Moving an immovable mother
October 11, 2009 3:37 PM Subscribe
How can I get my mom to go to her colonoscopy?
My mom has a colonoscopy scheduled for Thursday. She just decided tonight (Sunday) she doesn't want to go. Her reasons are: she has no family history of CR cancer, she's 74, she just doesn't want to. My argument: Just because you have no history doesn't mean you can't have cancer, age doesn't protect you here.
Part of wants to yell "Jesus mom, we watched dad die from this 35 years ago! Get the test! It's not painful, they knock you out. Yes, the prep is a nasty, but sometimes you just have to suck it up."
This test was ordered by her doc as part of her normal check up. Her doc tells me it's normal to get one every 10 years after you're 50 if there's no family history. She's never had one.
I know I can't make her go, she's a grown-up. I think she's repelled by the prep. I've done it 3 times, drinking that stuff isn't fun, but it seems to me cancer would be worse. I've tried the guilt thing (Mom, if you don't do this... you'll disappoint me) but guilt doesn't work son->mom, tried the appeal from the grandkids...
Any suggestions?
My mom has a colonoscopy scheduled for Thursday. She just decided tonight (Sunday) she doesn't want to go. Her reasons are: she has no family history of CR cancer, she's 74, she just doesn't want to. My argument: Just because you have no history doesn't mean you can't have cancer, age doesn't protect you here.
Part of wants to yell "Jesus mom, we watched dad die from this 35 years ago! Get the test! It's not painful, they knock you out. Yes, the prep is a nasty, but sometimes you just have to suck it up."
This test was ordered by her doc as part of her normal check up. Her doc tells me it's normal to get one every 10 years after you're 50 if there's no family history. She's never had one.
I know I can't make her go, she's a grown-up. I think she's repelled by the prep. I've done it 3 times, drinking that stuff isn't fun, but it seems to me cancer would be worse. I've tried the guilt thing (Mom, if you don't do this... you'll disappoint me) but guilt doesn't work son->mom, tried the appeal from the grandkids...
Any suggestions?
Best answer: The overall lifetime risk of having colon cancer in one's lifetime is 1 in 19. Most people who are diagnosed with it have no (known) family history of it. However, she does have at least one risk factor for it--age.
Another thing to remind her of is that if she does the colonoscopy and it comes out with nothing, she won't have to do it again for ten years.
I have a lot of experience talking to older people who don't think they need certain medical tests. A lot of them are just not going to be convinced that it's necessary, figuring that they're already old, so it doesn't matter or something. If she won't budge, which could be quite likely, try to convince her to get one of the tests for colon cancer that doesn't require bowel prep, such as one of the fecal tests (which I almost find grosser than the invasive tests). Here is some info on the "myths" about colon cancer, and here is a list of the most common tests for it.
posted by ishotjr at 3:52 PM on October 11, 2009
Another thing to remind her of is that if she does the colonoscopy and it comes out with nothing, she won't have to do it again for ten years.
I have a lot of experience talking to older people who don't think they need certain medical tests. A lot of them are just not going to be convinced that it's necessary, figuring that they're already old, so it doesn't matter or something. If she won't budge, which could be quite likely, try to convince her to get one of the tests for colon cancer that doesn't require bowel prep, such as one of the fecal tests (which I almost find grosser than the invasive tests). Here is some info on the "myths" about colon cancer, and here is a list of the most common tests for it.
posted by ishotjr at 3:52 PM on October 11, 2009
Best answer: That's tough, but I would think a gentler variation of what part of you wants to yell might help. The way your question is phrased I'm wondering if you've been holding back how strongly you feel and not discussing the emotional repercussions for you and the rest of your family from her decision. You seem to be approaching it from a rational, logical, largely unemotional place, and if so, an emotional appeal might be more effective. Pointing out that watching one parent suffer through this illness and then losing him was hard enough, validating her concerns about the prep and reassuring her about the actual procedure, and reminding her that if she does this now, she won't have to think or talk about it for another 10 years, might help. Maybe you've said all that already, but if not, I'd give it a shot.
