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My 78yo mother lives independently. Her typical day includes some light housekeeping, binge-watching tv, and eating. She cooks and eats healthy most of the time (she shops for herself and I take her shopping regularly) but snacks on potato chips and orders takeout fairly often. Every few months, I get a frantic call from her requesting a ride to the ER because her catheter is clogged. I order her ride and rush to meet her at the hospital, where she suffers extreme pain, unable to sit, in a packed waiting room while I beg for her to get seen ASAP. Eventually, she gets taken to the back and her catheter gets replaced. Crystals in her urine are the typical cause of the clogging, which she attributes to her salt intake. She says she is cutting back on salt but she is self-unconscious and super secretive about her eating (not because I ask or lecture - I don't), so I can't rely on what she tells me. These ER visits are stressing me out - they can happen at any time, I hate seeing her suffer like that, and I feel they could be prevented with more mindful eating. I'm tempted to arrange for her rides next time but not go and let her deal with it herself. Maybe she will get serious about her diet then. She recently told me this sometimes happened years ago, and she would go to the hospital herself, so it would not be a totally new thing. I just started being involved with this situation in the last couple of years.

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Do the doctors say this is related to salt intake?

Does she have dementia?

I see from another question that you were going to talk to her urologist. What did s/he say?

Maybe adult incontinence briefs would be a better idea?
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GreyGhost Jun 2023
Yes @ salt as the most likely cause - no bacteria were seen. No dementia, as far as I can tell - no diagnosis and no obvious signs, though I suspect my mom has always been neurodivergent but undiagnosed. I like the briefs idea, but a difficult topic for a male only child to bring up...
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GG, I hear you. You need to get one of the medical professionals to bring this up.

Call the urologist and have a discussion to be initiated by her/him at an appointment that you schedule for soon.

It is clear that YOU cannot keep doing this.

"Emergencies" are things that are unavoidable. This is an avoidable problem.

"mom, I can't do this anymore" was the hardest conversation I ever had with my mom. But it was honest, necessary and prevented much resentment and difficulty down the road.
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GreyGhost Jun 2023
Thanks for this. I'm going to ask her urologist to have a talk with her.
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If I can't enjoy a little occasional junk food when I'm 78 I'll be a very unhappy person.
Rather than taking away one of life's remaining pleasures I would look beyond her diet for solutions. For example my focus might be - why does she need an indwelling catheter? Would simply increasing her fluid intake help to alleviate her problems? Or can she be taught to flush the catheter herself?
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GreyGhost Jun 2023
I'm advocating for sensible snacking, not total deprivation. Her high sodium (and sugar) intake is not just occasional - she admittedly has no self-control when it comes to snacking and she treats it like her sneaky little secret - a disordered relationship with food that goes back to childhood. She's had the catheter for decades as a byproduct of a medical procedure - she has lived with it for decades at this point. And she only calls me once her attempts to flush it herself have failed. I'm open to solutions other than a catheter, but she would need to be open as well.
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You’re a male only child, so if there are topics you can’t discuss with mom, ask her female doctors and nurses to have those discussions with her.

Also, you are on the right track about getting someone else to take her to the ER. Find someone you can pay to do it. Otherwise you’ll be her jumping frog from now on until it’s over.
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GreyGhost Jun 2023
Agreed. Thank you.
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You had a similar issue over a month ago, and the advice at that time was to contact her urologist.

Have you done so?

You cannot continue to be your mother's only solution to these crises. Someone suggested that you pay for her to get a ride to the ER. Make that be from HER funds.

What is the eventual plan for when your mother cannot live independently any longer?
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GreyGhost Jun 2023
Yes @ urologist - please see my other replies. And I will have someone look after her in her home when the time comes or possibly assisted living. Either one is financially feasible.
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This from the internet:

"The following are the most common types of crystals found in the urine:
Uric acid crystals: Can vary in size and shape, but tend to look like rhomboids or parallelograms. ...
Calcium oxalate crystals: Found in acidic, neutral, or alkaline urine. ...
Triple phosphate crystals or struvite stones: Form in alkaline urine and composed of magnesium, ammonium, and phosphorus.........................."etc.

So the internet is your best friend. Just look up "crystals in urine".

Now on to a question: Why does your Mom, at the tender age of 78, have an indwelling catheter? I am 81, and quite active, but I admit to being an addict in the asles at Trader Joe's. OMG! Those Old-Fashioned Potato Chips! And no one at the ER told your mom her electrolytes are out of balance. No one mentioned high sodium. They only said "crystals". Do you know if mom told her "catheter doc" about her ER visits? There may be a hydration problem here. Mom may need to learn to flush her catheter with sterile saline, a very simple procedure.

I am sad Mom has decided to sit down and watch TV. It will do her entire body from joints to bones to weight to BP and heart and everything else no favor, to say nothing of mind. But that's up to her. I doubt that her occ. bag of chips is what's causing her problem.

