Week Two - Sunday to Saturday Advances and Frustrations.
Advances
The therapists tell mom she is doing very well. Because of her age, she isn't improving as quickly as she would like but both her physical therapist and occupational therapist say she is progressing just fine. She still takes a pain pill with breakfast so it has time to work before she she heads to therapy.
Her knee now bends better. Friday, the measurement was 82-degrees. Saturday, it was 90 degrees. She is still having some difficulty getting her knee straightened out, but the measurements the therapist does every day shows she is doing better each day.
While some younger knee replacement patients are making 3 rounds of the therapy room on their walker, mom is only doing 1 round before needing to sit down and rest. Of course, at 86, that's to be expected. She was also pretty sedentary in the months before the surgery so the three-four hours of therapy a day is pretty stenuous for her.
Her pain level is reducing steadily and she no longer needs medicine for nausea like she did during Week One. The staples were removed on Monday and the incision is healing well.
Occupational therapy has her doing upper body exercises (like lifting weights) to give her more strength to get in and out of bed or a chair. She can confidently get in and out of the tub, use the toilet, transfer from the bed to a chair to the walker, and balance to get herself dressed.
In occupational therapy, they are also teaching her to climb stairs, like using the left knee (the replacement) first, then hold on to the railing to bring the good leg up. I reminded her that our door opens outward and she only has the use of one railing (strangely on the left at one door and on the right for the other), so she told the therapist and they are practicing with one railing instead two.
Frustrations
Her main complaint is not from the surgery. She has some kind of allergy that is keeping her up most of the night coughing. The nursing staff consulted the doctor and he ordered a chest x-ray (negative for pneumonia) and ordered some cough syrup. The problem with being awake most of the night is that she might finally doze off about 6 AM. By 7 AM, the nurse comes to give her one pill, and a half hour later with the rest, just before breakfast at 8. 9 to 11:30 is therapy, lunch at 12, and PT again from 1-3:30. The exercise would be enough on its own but when she hasn't had much sleep, it's a long, tiring day. I visited once at 4 PM and she was sound asleep. I couldn't wake her, and knew she needed the rest, so I just hung up her clean clothes and let her sleep. I went back with a friend of hers the next morning.
SUGGESTIONS -
1) If you can, it's better for you to take your loved one's clothes home and wash them yourself. The high heat and strong detergent a facility uses is going to be rough on clothes. Even 3-4 weeks of washing there will fade them. And even if you mark them well, things will get lost. When my father was in a nursing home, I found his lap robe on someone else. It was not only well marked, had a sewn on tag with his name saying it was a gift from his daughter, Kathy, but it was a unique design I created, quilted, and gave to him along with a matching bed-side bag. There was no way anyone could say it wasn't his.
2) Staff meeting. Shortly after mom arrived, I recieved a letter saying I was invited to a staff meeting about her care. The date of meeting was set 3 days short of 3 weeks. Very late in my opinion. If we were doing it over, I would insist on a meeting within 3-4 days of her arrival to see what was planned for her care. Depending on the particular nurse on duty, it is sometimes difficult to get information.
3) Your doctor. Mom has only seen the internist once in two weeks. He is the same internist we had at the hospital, so we know him. (She also had him last summer when she was hospitalized) She also hasn't seen anyone from the surgeon's office. We expected the surgeon's PA if not the doctor himself. It was late on Friday when I finally confronted the nurse on duty and said we were confused because she hadn't seen a doctor and didn't know how she was doing.
Our main concern is who decides when she can come home. What is the criteria for her progress? What goals does she need to meet before she can leave? And once she comes home, will she need any additional formal therapy?
The nurse explained that the therapists are in contact with the surgeon daily and send him reports telling him her progress, how mobile she is, and even the increase in measurements for the knee bending and straightening. That was the main information I needed, but we should have been told that at the beginning. I intend to bring this up on Thursday when I go in for that staff meeting. Today is Sunday and I intend to call the surgeon's nurse on Monday morning and ask for a report. I still worry about her not liking the food and not eating enough, which also affects her healing and her energy level.
So my suggestion is to be more involved with the rehab care. Find out at the beginning what the goals are. Discuss the milestones so you can know when each one is met. Attend a therapy session with your patient to understand what they are doing and why, and what a typical session involves. For me, I know that the exercise machine I have at home approximates what they have her do at therapy and all the rest of the exercises are things she can do at home. Since she isn't getting enough sleep there, and isn't eating well, I want to bring her home as soon as possible and take care of her myself. (Note: My mom doesn't eat much to begin with, she never has, so while the type of food served at the facility isn't what she's used to eating is only part of her problem. I know what she likes, I cook primarily for her likes and dislikes, and I make sure she has fluids all day and good snacks in the morning and at 9 at night. Last summer she was down to 81 lbs. I helped her gain up to 107 and the hospital and rehab stays haven't been good towards keeping her weight.) If there are no physical reasons for her to stay longer, I intend to bring her home by mid-week.
Keep informed. Stay involved. And decide on your own what's best for your patient, then work with your doctor to make it happen.
Take care of yourself and those you love,
Kathy
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