You might also want to talk about how her refusing to do preventative care places a large burden upon you and other family members if an illness goes undetected. Elder care is tough enough, and if a more serious illness becomes a factor, it will require a lot from all of you logistically, emotionally, and possibly even financially. Obviously, you love her and will take care of her in a heartbeat, but if hardship can be prevented with a simple, though unpleasant, test, it's somewhat selfish of her to refuse to do that. Yes, it's guilt, but is far more concrete than disappointment or sadness. Best of luck to you and her.
posted by katemcd at 3:55 PM on October 11, 2009
You might also want to talk about how her refusing to do preventative care places a large burden upon you and other family members if an illness goes undetected. Elder care is tough enough, and if a more serious illness becomes a factor, it will require a lot from all of you logistically, emotionally, and possibly even financially. Obviously, you love her and will take care of her in a heartbeat, but if hardship can be prevented with a simple, though unpleasant, test, it's somewhat selfish of her to refuse to do that. Yes, it's guilt, but is far more concrete than disappointment or sadness. Best of luck to you and her.
posted by katemcd at 3:55 PM on October 11, 2009
I have had the colonoscopy twice and it really is a "non event" - at least for me. My doctor told me that I should have it as a baseline and to see if there were any polyps present. There were not any polyps. And, afterwards, I had this sense of good feeling because you just really never know about those things. The prep is easier now and she should just not think to much about that.
posted by JayRwv at 4:04 PM on October 11, 2009
posted by JayRwv at 4:04 PM on October 11, 2009
we watched dad die from this 35 years ago
Could it be that having been through that, she'd rather not risk finding out that she's looking at the same kind of future--even if that means the risk of leaving something untreated?
Maybe you're right, and it's just a matter of the prep being unpleasant. But I suspect it's deeper than that, and you can't use shallow guilt to thwart deep fear. I don't know if there's a way to persuade her, but perhaps understanding that this might not just be stubbornness might help you to talk to her about it more effectively (and respectfully).
posted by Meg_Murry at 4:17 PM on October 11, 2009 [2 favorites]
Could it be that having been through that, she'd rather not risk finding out that she's looking at the same kind of future--even if that means the risk of leaving something untreated?
Maybe you're right, and it's just a matter of the prep being unpleasant. But I suspect it's deeper than that, and you can't use shallow guilt to thwart deep fear. I don't know if there's a way to persuade her, but perhaps understanding that this might not just be stubbornness might help you to talk to her about it more effectively (and respectfully).
posted by Meg_Murry at 4:17 PM on October 11, 2009 [2 favorites]
Best answer: Tough situation- I am going through it with my grandma as well! The truth is it's much harder to justify getting a 74 year old to get it done than a 54 year old. (Here's a 2006 article that starts to get at that concept... http://jama.ama-assn.org/cgi/content/abstract/295/20/2357 ) The biggest argument FOR is that if there is a suspicious polyp, it can be dealt with on the spot. It's important to consider, though, that increasing age comes with a decreased ability to tolerate the stress of a colonoscopy complication (bowel perforation) or complications from surgery to resect a tumor, if one is found.
If I were you, I'd talk to mom more to try to figure out what it is that's disturbing her- is it a fear that could be addressed, or has she been thinking about the "what if" situations? Go easy on the guilt if that hasn't worked so far. It might be worth going with her back to the doctor to talk about some of the other screening tests as others have mentioned. If she's asymptomatic and has other serious heath problems, her chances of dying from another cause may be much greater than colon cancer. If she's the picture of health but HAS been having some symptoms, it might be worth pushing harder.
Either way, use this as a time to talk about how she makes her decisions and what she values, so you can be her ally and advocate from here on out.
posted by nutmegs at 4:19 PM on October 11, 2009
If I were you, I'd talk to mom more to try to figure out what it is that's disturbing her- is it a fear that could be addressed, or has she been thinking about the "what if" situations? Go easy on the guilt if that hasn't worked so far. It might be worth going with her back to the doctor to talk about some of the other screening tests as others have mentioned. If she's asymptomatic and has other serious heath problems, her chances of dying from another cause may be much greater than colon cancer. If she's the picture of health but HAS been having some symptoms, it might be worth pushing harder.
