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    Learning to Self Cath

    My cousin swears she can't cath herself.

    She was taught to cath in rehab by using a mirror positioned between her legs in a lying down position. During her last two weeks in rehab and in the two months since she has returned home, her mother or another family member has been cathing her, and she has never tried again. (As a side note: she claims that it is too icky).

    I know it is difficult to try to get her to do something while she is totally unmotivated, but do you have any ideas for ways to help her self cath?
    Last edited by ForMyCousin; 26 Jul 2011, 9:32 PM. Reason: Removed personal info

    #2
    If she knows how to cath and is physically capable of cathing, then she should be encouraged to wear gloves if that gets her over the "icky" factor. Most of us who are caregivers use gloves when we catheterize those for whom we care. It is probably more hygienic for her to cath with a clean pair of gloves for each cath anyway. Your profile says, "your little cousin." How old is she?
    If she is a child, I believe there are several threads on Care Cure Community posted by mothers whose very young male and female children cath themselves. You might try searching for these threads.
    If she just can't come to terms with self cathing, maybe she (if she is a child - her mother) should consult with her urologist about getting a supra pubic catheter (SPC). This is a minor surgical procedure that places a stoma just above the pubic bone into which a catheter (which is changed monthly) is placed and a urine collection device that is worn on the belly, thigh, or lower leg collects the urine.
    The key is for your cousin to gain as much physical independence as possible and she (if she is a child, her mother) may have to give some thought and make some choices about her physical care and needs that will help achieve that independence for her.

    NL (GJ's wife and caregiver)
    Last edited by gjnl; 26 Jul 2011, 3:27 PM.

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      #3
      Based on the posts you've put up, I think you are a little pushy. And perhaps overly involved in her life? Its clear that you want the best for her, but consider backing off because your approach may be off-putting to her.
      Wife of Chad (C4/5 since 1988), mom of a great teenager

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        #4
        Is she in counseling? Are other family members? Getting outpatient therapy and seeing a good outpatient rehab nurse for follow up? Seeing a physiatrist?

        What was she like before her injury? Immature and clingy? Active and athletic? Is this just her usual type of behavior? She sounds very depressed to me.

        What was said about all of her abilities at her discharge team conference? Where did she have her inpatient rehab? Is she on medications for pain mamnagement.

        If she is not committed to doing intermittent cath, perhaps she should just put in an indwelling Foley for now. If everyone is willing to enable her dependency by doing this care for her, she has no incentive to take on these tasks or become as independent as she can. She needs some incentive to do this work.

        Are there goals she has that would require her to become more independent to achieve them? For example, if she wants to go to a concert our out with friends, does she understand that in order to do this, she needs to learn how to cath herself? Is she going to school in the fall? Does she have friends who will take her places and push her as well?

        What did she do for menstrual management before? I find it amazing to see a 18 yo female who is squeamish about touching her own genitals...most girls that age have discovered masturbation and are very used to inserting tampons, etc. Guys are usually much more reluctant to insert a catheter into their urethra than women are, in my experience.

        Is she starting to go without the Kydex? It is easier to self cath for a female with out it on.

        (KLD)
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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          #5
          Originally posted by zillazangel View Post
          Based on the posts you've put up, I think you are a little pushy. And perhaps overly involved in her life?
          If ForMyCousin is in the position of cathing her it sounds to me that FMC has been forced into 'over involvement'. Also, if the paralyzed cousin isn't taking an active involvement in her own care she needs to be pushed. (IMO)
          ____________________

          "We are the ones we've been waiting for. We are the change that we seek."
          - Barack Obama

          Comment


            #6
            KLDs thought on a foley may be just the thing.

            There really shouldn't be any reason in my mind that other people should be cathing her at her level and age. Altho I am sure it will be easier once the brace is off, but it sounds like she was capable of doing it when taught in rehab?

            But at 18, maybe having a bag of pee on her all the time might be "ickier" than cathing herself? It might be a nudge in the right direction.

