Old 07-09-2018, 08:22 AM #1 (permalink)
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Default falling

When my doctor/clinic asks me about falls, what exactly do they classify as a fall? I know this is something I should ask them directly but I forgot at last visit.

I had assumed that "falls" only refers to falls resulting in ER visit injury.

Lately I am tripping a few times per week, but mostly just sustain bruising, so I have not reported those as falls, even though I do go down and hit the ground.

Then there are all the stumbles where someone catches my arm and steadies me or where I catch myself on furniture.

Other times I fall over from a sitting position (losing my center of gravity, not tripping), but again, even though I hit the ground I don't think this counts as an official fall and there is no real injury.

Am I correct in my assumption that a reportable fall is a bad fall resulting in moderate or serious injury?
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Old 07-09-2018, 08:34 AM #2 (permalink)
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Default Re: falling

any time you end up on the ground it is a full!
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Old 07-09-2018, 08:36 AM #3 (permalink)
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Default Re: falling

No I don’t think so. I tell them about all of them though I don’t quantify the almost ones just note they happen. I also don’t quantify the falling up the stairs because it happens so often. Anything else that I hit the ground I number ( fortunately few) and also the circumstances( tripped over nothing versus tripped over the cat for example)

They have never said oh we don’t care about that. The one fall where I was injured though not ER worthy ( or even doctor visit) they wanted to know more detail.
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Old 07-09-2018, 10:00 AM #4 (permalink)
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Default Re: falling

KRISTINA, et al; The amount of damage sustained is not the big deal. They want to know about falls because it is an indicator of a couple things, including new muscles weakening, possible head infections, and ALS progressing through the brain.


Make note and report any time you are Earthward bound. If you lose control of sitting, and slump over, that indicates a problem. If you don't negotiate the stairs well, also a problem. If a cat attacks you and you don't win the fight, that can also indicate slow or weak responses.


As Nikki suggests, tell them about all of the events and let them decide if they are interesting to discuss.

To all: If a human being is a little slow in adjusting hip, arm, leg, or head movements on the way down, a fall can be fatal or lead to a really, really painful lifetime. Do not fall.
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Old 07-09-2018, 10:21 AM #5 (permalink)
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Default Re: falling

Ok. Is there anything I'm supposed to do, besides being more careful? At my last clinic visit neuro suggested asking PT about a walker. I was skeptical due to my weak hands/arms, but she thinks it might still be helpful just to maintain balance. They are sending a PT referral for me to do a wheelchair evaluation, but I don't intend to use a chair fulltime, I can still walk pretty well. When I go to the wheelchair clinic should I discuss this with them, or do I need to have my doctor send a separate referral to have PT look at my walking situation? I might email my doctor. I had another fall this morning which prompted this post. I tripped on a piece of cardboard on the ground and went down hard on my side. But nothing serious.
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Old 07-09-2018, 10:36 AM #6 (permalink)
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Default Re: falling

Yes check with your doctor. Falls are a big deal as Mike says and you don’t know whether the next one will be one where you do get injured. Injuries can really impact your quality of life. We also sadly have seen them impact greatly the quantity.

Be honest with PT what you are doing now is apparently not working. A walker / rollator may be your answer for now but please be safe!
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Old 07-09-2018, 10:57 AM #7 (permalink)
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Default Re: falling

A fall is a fall, how do you know when "that" fall is coming? We all know that ALS only attacks strong willed, independent people. But stubborn does not have to be a trait also.

Kristina, don't be afraid of the wheel chair, it can give you independence you may not have known you lost.

I guess my warning is, you never know when the big fall is going to happen, lets hope it's not afterward.
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Old 07-09-2018, 11:05 AM #8 (permalink)
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Default Re: falling

Kristina this is serious. One bad fall can do damage that will not heal. Walker needed ASAP and if that doesn't work please consider chair. I was so careful and only had two major falls but they caused lasting damage. I was stupid. Don't be like me!

get ball rolling on chair it will take awhile. Tell them you are falling regularly.

good luck and be smart!
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Old 07-09-2018, 11:22 AM #9 (permalink)
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Default Re: falling

Okay, thanks for the feedback. I guess I've been trying to understand when it becomes a real concern. I just emailed the clinic's NP to discuss it. I guess I had thought my falls were not "real" falls because none of them have been serious.
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Old 07-09-2018, 11:59 AM #10 (permalink)
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Default Re: falling

Kristina be careful! I report all falls to my clinic Dr. They are actually kinda helpful once in a while. Besides I can usually make it into a pretty good story to get a few laughs.

