Mom's lectures about bones are saving me right now...

Last week I learned that all my mom's lectures about bones and health helped me even though she might not have followed her own good advice.  I had a quick and easy bone density test at work and learned that at age 50, I have the bone density of a 24 year old woman - that's someone half my age.  It was such a huge relief!

The test was so easy; it took only 1 minute and was completed by a machine the size of a large back pack.  The machine had a groove down the center where I put my foot.  The machine used sound waves to judge the thickness of my heel bone; it was pain free.  The nurse told me that heel bones are very similar to the large bones in our hips so testing it was a good indicator of the density of the large bones that support our frame - our hips.

I am in a high risk group for osteoporosis - or so I've been told...So for more than a decade, I've taken Calcium with vitamin D each morning and Calcium/Magesium/Zinc each night after I brush my teeth.  I also eat a lot of yogurt and cheese.   Years ago a doctor told me that due to small bones, white hair at an early age and  half Scandinavian heritage - I had a higher risk of osteoporosis.  I don't know if research continues to support those risk factors or not but, once my Mom heard that she began to nag me about calcium, Vitamin D and eating enough healthy food.  "Take care of the inside first. Don't worry about the outside; it won't look good of the inside's not healthy."  She's so right.

I must also give credit to my gynecologist who realized that my hormones where out of whack and started me on low dose estrogen at 46, two years before a full hysterectomy.  Though I've fretted about my weight over the past 3 years and been lazy about working out for the last decade, I wonder if my 30 extra pounds has actually helped me.  Has the weight meant that my frame - my skeleton, my bones - had to be stronger to hold it up?  I don't know but I don't think it hurt me.

Going forward though, I must be SURE I'm healthy from the inside out so I'll take my mom's advice and also do something she didn't. Mom had a large yard and garden that she tended all year long.  I hope to do the same after I purchase a house in a month or so.  In the mean time and even after I get the  house,  I MUST be deliberate about exercise. I must life weights to strengthen and do yoga / stretching to maintain my flexibility and balance.  I believe it's those things - along with a good diet - that will ensure I avoid osteoporosis and the pain that goes with it.

How do i prevent osteoporosis?  Easy bone density test, how do they test bone density? prevention of osteoporosis, prevention of weak bones, risk factors for osteporosis

Tough little momma is hanging in there...in spite of broken femur

I just re-read my post from March 2010 when I was reasonably certain my Mom would quickly fail and pass away after suffering a broken sacrum.  Well, it's 1 1/2 years and she's still with us.  Her latest ailment is a broken femur; suffered when she slipped from her wheel chair as she tried to reach a newspaper that fell to the floor.

Though she seems smaller and weaker each time I see her, her spirit is still strong and her mind is still curious.  She  reads every syllable in the news paper every day;  she wants to watch educational PBS programs on the outdoors, animals and science.  She wakes up to have hope for something positive every day.  That's how I want to approach life.  I wish I'd realized it sooner, the first 50 years would have been much more fun and less stressful.

So - what to do about the broken femur. The goal is to keep her pain free; it's unlikely the bone will heal well enough for her to put more weight on it.  The break is along a diagonal line about 2 inches above her left knee and at 92, there is little that doctors can do for Mom. They can't put her under for surgery since the amount of anesthesia would likely kill her.  If they tried to perform surgery they'd attempt to screw the broken piece of bone to the larger piece above but her doctor is worried that any screws would simply shatter either piece of bone making for an even worse break and more pain.  SO -the plan is to keep it immobile for 8 weeks hoping that it will knit together enough to keep the broken piece in place and avoid pain.  Mom can never put weight on the leg again.   If it doesn't work, I asked the doctor if it could be glued into place.  I'm hoping it might be done with a local anesthetic.  My aunt had part of her spine glued when she chipped a vertebra, my cousin had a knee cap glued.. so, I'm hoping....  He didn't say "no" but he didn't say it's possible either...  All I can do is hope and pray for my little momma...

