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Others have said this; I just want to emphasize it.

Contact the PA, NP or ortho surgeon who performed the surgery and ask if she should be non weight bearing.  This is critical.   My mother experienced a similar situation; the therapist said she wasn't cooperating and discharge was discussed.

We contacted her surgeon, got a letter attesting to the need for non weight bearing status, and took it to the rehab facility and presented it at a status update meeting.  In fact, the surgeon was angry that the therapist wasn't addressing this issue but was pushing for standing exercises.

We prevailed.   The therapist was moved to another facility; a new therapist was provided; non weight bearing exercises were introduced, and Mom healed and got better.
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PK1111 Oct 2019
The surgeon told us right after the surgery that she can put weight on her left (surgery side) right away if she felt ready.
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Recalling Dmanbro' s mother screaming out in pain @rehab, everyone thought she was faking or resisting P.T.
An x-Ray revealed a fractured pelvis.

Do not allow, imo. discharge from the acute care if she is in this condition.
The doctor should find out what it is and not rely only on P.T. staff's accounts.

Good for you! This does not seem a normal course after hip surgery (to me), for patients in general. The proof for that is she is not progressing as expected, and will not be ready for discharge as staff expects.
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BarbBrooklyn Oct 2019
THANK YOU for remembering DManbro! I knew that there was another example somewhere in my memory banks!
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You don't mention if she has dementia which could be a contributing factor as they can become stubborn and an unwilling participate.....especially since living a sedentary lifestyle. With that said, there would still be cracks that would reveal a window of the obvious. Was the procedure done under general anesthesia or an epidural? This could weigh in on her mental state. My mom broke her hip earlier this year and had a three week rehab stint. In the hospital before transfer she was given Tramadol because she was resistant to PT as well (not really suggesting this, but it did get us through the rough patches) and she would scream in pain and refuse to bear weight on her right side. The motivator for us was the threat she would remain in a facility until she was mobile. Enough said. A remarkable recovery at 89.

With us it was straight forward....it was a mind game. If your mom maintains clarity I would pursue further investigation. Could be a bad surgery in general, a stress fracture resulting from the surgery, infection, etc. I would think imaging would be the next step along with blood work.
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The biggest contributing factor here is how dedicated to physical therapy she is. Not getting up and walking every chance she gets will lengthen the time to recovery..including the pain.

different people have different levels of pain the can handle,,,but the only way forward is to get up, power thru it, and walk.
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gdaughter Oct 2019
But timing of the meds might help as well, and the meds should be adequate to relieve her pain.
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It is common for people to not want to do their rehab. They might resist but when coaxed into doing the exercises, it should not be painful. Whenever my grandparents were having pain with rehab, there was an underlying issue and the follow-up person would tell us the therapist should have stopped when they expressed being in pain.
Make sure she is x-rayed and examined again. It's possible they missed another hairline fracture or that there's some other complication. Medical staff tend to disregard what older people say. If she's getting rehab in the hospital it is no problem for them to get her x-rayed again. Talk to the nurse and her orthopedic surgeon. Do not leave it up to PT to handle. It can be intimidating especially because everyone is in a hurry and no one wants to take responsibility. But again, it's easier to take care of this now while she's still in the hospital.
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If it were me, I think I would push for an xray just to be sure there isn't anything else going on -- mistakes happen, maybe surgery looked like it went well, but something has slipped or cracked after the surgery.

Once you have the xray, if it is clean, then I would believe the PT who are thinking she is anticipating the pain - and work to help her through that.

Best of luck, it is no fun to see our loved ones suffering!
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My mother had a broken hip for about 2 weeks before the PT finally ordered another xray.

Jane Brody, science writer for the NY Times was in excruciating pain after a knee replacement and was laughed off by her surgeon. It turned out she had a massive infection within her knee.

Please get your mother to a doctor and INSIST on imaging. Women get miserable health care; older women get worse.

Please advocate for her. Today.
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gdaughter Oct 2019
EXACTLY. No one knows us as well as ourselves and we know when something is not right. I fear for those of us who will age without someone to be our advocates...
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If she's that insistent that she still has incredible pain, I'd insist on her doctor's evaluation. I know it can take a while to get another appointment back with that doctor, but, their office should be able to have someone there, see a person who has significant pain after surgery. There are ways they can evaluate if it's anticipation of pain upon bearing weight or if there is a real problem. Does she seem okay otherwise, like any fever, infection, etc?
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You know her best so if you feel that this isn't a case of malingering then do press hard to look for a physical cause of her extreme pain, perhaps asking for a second opinion. I can not help but think of my grandmother - after a fall she was made to walk for weeks on a hip whose break failed to show up in the initial x-ray. Doctors, physical therapists etc tend to be much too blind in their belief that they can't have missed a real problem.
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Please start thinking about the future. Your profile states that your mother lives in Independent Living. She may not be able to continue there. What would be the next step (no pun intended)?
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PK1111 Oct 2019
If if it comes to the point that she cannot live alone we probably would have to look at Assisted Living of some type either me or my brother have homes that would be suitable for her handicap. And neither of us are in a position to move at this point. So would the next step be assisted living or should we wait and see how well she does in the rehab at the SNF? She is covered for a hundred days so we have a little over three months to see how she does. I am hoping it won't take her that long in that she realizes that if she fights harder she can go home. When I talked to her about it she says she knows she wants to go home and that is her plan but then in therapy she gets tired very easy and keeps asking when she's done.
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Different people have different pain thresholds and the fact that she led a sedentary lifestyle could have something to with her not being successful in rehab. However, if she is screaming out in pain, the facility’s doctor needs to be contacted to make certain everything is ok. Speak with her therapists and ask their opinion on whether they feel she is really in so much pain or just has a low pain threshold.
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PK1111 Oct 2019
I have I have spoken to the therapist and they think that she is afraid of the pain and that she anticipates before the pain even starts. My sister-in-law and I both feel that after the surgery heals maybe after another week or ten days that when she starts feeling that the pain isn't as great that she will do better in therapy. I am hoping we will know something within a month as to whether she's going to recover and work hard or we will have to think of another plan. I am just curious is this normal?
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