I became a "housewife with none of the perks" overnight. I have grown up around doctors and hospitals with my sister, and I've always researched new medications and treatments when one of us had a new condition. But this dementia thing is all new to me. Navigating it in a pandemic is doubly scary. I appreciate the support!
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Reply to texascares
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I'm with CW. Something has changed. Call his doctor.

Most hospitals (at least where I am) are very effectively isolating injuries from "sick with COVID" patients.
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Reply to BarbBrooklyn
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My mom could walk just fine... until she couldn't. Some PT could help him recover somewhat but he may be past the point where he can walk and pushing him is going to result in falls. If you have a wheelchair available and he can stand long enough to transfer that may be your new normal, I was able to care for my mom relatively well when she was at this stage.

Have you considered that the sudden increase in pain could be due to a spontaneous fracture, either of the hip or vertebra, and that forcing him to continue to walk might be asking the impossible? If you are in an area with rampant CV19 could you at least ask for a telemedicine consult?
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Thanks for the feedback, everyone. Dad had dozed off in the recliner and when he woke up around 1 a.m., I put a gait belt on him (I have one for Mom, who had a stroke 7 years ago and has had a few falls since) and stood in front of his walker. He would stand about halfway, but when I told him to move his hand from the chair arm to the walker, he'd say he couldn't and sit back down. We did this for 20 minutes, then Mom came in (in her wheelchair) and tried. Finally at 1:45, I told him he would have to sleep in the recliner if he couldn't walk with the walker. He decided to do that, and Mom took him a blanket and pj's.

This morning he has been very relunctant to try to do anything for himself. With the gait belt again, he got as far as standing with both hands on the walker, but then said he couldn't do any more and plopped down in the recliner again. I told him that he will either make himself use the walker or we will have to call the EMTs to take him to the hospital. He doesn't want to go, and we really don't want him to, but I tried to explain that if he cannot do for himself, he needs medical attention.

The biggest problem with his dementia is that he thinks there are extra people that live in our house, and he gets very agitated when we try to correct him (more on that later). This morning, he asked Mom where was his wife, and when she said she is his wife, he said, "no, my real wife." He frequently gets me (a 50-something woman) confused with his 86-year old brother who lives out of town. I recently had a birthday and when I handed him a piece of cake, he asked where was the birthday girl. Later, I said "thanks for my birthday" and he asked "it's your birthday today, too?" He will ask where is my sister when she is sitting less than 5 feet away, and then say, no, the other one. Like he has two wives and four daughters, not two. (He wasn't married before Mom.)

Dad has seen a neurologist for years for various, non-brain, issues. A few years ago, he mentioned memory problems to the doc, but since Dad can always pass the doctor's tests, he was never diagnosed. He even did a four-hour test as the university several years ago and passed with flying colors. But he doesn't treat his sleep apnea properly and has developed A-fib and CHF. His heart ejection factor percentage on the echo test is less than 30% (normal is greater than 50%). His last neuro appt. was by telephone because of the corona virus. I talked with the doctor and he said we don't know what kind of dementia Dad has and there are no drugs that can improve memory. Any drugs that might help with sundowning and agitation could cause fatal heart rhythm problems. He told me that logic doesn't work with Dad's brain now, and to read the book "The 36-hour Day." And that as long as Dad can care for himself, he can stay at home. Sadly, we may be getting to the point where he can't. We have to weigh the risks of admitting him somewhere (which is scary right now) vs having a nurse come in every day (and possibly expose everyone). I have to think of not only what is best for him, but also my mom and sister (who was born with spina bifida and uses a motorized wheelchair).

Thanks for letting me vent, y'all. Stay safe!
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Reply to texascares
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Seniors with pain and any type of cognitive issue can be a challenge. Sometimes they do not clearly communicate their level of pain or reasons for some different choices. In the later CHF stages my grandfather would have occasional brief episodes of confusion and delusion; one time he thought he needed to get ready for a church service and another time he thought there was a hole in the bedroom floor. The doctor said these were probably times when his brain wasn't getting enough O2 since even though he had an O2 cannula he would frequently take it off.

So maybe your father is in enough pain and remembers the last walk to the bedroom as being painful enough he wasn't/isn't ready to face that again. The recliner might be more comfortable than the bed right now too. I took care of my mother for a couple of months when she couldn't walk or put any weight on one leg. She stayed in the lift assist recliner and would stand long enough for me to clean her up and change her incontinence panty. I found it easier to care for her in the recliner than the adjustable bed. Just one option you might need to consider for a while.
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My stepFIL had Parkinsons and often would sleep in the recliner. Because he was 6'5", when he fell his wife would call 911 (if we were at work). They'd come and take him to the hospital even though he told them he wasn't injured and there were no signs of injury. Then he'd have to do the 3 days of in-hospital Medicare stay, then 2 (or 3?) weeks in rehab. He cycled through this at least 3 times as I kept begging my MIL to not call 911 (but she had short-term memory problems that we were unaware of).

Because of the virus, and your father being high-risk, I'm not sure what they will choose to do. BarbBrooklyn suggested to call his doctor and I think that's the best option right now, not 911. I wish you all the best and that your own health is protected!
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Reply to Geaton777
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Tramadol comes in many different strengths, and unless it is slow release it will probably wear off in about 4 hours. Do you know if something has caused the pain? If the tablet strength is 100mg (which is what I take every morning) or less, perhaps he should take another. Then check in the morning. Sleeping in the recliner is not a problem. Just make sure he is warm enough, particularly underneath his legs.
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Reply to MargaretMcKen
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I would let him sleep in the recliner and see how he is in the AM. If this persists, call his doctor and seek advice.
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