            She is very new, and maybe needs time, but thinking the time has come to tell her that she needs to step up and take more responsibility for her own care. (Or at least what she is truly capable of, not saying to throw her to the wolves here or anything .....)

            I know in rehab, had I refused to cath myself, it would NOT have been accepted. Same for anything else I was capable of. Once I was taught a skill, and was able to do it independently, the nurses and aides would no longer do it for me. And if that meant it took me 2 hours to get dressed, so be it. (And the first time an aide got in trouble b/c I let her help me get dressed because I was feeling lazy, I learned my lesson!)

            And I bet this will be harder on her mom than it will be on her.
            Last edited by sjean423; 26 Jul 2011, 7:28 PM.
            T7-8 since Feb 2005

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              #7
              GJNL - She is 18, and her mother isn't in a position to care for her at the moment. I explain a little more below.

              Originally posted by SCI-Nurse View Post
              Is she in counseling? Are other family members? Getting outpatient therapy and seeing a good outpatient rehab nurse for follow up? Seeing a physiatrist?
              The answers to most of these questions is NO. She is only going to outpatient PT & OT. She didn't even get these services started right away after rehab as suggested by her care team. It was almost a month after leaving rehab before she had her first sessions.

              Things aren't happening like I feel they should which is why I am being pushy. As far as I am aware, before the accident she was seeing a PA in an urgicare-type clinic if she had problems. She does not have a regular family doctor, urologist, or GYN. I have been given some recommendations in the last week and began setting up appts. We have relied on the rehab doc to write her Rx since leaving rehab almost two months ago. Health insurance / affordability has been the issue.

              Originally posted by SCI-Nurse View Post
              What was she like before her injury? Immature and clingy? Active and athletic? Is this just her usual type of behavior? She sounds very depressed to me.
              This is & was her usual behavior - full of immaturity and rebellion. Officially, she isn't a child, which makes things difficult. My aunt lets her do whatever she wants under the excuse that "she is an adult." Unfortunately, that adult isn't caring for herself right now. My mom (my aunt's sister) told me to leave that issue alone right now because there is nothing that I will be able to say to convince my aunt otherwise.

              Originally posted by SCI-Nurse View Post
              If everyone is willing to enable her dependency by doing this care for her, she has no incentive to take on these tasks or become as independent as she can. She needs some incentive to do this work.

              Are there goals she has that would require her to become more independent to achieve them? For example, if she wants to go to a concert our out with friends, does she understand that in order to do this, she needs to learn how to cath herself? Is she going to school in the fall? Does she have friends who will take her places and push her as well?
              There are no incentives. Her mother will not tell her 'no.' This has strained her mother so terribly that she is not able to participate in my cousin's care for the time being. My aunt and uncle were together longer than I have been alive. My cousin was their late child (45 & 50yo). Six months to the day after my uncle dies, my cousin had her accident.


              Originally posted by SCI-Nurse View Post
              What was said about all of her abilities at her discharge team conference? Where did she have her inpatient rehab? Is she on medications for pain mamnagement.
              Baylor Institute for Rehabilitation in Dallas. She is on pain medications. During the team conference, they HEAVILY pushed her need for more therapy.

              Originally posted by SCI-Nurse View Post
              What did she do for menstrual management before? I find it amazing to see a 18 yo female who is squeamish about touching her own genitals.
              No clue. I figured the IUD would give me less things to worry about, so I was going to talk to her about it this week if I got good feedback from other users. We have an appt with the GYN next month.

              Originally posted by SCI-Nurse View Post
              Is she starting to go without the Kydex? It is easier to self cath for a female with out it on.
              She is still wearing it. She can't bend forward. In rehab, she was taught to cath using a mirror, but she has not done it since leaving rehab at the end of May.

