How do we handle this situation? Help Please!

Your mom is 85 and in chronic pain, I think she has just given up on life. Have you talked to her doctor about her depression? She may need meds for that as well as better pain management.
For your own sake there is nothing wrong with a little tough love. Tell her that what she is doing will result in her ending up in a nursing home because there is NO WAY you can care for her if she becomes wheelchair bound. It's hard watching our moms decline right before our eyes isn't it?
You might want to check out the thread started by dmanbro about his mother, www.agingcare.com/discussions/moms-stubbornness-is-confounding-to-me-184838.htm

Jilly, oh my gosh, it's like night and day from how your Mom-in-law was. Back pain can be very exhausting, I remember back 20 years ago when I had a disk problem which pinched on a nerve. Nothing really helped. For six months I used a cane, had something like a TENS to wear which helped somewhat. I thought I would be spending the rest of my life like this. Depressing to say the least. Thank goodness I had an SUV as that was easy to get in and out of.... sedans were torture.

Physical therapy didn't do squat for me.... finally doing "traction" worked... only two sessions and I was back to normal and since then rarely had any more back pain. Of course, each case is different, maybe traction won't work for your Mom, but it would be worth asking about it.

And if that is an option, tell Mom that the massive traction machine isn't what we saw on TV shows back in the 1970's, being in bed with weights hanging down. It's a nice small bed that you use for about 20 minutes for each session.

See if you can get her to see an acupuncturist (my personal preference is a Chinese trained acupuncturist) but check and see if the fact that she is on warfarin might contraindicate acupuncture therapy.

Thank you for your concern. She gets traction at physio and has had two acupuncture treatments and quit. Has not had relief from them and her acupuncturist is aldo her physical therapist says her condition isnt one that acupuncture will benefit. My husband got on her tonight, its bis mom, and told her she had to at least make the effort to do things like go to the kitchen to make toast or he was scared he would be ordering her a wheelchair. Afterward she told me tbat every step she takes is excrutiating, which I didnt know, so this thing has progressed from nothing to this severe in just 3 short months. I think its spinal stenosis although tbe doctor has not really given it an official name. Its just so sad to see what her life has become. She sits in front of the TV all day every day, in pain. It's terribly distressing.

Sorry for the mistakes, I type this on my phone, small keys and cant correct errors.

The pain clinic in 4 to 6 weeks -- is she on a list for cancellations? Explain how much she is suffering and beg for an earlier opening if one comes up.

Pain changes everything. If it is excruciating to take a step, all the "tough love" in the world isn't going to help. If the pain could be managed better if it weren't for the blood thinner, think long and hard about dropping the blood thinner. Who cares about preventing a possible stroke in the future if you are in debilitating pain in the present?

Do everything you possibly can to address the pain.

And then consider the depression. It sounds like this poor woman has already tried several things and they did not work. Can you blame her for being discouraged, and for not wanting to get her hopes up again? Work on trying to convince her that, "Yes, the acupuncture didn't work. But SOMETHING is going to work and we have to keep trying until we find it. Maybe the tens unit will help." No scolding or ordering, please, but some empathetic coaxing.

It sounds to me like she needs and deserves some help. Could you offer to help her get ready for the day each morning? Help find something in her closet that would be easy to put on. Maybe even buy a bright mumu that would slip easily over her head. Or at the very least help her into a nice housecoat. It may seem to her too much effort and it won't help the pain, but psychologically we feel less like invalids when we are dressed. Then settle her on the couch or a chair where she is least uncomfortable. Set up a card table next to her. Make her toast. Serve her tea or coffee in the prettiest cup in the cupboard. Fuss over her. Comforting love may be far more appropriate in this situation than tough love.

Come back up at noon and heat her a bowl of soup. Make sure she has enough water to last the afternoon. Help her to the bathroom if she needs it. If it helps the pain, have her lean against the wall as she walks. Consider getting her a walker.

Encourage her gentleman friend to come over and play cards or watch movies with her -- to help get her mind off her pain. Ask him to rent some comedies if they like watching those. Ask her golfing and bowling friends to stop by. Square dancers are the friendliest people on the planet. Let the group leader know MIL could use some cheering up.