As with all medical problems this old nurse always advises "Take Thee to a Doctor". And have Mom see the doc who placed the indwelling catheter. I sure do wish you the very best of luck.
Now I shudder to think of my daughter coming for my blue and gold bag of Trader Joe's chips!
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GreyGhost Jun 2023
Great information - thank you! The doctor who did the procedure retired and she is recently with a new one. Bottom line, I know I will need to get more involved with her providers to get to a root cause and solutions that work for her. I'm new to this journey with her, so just trying to find my way while being respectful to an independent, private, sometimes feisty adult.
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GG, I don't want to sound mean, but at this point, your mother needs you more than you need her. It's a tough cars to play, but play it if you must.

Something like "sorry, mom, but if refuse to get scheduled medical attention for this catheter problem, I can't participate in these emergencies any longer. Let's work together with a doctor to get to the bottom of this the way a person as smart as you would."
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I am 74 and have been told to watch my salt intake and drink more because my kidney #s are high. I agree that at my age I should enjoy what I want to eat but by not cutting down on salt and not drinking more water, I may see myself on dialysis one day. And for the friends that have been on it, its no fun.

My DH and I eat out alot then I get tired of it. Well this is the week I got tired of it and have been cooking. I have lost 1 1/2 lbs I am sure is water weight. I add no salt when boiling noodles. No salt on FF when out. No canned soups. Hotdogs (I do have an occasional one), or canned veggies. Even baked beans are very high in salt. Chinese food, frozen dinners and lunchmeat a lot of salt. Mom has to be a label reader. The average person is only suppose to have 2000mg a day. That's a teaspoon of salt. A serving of potato chips (13) is 170 mg. Almost 1/5 of what the average person is suppose to have daily. Your Mom does not seem to be on the average level.

So what I found out is eating out and take out means a higher level of salt in what I eat. Cooking at home is better because I can control it. And those potato chips Mom eats...should be a treat not an everyday thing. Me, the last place I would want to be is at the ER, all the time, knowing I could prevent it by just changing my salt intake. Your Mom should probably be drinking more water to flush out some of the salt.
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It sounds like gout. Has that been ruled out?
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Has your Mom had a good physical. Medicare recommends once a year you get a physical with labs. The labs show if numbers are high or low. Also, you can ask for a small cognitive test. If found she is declining in that area, tgen I would see a Neurologist for further testing.
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GG, read just the first paragraph of this medical paper:

https://pubmed.ncbi.nlm.nih.gov/24635559/

It's your MOM who is attributing this to salt intake, right?

Do you accompany her to the treatment room to hear what the DOCTOR says about it?

I started accompanying my mom to the doctor's office when she stopped driving. I discovered that what she thought the doctor said and what he ACTUALLY said were two very different things.

I have no doubt that the ER discharge instructions say "follow up with your primary within 30 days".

Had she done that?
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cxmoody Jun 2023
Barb,
This sounds just AWFUL for the patient.

The OP may want to print this article out, and wave it at the doc. Ugggh. 🤦🏻‍♀️
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I had been to the ER countless times and seen a bunch of urologists until I figured out that what were forming were calcium oxalate crystals, as Alva’s research shows.

No ER doc was able to figure it out. I was the one to figure it out, and EVENTUALLY the urologist agreed.

Salt MAY not be the culprit here.

I would make sure that Mom has a note taker at all appointments.
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Animallovers Jul 2023
I am glad that you finally were able to find out what was going on!
I too agree with Alva. When I used to work as a technician in an emergency animal hospital part of my job was doing urinalysis's. The different types of crystals can usually be fairly easy to tell apart with proper technique under a microscope to a trained eye. I don’t know how human hospitals do their urinalysis but I wouldn’t be surprised if they had a machine to do it. It may be worth asking about that like everything else these days. Personally I have not heard of salt specifically causing stones, but then again I haven’t worked in human medicine. Human ERs may not deal with urinary blockages often enough to have the expertise and experience with types of stones. They also usually rely on being able to pass cases on to specialists the next day, or refer someone to a specialist and address only the acute issue in emergencies. They don’t follow up on the causes.
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As they get older they sure love their salt & sugar. This might sound silly but there is a salt called half salt ( less sodium) It was suggested to us by my mil doctor as supposed to regular salt which has more sodium.
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Suetillman Jul 2023
She is getting the salt from potato chips and take out food
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You say "she attributes the crystals to her salt intake" Has this actually been confirmed by her doctor or a doctor via lab testing to confirm that the crystals are caused by the salt?
If that has not been done I would do that.
Honestly though if this is the cause...
and she knows it is the cause....
and she continues to make the decision to eat foods high in salt content
this is her decision and she is fully aware of the Cause and Effect there is not much you can do other than have someone there that will monitor her salt intake.
Obviously the 2 (ok, 4) ways to do that are...
1.) Mom has caregivers that will monitor but unless they are there 24/7 there is no telling what she will do when they are not there.
2.) Mom moves to Assisted Living or Independent Living where her diet can be monitored. But again in both IL and AL people can shop and eat what they choose.
3. and 4) She moves in with you or you move in with her so that her diet can be monitored. both of these are said with tongue firmly planted in cheek.
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The answer is for your capable mother - who, after all, takes perfectly good care of her catheter almost all the time - to take the events seriously, get medical advice about them, and stop hooeying both herself and you that it's punishment for enjoying take-out and potato chips.