Either way, use this as a time to talk about how she makes her decisions and what she values, so you can be her ally and advocate from here on out.
posted by nutmegs at 4:19 PM on October 11, 2009
Best answer: I can't imagine that, at age 74, one would want to think about the possibility of having cancer because having to think about what treatment would be like for a 74 year old is fairly terrifying (I went through a similar experience with my grandma). I can't imagine that, having watched a loved one go through cancer and/or treatment, one would want to think about going through it themselves too. I'm assuming some things, here, but I would guess that she's very afraid of finding out that she may have cancer because of the experience with your dad. Maybe talk to her about that rather than just pushing the tests, because that's where the roots are.
posted by so_gracefully at 4:20 PM on October 11, 2009 [1 favorite]
posted by so_gracefully at 4:20 PM on October 11, 2009 [1 favorite]
The best thing you can do is accept that other adults, given all of the same information you have, will make different decisions than you would, and respect their right to do so.
posted by DarlingBri at 4:33 PM on October 11, 2009 [3 favorites]
posted by DarlingBri at 4:33 PM on October 11, 2009 [3 favorites]
Best answer: I hated the idea of having that done. What my doctor told me: A colonoscopy can prevent cancer. If a polyp is found, it can be removed during the coloscopy; thus it will never become cancerous. Most people find it mildly uncomfortable, at worst (you can google for actual statistics). It might help if she knew exactly what happens. The day before, you use a laxative. That and its effects are actually the worst part, and not too bad. You show up at the imaging lab, change into a gown, and take a sedative; during the procedure you're awake but relaxed and kind of oblivious. I don't know how long it takes, because I had little sense of time going by. I had no discomfort afterward, though the doctor did remove some tissue. The patient must have a ride home afterwards, but the sedative doesn't last long.
If she's still reluctant, it's appropriate to tell her that her continuing good health benefits you, or that her refusal troubles you and that any future health problems she may have will certainly affect you. It's the truth. If that makes her feel guilty, it's not your fault.
posted by wryly at 4:35 PM on October 11, 2009
If she's still reluctant, it's appropriate to tell her that her continuing good health benefits you, or that her refusal troubles you and that any future health problems she may have will certainly affect you. It's the truth. If that makes her feel guilty, it's not your fault.
posted by wryly at 4:35 PM on October 11, 2009
Best answer: It is your mom's decision in the end. There's probably a lot more to her aversion to the procedure than just not liking the prep. Some people would prefer to ignore an ogre like cancer, rather than face the tension and worry of waiting for results to come back. And then what if the results are positive? What then - what does a 74 year old lady do in the face of cancer?
I feel like your fear of your mom's death, and her fear of her own death, are coming into conflict. I think if I were in a similar situation I would try and respect my mom's right to autonomy - not an easy thing to do, but the best thing I think you can do is respect and accept her decision. She probably won't budge, and if you don't accept it it's just going to turn into a running source of acrimony, and you probably won't accomplish anything.
My advice: let go.
posted by schmichael at 4:53 PM on October 11, 2009 [1 favorite]
I feel like your fear of your mom's death, and her fear of her own death, are coming into conflict. I think if I were in a similar situation I would try and respect my mom's right to autonomy - not an easy thing to do, but the best thing I think you can do is respect and accept her decision. She probably won't budge, and if you don't accept it it's just going to turn into a running source of acrimony, and you probably won't accomplish anything.
My advice: let go.
posted by schmichael at 4:53 PM on October 11, 2009 [1 favorite]
Best answer: So you know that treatment for colon cancer can be pretty rough. Worst case, you might end up with a colostomy bag, suffer one of the more vicious forms of chemo and still die. You mother knows that too.
She's reaching a time in her life where she might be thinking so what if they find cancer -- I've had a good run, my kids have kids, and I'd rather die than go through with treatment anyway.
Argumentative leverage might be better directed at what SHE has to look forward to, and whether treatment for early stage colon cancer has become more acceptable.
posted by i_am_joe's_spleen at 4:54 PM on October 11, 2009 [1 favorite]
She's reaching a time in her life where she might be thinking so what if they find cancer -- I've had a good run, my kids have kids, and I'd rather die than go through with treatment anyway.