I understand that tough love is real love. I KNOW your motives are to keep her out of a wheelchair. But your message is "We don't really believe you about your pain. We believe the doctor that you should be able to walk!" I'd much rather hear "We are so sorry about this awful pain that is no fault of yours. We'll try to help you as much as we can. We love you. I'm trying to get you into the pain center sooner, and until then I'll help you get through the day."

And, BTW, walking or moving in water is MUCH less painful than on land. See if there is a rehab center or hospital in your area that offers water therapy. She would need a lot of help, probably, getting dressed afterward, but it could be very worthwhile. I took arthritis exercise in such a pool while therapy was going on. Sometimes the person had to be wheeled down the ramp and only gotten out of the wheelchair when they were submerged, but in the water they could do what the therapists wanted them to.

And I'd be a little careful about making a wheelchair sound like a terrible things that will happen if she doesn't cooperate. With or without her cooperation she may wind up in a wheelchair, and it may be the very best thing. Try not to make it sound like a punishment or a sign of failure.

Bless you and hubby for moving into the lower suit so that MIL could remain in her home. Bless you for caring and trying to do the right thing by her now. I hope what I've said hasn't sounded like criticism. I do admire your efforts and know that your heart is in the right place.

I have seen my mother and one sister in constant pain over long periods. It is not pretty! I have not experienced anything that severe myself, but the few bouts of pain I have had convince me that I want to feel loved, accepted in spite of my inability to do what I used to be able to do, a bit pampered, reassured that no one has given up and there are other things to try. The last thing I would have wanted when the pain caused the 45-second trip to my bathroom to take 10 excruciating minutes would be for someone to tell me I had to get my own breakfast.

I sincerely hope the pain can be managed eventually. Maybe MIL can go back to some of her old activities, but start preparing yourself mentally that that may not be possible. You and your husband's roles may change.

(And, wow!, you are good on that tiny keyboard!)

She definitely needs better pain control. I have had 2 back surgeries and still have chronic pain, and am on the Butrans patch. First, the patch makes you very sleepy and isn't the greatest for pain. And if she is taking a nerve pain med like neurontin, then she is probably so zoned out that she doesn't know what is going on. My 90 year old mother just went through all of thks, and responded well to a very mild narcotic (Norco). I also added Advil PM at night to help her sleep.

She most likely can't attach the TENS leads herself, and may not know how to work it. She is 85, after all. Just because she was fine before, an injjry and pain changes a person, and especially elderly.

I agree to try to get her into pain management faster if possible. Can her regular dr or clinic get her something until she gets in?

I would consult with her doctors and/or a geriatric psychiatrist to get her some medication for both pain and depression. Cymbalta was a miracle drug for my loved one when she suffered multiple fractures from falls, including a spinal fracture. It really helped with her pain and lifted her mood. Discuss the options with her doctor.

When you have someone in their 80's who has declining mental and physical abilities, I don't find that tough love or ultimatums are helpful. To me, it is requiring the patient to do something they simply are not capable of doing. Why add to their pressure? Pulling yourself up by your bootstraps may be fine for middle aged people, but for injured, sick seniors, it's just not fair, IMO.

Pain can cause a lot of symptoms, but I would watch your mom after she gets her pain under control to ensure that the pain is what is causing her mental decline. It could be something else that is causing this change in her.

