Mother has broken leg and they won't operate because of her heart. Their only advice is to put her in hospice. Any advice?

Thanks Barb, well that's the next thing we have to worry about, I doubt we'll qualify for medicaid as my dad has lots of assets. Now they have her back in the nursing home, with the broken leg (I guess immobilized), and as far as I know nothing but Vicoden for pain. She can only get the rest of her 20 days of medicare-paid stay there if she makes "progress" in physical therapy, which is doubtful.

Craig, Medicare covers Hospice services but not the room and board part. Can you talk to the hospital social worker about applying for Medicaid asap for mom? Find out if mom has a Catastrophic Medical policy that might cover some long term care or home care.

You are right Ahmijoy we really need to get better answers from the doctors. And we always think of the question we should have asked later after the doctor is gone...

One other thing: so this all started when she had a cellulitis infection and went to the hospital. They gave her some pills and sent her home. Then she started falling down several times. So they ALMOST sent her home another time until a caring nurse thought to have the enzyme test done, and they found she had had a heart attack.

The hospital did X-rays of her whole body and didn't find any breaks.

Then she got sent to a nursing home, and a few days later she was complaining her knee hurt. So they brought in a mobile x-ray maching and found the break in her femur.

So it seems like it must have gotten broken in the nursing home somehow!

Anyway, medicare doesn't cover Hospice. They only cover "skilled nursing" which would mean she would have to go home, but now way my 82 year old dad can take care of her in that condition, even with nursing help. So we are at a loss what to do now.

Thanks everyone for your answers they have really helped a lot!

You can't solve the problem on this forum. But you can get a 2nd opinion form another physician

The condition of the heart and the prevention of clots (which can cause heart attacks, strokes and pulmonary embolism (blood clot in the lung) should be the first thing that is taken into consideration.

Don't worry about the bone. Bone will heal back together, as evidenced by the poor street animals who have been hit by cars. The bone may not be straight nor would it be able to bear weight necessarily but that's not of tremendous importance. She could get around in a wheelchair.

You could get a second opinion from another cardiologist but they usually are of one thought on a subject such as this.

The Coumadin is keeping her blood thin to prevent clots. They can't scrape out her arteries, so pray that the blood thinner is enough.

Hospice will keep her pain free from the broken leg. Even if she doesn't fully wake up, talk to her anyway. Hearing is the last sense to go.

I'm sorry this is such a tough situation for you and your mom.

craigh1025, my Dad was placed on a blood thinner after a heart attack. A couple years later he needed surgery for something else, and the hospital put him on Heparin. He did quite well being in his late 80's at the time. But I guess it depends on how evasive your Mom's surgery would be to correct her broken leg and the condition of her heart.

Any chance your Mom's leg could heal on it's own? I noticed doctors will use the word "break" even if it is hairline crack. I would think a hairline crack can heal itself. I had one in my upper arm, no cast, just a sling. Hurt like heck. The orthopedic doctor said it would take awhile to heal because of my age. Then I needed 3 months of Rehab 3 times a week.

Craig, just an observation and opinion on my part, but I think you may need to sit down with your mom’s medical team (and any sibs or other family who needs to know) and speak frankly with them about what’s going on. Don’t let yourself be “blown off” by the doctors. During the many times my husband has been hospitalized, I came to the realization that not much information would be given out unless I asked (and asked). Doctors would come in and explain things, but by the time I formulated questions, they had been abducted by aliens and were nowhere to be found. I also discovered that if you want the real poop on the scoop, ask the nurse. Get on their good side and they will go out of their way to help you.

There are medical professionals on this site. But even so, they cannot guess and advise what should be done with or to your mom. Each case is individual. If you want a definite diagnoses and prognosis, you need to call everyone who is personally involved in Mom’s case together and put your foot down, politely but firmly. Make sure you understand what is told to you. Take notes and write down questions you have.

Please keep us updated.

Craig, just to emphasize; Hospice does NOT mean that she will inevitably die. We have a poster on here (hopefully she will chime in soon) whose mom broke her hip; she was NOT a candidate for surgery and so was admitted to Hospice. With the good and attentive care she got, she recovered well enough to "graduate" from hospice and lived for several more years, wheelchair bound, but content in her nursing home.

