My dad fell and hurt his knee on Monday. After waiting a day for it to get better, during which it got a lot worse, my mom wound up calling an ambulance to take him to the emergency room. The knee is fractured in two places. At the hospital, the orthopedic surgeon put a brace on it, gave him narcotics, and said to come back next week.
The pain has been monstrous, and the drugs have not helped. So they decided to go back to the doctor today. Holy shit, it was a goddamn nightmare getting him out of the house, into my minivan, and then reversing the process after the appointment. Using crutches has messed up his shoulders so bad he can’t bring his hand to his face, and THAT is causing him a lot of pain too.
The doctor says the new pain meds will make it so he can get around, but I’m very dubious about that. Plus, if he’s on oxycontin, I’m worried that trying to crutch down stairs will be unsafe even if the pain’s better, since his balance will be compromised!
TL;DR: it’s far too risky and difficult for my mom and me to get him down the five stairs to get out of the house and to get him into a vehicle. Assuming this situation will only last a week or two, how do we deal with it? If it was long term, we’d get a wheelchair, build a ramp, etc. But that’s ridiculous for one or two doctor’s appointments. Do we just call an ambulance each time? That seems kind of crazy too. What do people do in a situation like this?
with a aRent a wheelchair. Buy a sheet of plywood to lay over the steps.
There’s just no easy solution. Five steps would be really steep. I’m not sure one person could safely back a wheelchair down an incline that steep.
I’d consider a weekly rental in a motel. Find one with a ground floor room where you park the car directly by the door. One week might buy him enough time to adjust to crutches. $400 should cover a full week at motel 6.
Hope he starts feeling better. I don’t have a clear answer, but a few thoughts:
He might want to get someone (nurse or physical therapist) to show him good crutch techniques. They shouldn’t be messing up his shoulders that much. It’s not like any of us get much practice on using crutches, so there’s no shame in getting someone to show you how.
I assume you could rent a wheelchair for a couple weeks, if that helps.
If there’s some decently able-bodied friend or relation you can call upon, a couple people should be able to carry him down five steps, especially if he can help at all. If it’s only a couple of doctor’s appointments, that’s not too much of a favor to call upon someone for.
Ambulette? It’s basically a non-emergency ambulance that you can reserve like a taxi. I have no idea whether there are services in your area or what the cost would be, but it’s worth checking into. One of the doctors or someone at the ER might know more.
I also like the idea of renting a wheelchair and ramp. Even if it’s just for a short time, if he’s having a lot of pain using the crutches, it might be a better solution for him.
I didn’t find much when searching for “ambulette”, but it looks like there are a number of ambulance companies in your area, and all that I’ve checked so far do offer non-emergency service. However, none list prices, and I saw language on a couple of sites regarding medical necessity and reimbursement through insurance/Medicare, so it may be something you need a doctor’s approval. Too bad I don’t actually know anything, huh?
In any case, good luck to you all. I hope he feels better soon.
When my parents had knee surgery, they were prescribed a course of in-home physical therapy. Could your doctor prescribe someone who is able and trained to come and help him into the car? This is not something for amateurs to be doing.
And yes, pain relievers can really mess up people’s ability to get around safely.
Thanks guys! Wonderful ideas. Regardless of whether his knee pain gets better, I will definitely tell them about the idea of having a physical therapist teach him crutch technique - brilliant!
Funnily enough, while looking for a taxi for my mother in law today, I discovered a taxi service that has lift-equipped vans! So if we do need to rent a wheelchair for him, we could use that service. Then the only challenge is getting him out of the house.
Hopefully he will get to the point that he could just scoot down on his butt, but today that was totally out of the question. I wonder if we could use plywood to make a ramp from the front porch, sloping down to the front yard, so it’s not too steep? We will look into that if a wheelchair is necessary. If all else fails, my husband could semi-carry him enough so that we could get them into a handicapped-accessible motel room - what a clever idea.
Also thinking maybe a walker would work better for him than the crutches, especially if he’s loopy on drugs - good idea.
Thank you *so much *for your sympathy and suggestions. It was an extremely frazzling morning, and you have helped me feel more in control!
You’d have to assume that the house is wheelchair accessible also. (are the doors wide enough? are there any parts of the house lower than the others? etc)
At times like this I’d wish there were more doctors (heck maybe a RN) that come to your house so they can check up on you or prescribe things. Bigger things like getting x-rays, MRI, etc would have to be done at the office or a hospital, but having a doctor come to you would improve quality of life immensely.
Every area seems to have their own name for the service. In our city, it’s called The Hopper. I went to the site to look for keywords. I found:
deviated fixed route bus service
(there are basic routes, but they’ll go up to a mile outside of the route)
ADA certified passengers
General Public Dial-A-Ride
reservation pickup
Elderly & Disabled transportation services
and all of their information has RTD on it, so checking the basic RTD site for the area would probably be a good start. The doctors office might know about private non-emergency transportation services.
Good luck. I’m glad you’ll be checking on proper crutch use. After years of using a cane, I had knee surgery and the physical therapist showed me the right way to use one. After I got used to the new rhythm, I had to admit it worked better.