jeannegibbs I fuss over her as much as she will possibly let me. Up until this happened she was a VERY independendent lady and we continued to allow her to keep the charade that we moved in with her not to help her but because we needed help financially that's how proud this lady is! So its a very difgicult tadk indeed. I take her her coffee in the morning in a pretty cup. I get her her pills and her water. I clean her TV tray off for her, I do her laundry, I clean her house, I chat with her, we discuss her options, I keep her optimistic, I drive her to appointments, I make her snacks, I buy her treats, I pick up her prescriptions, I make her bed, I worry myself sick over her pain, in fact, I'm too soft and that's the only reason the tough love comment came up because her doctor has said that she should be walking and riding an exercise bike and wading through the water at the pool so we feel that she should at least be walking to the kitchen. Do we ignore the doctor and let her languish until she is in a nursing home flat on her back? When we sit with her for awhile and she can talk and talk the pain seems to miraculously go away so we believe she is in pain but we also think that that jt is amplified by the complete change in her lifestyle and tbe fact that she is so bored and housebound and lonely. Yet she doesnt want me there much either. Sbe tells me to go home. She wa ts her boyfriend there and whdn he isn't she cries about the pain, wont eat and is cranky. When hes here she is happier, eats well and isnt in as much pain. She is also using her pain to get all of us to do things for her, I'm afraid. She is very little in to nice clothes or having someone bring her flowers or things. She is actually quite difficult. My husband is amazed I am so persistent with how special I have always treated her when I have always been so spurned over the years. There is always some complaint. Too much honey on the toast, the coffee is too strong, the mug too heavy, she doesn't care for the chips I bought her, theyre too thick, dont buy that brand again. I tell my husband it doesnt bother me because I know she loves me and I had a mother of my own who didnt so I just go with the flow anf think of the day I wont even have that anymore and it makes me very sad. I dont know if I'm doing the right thing or the wrong thing jeannegibbs and I sure dont want to get into a semantics argument about it. Love, tough love. Its just love to me. My husband is kind of tough on her but last night night he sat down with her and told her it sas only because he is so concerned. She has a call from a pharacologist at the pain clinic today. Shes on the cancellation list. The head doctor is in Europe until end of Sept. This pharma was wonderful. Talked to her for a long time. Gave her his direct line and told her to call any time. Said he was going to send his recommendations to her family doc. Said he thinks her pain patch is likely not sgrong enohgh if she hasnt had relief after 4 days. Will recommend a 10 mcg butrans patch. Jeannegibbs I tend to agree with your suggestion about the warfarin but I dont think her doctors would agree. She has advanced atherosclerosis. One thing the pharmacologist did say is that she could indeed bave a sterlid injection which her doctlr has been zaying for 3 months is contraindicated to the warfarin a d therefore he wouldnt refer her for one. Both her darn family doctors have been useless as far as helling her. I finally had to go with her, suggest a pain patch, suggest acuphncture, suggest diclofenac, suggest pain clinic, wth?? For the 2 and a half months and 4 visits before that the had her on Tylenol and physio! But she wouldnt let me go with her before then. She finally broke down and asked me to go after 3 months and the 5 visit. I was almost frantic. I thought I would go on a rampage. Then they still didnt do much. Now we are waiting for the pain clinic appointment. We dont even have one yet. This is Canada's medical service for you. Horrendous.

Sunnygirl, good point about the mental decline and I hear what everyone is saying about the tough love idea. Question then: why do you suppose her doctors have said she should be outside walking, on an exercise bike and swimming? And bear in mind, 3 months ago this lady was golfing 18 holes twice a week, bowling in 2 leagues a week and square dancing every Thursday night until 11 p.m., not to mention driving all over hell's half acre to the city 30 miles away to do these things, partying every night of the week, casinos and dinners out and never to bed before midnight. So she is a very young, vibrant 85.

Back to the beginning. Who has looked at her back with what imaging? Are they CERTAIN that this is nerve damage and not a new fracture or a tumor?

She's on War far in for "just" artherosclerosis? Not a heart valve or some more serious cardiac issue? My impression (I am not a doctor, my husband has an artificial valve and has been on Coumadin for 10 years) is that there many other blood thinners that can be used for other applications. Is this doctor of hers very old, or very old school? It might be worthwhile getting some other opinions.

The stronger Butrans patch will make her even sleepier, so dont expect her to jump up and want to go dancing or anything else. I'm in my 50's and can't stay awake with it!
If she has a steroid injection, she will have to discontinue warfarin a week before.

