Help! I want to spank my 90 year old mom!

shamboAugust 4, 2005

I've spent the last year hearing about my mother's constipation problems & trying to get her to do something about them. I spent the last two days dealing with her fecal impaction. Tuesday included a doctor visit & trip to the hospital for an x-ray. Wednesday was an all day trip to the hosptial emergency room for treatment that included another x-ray, enemas, manual extraction, & finally that foul tasting liquid they give people before a colonoscopy. Finally by the end of the day, she had, indeed, pooped.

I left her with strict instructions form her doctor & from me. She needs to take 2-4 Metamucil capsules daily along with 2 stool softeners each night at bedtime, and, finally, a mild laxative (Dulcolax) every 3 days. In addition she is supposed to increase her water intake considerably.

Today when I talked with her, she told me she wasn't going to take the "stomach medicines" because she was OK now. I told her that she needed to take them to ensure regularity, otherwise she'd end up back at the emergency room with people sticking their hands up her butt again. She honestly didn't understand the concept.

I'm so frustrated right now. She's in an assisted living facility but monitors her own medications. I'm ready to tell the facility to take over because she gets so darn stubborn. However, she begs me (literally) to not have the facility put in charge of her medications.

What should I do? Threaten her with facility oversight? Call her every day to check on whether she had taken the Metamucil & stool softeners? Set out the medications in those daily pill organizers & check every time I visit? Please give me any advice you have, and thanks in advance.

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Oh, dear, I have no advice, only my greatest condolences.

I swear that when I am of a certain age I will NEVER discuss my bowels with anyone but my doctor. I am sooooo tired of the discussions.

I know exactly what you are facing. I'd bite the bullet and go for the meds management. Mother would read every dam*ed patient insert, the small print, etc., and it meant that she also had every potential side-effect known to science.

Sign up now for the service. It'll be easier to get the battle over with now, instead of later when you have to add or change medicines.

Oh, boy, I will never discuss so much as comparative brands of toilet paper ever again.

    Bookmark   August 4, 2005 at 11:42PM
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I think you've answered your own question. Have the staff at the Assisted Living facilty medicate her.

Your mom has more than adequately demonstrated that she is unable or unwilling to take her medications as directed. I can't imagine the humiliation of a manual disempaction didn't change her behavior, but apparently not. While it's disturbing that she doesn't take her laxatives, I'd be very concerned about what else she isn't taking.

You'll probably have to have a very blunt discussion with her, the tables have turned, you are going to have to start making the important decisions for her, and this is the first one.

Also, have a good look at the side effects of some of her other medications. A lot of them cause constipation, and there may be suitable alternatives that don't have such a problem. I speak from personal experience - when I was first diagnosed with high blood pressure, the first med my doctor put me on caused terrible constipation - I gave it a month and then told him to change it, I would not tolerate this side effect. He changed it.

Good luck.

    Bookmark   August 5, 2005 at 8:19AM
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Fairegold, I just had to laugh at part of your post. I, too, have sworn I will NOT discuss my bowels with my children when I get older.

Momj47, you brought up a good point that I neglected to mention. Although my mother has complained about constipation for over a year, two weeks ago her orthopedic surgeon put her on Vicodin for the severe pain in her knees. She has osteoarthritis and almost all of the cartilage in her left knee is gone. She's awaiting Synvisc injections, but until then, she's taking the Vicodin.

I told her that the pain killer would cause constipation and she needed to follow the doctor's instructions. But,... you know the rest. Unfortunately, she's tried quite a few other medications and none of them seem to help with the pain. However, we have an appoinment for the first Synvisc injection next week, so I'll ask about a pain killer that might create less of a problem with constipation.

I know I have to step in & get her medications monitored. But it's hard to take away that last shred of independence from her. Thanks for your help. I know you've gone through the same thing. Right now, I think that saying about "growing old gracefully" is a bunch of hooey.

    Bookmark   August 5, 2005 at 12:14PM
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I call it the "Water Wars" here. Mum has an urostomy and lots of water is key to urinary tract health and cleanliness. She prides herself of being a camel... I'm less that impressed. She gets 8 oz. in the AM with her pills (I make her drink every drop). She only gets decaffientated tea/coffee. The only snacks available to her during the day is fresh fruit. She gets another 8oz. when she has lunch (monitored), and another when I get home from work. And 8 more oz. when she has dinner... . Sufferin' jesus, it's a drag to have to continually harp on the water thing. I HATE it!

