Tuesday, September 16, 2008
Excellent Recovery
Movement for 9/16/08:
- At my insistence, and to my mother's initial displeasure, "I don't walk on my hands," she argued, which is funny because I kid, and sometimes scold, her for "standing on [her] hands" in the bathroom when she supports herself with the various bars and the counter and hangs on them for foot purchase, we are using the wheelchair for all ambulation between transfer points today. As Mom's morning progressed, though, and she discovered the circumstances behind my reasoning: She injured her left shoulder, it is still causing her moderate to sharp discomfort, and she uses her shoulders substantially for keeping her balance when she's walking or walkering. Even transferring causes a noticeable twinge, so we've just about decided, for today, at least, to avoid standing up and sitting down as much as possible, although she insisted on greeting the Hospice RN from her usual chair at the dinette table. In the bathroom, just before her nap, we did not transfer from wheelchair to toilet to wheelchair. I simply had her stand, took off her slacks, changed out her underwear, she sat back in the wheelchair, and off to bed we went.
- Her pain is significantly less than last night. Her bicep no longer hurts, just her shoulder, toward the back. She is having trouble lifting her arm, although she's leaning on it as usual without pain. No problems with her left thigh, about which she complained last night; no problems with any other part of her body, except that she had a minor lower back ache this morning upon arising, but that has disappeared since the regular acetaminophen, which I will continue throughout the day, kicked in. I think the back ache occurred because she was trying to transfer some of her use of her left shoulder for rising to her back. Didn't work as well as she hoped.
- I was very impressed with Hospice's response, both last night and today. Our RN took a full and detailed report of the fall, the paramedic visit, everything that occurred from the time of the fall to her going down for the night and conducted a Prevention Assessment, the upshot of which was: Make sure Mr. Man is secured before Mom arises from her chair to "ambulate". I didn't mention that in last night's report did I? The reason I wasn't right by her while she was walkering (I usually am), is that Mr. Man has taken to stretching out right in our path every night when Mom rises and heads north for her bedtime ritual...so I always move him while Mom is standing at the ready at her walker. I saw her lose her balance. It was such a gentle collapsing that, had I been where I usually am when she moves, I would have been able to catch her before she went down.
- We've got a gait belt. I learned how to use it in rehab and we've used it a few times here. Mom, though, doesn't like it and I don't blame her. I don't, either. No matter how tight I secure it, because of her shape, it invariably slips up just underneath her breasts. Very uncomfortable when I have to grab and pull it for security reasons. Most of the time, in circumstances where a gait belt would be used, my fingers are locked around the waistband of her slacks. That works well. I just wasn't doing that last night.
- She's up for the evening, as of 1700, on her own. She's been wary of transferring because of the sharp twinges it causes in her shoulder, but with a bit of "working up" to them, she's doing them. As it turns out, after reminding her (while I was wheeling her toward the bathroom) that we wouldn't be doing any more transfers until bedtime, as we'd decided to substitute sitting in her wheelchair in the living room for sitting in her rocker, she nixed that idea. "This is too uncomfortable," she said, patting the arms of the wheelchair.
"That means two more transfers this evening," I reminded her.
Fine with her.
Actually, out of four total transfers since her nap, only two of them have hurt her. I'm noticing that she's sequeing from "hurt shoulder" to "iffy legs", so I have to remind her that her legs aren't injured and she can use them as she usually does. This has surprised her each time it's proven to be true.
So, it looks as though we're in for an evening that will be only somewhat more sedentary than usual. I'll report back later, after she's down for the night. - Despite being a little rum-dumb from the constant acetaminophen I fed her throughout the evening, she did well. She registered pain in her shoulder (seems that area took the brunt of the blow when she fell, not her bicep) only twice: Once the first time she attempted to transfer from sitting on her bed after her nap to the wheelchair, then, again, going from a standing position (so I could pull up her underwear) to a sitting position in the wheelchair in the bathroom while going through her bedtime ritual. A few more movement quirks of the day:
- She asked if I could wash her face and neck for her while bathing. This is something she usually does and, a few times in the past when I've offered for various reasons, she's refused the offer with disdain. So, it must have been particularly difficult for her, today.
- I decided against taking her BP this morning, as the best way to do it with my equipment (a wrist cuff) is using the left arm. I was concerned that the position in which I hold her arm for a reading would cause some stress on her shoulder and I'd get a false reading. The RN took it at 1400, though, and it was normal for my mother (although the diastolic was a little low): 132/56.
- Including last night, my mother has not brushed her teeth since yesterday morning. She simply isn't interested in using the spit bowl routine. I think this is okay. I anticipate that she'll be feeling better tomorrow than today and we may be able to include this, again.
- I am learning a lot about how much she actually uses her arms for balance and how much she depends on them in transfers (I always help in transfers; I have been for quite some time, now). She depends on them so much that, today, I had to coach her into remembering that, once she's on her feet, with me giving her support she doesn't need her arms in order to use her legs. "Your legs can support you on their own," I told her. This is true. She just hasn't been used to doing this.
- I brought up the three-month-tabled suggestion of maybe checking out Hospice for a little in home therapy for her arms and legs after her shoulder has healed to the point where it can take some exercise. Surprisingly, this time, she was enthusiastic. I don't know how long that will last, but I'm going to keep talking it up.
# posted by Gail Rae @ 16:16 email...
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