Argumentative leverage might be better directed at what SHE has to look forward to, and whether treatment for early stage colon cancer has become more acceptable.
posted by i_am_joe's_spleen at 4:54 PM on October 11, 2009 [1 favorite]
How about if you offered to take the prep test at the same time, so you could suffer through the Great Purge together? (Note: Needs one toilet per person.) Just a goofy thought ...
posted by vickyverky at 5:35 PM on October 11, 2009
posted by vickyverky at 5:35 PM on October 11, 2009
Best answer: I just watched my mom die from cancer a few months ago. She was essentially your mom's age. It has been incredibly painful, for all of her children and especially for my father. If you could avoid causing your family this pain with one simple test, why would you not do it? The test itself is a breeze for most people. Sitting on the john for the night before is a bit less comfortable, but not so bad in the scheme of things. It's one of those cancers that should kill almost no one if they just take the tests. If you do get it though, and you find it late, it is a painful death sentence, hundreds of times over what the minor inconvenience of the test prep is. I know people who died from this. It was awful, really, really awful. Don't be that person. Anyway, despite that awfulness, these tests are things you do as much for your family as for yourself.
posted by caddis at 5:36 PM on October 11, 2009
posted by caddis at 5:36 PM on October 11, 2009
You could try humor and bribery. Why not? Some sort of reward? If there is some thing she loves to do that you resist you could just throw that out there. What the heck..! "Mom, if you go through with a colonoscopy I am prepared to (fill in the blank)". Then do that thing. Sounds childish and silly--but maybe she would see the value in it and it could be sort of fun. My mother liked antique stores..I didn't. I would have been able to bribe/reward her with that type of outing..including lunch. My Mom wasn't easily convinced to do anything but with the right kind of persuasion....
oh, and also tell her that having polyps removed before they become cancer is a large reason why people go through with it.
posted by naplesyellow at 7:31 PM on October 11, 2009
oh, and also tell her that having polyps removed before they become cancer is a large reason why people go through with it.
posted by naplesyellow at 7:31 PM on October 11, 2009
I had a resection for colon cancer almost 10 years ago (at age 42!) and have been through several colonoscopies. I was dragging my feet on my last follow up colonoscopy and told my doctor it was because I didn't think I could bear to drink that nasty, rancid tasting liquid in preparation for the procedure. That's when my doctor told me I could take it in pill form. What a revelation!
IMNAD so I don't know the benefits of taking the liquid vs. the pills - but from a patient standpoint, it made the whole procedure a piece of cake! I will never drink that liquid again, but I will get my colonoscopies as recommended.
posted by kbar1 at 9:59 PM on October 11, 2009
IMNAD so I don't know the benefits of taking the liquid vs. the pills - but from a patient standpoint, it made the whole procedure a piece of cake! I will never drink that liquid again, but I will get my colonoscopies as recommended.
posted by kbar1 at 9:59 PM on October 11, 2009
Best answer: I don't know your mom, and I'm don't have any experience trying to persuade someone to get a colonoscopy. But I do know my mom and dad, and I remember my seemingly futile efforts to try to get them to be on top of their self-care for adult diabetes (dad) and to please please please get a gynocological exam after years of refusing to go (mom). In my experience, katemcd has it.
I thought that a "rational" approach would induce my parents to take care of themselves; that is, persuading them by laying out the potential or even likely consequences (in this case, "you could lose a foot or go blind" for dad, and "you haven't had a pap smear in years and could have cervical cancer" for mom). But this didn't overcome their reluctance. It just magnified their feelings that this wasn't something they wanted to confront and added an extra burden of anxiety surrounding tests that are annoying, humiliating, or physically unpleasant.
What was more effective -- or at least somewhat more effective -- was expressing what I was feeling in emotional terms. This isn't "irrational," but it's more honest and compelling. You want your mom to look out for herself because she is your mom, you love her, and you want her to be around as long as possible and have the best possible quality of life as she ages.
