DEAR DR. GOTT: My mother-in-law is bed-ridden after a fall (in 2008) which broke her left femur at the portion that comes out of the ball. The pain of rehabilitation was too much and she refused to do the work needed to be able to walk again. She was sent home with home care and physical therapy just to keep her moving. She refused to exercise enough to show improvement so her insurance discontinued payment for her therapy.
She is now 87 and insists on living at home so we have developed an exercise program similar to what she was doing at therapy and she has improved remarkably, but she still doesn’t walk. She is on 2 mg of Coumadin (daily), 25 milligrams of metoprolol (half in the am, half in the pm) and 70 milligrams of Fosamax (weekly). She also takes a multivitamin. Her doctors say she is in fine health.
She wants to be totally off the Coumadin but so far her doctors don’t feel she is active enough. Can someone bed-ridden and exercising three to four times a day get off the Coumadin or do they have to be up and walking? Also, Fosamax is said to now be the cause of broken bones in some people instead of helping prevent them. We are extremely cautious about how we move her and what exercises we have her doing since they say she broke the femur before she hit the ground. What do you say?
DEAR READER: As I have said in the past, no one can be forced to take a medication. Every patient has the right to say “no” to any medication, medical procedure, etc., but must be thoroughly informed of any possible risks or complications of denying that treatment.
Based on your comments, it appears that your mother-in-law doesn’t move much. She doesn’t walk and your comment that you are “extremely cautious” about how you move her, leads me to believe that you are doing most of the heavy lifting, likely even during her exercises. If this is the case, then I understand her physicians’ concerns and would, myself, recommend that she stay on the Coumadin to reduce the risk of developing a blood clot which could, in turn, travel her to heart, lungs, or brain and cause serious damage, even death. If she is insistent on discontinuing it, a 325 mg aspirin daily may be an appropriate alternative. Compression hose may be beneficial as well.
While I understand that this was a major fall and the resulting trauma caused extreme pain, it is now 2012 and some of that discomfort should have eased. Does your mother-in-law get out at all? Is she capable of leaving her bed, standing for short periods of time to move to a wheel-chair or electric scooter so that she can move into other areas of the house, or can she even get out of the house?
You also state that her femur (thigh bone; incidentally, the strongest bone in the body) fractured before she even hit the ground. This is a very unusual situation. If she were on Fosamax for five or more years before this event occurred, I would be concerned the medication might be to blame because as you know, Fosamax, when taken for five or more years, may increase the risk of femur fracture, with or without trauma. If this is the case, the Fosamax may not be doing her any good and should be discontinued or switched to a different medication. Perhaps 1000-1500 mg of calcium and 800 IU of vitamin D daily would be a good substitute. The calcium will be better absorbed if taken in smaller doses throughout the day.
All-in-all, your mother-in-law appears to be a feisty, if not stubborn, lady but this may or may not be a good thing. If she were more willing to try to get up and around, even if she doesn’t walk, she would be better off, but she appears to be sticking to her guns on staying at home and isn’t willing to take the necessary steps to allow that to remain a viable option. If she wants to discontinue the Coumadin, make an appointment with her physician so the two of you can sit down and discuss what that entails. You should also use the time to discuss the Fosamax and whether or not that is an appropriate medication to continue. As I said above, she doesn’t have to take these medications, but you and she need to be fully aware of what can happen if she discontinues. (The same can also be said for beginning a medication, as well.)
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