SuperHawk Asked May 2020
Should an elderly person with severe malnutrition anemia get physical therapy for reconditioning his new hip without addressing the anemia?
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While waiting for surgery my dad spent days without food nor water. So anemia creeped up and now they say it is due to his age. My concern is that PT is not requesting help with dad's anemia in order for him to get stronger to be able to stand up. This seems nearsighted. Would appreciate any comments if any therapists are around here. Of course dad has no energy.
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My question was why his anemia wasn’t found before he had surgery. Everyone has pre-op labs done. He may have lost some blood during the surgery to have caused the anemia, or not. Why wasn’t this found before?
A lot of variables here. We have an emaciated patient with a reddened area on his sacrum from your last post who appeared to have been on bed rest for months prior to surgery. Am I correct?
Where was he before all this happened? People don’t get malnutrition or anemia overnight. Malnutrition is a contributing factor to developing pressure ulcers.
Re his anemia. Often physicians don’t transfuse red blood cells unless the HGB is less than 7-8. Without knowing his numbers it’s hard to tell. Anemia can be caused by many things most common is low iron. Some people are prescribed B12 injections or take it by mouth for pernicious anemia. And of course bone cancer can cause anemia because red blood cells are made in the large bone marrow- femur and iliacs.
For bones to strengthen to produce red blood cells (all blood cells I should say) the bones need to be used and exercised. So your father has to get up and move. His inactivity most likely led to his reddened sacral area.
PT’s don’t order transfusions. The PT person could have just said this in passing without knowing his history. Some patients get CHF when transfused so they have to balance many factors. But if his HGB is not too low he won’t get transfused.
If you don’t like how he is being managed get him another doctor.
He needs to get moving, anemia or not. I suspect a lot of this is dad being tired is not only due to anemia but also because the man hasn’t had any physical activity in a long time. The longer he stays in bed the longer it will take to recover.
Push him to get up and do PT. Standing builds up the bone. Anemia or not, post op hip replacements need to exercise. His doctors can work to fix the anemia but right now dad needs to put some effort into therapy. Make sure they pre-Medicate him 1 hour before PT. I had a hip replacement @ 60 y/o- the pain he is having is post-op pain from the incision because the hip pain should be gone. I had surgery at 7:30am and they made me get up and walk at 6pm- around the nurses’ station! No more hip pain for me.
1. Wound care treatment and plan
2. Anemia/nutrition treatment and plan
3. eligibility for PT
4. eligibility for hospice.
Make yourself a list of all the issues you'd like to get answers to. Are these comments about his being "an old guy" a veiled hint that he needs hospice? If so, they need to speak up and discuss it with you and with your dad, not pussyfoot around.
2 weeks ago, my FIL was found to have extremely low hemoglobin which did not improve much after 2 units of blood were given. He likely had some condition that was causing bleeding somewhere but at 95, with dementia, we elected not to put him thru any investigation of the source.
There are hazards to bed rest. PT is ordered to try to mobilize patient. It was ordered by the doctor. OP needs to have this discussion with his doctor. We don’t have enough information to provide advice.
Where was Dad prior to surgery that he was not given any nutrients?
Who has diagnosed the anemia?
This story began only on March 11. Dad is 90 never sick in his life other than the first time he fell over 20 years ago I think. He got a femoral implant then. Since then he kept a walking cane. Until maybe 5 or 6 years ago graduated down to a walker. He has always had a big appetite. Even now! He was not eating Only because they were not giving him food while waiting around for procedures. First colonoscopy. Then discharged only to come back next day with broken hip. Then 5 more days no food. Then a colectomy. No food until next day. Then one more until midnight in preparation for his hemiarthroplasty.
Then ICU no food. I do not know if next 24 hours he ate anything. So in 3 weeks He saw all his life as he knew it passing by. He was discharged to a SNF after 2 weeks in hospital.
At SNF I had to request something for his anemia. Agreed on some kind of shot to stimulate RB production. Anything I told the attending doctor.
He was weak but slowly recovering. The therapist said he couldn't get up. Another phys assistant simply told me he is very sick! He is old. Except did not say which illness he had! So I asked for motion range exercise at least. They were eager to get him walking regardless of anemia. Of course he tried. But not able to stand up on walker. Then discharged. Came back home via ambulette.
Skilled nursing was rushing him out. The only thing good was that his hemoglobin level was up. Only because I pushed as a necessity for physical therapy success. You suggest more discussion is needed with his physician? Physicians do not discuss anything unless I am as forceful as possible. I notice they do not dialogue. They Only have to say what they originally had to say. This is ugly. Really. Gets worse when several physicians gang up and crosscontaminate their thinking processes.
Since you are concerned about his nutrition, please talk to his doctor. His doctor can have labwork drawn to see if anemia is a problem, to diagnose the type of anemia, and to prescribe treatment.
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