Sam Bauman: Medical misadventure

I was getting out of my car with an armload of packages when I misjudged the step and fell on my butt. No injuries, but as is common with age, it was hard, if not impossible, to get up. It had happened to me a few weeks earlier and I had dialed 911 for help. So I dialed 911 again and in minutes a fire engine and crew were with me, checked me over and helped me to my feet.

But this time, probably to avoid another fire truck outing, they put me in an ambulance which took me to the hospital emergency entrance. And wheeled me in.

Eventually I was checked out and they called in an occupational therapist.

Eventually the therapist arrived — a neat and confident lady. She examined me, could find no problems. She was kind and quick and signed me out. I was free to do to my own apartment after a $17 taxi ride.

That was adventure one, sort of. While I was in the hospital, two doctors examined me and found a slow heartbeat. They had a cure for that — implantation of a pacemaker. This was quickly done, inserting a small plastic box about the size of a matchbox in my left shoulder under the skin.

From the pacemaker, wires were inserted in the large artery to the heart. They would impinge on the heart, transiting signals from the pacemaker. That would increase the beat of the heart to a more normal condition.

All well and good except for some conditions:

Don’t drive for several weeks until the doctor says OK.

Keep the left arm low to keep the pulse wires in place against the heart.

Don’t use the left arm to pick up 50 pounds.

So here I am, my left arm in complex sling, which is to remind me not to use it and to keep from lifting it in my sleep.

I also have a nice little booklet, titled Medtronic MRI Surescan Pacemaker, which I will read.

What next with the arm and pacemaker? I guess I’ll have to wait for doctors to decide.

Meanwhile, perhaps taking note of my falls, Carson Tahoe Health sent me a pamphlet “Patient & Family Fall Prevention.” I read it eagerly, anxious to avoid such mishaps. Starts out, “At Carson Tahoe Health patient safety is a top priority. It used to be that if you fell you got back up, dusted yourself off and blushed in embarrassment if someone saw you. But as you age, there’s a good chance a fall may bruise more than your ego. In older adults falls often cause broken bones and other injuries that can set off a chain of events leading to declining health, isolation and loss of ability to live independently.

“Many people over the age of 65 fall each year (I’ll agree to that!). Although most escape serious injury, many fear another fall so much that they begin to limit their lifestyle. But that’s exactly what you shouldn’t do. Staying active and making some common sense changes around your home can help prevent falls and their potential debilitating consequences.”

Risk factors

One reason falls are more likely as you get older is that your sense of balance declines and your reaction time slows. That makes it harder for you to avoid anything in your path, or to adjust to a sudden change in the surface you’re walking on.

Medications can also affect your balance or perception. Your risk of falling may increase if you take diuretics, sedatives, pain meds, high blood pressure meds or medications for some psychological conditions.

Older adults are often affected by many health conditions that can increase the risk of falls — such poor vision, gait and balance disorders, cardiovascular disease, lung disease, disorders affecting the legs or feet and bladder ills.

Safe hospital stays

Nurses will act to prevent falls. The course of an illness can make a person weak, so much more than we expect. Waking in unfamiliar surroundings with medications can cause disorientation. You may have one or two lines connected to your body (IV, oxygen) and it’s easy to get entangled in them.

Nursing will ask us to call for help when getting out of bed. Rise slowly.

Nursing will keep pathways clear of clutter.

Items that you will need are kept in reach.

Side rails will be fixed to your bed so that the controls of lights, TVs, and the nurse call light are close.

An emergency call cord may be attached as a bed alarm.

Family members may be called in and encouraged to take an active role in observing the patient.

Nursing will ask you to wear slippers with skid-proof soles. We can provide them for you.

You will be instructed on how to use assistance devices you may need, such as canes or walkers.

Fall prevention: Exercising to improve strength and balance, being alert to drug side effects and keeping the home free of clutter will help prevent falls.

Safety at home

Keep electrical and phone cords out of the way.

Arrange furniture so you can move around it easily.

Get rid of throw rugs.

Install grab rails around the tub and beside the toilet, non-skid mats in the tub or shower.

Use low-level night lights.

Keep stairways, hallways, and pathways free of clutter.

Wear rubber-soled or low-healed shoes.

Place light switches within reach of the bed and be sure the phone is within reach of the bed.

Fall prevention

Keep a healthy diet.

Call light and phone in easy reach.

Hearing aids close.

Use eye contact when speaking.

Physical

Assess for disease

Monitor blood pressure changes

Notify doctor of altered mentation or mobility

Review meds with the doctor.

Observe patient hourly.

Ambulation

PT referral if needed

Rise slowly

Walk patient in hallway

Use gait belt

Maintain mobility, up in chair for meals

Function

Cane or walker within reach

Elimination

Assess need for use of bathroom every 1-2 hours.