From someone who has also had 2 back surgeries, chronic pain will keep you on the couch. Unless your pain MEDS are strong enough to let you move around there is no way you can exercise. As stated above you need to get the pain under control. I don't know how the medical system works in Canada but has MIL had an MRI? This is truly the only way to get an accurate diagnosis of the problem. My dad who was around 82, under the care of an orthopedic doc, went majorly downhill in about a week. Doctor was out of town and we were told to go to ER on Monday, they gave him pain MEDS till dictir returned on Friday. On Wednesday he was having problems urinating, back to ER and catheter was inserted. Went to doc on Friday and he sent us right to the hospital in town. Y dad had emergency back surgery on Saturday of labor dad weekend. He was told he would probably lose the use of his bowels and bladder if he chose not to do the surgery. Prior to my first back I went thru pain management for injections/epidurals and requested physical therapy because I felt like I was losing strength in my leg and was told I needed clearance from a surgeon Waited 3 weeks for sppt. When I finally saw the surgeon i was told my foot was almost fully dropped and needed immediate surgery. My advice, see a surgeon first to make sure your MIL is doing more good then damage by going the physical therapy route. Back pain and nerve damage suck, I live with it everyday. Good luck.

Thanks everyone. She takes the warfarin for atherosclerosis and heart valve issues. I believe her family doctor has told her they wont consider surgery because of hef heart condition but thats just from her. Apparently, the pharmacologist at the pain clinic says she can have a form of steroid injection without going off he warfarin bht again that is second hand info from hef and a conversation they had on the phone Friday. No MRI. To get a senior in for an MRI in Canada they either have to fork out the $600 to $700 for it or the doctor has to suspect cancer and he didnt see a tumor on the x-rays she has had. No fractures on the CT scan and nothing from the bone scan so she didnt want to pay for an MRI and we cant get her to let us pay for one. Its not for lack of funds on either part, shes just stubborn, she didnt even want the patch when she heard Blue Cross wasnt covering it in spite of the pain she is in! Shes a tough case! This morning was difficult. We sat and cried together on the couch. She looked like she had aged 5 years when we were first sitting there. She was judt spent. I was so mad I texted her family doctor because we werent able to even get through to the clinic switchboard on Friday to make an appointment after talking to the pharmacologist at the pain clinic so now we wait in pain another whole weekend! He never even responded. Im going to go postal I'm so riled at the lack of help we are getting. I want to take her into the city to a decent hospital but she wont go. My husband (her son), her 89 year old boyfriend and I all agree thats the route we shluld take but she wants to wait and see what happens with the pain clinic! We dont even have an appointment to the pain clinic yet! It could be 6 weeks yet! She is failing before our eyes! On Monday she is seeing this doctor again. My husband and I are both going. I am going to get my husband to tell this doctor, who is the same age as him, how she sits at home in agony crying and ask him if he would like to watch his 85 year old mother like that day after day.

And Babalou her doctors are QUACKS. We live in a bedroom industrial city that has two walk in medical clinics with doctlrs that see patients at 10 minhte intervals all day long. Or for howevero g their shift is. They are so overworked, uncaring and so fearful of litigation that they just pass you off, if they remember who you are at all. They move people through this system like cattle. Its terrible. Her actual doctor is probably in her 50s and she keeps passing her off tl her nurse practitioner and was taking so little interest that she finally went to see this other one whom she says is so thorough. Hes 65. He did notice that the x-ray the last one was referring to wasnt even low enough to show ghe proper location and that was after 6 weeks of pain and now its been another 6 weeks and HE hasnt done much more other than another x-ray and a bone scan and pushed extra strength friggin Tylenol until I freaked at him last week for a pain patch. WHY arent these doctors PROACTIVE?? WHY do I have to PRESENT my OWN treatment options to my doctor nowadays??? Isnt HE the expert anymore?? I find this even when I go to see the doctor! But for my MIL I had to ask him to try her on neurontin, I had to ask for acupuncture, I had to ask for pain clinic appointment, I had to ask for diclofenac, I had to ask him to suggest to her she use our home TENS, I had to ask for pain patch when she couldnt tolerate pills. Dont these doctors give out treatment advise any longer?? And if not, what do they do????

Jilly, you sound like a very caring, very compassionate caregiver. You say, "her doctor has said that she should be walking and riding an exercise bike and wading through the water at the pool so we feel that she should at least be walking to the kitchen. Do we ignore the doctor?" Yes.

You also explain how little respect you have for her medical providers and why. Why are you torturing yourself trying to implement what these (in your words) "quacks" are telling you?

It is precisely because this lady "was golfing 18 holes twice a week, bowling in 2 leagues a week and square dancing every Thursday night," that for her to suddenly not be able to do anything is suggesting to me that something is drastically wrong. And besides that you describe her as fiercely independent. Such people do not suddenly decide they'd like some attention and fuss and moan about pain they don't have. They do not ask for someone to make them toast. They drag themselves to the kitchen just to prove they are still tough and independent.

