Dear Fellow PDIEN subscribers:

Might any of you be able to suggest solutions for this following problem?
It would be appreciated.

This problem, which is afflicting my mother (who has PD), relates to a
serious problem with the digestive tract not quite working properly.

My mother (late 80s) has had PD for perhaps 25 years, but it's been under
decent control most of this time via medication; in the last few years,
she's been taking Sinemet, Sinemet CR, and Bromocriptine (mornings,
lunchtime, and dinnertime).

A few months ago, she began experiencing the sudden onset, during the
nights, of difficult tremors in her legs, the tremors usually lasting
about 30-40 minutes. So we went to see her then-neurologist, who prescribed --
in addition to her regular daily PD medications -- a bed-time dose of 2
bromocriptine tablets. (When I asked him, during that visit, if there
might be any side-effects or adverse reactions that we should watch out
for, he said no, there would be no problems, nothing to watch for, don't
worry. If only I had known then what I have learned since!). So my mother
started with the bed-tiem bromocriptine doses that very night.

Over the next few days, she felt increasing constipated, her abdomen went
from uncomfortable to painful and it began to swell. We then went to her
internist, who examined her and had me bring her on an emergency basis to
the ER of a major hospital in our area (Queens, NYC).

The ER found (via x-rays etcetera) that about 1/3 of her colon was packed
with matter, that her abdomen was seriously distended, that she was
seriously obstructed, and they immediately admitted her. Many of the doctors
& nurses there (and during the rest of her 2-MONTHS stay at the hospital,
where they never quite cleared up the digestive tract problem but where she
got 2 heart attacks and pneumonia, all of which nearly killed her several
times) told us that PD medications -- especially Bromocriptine -- are
"notorious" for slowing or paralyzing the digestive tract.

Fortunately, despite the terrible battle that my mother had to go through
("thanks", in my opinion, to her then-neurologist's incorrect, misleading
advice), my mother pulled through all this and is now in an excellent rehab
facility and working on getting her strength and proper weight and mobility
(all of which were also very seriously diminished during her hospital
stay) back.

For long stretches of her hospital-stay, my mother received (initially) no
nutrition at all (i.e., not even parenteral feeding), or (soon, for
weeks) nutrition first parenterally and soon via a nasogastric
feeding-tube; and (finally, during her last week in the hospital)
thickened liquids to drink, and then (during her last day or two there)
some thickened liquids plus very soft real food by mouth. Though her
weight, over this long stretch, dropped dangerously, at least toward the
latter part of her stay there her abdominal swelling gradually decreased
to almost normal, and we were all encouraged that maybe the problem was
gradually clearing up on its own.

However, since she entered the rehab facility, where they've been giving
her a menu of real food (real breakfasts, lunches, dinners), her abdomen
has begun, in recent days, to become distended again, and although they've
been administering laxatives, it seems that she may again be having some
serious partial constipation (now several days long, as of yesterday). I'm
worried about this problem: It could be dangerous, as it was a couple of
months ago, if her digestive tract again has trouble doing what it's supposed
to do.

At the hospital, and also here at the rehab facility, they've been giving
her *Propulsid* (which seemed to help when she was in the hospital); and
the rehab facility has also lately been trying *Milk of Magnesia*, a
laxative called *Senokot*, and last night administered a different
laxative called *Lactulose* (which also had been tried at the hospital and
which may have worked back then). I have not yet heard whether or not last
night's dose of Lactulose had any result.

My mother is also receiving, since perhaps a couple of weeks ago or so,
low doses of Sinemet Regular, and NO Bromocriptine. The rehab doctor is
still trying to adjust this to suit her needs. (For most of her
2-month hospital-stay, i.e., except for perhaps the last 2 weeks or so
and her first 4 days there, she was receiving ZERO PD medications.)

*So, to the questions:*

(1) Could the Sinemet (even at the presently lower-than-pre-hospital-admission
dosage-level) be hindering her intestines from working properly?

(2) What solutions might you be able to recommend to the constipation
problem or to getting the intestinal tract to function properly again?

(3) Do you have any experience or suggestions regarding this condition
along with Propulsid, Senokot, Lactulose? Can you suggest other
medications that might safely help in this situation?

(4) What can be done to help the digestive tract not only function well
-- i.e., to do the job that it should as fast as it ought to -- but also
to *repair* whatever damage may have been done (if any) to the intestinal
tract? (What I'm thinking of here is: (a) its overall condition, (b) the
fact that for so long, during her hospital stay, her colon was bloated and
perhaps (my guess:) stretched, (c) any long-term effects (if any) of the
Bromocriptine (or even Sinemet) on the functionality of the intestinal
tract.

I'm open to whatever reasonably may help, whether it's from standard
"Western medicine", or "alternative" medicine, and so on.

Thanks to any who can offer some insights.

-- SJS
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   7/6/96