Indwelling catheter maintenance is usually managed by specialist nurses. That's who your mother should contact in case of emergency, and I don't believe either that she gets no notice when things are in need of attention.

Anyway, bottom line - not your responsibility, hers, and it is in her best interests that you encourage her politely but firmly to deal with it more methodically and logically than this. Maybe start by praising and agreeing with her general rule of self-sufficiency.
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DrBenshir Jul 2023
If Mom has a chronic, permanent medical problem, she might be eligible for nurses to check her regularly at home.
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Get the ER reports.See her family dr for medical advice. Get a caretaker to for all the above reasons.Not rocket science but you must be practical.
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whysterical are you and she addressing the clogged catheter with her own doctor? Does she also have a urologist? Start there first. ER visits are for emergencies and you won't have someone following her ongoing care afterwards. It might or might not be due to diet but you won't know this until she sees her primary doctor first, and then she will probably be referred to a urologist. An ounce of prevention is worth a pound of cure.
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Some great suggestions here about finding out what kinds of crystals are the culprit here and about catheter maintenance in general.

As for your rushing to the ER to wait with her, that's up to you. If you or someone else drives her there, she will wait her turn in the waiting room, sometimes for a long time. If she requires an ambulance ride, she might be seen mote quickly. Catheter maintenance should not be a repeated ER problem. Your tough love may be better employed in getting her to doctors who will diagnose the problem or in arranging catheter maintenance appointments for her if she is not doing an adequate job of this herself.
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go on care.com a website that will you a local companion to come in and supervise her how many hrs you want 15 dollars a hr on avg. theres a fee to join website because they do Bac round checks.
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At some point, you need to stop - as it doesn't do any good.
* If she is able to function well enough in ind living, she makes a choice on how to eat / dietary needs, etc. and pays the consequences. As you say here "maybe she will get serious about her diet then." I believe that the odds are she will not.

* If I were you though - I might try ONE POSSIBILITY ... replace the salt in her shakers with something else that looks like salt. ... or light salt ? There is little to nothing you can do if she orders take out / eating heavy salt ladened foods.

* Often our options are limited even though we do EVERYTHING we can to support / help. As I see it, the change that needs to happen is with you:
1. Tell her you will not be available to manage emergency calls / visits / etc. She will be on her own.
2. Learn to set boundaries, knowing it will be hard ... tug at your emotional and psychological heartstrings. And, yes: Tough love ... for your own quality of life/health needs, and hers.

* Have you considered she might:
- need more caregiver assistance / for meal prep
- move into assisted living or elsewhere with more care / supervision

You need to decide what changes you will make.
The rest will be up to her.
And, realizing this is the hard part. Letting go.

Gena / Touch Matters (and Tough Love matters)
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Grey Ghost, It's been plenty of time now to contact the urologist about this catheter which is almost certainly not suffering due to salt intake. I sure hope you did so. When and if you do could you update us about your progress in addressing this cath which will continue to clog until changed, or until someone is taught how to flush a catheter by STERILE method.
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GreyGhost: She needs to be seen by her urologist as soon as possible.
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Perhaps talk to her doctor to request in-home health care for her. Maybe they can change it more frequently for her. From what I read about this, it may just be not enough water during the day. She may need to go in to see her doctor. Could be something else creating her problem. I don't think there's any kind of 'tough love' to fix a catheter problem.

I found this info about catheters that might help you:
https://www.health.qld.gov.au/__data/assets/pdf_file/0026/427508/catheter-blockage.pdf
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Ask the hospital to test the "crystals" to see what they are made of. Then, you will know which foods are problems for her. Until then, limiting salt is probably not her problem. Lack of fluids is more likely the culprit. Many seniors do not feel thirsty and do not drink enough water or water-based drinks. Help her develop some new habits to get extra fluids into her daily routine. If she resists your efforts, ask her doctor for a referral to a registered dietician. This healthcare professional can evaluate her diet and make suggestions for healthier food and drink options. Many seniors are more likely to follow the advice of a healthcare professional than their loving children.
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AlvaDeer Jul 2023
Taarna, I suggested this testing to our OP when he first came to us with this question. He hasn't returned and I think may not be reading any more. His Mom's doc retired, and he needs a new one for this indwelling catheter . She isn't testing high sodium in the ER. She likely has crystals forming because this cath is disintegrating and needs changing. Uric acid crystals will clog then, adhering to the wall of the catheter.
Hopefully our OP will return and update us. I am amazed that after irrigating the catheter in ER and hearing his story that no one changed it. They have a lifetime. The often need sterile saline flushing.
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A dietician may be able to assist mom in choosing spices that minimize the need for salty foods.


Also, https://dashdiet.org/

https://www.canr.msu.edu/news/lower_your_salt_and_sodium_intake_with_spices_and_herbs#:~:text=Try%20adding%20curry%20powder%2C%20garlic,be%20kept%20for%20one%20year.
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