              Originally posted by zillazangel View Post
              Based on the posts you've put up, I think you are a little pushy. And perhaps overly involved in her life? Its clear that you want the best for her, but consider backing off because your approach may be off-putting to her.
              I'll be the first to admit that I am pushy. Please believe me when I tell you that I have seriously scaled back over the past two months. When I stopped being so involved, she cried to me saying that I don't care about her any more. I'm having a hard time finding a balance. Reading the responses to my posts today have given me a greater understanding of how I can help her without being so pushy. I know I've posted a lot today, but it is the accumulation of things I have found I needed help with over a four month period all coming out at once.

              Originally posted by flicka View Post
              If ForMyCousin is in the position of cathing her it sounds to me that FMC has been forced into 'over involvement'. Also, if the paralyzed cousin isn't taking an active involvement in her own care she needs to be pushed. (IMO)
              I do feel like I've been forced into over involvement. At first, I did everything my cousin asked, and my family acted like I was the most wonderful thing that could have happened for my cousin. When I backed off after starting my new job on July 1st, my family brought me to tears last week blaming me for being unhelpful. They asked me to postpone my position so that I could stay home and care for her.

              Originally posted by sjean423 View Post
              I know in rehab, had I refused to cath myself, it would NOT have been accepted. Same for anything else I was capable of. Once I was taught a skill, and was able to do it independently, the nurses and aides would no longer do it for me. And if that meant it took me 2 hours to get dressed, so be it. (And the first time an aide got in trouble b/c I let her help me get dressed because I was feeling lazy, I learned my lesson!)
              I really wished this would have happened for us, but it didn't. The rehab people were great, but they let her (& us) get away with too much. Our family has allowed things to be this way. I'll admit that I was guilty too. I cathed her, bathed her, and did her bowel program more than once. I have a big family. Most of them live 10 hours away, and several came to visit during rehab. Very few of them didn't learn to cath her while they visited.

              Comment


                #8
                I'd have been kicked out of rehab for refusing to try to cath, and I'm a quad (incomplete injury, pretty darned complete during that spinal shock period.) The only thing I ever refused was my husband being taught my bowel care. I had a snotty nurse at home until my c-collar came off, and having been spared maybe 80% of my left hand function, I took it from there.

                Does she know the consequences of being cathed by apparently everybody? The risk of infection? I'd rather keep my own germs to myself.

                But I do know that paras in clamshells have a hard time cathing, even w/ 10 good fingers.

                I'm torn between believing she's depressed or just spoiled. I've heard of sci's like her but never have I met one. This is a tough road, she has got to sack up or her life will suck. Doesn't she want to wear cute clothes w/out that damned brace?

                Sorry, I'm a quad w/ para envy. Rehab told my family to do NOTHING for me if I could remotely do it myself. My husband got yelled at for dressing me-and it never happened again.

                I can't believe she wants to be so dependent, it's just unnatural in my eyes.
                Blog:
                Does This Wheelchair Make My Ass Look Fat?

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                  #9
                  Originally posted by ForMyCousin View Post
                  No clue. I figured the IUD would give me less things to worry about, so I was going to talk to her about it this week if I got good feedback from other users. We have an appt with the GYN next month.
                  ok, sorry, but this is the wrong way to think... it's nice you're helping her and all, but medicating her for any reason to make YOUR life easier is pretty twisted thinking.

                  along those lines, why don't you give her a little bump of adderal so maybe she has the energy to do more of the shit you want her to.
                  An administrator made me remove my signature.

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                    #10
                    Originally posted by feisty View Post
                    ok, sorry, but this is the wrong way to think... it's nice you're helping her and all, but medicating her for any reason to make YOUR life easier is pretty twisted thinking.
                    This isn't exactly the way I meant it. I'm not forcing her to do anything. I stated that I would talk to her about the IUD before the upcoming appointment. She wants to start taking BC pills again in order to regulate her own periods because she is upset by having her period so frequently. I don't like seeing her upset by something that I see as a fixable issue. Since she was strongly advised against the pills, I was hoping and IUD would solve the problem. Which means one less thing I have to deal with at this moment as far as day-to-day care and her feelings. We have lots of other things to work on right now, so I felt that it would be easier to manage the things that were manageable.