If she sustained this fracture spontaneously, with no obvious injury, the quality of bone may be so poor that they can't fix the leg: you need stable material to fix pins or splints to. So there's not only the risk of the surgery to her heart, there is also a serious risk it just wouldn't work.

I agree that the crucial immediate thing is to get her stable and comfortable and hospice must be the best way to do that. Do not allow your mother to think she is being written off. The point is to let her body settle down and then see where we are.

It is very sad that what seems like a minor obstacle has tripped her up so dangerously, but it's the complexity of her conditions that's the real problem. Concentrate on her comfort and her morale and hope for the best. Please let us know how you're all doing.

What does he mean " her Coumadin is too high"? Coumadin is a drug that thins the blood. They can lower her dosage, or they can use lovenox or heparin
( when my husband needs surgery, this is what is done).

Hospice may be what she needs right now, to rest and heal, out of pain. If her body and will to live are strong, she'll graduate from hospice and perhaps be a candidate for further treatment.

Craigh1025, what do you expect a CT scan to show? I take it you are thinking of a CT of her heart? The enzyme test shows if there has been a heart attack, she is on blood thinners to prevent clots and a stroke. She likely is not a candidate for open heart surgery.

She will bleed out if she has surgery on her leg. My ex had a spiral fracture of his tibia, it was a significant surgery to put in the steel rod. It sounds like the doctors told you Mum needs a steel rod. That is not just a matter of setting the bone.

My Dad was on blood thinners due to a heart condition. He did not like how he would bleed if he nicked himself shaving, plus he would get nose bleeds. So he stopped the blood thinners. Within 3 months he had a massive stroke. He was lucky to survive and go home after months of rehab. Now he takes his blood thinners.

I know it is terrible to think that something as simple as a broken bone can lead to the end of a life. My heart goes out to you.

I agree with Sue. The Coumadin level can be lowered by switching to Heparin or Lovenox, which are more fast acting and out of the body quicker. That's what the medical team did when my father suffered broken femurs, one right after the other.

The other thing is I can't get an answer on what's wrong with her heart. They only say she had a heart attack because of some kind of enzyme test. And I think echocardiography (?) And the right side is enlarged, that's all I know. Couldn't they do a CT scan or something...

Her quality of life was pretty good before this. She didn't have dementia, she could get around on her walker, go to the bathroom by herself, eat, and so on. She did have an ostomy bag that my dad took care of. Now because of the morphine they put her on she's not lucid. I saw her before they figured out she broke her bone and she was lucid but very depressed.

If I pushed for surgery and she did pass away I wouldn't blame myself because the alternative isn't much better.

That's a good idea maybe they could do a spinal block and set her leg. The thing is, it's not really broken, it's cracked I guess. I didn't see the x-rays.

Well, he can lower the Coumadin dose to do the cath, but he puts her at risk of having a fatal blood clot doing that. So, it really isn't an option. This is one of those "damned if you do and damned if you don't" situations.

The femur (big bone in the upper leg) is the largest and strongest bone in the body-strange IT is broken. More often, the lower leg bones (tibia and fibula) break due to wheel chair accidents, etc.. I'm sure they can put her in an immobilizer but it may be rather bulky and uncomfortable.

Is your mom alert? Does she have dementia?

Coumadin levels go up and down. Her cardio is worried that she’ll bleed out if he does a catheterization. He (rightly) doesn’t want to take responsibility for that. What is her quality of life now? Does she have dementia? Before she had the heart attack and then broke her leg, was she able to function on her own? Could they do a spinal block and set her leg? Lastly, how would you, yourself feel if you pushed for the surgery and she DID pass away? If she’s coherent, has anyone asked her how SHE feels about it?

I am so sorry to hear about your Mom.

You could always get a second opinion. But it sounds like your Mom's poor body just couldn't handle the surgery. Sometimes things just can't be fixed.

Hospice is good at helping their clients be as comfortable as possible for whatever time they have left - which sometimes can be a while. Hopefully whatever your decision your Mom can be comfortable and pain free.

Maybe she could be saved. But what is her quality of life at this point? Search this site for info on hospice. It’s not a death sentence. For people with lots of serious health problems it doesn’t always make sense to keep saving them.