She gets a serving of fruit for breakfast. EVERY DAY. She must eat her vegetables at dinner and her brown rice... OR (ready for this one?) there's NO DESSERT, lol. You may imagine how much she likes hearing that.

We did the constipation routine last Sunday, too. "I'm SO uncomfortable, dear!". "Well, Mum, here you go... drink up! then come upstairs for breakfast... there're fresh blueberries and a bran muffin..." "Oh, I'm too uncomfortable to eat that!" "Then stay here and I'll keep bring you water... your choice, PICK. And go walk around the gardens a few times, that'll help lube things up, too".

By 3 PM the goal was reached... no laxatives allowed here unless it's truly at crisis point (2-3 days).

Nursing homes are NOTORIOUS for not insisting their wards get enough water, fibre, and exercise... . My regimen may sound like bootcamp, but Mum dumps pretty nearly every day AT THE SAME TIME.

    Bookmark   August 5, 2005 at 4:14PM
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Oh, Chelone, you are too funny! I loved your line about being a camel. That describes my mother perfectly too. And you're so right. It is a real drag to constantly harp on the water, fruit, & vegetable thing all the time. My mother gets her meals at the assisted living community. If she wanted to, she could ask for juice, water, & herbal tea (all three) at each meal. She could also ask for double or triple helpings of vegetables. Each wing of each floor has a refrigerator for the residents stocked with apples & oranges & single serving orange juice bottles. Plus twice a week, the facility bus takes them to the local grocery store. She's got a full-sized refrigerator, small kitchen sink, & microwave in her apartment kitchenette. There's absolutely no reason for a lack of fluid & fiber intake other than stubbornness.

    Bookmark   August 5, 2005 at 5:06PM
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We actually had a battle about this very thing last night. I had noticed upon emptying the night collection jug yesterday morning that the color was too dark and the odor quite strong. I mentioned it while changing the urostomy appliance yesterday morning.

I made sure she received a big glass of water, and very liquid fruit (pineapple in its juice) for breakfast. Tea, too. I asked the helpmeet to be sure she had a glass of water with lunch. He didn't. Predictably, she grumbled and carped about drinking water and finishing her dinner (Cobb salad)... drinking her wine, though! and asking for dessert. I was furious, and frustrated. I put another glass of water in front of her, and told her to enjoy dessert. Bless her heart, she finished her salad, sucked down the water, and savored a molasses cookie. This morning the urine was the color it ought to be.

I absolutely HATE losing my temper with her. I know it's counter productive but sometimes... I just can't help it. I told her I feel as though we're on a bicycle built for two, with me up front. We're headin' uphill and she's not making any effort to pedal.

I am SO sick of doing this EVERY SINGLE DAY. sigh. I've come to the conclusion that it's the relentless monotony of the required routine that wears you down and sucks the spirit out of you.

    Bookmark   August 6, 2005 at 11:39AM
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Chelone, when is your mom scheduled to visit your brother? You're entitled to a well-deserved break.

What would happen if she didn't drink enough water for a day or two? Would she immediately get a UTI? I'm not trying to be disrespectful, just wondering if you can pick your battles and save yourself some acida, as we say in Italian.

    Bookmark   August 6, 2005 at 7:41PM
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She's going in the next 2-3 wks.. Good lord willin' and the creek don't rise...

What I've come to realize about UTIs is that they're opportunistic infections... when they find a breach in the security they infiltrate quickly. VERY quickly. And, they're devious... you don't realize they've breached the defenses for a few days, making them harder to stamp out. ALSO, requiring drugs (to which immunity is quickly established when they're used improperly, read: not the full extent of the prescription or the prescribed term).

I'm not offended by what you wrote. Not at all. I've just been down this road too many times... I know that assiduous attention to daily detail is what keeps the hassle/irritation/inconvenience at bay. I'd rather have a "knock down, drag out" every month/or so than deal with 10 days of Cypro and the inconvenience of urine samples from an urostomy patient. Add to the inconvenience of Mum's condition, the "battiness" that generally goes hand in hand with UTIs...

Sorry, I have a full time job, and I HAVE to work. I don't have time to jackass around with failure to stick with the program. I sound like a drill sargeant, but we're doin' it MY way. The way that guarantees her health and (what remains) of my "life".