What caused the broken femur?  There are 2 obvious causes - osteoporosis and mom falling from the wheel chair.   The osteoporosis is a natural occurance of aging and the fall from the wheel chair is inevitable - but BOTH could have been minimized.  If Mom had remained more active, taken calcium and vitamin D and low dose estrogen her bones might be in better shape.  If the nursing home aides had helped mom to her recliner instead of leaving her in the wheel chair, she'd never have slipped out of it.   Again, it's another thing about to complain to the state but it's unlikely to change.  There are just too few aides to take care of too many patients.

Read my next post on how to prevention of osteoporosis...
How can i prevent osteoporosis?  How did mom break her femur How did dad break his femur  broken femur in elderly

What caused Mom's broken sacrum? - spread the blame...

Mom's flat on her back in the hospital, full of painkillers and unlikely to sit up soon - if ever again. Her prognosis is poor and my instincts tell me she will live a while but won't come back from this incident.  I've been racking my brain trying to understand the "one" thing responsible for Mom's broken sacrum and thus her excruciating pain and poor prognosis.  After days of guilt, I've come to realize that it's a combination of things  that caused this, though that doesn't make my sense of guilt go away.

The "fault"  lies with all of us who SHOULD have noticed Mom's increasing pain and thus her vulnerability and worked to PREVENT a break or fix it as a hairline fracture.    The primary cause of this break is Mom's age and physical condition.  She's 90 with has bad osteoporosis. This fact alone should make anyone more careful as they move her and more sensitive to her complaints of increased pain. For years she's refused to exercise, to take calcium or vitamin D and small estrogen supplements to maintain bone strength.  The brake could have occurred if she sat down too hard or was constipated and had to strain during a BM.   Mom asked that aides, my neice and myself rub her lower back to help her pain.  The location where she wanted us to rub was very near her sacrum.  We, in our attempts to help her, might have aggravated her break without knowing it. 

I feel some responsibility for her current state because I didn't visit for nearly two months. I live 7 hours away and didn't want to drive through snow and ice.   Had I gone there, I'd have listened to her; I'd notice her pain.  Had I asked questions, had I understood that her pain was increasing, I could have pushed for an MRI earlier.  Had I called the nurse at night instead of just calling Mom to visit, I might have known something was up.

I blame my brother because he lives in Mom's home town and got 2 calls about her being "assisted to the floor" after her wheelchair rolled out from under her as an aide sat her down. He didn't call me, he didn't call the doctor.  He just told the nursing home aides TWICE to fix the brakes. After the 2nd "assist to the floor", the nursing home used a portable x-ray to look at her hip but never looked further to her back. This is an elderly person with KNOWN osteoporosis - it's absolute neglect NOT to look at BOTH hips and her back.  I'd have insisted on an MRI then - 5  weeks ago when her pain was controlled with tylenol and rest.  Obviously the break was not as bad then and perhaps something might have been done that would cause her less pain and NOT cost her life. 

I blame the nurses and aides at the nursing home for their failure to simply pay attention.  I'm REALLY angry about this and plan to complain to the state after Mom passes away.  After learning of these "assists to the floor", I visited her. I spoke with the night nurse on 2/18 who told me that she's noted an increase in Mom's pain for 8 weeks - that's 2 MONTHS and no one did a thing.  The night nurse DID HER JOB; she wrote down her concerns so the DNS - director of nursing services - could see it and take action.  Yet, there are NO reports to her doctor, NO calls to family until something happens that might be a liability to the nursing home.   When something DID happen - the brakes on the wheelchair failed, they called the family to fix it when the chair belongs to the nursing home!  They KNOW this yet they called my brother anyway.

I blame her doctor for insisting that she be in this particular nursing home because "none of the others communicate with me as well."... Hmmm... I hope he'll reconsider THAT opinion NOW that they've caused my mom a painful death.   I blame him for a failure to act sooner, he waited two weeks to order an MRI and during that time her pain became worse. Thus the trip to the ER and the failed attempt at a, literally, heart stopping MRI.

