-----------------------------------------------------------
As requested:

One version of a "preventive" mixture--
"In yesterday's PD Digest, someone asked about a recipe for easing
constipation. Some time ago, I saved a recipe that had been posted here (by
an RN based in Honolulu, as I recall) that addressed that same problem, and
so I'm taking the liberty of herewith posting that same recipe (Note: I did
not originate this recipe and take no credit for it; I would be pleased if
the originator would like to take credit for it and to add any updates, if
any, to it)."--Ralph Reichert

*** Anti-Constipation Fruit Spread ***

1 lb pitted prunes
1 lb raisins
3-4 oz pkg of Senna tea
1 cup brown sugar
1 cup lemon juice

Prepare tea with 3-1/2 cups of boiling water. Steep 5 minutes. Strain to
remove leaves etcetera. ONLY 2 cups of tea to large pot.

Add fruit to the tea, and boil together 5 minutes. Remove from heat; add
sugar and lemon juice. Use food processor or blender to blend to a smooth
paste.

Place the blend in plastic or glass containers. Put in freezer -- the blend
does not freeze and will keep for a long time.

Use 1-2 times daily on crackers or toast. --

ANOTHER SIMPLER VERSION:
Mix equal parts applesauce, wheat or oat bran, and prune juice. Take a
tablespoon as needed (Peter uses once a day)

******************
THIS IS ALSO FOUND IN THE ARCHIVE:

PD Protocol For Prevention of Constipation

NOTES RE:  PD PROTOCOL FOR PREVENTION OF CONSTIPATION

The following document was given to us by our internist, who has worked with
us on this problem for some time, and who requested our input and comments.
He has given permission to share it on the list. It was given to him by a
patient, who said the original source was "a computer".

In commenting on the protocol, Peter noted that the book, "Worst Pills, Best
Pills" lists Surfak (stool softener) as a "do not use" medication for
"simple
constipation"--not exactly what Parkies have, however. In addition, he
commented that he no longer finds Metamucil helpful, even with LOTS of
water,
though it did work at one time. (Nothing seems to work forever!) At present
he has a regimen that works for him MOST of the time, with occasional
relapses. That is to take 2 tab. Prepulsid (Rx drug--generic= cisapride) a
half hour before each meal, followed in 15 minutes by 2 teaspoons of
Chronulac (Rx drug also known as Duphalac, generic= lactulose syrup). Thus,
he skips step 1 entirely. Though the internist gave him the Rx for
lactulose,
the only instructions were to take it three times a day, and the timing is
Peter's.

We share this protocol with the understanding that everyone is
different--some Parkies don't even have this problem, and some do well with
other remedies, herb teas, Metamucil, etc. Note the detailed instructions
for
use of each med., and consult your own doctor, of course, if you wish to try
the Rx meds.

In addition, we call your attention to the excellent "Algorithm for Managing
Parkinson's disease", which appeared as a special edition of the Journal
Neurology, De. 1994, V. 44 No. 12, Supplement 10, and which was placed in
the
list archives by our industrious John Cottingham. In the archive it may be
found in 4 parts, reference numbers as follows:
          part 1  3268  633
          part 2  3269  545
          part 3  3271  506
          part 1  3270  477
This is an excellent overall view, intended for doctors, but also of
interest
to patients and CGs. If you don't know how to use the archives, ask John,
who
so graciously helps us all-- <[log in to unmask]>

We hope this will be helpful information to many of you--- "Stay Connected!"
Peter and Camilla Flintermann, Oxford, OH  <[log in to unmask]>

IMPORTANT DISCLAIMER
ALL MATERIAL PRESENTED HERE IS FOR INFORMATION PURPOSES ONLY AND IS NOT
INTENDED TO REPRESENT DIAGNOSIS, PRESCRIPTION OF MEDICATIONS OR TREATMENTS,
NOR SPECIFIC PRESCRIBING RECOMMENDATIONS.
PARKINSON'S DISEASE
PREVENTION OF CONSTIPATION

All of the medications utilized in the treatment of Parkinson's Disease tend
to cause constipation which, at times, may become severe. In order to avoid
problems, particularly fecal impaction, the following preventive approaches
are set forth. However, DO NOT use laxatives if there are any signs of
abdominal swelling, pain, or lack of bowel sounds, before consulting your
doctor.

