Camilla,

Thank you very much for your info.

Yen


>From: Camilla Flintermann <[log in to unmask]>
>Reply-To: Parkinson's Information Exchange Network
><[log in to unmask]>
>To: [log in to unmask]
>Subject: Managing Constipation in Parkinsons: Parkinson Foundation of
>        Canada
>Date: Thu, 12 Oct 2000 23:00:03 -0400
>
>Dear Yen--I think I sent you some references before for your father about
>constipation. Perhaps you didn't get them?  You may find this article
>helpful...and there is MUCH information in the archives, at the URL in blue
>below.  This is a very common and serious proiblem. Not everything works
>for everuyone, or all the time. My husband has tried many things, and at
>present he also is doing well with Lactulose,
>with occasional Senokot if he has no results.  Please try the suggestions
>here, and I hope it will help.
>May I suggest again that you join the CARE list for caregivers of PWPs--you
>do NOT have to be living with your father to be a  caregiver for
>him.....write me offlist if you have more questions.
>
>Camilla Flintermann, CG for Peter, 82 dxd 1989
>********
> >Date: Sat, 05 Dec 1998 15:29:42 -0500
> >From: janet paterson <[log in to unmask]>
> >Subject: Managing Constipation in Parkinsons: Parkinson Foundation of
>Canada
> >Sender: Parkinson's Information Exchange <[log in to unmask]>
> >X-Sender: [log in to unmask]
> >To: Multiple recipients of list PARKINSN <[log in to unmask]>
> >Reply-to: Parkinson's Information Exchange
><[log in to unmask]>
> >MIME-version: 1.0
> >X-Orcpt: rfc822;[log in to unmask]
> >Comments: cc: Ann Erickson <[log in to unmask]>
> >
> >[Note: for those with wwweb access this information is available
> >in the pd list archives at:  <http://james.parkinsons.org.uk/>
> >search by using 'managing constipation' as the search criterion]
> >
> >
> >---------------------------------------------------------
> >Managing Constipation in Parkinsons
> >---------------------------------------------------------
> >
> >Introduction:
> >
> >The goal of this pamphlet is to help you understand what makes
>constipation a
> >problem in Parkinsons, and what you can do to develop a plan of
>prevention.
> >
> >In Parkinsons, the constipation is most often due to a combination of the
> >following factors:
> >
> >- Your intestines move more slowly than normal because of your
>Parkinsons.
> >- Your drug therapy
> >- Your inability to exercise enough
> >- Not drinking enough fluids. If you have Parkinsons, you must be
>particularly
> >careful about constipation in hot weather when you may become dehydrated.
> >- Difficulty expelling a stool because it is hard, dry and painful to
> >pass. The
> >longer the stool remains in the gut, the more water is reabsorbed into
>the
> >tissues and the dryer it gets.
> >- Difficulty expelling a normal stool because you feel weak. This
> >difficulty may
> >arise if you are under-medicated or your drugs are wearing off at the
>time you
> >feel the need to have a bowel movement.
> >
> >Try the following in the order given. Do not hesitate to call your
> >physician if
> >your constipation is prolonged as it can lead to problems that can be
>very
> >serious and need urgent medical attention: in Parkinsons, the bowel can
>twist
> >and cause an obstruction.
> >
> >Physical Activity:
> >To promote regularity, be as active as you can. A physical therapist can
> >advise
> >you on exercises that suit you. The Parkinson Foundation of Canada also
>has an
> >exercise pamphlet. It is possible to exercise even if you are confined to
>your
> >home.
> >
> >Regularity:
> >The following may help you establish regular bowel habits:
> >- Eat meals and snacks at regular times.
> >- Establish a regular time for emptying your bowels.
> >- A hot drink can stimulate bowel activity.
> >- Go to the bathroom regularly after breakfast as food stimulates the
>bowel to
> >empty.
> >- Always respond to the urge to empty your bowel.
> >- Make sure you are comfortable on the toilet, with your feet flat on the
> >ground
> >or on a stool.
> >- Take your time.
> >- If you need to modify your toilet or the area around it (hand rails,
>raised
> >toilet seat etc.) Talk to your physician, home care nurse, or
>occupational
> >therapist.
> >
> >Level One:
> >Modify your diet by increasing your intake of fibre-rich foods:
> >- Whole grain bread, crackers, muffins.
> >- Serve breakfast cereals with at least 4 grams of fibre per serving.
> >- Use dried beans, peas, lentils in soups, salads and casseroles.
> >- Add 1-2 tablespoons bran to hot cereal, yogurt, stewed fruits and
> >milkshakes.
> >- Eat plenty of raw or soft-cooked fruits and vegetables, including the
>skin
> >whenever possible.
> >- Add dried fruits to cereals, salads, desserts.
> >- Try the following fruit-lax recipe: Soak 1 lb. mixed dried fruits
>cranberry