Either she is having very legitimate pain problems or something has gone haywire in her brain, or both.

If you were going to insist she do something she doesn't want to do, I'd vote for getting her to a big-city medical center, to specialists who will actually examine her.

Jilly2015,

Today, it appears that the insurance companies control the doctors and basically tell them how to practice medicine.

The so called affordable care act has skyrocketed the amount of paperwork done, My doctor tells me that his perception is that all of these changes are really about control and not about care.

Fewer people seem to be going into general medicine because of how difficult it is to sustain a practice with mainly government supported health care which does not pay like private health insurance companies do.

Our whole medical world view is far more into being reactive with care, than being proactive with prevention. Many doctors carry a stigma about the health care needs of the elderly which leads them to be more passive than active. Thus, we end up having to advocate for ourselves and our elderly relatives.

In looking out for myself and my own care, I am now changing to my 4th doctor in 13 years.

It's a sad messed up world in which it looks like doctor's are no longer free to practice medicine without the insurance company henpecking them; teachers in public education have to basically teach the test and so what's next? Are clergy going to be told what they can or cannot preach or teach about because of some government control regulation? We seen to be getting closer and closer to that strange new world that the science fiction writers have been warning society about.

Do you have any option to find a new GP, or are there doctor shortages where you live too? I'm in Ontario and every province is different, but I have discovered you need to find a doctor that can work with you. If your doc's main practice is running a walk-in clinic they are NOT focused on long term caregiving. Yes, it's difficult to get an MRI, but if the right doctor pushes for one it CAN happen. You need to INSIST on seeing a specialist, and you need to INSIST that the appointment takes place in a timely way, not in months from now. You may have to travel to find one with an earlier opening but it might make all the difference. As for you having to do all the research about treatment options, I think has becoming all too common. It is a rare doctor that takes the time to look at healthcare holistically and treats the whole person rather than the most immediate symptom.

I'm thinking back to what your eventually told about your mom's condition. They say she does NOT have a spine fracture, right? Have her doctors actually treated seniors with spinal fractures before?

Even if it is a spine fracture, the options are limited. When my cousin fell and fractured her spine, they told her that it would take time for it to heal and prescribed her pain medication. They also prescribed a back brace, which is supposed to help with pain during the healing,( including Tylenol), but due to her dementia, she refused to keep it on. Because of her dementia, she couldn't understand she needed to wear it and it could not be forced on her. The dementia also made her resist therapy.

Over the course of about 6 months the fracture healed and she doesn't have any pain from it now, however, she never regained her mobility and she is wheelchair bound. She can propel with her feet and get around though. The doctors believe it was the dementia that put her in the wheelchair and not the spinal fracture. No way to know for sure.

If your mom is not a candidate for surgery, then what benefit will the MRI have? I would see if the doctors could answer that.

Have they checked her out for pain somewhere else in her body? She may have pain from something else that is not being properly conveyed to you or the doctors.

Jeannegibbs you are absolutely right. Thank you. Thank you. Thank you. Thank you. Why couldnt I reason that out for myself??? Best knock on the head I have had in awhile.

My mom had back pain the CT scan showed a compression fracture Thoracic 12 and Lumbar 1 . I'm a RN and had her placed in the hospital they did a kyphoplasty , which is where the dr injects cement into the fractures to give it strength . There's no reason for your mom to live in pain. She needs a CT scan and treatment . My mom is doing great now hardly any pain and up walking ! She was in agony believe me but we got her fixed and now we can work on other things ....

The kyphoplasty is a easy procedure , you go home that day or the next . Easy peasy and I had her placed in the hospital where I work . It's just her and I now and I can go to work and check on her .