1. Starting Regimen

          Prune Juice (4 Oz.) with Breakfast and at Bedtime
          Surfak (Docusate Calcium): One 50 mg Capsule at Bedtime
          (May be increased up to a maximum of Three 50 mg Capsules)

          Warning:  DO NOT use Mineral Oil while using Surfak

2. If relief is not forthcoming, at Bedtime add:

          Senokot (Senna): Two 8.6 mg Tablets
          (May be increased up to a maximum of Eight 8.6 mg Tablets/day)
                                                             OR
          Senokot (Senna): One Level Teaspoon Granules mixed with water
          (May be increased up to a maximum of four Teaspoons/day)
                                                             OR
          Senokot (Senna): One Suppository (repeat in 2 hours if necessary)

3. If no bowel  movement is achieved by the third day, give:

          Dulcolax (Bisacodyl): One 10 mg Suppository before Breakfast

4. If no bowel movement is achieved, give:

          Magnesium Citrate: 5-10 oz. at Bedtime

5. If no results are achieved by the fifth day, seek the advice of a health
care
     professional regarding the use of an appropriate enema.


PATIENT INSTRUCTIONS

LAXATIVE
     DOCUSATE CALCIUM  ( SURFAK )

     TAKE THIS MEDICATION ACCORDING TO THE FOLLOWING INSTRUCTIONS:
          Preferably taken at bedtime.
          May be taken with milk.
          Take tablets and capsules with a full glass of water (8 ounces).
          Do NOT take other medications within 2 hours of taking this
medication.
          Do NOT exceed recommended dosages.
          Do NOT crush tablets or open capsules; take this medication
intact.
          Take this medication at the same times(s) each day.

     WHILE TAKING THIS MEDICATION:
          Follow your doctor's guidelines regarding diet.
          Do NOT take mineral oil.
          Take at least 6 to 8 glasses of fluids daily unless advised
otherwise.
          Maintain adequate dietary fiber intake.
          Follow doctor's guidelines regarding exercise.
          Do NOT take over-the-counter products, before checking with
pharmacist.

     OTHER INSTRUCTIONS AND PRECAUTIONS:
          Do NOT take if you have abdominal pain, cramping or soreness; seek
advice.
          Do NOT take other medications within 2 hours of taking stool
softeners.
          Long-term use requires guidance by your doctor; keep all
appointments.
          Do NOT take more than 7 days unless advised otherwise by your
doctor.
          Read package directions carefully before using this medication.

     INFORM YOUR DOCTOR - IMMEDIATELY - AT THE SUDDEN ONSET OF:
          Persistent vomiting.
          A rash upon any part of your body.
          Diarrhea that lasts more than 24 hours.




PATIENT INSTRUCTIONS

LAXATIVE
     SENNA
     ( BLACK-DRAUGHT LAX-SENNA, FLETCHER'S CASTORIA, GENTLE NATURE,
        NYTILAX, SENEXON, SENOKOT, SENOLAX, X-PREP )

     TAKE THIS MEDICATION ACCORDING TO THE FOLLOWING INSTRUCTIONS:
          Preferably taken at bedtime.
          Take tablets and capsules with a full glass of water (8 ounces).
          Do NOT take other medications within 2 hours of taking this
medication.
          Do NOT exceed recommended dosages.
          Mix granules/powders with liquid, per instructions, before taking.
          Do NOT use more than 10 days unless advised otherwise by your
doctor.

     WHILE TAKING THIS MEDICATION:
          Maintain adequate dietary fiber intake.
          Follow your doctor's guidelines regarding diet.
          Do NOT take over-the-counter products, before checking with
pharmacist.

     OTHER INSTRUCTIONS AND PRECAUTIONS:
          Read package directions carefully before using this medication.

     INFORM YOUR DOCTOR - IMMEDIATELY - AT THE SUDDEN ONSET OF:
          Itching and/or hives.
          Any breathing difficulty or shortness of breath.
          Severe confusion.
          Severe abdominal pain.
          Persistent vomiting.
          A rash upon any part of your body.
          Unusual tiredness and/or weakness.

     INFORM YOUR DOCTOR, AS SOON AS CONVENIENT, AT THE ONSET OF:
          Muscle cramps and/or spasms.


PATIENT INSTRUCTIONS

LAXATIVE
     BISACODYL
     ( BISCO-LAX, CARTER'S LITTLE PILLS, DACODYL, DEFICOL, DULCOLAX,
        FLEET BISACODYL, THERALAX )

     TAKE THIS MEDICATION ACCORDING TO THE FOLLOWING INSTRUCTIONS:
          Preferably taken at bedtime.
          May be taken with or following food to reduce stomach upset.
          Take at bedtime to produce results in the morning.
          Take tablets and capsules with a full glass of water (8 ounces).
          Do NOT take other medications within 2 hours of taking this
medication.
          Enteric coated tablets should be taken intact, DO NOT crush.
          Do NOT exceed recommended dosages.
          Mix granules/powders with liquid, per instructions, before taking.
          Do NOT use more than 10 days unless advised otherwise by your
doctor.
          Do NOT take antacids within 2 hrs before or after taking this
medication.
          Do NOT take this medication with milk or other dairy products.
          Do NOT crush tablets or open capsules; take this medication
intact.