    Bookmark   August 6, 2005 at 8:24PM
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I'd like to address the whole question of treating opportunistic infections like that in an elderly person. When I went over the comfort care measures with the nursing home, we sort of touched on the subject, but now I'll ask more questions.

So what if my Mother developes pneumonia? She'll have oxygen/suction as needed for comfort, but we agree that we are not treating everything that happens. This sounds cruel, but the last thing my Mother wants right now is ANYTHING that would keep her alive any longer than necessary, and she'd welcome an end to things, and prays for it every night.

So, have you had those sorts of discussions with your Mother in the past?

I am understanding more and more the "control" issues, and what little our Mothers have to really control in their lives. Maybe it's just us they can control, and basic elimination issues. Sigh.

This isn't fun, is it?

    Bookmark   August 6, 2005 at 8:50PM
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Pneumonia used to be called "The Old Man's Friend" because it made the passing quicker. But now, thanks to antibiotics, pneumonia vacine, the elderly have been denied this. So they suffer until the body just wears out.
I had one of the milestone birthdays yesterday and I know that because of my genes, I will be looking at a long, unpleasant life unless something happens. I DO NOT want to put my family through what you all are dealing with.

    Bookmark   August 6, 2005 at 10:01PM
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God Bless You and Happy Birthday...I feel EXACTLY the same as you do..... Mimi

    Bookmark   August 6, 2005 at 10:12PM
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Allowing your mother to take her own medications is not independence, it's negligence, on her part, and sadly, on yours. Something even worse could happen, especially with the Vicodin, and you and she will be responsible for the consequences. Is she taking too much? An overdose would be a terrible tragedy. Think about how you would feel if she died from a drug overdose or a bowl obstruction/rupture. She's in a facility that can and apparently, should be giving her meds to her, rather than allowing her to do it herself.

It may be time to sit down with your mother, knee to knee, and lay it all out, that enough is enough, and that no matter how much she whines, she's clearly lost the ability to manage her own life. She needs to understand how much better she'll feel (and you'll feel) once her medications (and bowel habits) are well regulated. She also needs to understand that she has to cooperate with them in taking her medications, reporting problems, etc.

Your mother is struggling with the medication issue, you've acknowledged it, even if she denies it. She doesn't understand the drug interactions, the need for adequate fluids and laxatives to counteract the effects, and both of you are paying a heavy price. Her behavior is putting her life in jeopardy.

You visits with your mother will be much more pleasant if they aren't spent in the Emergency Room getting her disimpacted (I had to do that once for a patient - never again).

Good luck.

    Bookmark   August 7, 2005 at 11:18AM
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Boy was I lucky. Mom was so foggy after her stroke that she actually welcomed the nurses handing out her meds. She also had a strong sense of what I call the "shoulds", namely that she should drink fluids, should eat fruit, etc. The staff was very pleasant and they adored her- which was an enormous help.
Not so with my MIL though. Battles all the way. Tried the med boxes, the thrice daily phone calls, all sorts of promises and pleading. To no avail. She listens to men though, so SIL got her lawyer to sit down and tell her she must accept the assistance of the staff. She very grudgingly does now. She is not incarcerated. My SIL has done outings with her regularly and she has many visitors. She still has a life- better than many a 94 year old can.

There was other crap though about which I was not so lucky of course.

My daughter who shared some of the difficult times with me knows exactly what I mean when I say I want to be shot before I impose anything like that on her or my son. Now how this will work out I cannot say. I don't want her in jail instead of living a good life.

    Bookmark   August 8, 2005 at 12:54PM
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Thank you for all your understadning & advice. It is comforting to know others are facing similar situations.

I did talk seriously with my mom about her medication. I typed a schedule up for her & told her if she couldn't follow it, I'd have to let the staff monitor everything for her. She promised me she would comply and so far, so good. She's keeping track of her BMs and for the first time in a year, she's regular.

Gardenbug, I had to laugh at your last paragraph. That's what my husband & I tell our children too. On a more serious note, I think watching me deal with my mother has given my two children a real education. I think they'll be better prepared for my old age than if they had been left out of the loop. And, I think (I hope) I'll be better prepared for my old age too.