Thank you so much EVERYONE. This site is a Godsend for me. I cannot possibly answer everyone's questions separately, I'm so exhausted. But believe that I have taken each piece of advice spoken into consideration and every other comment as well. Every one of you has such a wealth of experience, information and knowledge, I feel blessed to have stumbled in here. Sunnygirl, this resulted, apparently, as a result of a healed fracture. She went for a massage to a woman a friend referred her to and a day later this started. The rmt was obviouly not qualified to work on geriatric patients with spinal compromise but MIL will never admit it. She still says she wonders how this started. Cwillie at this point she refuses to change doctors. She also defends them and resists us when we suggest taking her to hospital in Edmonton to get her seen by a specialist more quickly. HOWEVER, this weekend her 5 mcg butrans patch, after 6 days of wearing it, finally may have started to relieve her pain a bit as today she said it wa somewhat better. We spent most of the weekend with her watching golf and her boyfriend's brother is in final stages of terminal cancer so she was busy on the phone all weekend, she is finally weaned off all ghe neuontin she was taking that wasnt working so she has her appetite back a bit (plus perhaps not in as much pain) and so her only complaints were that she was very tired, the pain was wearing her out, it was better, she could actually tolerate the pain but the heaviness in her chest and shortness of breath is really getting to her these days. Now I KNOW that is her atherosclerosis but the damn doctors wont TELL her that's what it IS. They just let her go on WORRYING about what it is!!! I have gently told her her and she tells me I am wrong and continually comes up with things that might be causing this. Its usually related to some medication she is taken, something she has eaten or the weather!! What is wrong with these doctors?? They have also never told her exactly what is going on in her back. It makes me wonder if they even KNOW. My husband and I told her today that we feel that if we dont get satisfactory reslonses from our appointment tomorrow we feel we should take her to the University hospital so that she can immediately be seen by orthopedic and pain specialists rather than waiting any longer. She continued to fight us. I'm beginning to think she is frightened that if she goes she wont come home.

Ohmeowzer, this kyphoplasty, do they have to have a general anaethestic, because her doctors have told her with her leaky heart valve she would not be a candidate for surgery. I question the validity of this and have asked her if we could please see someone more qualified to give us this decision, but again, she believes every word these walk-in clinic family doctors tell her to be gospel.

No they don't it's a local its done in radiology dept they give a little anesthesia but it's just twilight and the interventional radiologist injects the cement it takes 1 hour then you lay flat for 3 hours until the cement sets ... Then you are up,and about as normal

it's awesome mom has no back pain anymore she is mobile and it's easy peasy .. Low risk , fast and I'm grateful they did it

Take your mom to the hospital get her a CT scan and find out if she has compression fractures or herniated disks , find out what can help her , sounds like to me they are just snowing her with medication and not helping the problem ... She can get off all that narcs and have a quality of life ,,,ask if a kyphoplasty or vertabralplasty ( another name for it) will help,the poor woman . She doesn't need all that if they fix the problem sounds like to much drugs , elderly people's kidneys don't metabolize meds well , the meds hang around in their system and they end up drowsy and high fall risk. I hope they can help her , please keep me posted .. Hugs to you

Heaviness in the chest and shallow breathing could be pneumonia and/or pleural effusion. If this were my mom, I would be taking her to the ER pronto.

I'm sure if the do proper imaging they will find a fracture. There is a thread in Discussions on this site titled "My mother's stubbornness is so confounding". Stubborn mom had a fracture that the hospital missed. But right mow, I'm more worried about her chest.

Well we started out this morning not being able to get through on the phone to the clinic again so I drove there and got a conference with my MILs principal doctor. She has made a time to see her at noon today. No more of this crap. I told her the pain she is in, the chest heaviness and loss of breath, the not eating, the depression, her inability to walk more than just from the bedroom to the living room to the bathroom to the kitchen and back, the crying, the inability to leave the house because of the pain, the fear of going to the hospital. She agreed with me that she should probably be in the hospital and I should just call an ambulance. I said she would never forgive me. I think she is scared that if she goes to the hospital first, she will sit there for hours in severe pain and second that she may never come home. The doctor did tell me that no ortho specialist would see her if she is not a candidate for surgery and she is not. Also that you cannot get a priority appointment for a pain clinic. So it is simply up to these doctors to make her comfortable OR she has to go to the hospital. Thats it.

Why would an ortho not see her? There are other treatments besides surgery (cortisone shots, etc).
So, she will never forgive you..for what? Trying to do the best for her? She will, and if not, you can rest easy that you did what is best for her health.