     WHILE TAKING THIS MEDICATION:
          Increase daily intake of fluids, unless advised otherwise by your
doctor.
          Maintain adequate dietary fiber intake.
          Do NOT take mineral oil.

     OTHER INSTRUCTIONS AND PRECAUTIONS:
          Digital rectal examinations should be performed regularly during
therapy.

     INFORM YOUR DOCTOR - IMMEDIATELY - AT THE SUDDEN ONSET OF:
          Persistent vomiting.
          A rash upon any part of your body.
          Unusual tiredness and/or weakness.
          Diarrhea that lasts more than 24 hours.
          Any breathing difficulty or shortness of breath.
          A rapid and/or irregular heartbeat over 120 beats/min.
          Severe confusion.

     INFORM YOUR DOCTOR, AS SOON AS CONVENIENT, AT THE ONSET OF:
          Problems in urinating (hesitancy, pain, etc.).



PATIENT INSTRUCTIONS

LAXATIVE
     MAGNESIUM CITRATE - LAXATIVE
     (   CITRATE OF MAGNESIA   )

     TAKE THIS MEDICATION ACCORDING TO THE FOLLOWING INSTRUCTIONS:
          Preferably taken at bedtime.
          Do NOT exceed recommended dosages.
          Do NOT use more than 10 days unless advised otherwise by your
doctor.
          Preferably taken on an empty stomach.
          Shake oral suspensions or liquids well before using.

     WHILE TAKING THIS MEDICATION:
          Take at least 6 to 8 glasses of fluids daily unless advised
otherwise.
          Maintain adequate dietary fiber intake.
          Follow your doctor's guidelines regarding diet.

     OTHER INSTRUCTIONS AND PRECAUTIONS:
          Read package directions carefully before using this medication.

     INFORM YOUR DOCTOR - IMMEDIATELY - AT THE SUDDEN ONSET OF:
          Diarrhea that lasts more than 24 hours.
          Persistent vomiting.
          Unusual tiredness and/or weakness.

     INFORM YOUR DOCTOR, AS SOON AS CONVENIENT, AT THE ONSET OF:
          Changes in mood or mental state.
          Muscle cramps and/or spasms.


Date:         Wed, 3 Jan 1996 11:30:30 EST
From:         Camilla Flintermann <[log in to unmask]>
Subject:      Corrections to Constipation protocol

Thanks to Brian Symonds for posting the protocol so promptly upon receipt
of it! Otherwise, Iwould have had to send out some 17 copies! Now you can
see
if it sounds helpful, and it will be in the archives also.
Brian asked me to review it, and I will note here 4 changes which I ask you
to make if you download the protocol for your use.
The name of the drug is PrOpulsid (Janssen pharma.) not PrEpulsid,but the
generic name, Cisapride, is correct.
The dose for Peter's Lactulose syrup should be 1 Tblsp. not 2 tsp--my error.
On the Patient instruction pages, the last 2 lines were omitted for 2 meds--
  Docusate Calcium: final lines are "INFORM YOUR DOCTOR AS SOON AS
CONVENIENT
AT THE ONSET OF: Severe and persistent constipation.
   Senna: final lines are: INFORM YOUR DOCTOR AS SOON AS CONVENIENT AT THE
ONSET OF: Muscle cramps and/or spasms.

Everything else was perfect, and again, many thanks to Brian Symonds.
Camilla Flintermann,CG for Peter,76/6+ in Oxford,OH



Date:         Thu, 2 Feb 1995 21:41:45 -0500
From:         Woody Schneider <[log in to unmask]>
Subject:      Constipation

At our support group yesterday the subject of constipation came
up again. Although not the most pleasant subject to discuss, it
continues to be a problem for a lot of members of the group,
especially my wife. The things which have been discussed are
herbal laxatives (Senna Tea, Cascara Sagrada aged Bark capsules,
mineral oil, and castor oil). In addition some members have had
Propulsid prescribed ( my wife included). These items work to
varying degrees for different people. If anyone has any other
suggestions or input for us we would greatly appreciate it.


Our group leader suggested that perhaps sharing her latest
essay, in a continuing series, be with this list. The essay I know
speaks from experience and follows:



       PATIENT PERSPECTIVES ON PARKINSON'S

        19.  CONSTIPATION AND PARKINSON'S
                By Donna Dorros

     It is ironic that Sid was preparing to write this essay on
constipation, not knowing that it was going to be the cause of
his death.

     The reason we had chosen this topic as the next in our series
of essays was that we both felt that more discussion and
information was needed on this subject.  It was no surprise to
us, on a recent trip to England, to learn that the #1 medical
concern of Parkinson patients in the United Kingdom was
constipation.  This was expressed by members writing in prior
to the annual general meeting of the Parkinson's Disease
Society.  We already knew this to be true both from personal
experience and from feedback from hundreds, if not
thousands, of fellow sufferers we had met over the years of
speaking before support groups.