One element to keep in mind is that your mom already knows the risks and statistics and all that. She doesn't need to be scared into doing this because it's likely she's already scared. She probably thinks about your dad and the suffering he went through all the time, just as you do, and I'm sure it saddens and terrifies her. Being honest that it saddens and terrifies you can spark a different series of conversations, ones that might be able to change her mind. Those are different kinds of reasons than the frightening specter of statistics, but you are her child, not her doctor, and it's appropriate that your reasoning and your arguments are different that what she's going to hear from her treaters.
I hope this helps. Good luck.
posted by foxy_hedgehog at 7:21 AM on October 12, 2009
I thought that a "rational" approach would induce my parents to take care of themselves; that is, persuading them by laying out the potential or even likely consequences (in this case, "you could lose a foot or go blind" for dad, and "you haven't had a pap smear in years and could have cervical cancer" for mom). But this didn't overcome their reluctance. It just magnified their feelings that this wasn't something they wanted to confront and added an extra burden of anxiety surrounding tests that are annoying, humiliating, or physically unpleasant.
What was more effective -- or at least somewhat more effective -- was expressing what I was feeling in emotional terms. This isn't "irrational," but it's more honest and compelling. You want your mom to look out for herself because she is your mom, you love her, and you want her to be around as long as possible and have the best possible quality of life as she ages.
One element to keep in mind is that your mom already knows the risks and statistics and all that. She doesn't need to be scared into doing this because it's likely she's already scared. She probably thinks about your dad and the suffering he went through all the time, just as you do, and I'm sure it saddens and terrifies her. Being honest that it saddens and terrifies you can spark a different series of conversations, ones that might be able to change her mind. Those are different kinds of reasons than the frightening specter of statistics, but you are her child, not her doctor, and it's appropriate that your reasoning and your arguments are different that what she's going to hear from her treaters.
I hope this helps. Good luck.
posted by foxy_hedgehog at 7:21 AM on October 12, 2009
Response by poster: Thanks to all. Everything worked out in the end.
After I posted this, I tried a few of the suggestions here, but she was adamant about not going. OK, I called the doctors office that morning and insisted she cancel the appointment. She spoke with the nurse for about ten minutes... then decided to get the procedure done!?!
The nurse didn't bring up anything new, but I guess hearing it from an authority figure rather from her "little boy" made the difference.
Drinking the prep fluid went as expected, she got all but the last glass down. Pooped for a few hours. We even found a parking place right by the door! Of course, it was 6:30am. The staff walked her right in, and she was back by 9:30. She had some discomfort from the air pumped in, but we were home by 1pm.
The doc didn't see anything bad, but he said the prep was incomplete. This may have been due to her age. When I asked if she needed to do it again, he just laughed and said no, "I'll see you again in ten years."
So all's well.
Thanks again to all. You helped out alot.
posted by Marky at 3:14 PM on October 16, 2009 [1 favorite]
After I posted this, I tried a few of the suggestions here, but she was adamant about not going. OK, I called the doctors office that morning and insisted she cancel the appointment. She spoke with the nurse for about ten minutes... then decided to get the procedure done!?!
The nurse didn't bring up anything new, but I guess hearing it from an authority figure rather from her "little boy" made the difference.
Drinking the prep fluid went as expected, she got all but the last glass down. Pooped for a few hours. We even found a parking place right by the door! Of course, it was 6:30am. The staff walked her right in, and she was back by 9:30. She had some discomfort from the air pumped in, but we were home by 1pm.
The doc didn't see anything bad, but he said the prep was incomplete. This may have been due to her age. When I asked if she needed to do it again, he just laughed and said no, "I'll see you again in ten years."
So all's well.
Thanks again to all. You helped out alot.
posted by Marky at 3:14 PM on October 16, 2009 [1 favorite]
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Hard as it is, this may be one of those times when you have to accept the "circle of control" and realize that you just can't MAKE another grown-up (even when it's family and even when it's for their own good) do something that they've decided that they don't want to do. Easier said than done, I know . . .
posted by bookmammal at 3:45 PM on October 11, 2009 [3 favorites]