> >juice overnight. Chop in blender, store in refrigerator and have one/half
> >- one
> >whole cup every morning with cereal or yogurt.
> >
> >Sample high fibre menu:
> >Breakfast:
> >- half banana
> >- 3/4 cup high fibre cereal & milk
> >- 1 slice whole wheat toast
> >- butter/marmalade
> >- 1 glass water/juice, coffee, tea
> >Lunch:
> >- 1 cup split pea soup
> >>- 1 slice rye bread with tuna, mayonnaise, tomato & cucumber
> >- 1 orange
> >- 1 glass milk/water/juice
> >Dinner:
> >- baked chicken breast
> >- baked potato with skin
> >- cooked carrots & green beans
> >- fruit salad with yogurt
> >- 1 glass water or juice
> >Snacks:
> >- Take with medications or at bedtime
> >- Could include whole grain muffin or scone with a glass of milk, or 2
>oz.
> >cheese with whole wheat crackers plus a glass of juice, water or milk.
> >
> >Increase your fluid intake:
> >- Drink 6-8 eight ounce glasses of water, milk or juice a day, most of it
>by 4
> >pm to avoid sleep upset.
> >- If necessary, measure out a pitcher each morning and put a reminder on
>the
> >refrigerator door.
> >
> >Level Two:
> >- If after two days you are still constipated, add 1-2 tablespoons of
>Psyllium
> >(Metamucil) 2-3 times a day with a cup of water. Taking Psyllium or
>Metamucil
> >three times a day with plenty of water is preferable to taking it all in
>one
> >dose.
> >- You must also be able to maintain an adequate fluid intake (6-8 glasses
>of
> >water a day) and take regular exercise if you want the bran or bulking
> >agents to
> >work well for you.
> >- lf you have difficulty swallowing, and/or choking episodes, you should
>avoid
> >bran (including bran muffins), Metamucil, Prodiem and other bulking
>agents.
> >- If using the advice in level 1 or 2 relieves your constipation,
>continue
> >indefinitely. Levels 3-5 are NOT intended for continuous use.
> >
> >Level Three:
> >- If you are still constipated after two days, add: Sennosides 12-24 mg.
>at
> >bedtime or Bisacodyl 10 mg at bedtime or Cascara 5 ml (1 tsp) or 2
>Senakot
> >tablets.
> >
> >Level Four:
> >- If you are still constipated after 1-2 days, add: Lactulose 15 ml twice
> >daily
> >or Glycerin suppositories: Use 1-2, lubricate tip with KY jelly and
>insert
> >gently while sitting on the toilet.
> >
> >Level Five:
> >- If you are still constipated after 1-2 days, give a Fleet enema. If
>this
> >fails, then you should contact your physician or the local health unit.
> >
> >Giving an Enema:
> >The patient lies on a towel, on the left side, knees bent, as close to
>the
> >edge
> >of the bed as possible. The buttocks can be raised (for gravity) on a
>plastic
> >covered pillow (a trash bag will do). The enema should be warmed, the
>rectal
> >tube lubricated (KY jelly) and inserted gently and slowly as far as
>possible.
> >Give the enema slowly and then withdraw the tube. Cover the patient and
> >offer a
> >heating pad or hot water bottle for the abdomen. Encourage the patient to
> >retain
> >the enema for as long as possible, and then assist him/her to the commode
>or
> >toilet. A successful enema will often yield more than one bowel movement
>over
> >several hours and so it should be given early in the day to avoid
>disturbing
> >sleep.
> >
> >Gas and Bloating:
> >Increasing the fibre content of your diet too quickly and by too much can
> >cause
> >painful gas, bloating and cramps. There are several anti-gas products
> >available
> >>from your pharmacy. Hot peppermint water (made with peppermint oil) plus
> >>a hot
> >water or heating pad on the stomach can be comforting.
> >
> >Retention and Overflow:
> >This is a situation where small amounts of watery stool seep around a
>bolus of
> >constipated stool. This needs attention, most often with an enema,
>because the
> >blockage is usually higher than can be reached with suppositories.
> >
> >IMPORTANT:
> >Everyone concerned with Parkinsons needs to be alert for the possibility
>of
> >volvulus (twisting of the bowel) and obstruction (blockage). Parkinson
> >patients
> >are more prone to these for unknown reasons: perhaps the sluggish
>motility of
> >the bowel is to blame. By the time either of these develop, the patient
>is
> >often
> >out of the hands of the neurologist and under the care of a surgeon who
> >may not
> >know about the risk and mortality.
> >
> >This pamphlet has been prepared by Susan Calne, RN,
> >Clinical Coordinator, Karol Travis, RDN,
> >and Shellen Letwin, Ph.D. Pharm.,
> >University Hospital,
> >Health Sciences Centre,
> >2211 Wesbrook Mall,
> >Vancouver, BC
> >V6T 1B5
> >0ct/97
> >
> >The Parkinson Foundation of Canada
> ><http://www.parkinson.ca/confrm.html>
> >---------------------------------------------------------
> >
> >janet paterson - 51 now /41 dx /37 onset - almonte/ontario/canada
> >[log in to unmask]
> >

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