I shattered both my left tibia and fibula in 1996, resulting in multiple rounds of surgery, hospital stays, and countless hours of therapy over a multi-year period, so I’ve been down this road. I had an HMO at the time, which really sucked in some respects, but in others it was helpful - for instance, the day after I was released from the hospital after the first surgery, they sent a physical therapist to the house to evaluate me (actually, my mom’s house - they paid to rent a hospital bed, which we put in her living room). I was far too frail to be home alone, and the other option was to send me to a nursing home because there really wasn’t any sense in keeping me in the hospital anymore, but as much as being in Mom’s living room sucked, it was a hell of a lot better than being in a nursing home. Plus cheaper for them, even with bed rental, so win-win. And then I got a blood clot, and for a while they sent a phlebotomist to Mom’s house every couple of days to check how I was handling the meds for that.
IME it’s usually a physical or occupational therapist who handles the nitty-gritty stuff like crutch lessons, anyway - they literally wouldn’t release me from the hospital until they were satisfied I was doing OK with crutches.
A tow rope or similar tied to the top stair post is great to hang on to whilst bumping down the stairs on your bum. It also helps later when you can stand up but still need to keep the weight off your injury.
Ask the doc about anti inflamatories as well as opiates
I’m assuming you mean a patella fx, yes?
Did he get one of those big knee immobilizers? The long ones with velcro wraps and stiffening bands and a bump in the back for behind the knee? Those are usually a one-size-doesn’t-fit-anyone-very-well design that you can often modify for a more custom fit. Among other things, it shouldn’t be so tight as to put pressure on the patella.
Ditto the crutches, I’ve seen some badly adjusted crutches given out by professionals who should have known better, this can cause a lot of upper body pain and inefficient walking (‘I feel like I lifted 400# at the gym yesterday’).
I recommend my pts go down the stairs on their butts the duration of crutch use.
If you don’t have a friend in meatspace that can do the adjustments, consider a home health visit or hit a physical therapy/rehab place. He’ll likely need the latter eventually, so why not sooner. Choose wisely, some are geared for athletes, some for more general pts, call a few and spell out your needs.
A walker will be much easier, and more stable, than having to wrangle crutches.
If your stairs have a stable railing, he may be able to lean on it and negociate the stairs sideways with somebody to help stabilize him. Always take stairs/curbs with the good leg up, bad leg down.
Also, a ‘riser’ toilet seat will be greatly appreciated for when he needs to use the throne. Portable hand rails and a box to prop the leg up too. A shower bench and a hand-held shower wand will be useful.
Unfortunately things have not gotten better yet. He has been in the same chair for 26 hours, and shows no signs of being able to get out of it. He wants to wait until tomorrow morning before pursuing further help, because the doctor said the oxycontin he started yesterday will take a long time to start working.
On my advice, they’re going to call their insurance company, tell them he has zero mobility, and ask what services are covered for this kind of situation.
I’m just beyond frustrated and pissed right now, because it seems to me like there should be some support and guidance from the medical professionals on how to proceed. They seem to comfortable saying, “I understand that you can’t get up even to use the toilet - sucks to be you.”
General advice on how to help them cope with this is appreciated.
Hopefully their insurance can cover a skilled nursing facility - they’ll have staff available to get him cared for during his recovery, medical staff to watch over him, therapy facilities and transportation for office follow-ups.
His pain situation needs to be brought under control - likely he’s experiencing nerve pain/spasms so medications such as Neurontin and/or Robaxin should be used as well as pain medications. Ask the doctor for prescriptions.
Speaking of pain medications - narcotics such as Oxy often don’t provide much releif, they just make you don’t care about the pain or simply feel miserable/nauseous as well as constipated.
Check about the possibly of using Ultram(tramadol) as this is less likely to cause nausea, will provide better pain control, and won’t depress lung function like most narcotics.
Knee injury revovery can be long and drawn out, especially for older folks and those with other medical concerns.
Around here, the not-emergency not-quite-an-ambulance is called a “Medcar”, so there’s another search term for you. But, as you say, they only generally help from the front door to the van, and may not help with the chair-to-door part.
If he really can’t get out of the chair, I highly suggest calling an actual ambulance with actual paramedics.Without training, you and your husband could hurt yourselves and your dad pretty badly trying to transfer him into wheelchair or down the stairs. And when they get him to where ever his appointment is, tell them he can’t go home again safely, and they’ll have to find him placement at a skilled nursing/rehab place until they can train him to use the crutches safely. He’s going to bitch and moan, but at least he’ll be safer, and it will be good motivation to learn.
At the very least, I’d call a home health care agency (you knew I’d say that, right?) in your area and find out how to initiate services. While they need a referral from his doctor, most of us are so hungry for patients that we’ll come out and do an assessment and get the ball rolling ordering Physical Therapy and any ambulation aids (walkers, wheelchair, etc.) that he might be eligible for and *then *we worry about getting the doctor’s orders in the next day or so. I guess what I’m saying is, don’t wait until Monday to call the doctor, just flip open the phone book or Google for home health agencies in your area and call them directly. They may come out over the weekend. They may even be able to hook you up with a mobile doctor who comes to the home and can examine him in that chair. He certainly qualifies as “homebound” by Medicare guidelines at the moment.
Not being able to get yourself out of a chair to toilet is a big problem, and it’s a problem bigger than a “simple” fractured patella. You need to be persistent until they figure out what’s really going on here.
Be very, very careful with homemade/jerry rigged ramps. A lot could go wrong there.
Thank you, guys. I knew you would know how this stuff works.
I will pass along the information about possible meds and home health care (I’m pretty sure he has a phobia of hospitals, so that would be better than a care facility if it’s possible).
I will also urge them to only use qualified actual EMS people to get him out of the house as long as he’s in this condition. It was so terrifying getting him back in after his appointment that I think my mom will be on board. And then we don’t have to jerry rig something, so no worries on that score.