I know I need to let this go.  I know that my regrets don't help Mom now but by talking about it, by making people aware, I hope something positive will come out of it.  My Mom is suffering and I am so sorry.  I want so badly to prevent this for someone else.  Listen to their pain and act to prevent problems as soon as you can.

Dead in the MRI and broken sacrum = long recovery IF mom can make the trip at all

In the past 5 days Mom’s died once, received 9 IVs and one epidural.   Last Friday, Mom was in so much pain that the nursing home insisted she go to the ER.  They called her doctor to meet her at the ER but he was too late to stop the ER doctor from attempting an MRI.  They did an EKG before the MRI but didn’t look at the results before giving her propofol (Diprivan) as a sedative.   Though they only gave her a small amount –about 1/5 the “usual dose” for an adult – it was enough to stop her heart.   If the ER doc had looked at the EKG, he’d have seen that she was in atrial fibrillation – her heart was beating erratically and not in regular sinus rhythm.    The technicians gave her epinephrine (also known as adrenaline) and did chest compressions to successfully restart her heart in normal rhythm.  

She was transferred to the ICU and hooked up to every monitor known to man and medicine.  I arrived in town to find her confused and begging for God to deliver her from such torture.  She was on a fentanyl patch and 2ml (milliliters??) of dilaudid (hydromorphone) every 2 hours.  The nurses in the ICU were great; they came in every hour to give her 1 ml and were quite attentive to her every need.  They even tried to feed her but she would not budge – she wanted no food at all.  On Monday she was in and out of it, she recognized us all but had a hard time focusing on a thought.  

The doctor developed a whole plan to administer certain drugs on Tuesday to complete an MRI to see exactly what was happening with her back and hip.  The results were poor – cracked sacrum, severe osteoporosis and arthritis that is compressing her sciatic nerve and causing extreme pain.  Tuesday was a rough day. She was terribly confused by the drugs and didn’t want to go into the MRI machine.   Luckily, she made it through just fine but the drugs she had to take made her feel awful well into Wednesday.   Every 5 minutes she repeated that “everything is backwards”.   It was as though she developed severe dementia overnight.  She told me that she saw God sitting next to her while I had some lunch.  All afternoon I had to share my chair with God.  It was the only chair so I had to sit on the forward part of the seat so that he had room to sit down with me.  If I tried to move back she’d correct me and tell me to leave room  for God.  She realized it sounded crazy and said she was embarrassed to tell me; she could not actually see God in the room but she was certain he was there.   As the day wore on, I wondered if it was metaphorical and if she really was trying to tell ME to become more spiritual; that I should make room for God...   What ever the purpose, we laughed about it a bit and she remembered it the next day on Wednesday.  

Wednesday morning Mom was less confused but still agitated.  She was scared and wondered why she had to suffer so; why they could not fix her pain and return her to “normal”.  She was tired of laying down and wanted to sit up but it hurt too much.   In the afternoon she went for an epidural and returned changed – more alert, more at ease and less agitated.  During the epidural, my brother and I sat nearby and heard her yelling out. We nearly cried, believing she was in pain.  Soon after the yelling the doctor came out and told us that she was yelling because they had to move her into a bath and it was cooler than she wanted.  On the way out of the epidural, again, she was asking “why” – “I’ve been a good girl, all my life… why must I suffer like this…”  It was hard to hear but she looked so much better that we still felt relieved.  

The “pain” doctor had good news and bad – the epidural went well but…. The fracture in her sacrum was worse than we thought, it was in pieces and healing was unlikely.  Generally, they could glue a crack with surgery but there is no way they’d put mom out again.  Given her osteoporosis, it might just break again soon anyway.   He said she’ll have constant pain for the rest of her life;  laying flat or sitting probably won’t hurt but moving up or down will.   So – how do we tell her that?  Having to tell her is worse than learning she had the break… dammit!  My poor momma!