     What I have come to understand since Sid's death is that
the problem of constipation in Parkinson's is not well
understood either by doctors or patients.  Nor, do they
understand how critical it is that it be well managed.

     First of all, in Parkinson's the disease process itself causes
constipation and the most commonly prescribed drugs for
treatment all have constipation as a possible side effect.  In
other words, patients have what could be called a "double
whammy" effect.

     It might be helpful at this point to define exactly what
constitutes constipation.  According to Taber's Cyclopedic
Medical Dictionary it is "A sluggish action of the bowel."  The
typical form of constipation which affects most of the general
population from time to time usually responds well to the
conventional forms of treatment.  In Parkinson's patients, this
is not necessarily the case because the condition is much more
complex.

     In doing a search of the medical literature, I discovered that
in a fairly recent study, it had been determined that
physiological changes take place in Parkinson patients as a
result of the disease process.  For one, "abnormal control of the
pelvic floor musculature caused by PD itself may play a
significant role in the constipation of these patients."(1)
Also, "defecatory dysfunction was....significantly more common in
patients being treated with dopaminergic
medications....prevalence appears to correlate with the
duration and severity of PD, not with diet or treatment....In
short-term studies, apomorphine has shown considerable
promise in patients with defecatory dysfunction."(2)

     In a follow-up study, it was stated that "There is a
paradoxical puborectalis contraction during straining in PD
patients, thus preventing the normal straightening of the
anorectal angles accentuating the flap valve action and
preventing the onward passage of feces."(3) In this study,
constipation was defined as less frequent bowel movements
rather than difficulty with defecation and may largely be an
expression of delayed colonic transit.

     What does all this mean to the average Parkinsonian who
suffers from chronic constipation?  As in all aspects of coping
with Parkinson's, you should be an informed and observant
participant in the medical management of the problem.

     Together with your doctor, you should develop a strategy
that works for you   As  each person is on different dosages of
medicine as well as being in a different stage of the disease,
your method of coping with this problem may be unique to
you.

     There are a variety of over-the-counter and prescriptive
treatments available for constipation.  In using any of these,
patients should work closely with their physicians.

     A log of your bowel habits may be helpful in determining if
you have gone too long without a bowel movement and need to
seek further medical treatment.  You could have a blockage,
obstruction, or as in Sid's case "acquired megacolon."
"Megacolon is clinically asymptomatic until the late stages
when fecal impaction occurs, and its presence is frequently
unsuspected in neurological disorders....(However), the high
incidence of megacolon in neurologic disorders is out of
proportion to the incidence in the general population."(4)

     In the commentary of this study, the authors state:
"Megacolon is a dysfunction of the bowel of unknown origin
giving rise secondarily to characteristic dilatation....the
primary factor is failure of the anal sphincter which should
take place when the rectum contracts."    They also stated that
attention to the gastrointestinal tract, particularly the large
bowel, is extremely important in the management of chronic
neurological disorders, such as Parkinson's.(5)

     Signals that you may have more than constipation are: a
hardened and distended abdominal cavity after several days of
no bowel movement, which may or may not be accompanied by
vomiting; and decrease output of urine which is darker in color
than normal.  Seek immediate medical intervention is this
occurs.

     In addition to apomorphine, referred to in the first study
above, there is a new prescription drug which has recently
been FDA approved for use in the United States that might be
of help.  It was approved for reflux esophagitis, not
Parkinson's, but it is of interest for its use in decreased motility
in P.D.  The  name of the drug in the U.S. is PROPULSID.(6)
How strange that the last part of this drug's name is 'SID.'




This essay is a continuation of the series of 18 essays in
PATIENT PERSPECTIVES ON PARKINSON'S which has
already been published in booklet form (purple cover) by the
National Parkinson Foundation and is available free, upon
request.



(1) Edwards LL, Pfeiffer, RF, Quigley, EMM, Hofman Ruth, and Balluff
Mary. Gastrointestinal symptoms in Parkinson's disease.  Movement
Disorders 1991;6;2:151- 156.
(2) Ibid.
(3) Edwards L, Quigley EMM, Hofman R, and Pfeiffer RF.
Gastrointestinal symptoms in Parkinson's  disease:18-month follow-up
study. Movement Disorders 1993;8;l:83-86.
(4) Lewitan A, Nathanson L, Slade WR. Megacolon and dilation of the
small bowel in parkinsonism. Gastroenterology 1952;17:367-374.
(5) Ibid.
(6) Parkinson's Disease Update. 1993;30:121-123.


-------------------------------------------------
[log in to unmask] (Woody Schneider)
Gaithersburg,MD
-------------------------------------------------




  Camilla Flintermann, CG for Peter 80/9
  Oxford, OH
  [log in to unmask]
"http://www.newcountry.nu/pd/members/camilla/one.htm" My Home Page

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