    Bookmark   August 8, 2005 at 7:59PM
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So today, I decided that Mother needed a real treat, so I went to McDonald's and got her a Fiet-o-fish sandwich and fries and a small coke. And a sandwich for me, too. So I come in and start setting up the food on her little table, and sit down to eat, and the first thing she says is, "I just had a good BM."

I swear I will not have these discussions with my child when I get to be old......

    Bookmark   August 8, 2005 at 8:08PM
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Oh Fairegold, I just had the biggest laugh! I know it's not funny, but IS funny!

When my aunt died and we cleared out her apartment, we found dozens of scraps of paper (I called them her "Diary of Bitterness") in which she recorded transgressions (real or imagined), conversations, feelings, and..... bowel movements. How many times a day, how she felt before and afterwards, the list goes on.

My cousin exclaimed, "NOW I know how she remembered all those things that happened so many years ago!" Yup, when you chew and stew on things for years, you tend to remember them in detail. But the BM details....oy. Never, never, never -- like you, I say "Shoot me if I get to be like that", when a BM is the highlight of my day!

Then again, when I was young and scornful and in my 20s, I never imagined I'd discuss things like the fiber content of food with my you never know! LOL.

    Bookmark   August 8, 2005 at 8:39PM
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Oh, Fairegold, I feel your pain! This past Christmas Eve, my dad had emergency surgery to repair a hole in his colon. He had a colostomy bag for several months. He tried to change his bag so often that the nurses had to hide his supplies. It was his only topic of conversation. Better yet, he was constantly trying to *show* us his bag and usually succeeded before we could stop him. The idiot surgeon tried to get us to not remove the bag because he thought it was easier than diapers at the end. But Daddy wasn't close to the end, and I'll take a few weeks of diapers over years of that bag any day! (Yes, I have changed many poopy adult diapers.) The details of a BM are now considered pleasant conversation after that.

    Bookmark   September 15, 2005 at 4:54PM
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It's nice that we can laugh, I guess....

    Bookmark   September 15, 2005 at 5:45PM
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Either laugh or cry.....

    Bookmark   September 18, 2005 at 8:12PM
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Believe it or not, I thought I was going to have to take my mom to emergency AGAIN! The last two weeks have been pretty hectic for me. Our first grandchild was born and she had serious breathing difficulties. She improved quickly, but, in the meantime, I didn't go visit my mother as often as usual. And last week we took a two day trip to see the baby. When I finally saw my mother yesterday, I discovered that she had not had a bowel movement for ten days. TEN DAYS!! She never said anything to me before we left and she wouldn't have said anything if I hadn't noticed her "poop" calendar.

All I could think of was, "Oh, great! Another trip to the emergency room!" I wanted to avoid that at almost any cost; it would be too embarrassing. So I took her to the drugstore to buy an enema bag. At her assisted living apartment, I put it together (I ended up with two blisters from connecting the ribbed plastic tubing to all the parts.) I told her to add Milk of Magnesia to her daily routine and take the Dulcolax every night instead of twice a week. Then I left and crossed my fingers.

I just called her and the enema worked. Thank goodness! I dreaded taking her to the doctor again over her constipation. Even though I've got signs up in her apartment and lecture her every time I see her, I now know that she absolutely cannot be trusted to drink anywhere near the amount of water she should be consuming. So I will now have to buy her four gallons of bottled water each week. I'm going to mark them so she'll know she has to consume at least half of the gallon each day. I'm also going to give her one of our giant, oversized tumblers and tell her she need to drink three glassfuls each day.

She's already taking four Metamucil tablets and three stool softeners each day. And every Monday & Thursday she takes Dulcolax. She really shouldn't be having a problem, but I know that the missing key is the water intake.

As you can tell, this situation frustrates me. She has other problems -- wet macular degeneration & severe osteoarthritis in her knees. The doctors haven't been able to help either of those problems, But at least she can do something to ease her constipation!

Thanks for listening,


    Bookmark   September 18, 2005 at 8:37PM
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On the sunny side of the street, congratulations on your new grandbaby! I hope she continues to improve, and will be the light of your life!

And I guess congratulations are in order for your Mother's success, too. Does she has assisted living? Can the staff remind her to drink water, too? Mother now get her Rxs from the aide, and the aide watches her take the pills, and also encourages her to drink a full glass at that time. It helps.

I understand... Here's hoping that your water wars will be a success!

    Bookmark   September 18, 2005 at 8:52PM
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