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Old 07-09-2018, 01:15 PM #11 (permalink)
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Default Re: falling

Kristina, get the walker and get the wheelchair and get them now and use them both. Just do it ! ! And keep the phone within arms reach so that you can dial 911 when you can't get up. I have been in your situation and unfortunately didn't listen to advice.
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Old 07-09-2018, 01:32 PM #12 (permalink)
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Default Re: falling

Kristina, when I go to clinic (once every three months) they ask how many falls
I've had since my last visit.

The last two I've come back with... "How many falls or how many considerable
stumbles?"

It seems they are hung up on falls because they come back with... "Falls."

So I keep to my persistence and say,

"Two falls and a dozen considerable stumbles that could have been falls."

Whatever... they come back with... "Did you get hurt from those falls?"

i say... "Yes, no broken bones but some of the considerable stumbles
sometimes hurt too causing after ache to maybe my wrist or shoulder."

Again whatever... they go onto the next question.

There's time to give into a cane full time and a time to give into the
walker. And then the chair. But... the sooner the better for each
decision.

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Old 07-09-2018, 03:22 PM #13 (permalink)
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Default Re: falling

When I go they ask me if I've fallen since my last appointment. If I say "no" they ask me if I'm afraid of falling or if I'm having more trouble with my balance.

After my fall in September 2016, I lost six months of good mobility because my ankle was badly sprained. It was on my good leg and I'm very lucky it healed. I still suffer from the back pain hopping around and not being able to walk caused.

Tell them everything. When I got my wheelchair evaluation, I was still not walking because of the sprain. I couldn't wear sneakers or shoes for six months.

Get the paperwork for your wheelchair moving, Kristina. It doesn't mean you'll be confined to it right away. I tried several walkers that either made my torn rotator cuff worse or hurt my back. All price ranges, all features. I'll have to find something eventually.

I'm very relieved I have my wheelchair. We have a park 1/2 mile away. Right now I drive to it. In the future I'll use the wheelchair to get to it.
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Old 07-09-2018, 05:10 PM #14 (permalink)
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Default Re: falling

Early on, I asked my doctor to clarify what he meant by a "fall". He told me he wants to know any time I hit the ground.

I started using a wheelchair pretty early, because I became aware of the significant risk to my quality of life posed by falls.

I have broken an elbow, broken a toe, and sprained an ankle in various falls. I have also damaged ribs and been generally battered and bruised.

I encourage you to learn from my mistakes. Don't injure yourself in a fall! Start using assistive devices early. They really do make a difference.

I have been using a power wheelchair for over 3.5 years and am so glad I have it. I still fall a bit, but that is because I lack common sense and I try to walk too much.

Steve
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Old 07-10-2018, 09:47 AM #15 (permalink)
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Default Re: falling

Kristina,

All falls and "near falls" (when you are able to stop yourself from hitting the ground) are important because they signify that unassisted walking is becoming too dangerous for you.

My husband, Frank, had fallen several times which resulted in fractures of the upper arm and facial bones. His ALS clinic neurologist ordered a platform walker in which the elbows and forearms are supported because Frank had arm and hand weakness. Frank was very stubborn and insisted that he did not need the walker yet and refused to use it. It sat in a closet for 6 months. Then Frank had the worst fall he ever had and ended up in the hospital for 10 weeks with bleeding on both sides of the brain resulting in a coma for 3 weeks. This caused dramatic progression of his ALS, which had been very slow up to this point.

The day before he was hospitalized, he could walk, feed himself and eat, drink and talk with no problems. He came out of the hospital unable to walk and with complete loss of arm and hand use. He lost the ability to swallow safely, developed near fatal aspiration pneumonia and ended up with a PEG and tracheostomy.

I think one of the most important things all PALS can do is take whatever steps are necessary to prevent falls. Please get and use a platform walker now and start the lengthy process to get a wheelchair.

Sharon
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