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                      #11
                      LOL, I was wondering who she was going to get it on with if she lives in a clamshell forever. I kind of get the drift both ways re the IUD. Cuz needs to let the girl grow up, granted, and that includes contraception. However, if she's rebellious, spoiled, 18...Those girls sure get pregnant a lot. I always thought if I'd had a daughter I'd have given her the monthly birth control shot while she slept. Or put a pill in her orange juice.

                      But my mom believed there should be birth control in the public drinking water, and ppl should have to pass a test before they had babies. LOL, we may have been a bit neurotic on the teen pregnancy question. Mom offered me BC pills when I was 14. Ah, the 70's.

                      Cuz-REFUSE to bathe her or dress her. The corset is a good suggestion.

                      Hell, refuse to cath her and tell her the option is a foley, and a bag of pee. You have to go to work!
                      Blog:
                      Does This Wheelchair Make My Ass Look Fat?

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                        #12
                        Me again. When you say your aunt lets her do whatever she wants, what is that? Because when I was 18, I did what I wanted, and that included a lot of chasing boys, drinking beer, working to buy beer, driving around, certainly not sitting in my mom's house waiting to be cathed. At her level she is capable of all those things.

                        It's kinda weird that your whole family is trained to cath her, wtf, I would not have wanted my brothers literally up in my business. Or my cousins either.
                        Blog:
                        Does This Wheelchair Make My Ass Look Fat?

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                          #13
                          Originally posted by ForMyCousin View Post
                          This isn't exactly the way I meant it. I'm not forcing her to do anything. I stated that I would talk to her about the IUD before the upcoming appointment. She wants to start taking BC pills again in order to regulate her own periods because she is upset by having her period so frequently. I don't like seeing her upset by something that I see as a fixable issue. Since she was strongly advised against the pills, I was hoping and IUD would solve the problem. Which means one less thing I have to deal with at this moment as far as day-to-day care and her feelings. We have lots of other things to work on right now, so I felt that it would be easier to manage the things that were manageable.
                          Why not manage your expectations. She's an adult. Let her ask her obgyn without your influence, if you're really a healthcare professional, you should know that there are easy places to search and see the side effects. Also, again, there's a search function on this site. Many members have experienced problems with birth controll after reduced circulation.

                          Maybe if she's upset about something she'll get off her ass and do something about it. Isn't that your beef, that she doesn't do anything?

                          If you're worried about having to help her deal with that nonsense, either do it, or don't. like... the invasiveness of having to have someone help you cath and stuff is probably humiliatiang enough and she's gotta deal with that, get over it, and learn to deal with it herself without you codependently picking out her birth control.
                          An administrator made me remove my signature.

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                            #14
                            I guess I'm not reading your posts as pushy. It seems as if you care for your cousin, can see the possibilities for her future and are frustrated by her lack of initiative. I'm sure that this is the sentiment of a lot of caregivers. I would also encourage the family not to make things easy for her. If no one will cath her, she will have to do it herself, icky or not. There are many things about the SCI condition that are unpleasant. However, getting past that will generate greater independence. I suspect, also, that she has given up somewhat. If she doesn't feel there is anything for her to enjoy, it may not seem worth it to improve. I wish she'd come out to this site, herself, to see what people with SCI can do...get good educations, jobs, marry, raise families, travel. Has she had any good examples of folks with SCI who have succeeded?

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                              #15
                              Originally posted by betheny View Post
                              Me again. When you say your aunt lets her do whatever she wants, what is that? Because when I was 18, I did what I wanted, and that included a lot of chasing boys, drinking beer, working to buy beer, driving around, certainly not sitting in my mom's house waiting to be cathed. At her level she is capable of all those things.

                              It's kinda weird that your whole family is trained to cath her, wtf, I would not have wanted my brothers literally up in my business. Or my cousins either.
                              I commented about way too many people seeing her hoohoo, but erased it. I agree totally with wtf.

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