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Date:  04/08/97 16:06
From:  Camilla Flintermann
Subj:  Constipation Protocol
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Several have asked recently about dealing with constipation - while we know
that NOTHING works ALL the TIME for EVERYONE, this may be helpful.

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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. Propulsid (Rx drug - generic =
cisapride) a half hour before each meal, followed in 15 minutes by one
tablespoon 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.

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.


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1. Starting Regimen

- Prune Juice (4 Oz.) with Breakfast and at Bedtime
- DOCUSATE CALCIUM (SURFAK): 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


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2. If no relief, at Bedtime add:

- SENNA (SENOKOT} : Two 8.6 mg Tablets
(May be increased up to a maximum of Eight 8.6 mg Tablets/day)

OR

- SENNA (SENOKOT} : One Level Teaspoon Granules mixed with water
(May be increased up to a maximum of four Teaspoons/day)

OR

- SENNA (SENOKOT} : One Suppository
(repeat in 2 hours if necessary)


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3. If no results are achieved by the third day, give:

- BISACODYL (DULCOLAX) : One 10 mg Suppository before Breakfast


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4. If no results are achieved by the fourth day, give:

- MAGNESIUM CITRATE (CITRATE OF MAGNESIA) : 5-10 oz. at Bedtime


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Day 5. If no results are achieved by the fifth day:

Seek the advice of a healthcare professional
regarding the use of an appropriate enema.


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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.
>
INFORM YOUR DOCTOR - AS SOON AS CONVENIENT - AT THE ONSET OF: Severe and
persistent constipation.


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SENNA (SENOKOT, BLACK-DRAUGHT LAX-SENNA, FLETCHER'S CASTORIA, GENTLE
NATURE, NYTILAX, SENEXON, 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.


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BISACODYL (DULCOLAX, BISCO-LAX, CARTER'S LITTLE PILLS, DACODYL, DEFICOL,
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.).

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MAGNESIUM CITRATE (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.

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janet paterson - 51 now /41 dx /37 onset - almonte/ontario/canada
<http://www.newcountry.nu/pd/members/janet/index.htm>
[log in to unmask]

Camilla Flintermann, CG for Peter 81/70/55
Oxford, Ohio
http://www.newcountry.nu/pd/members/camilla/one.htm
<[log in to unmask]>

                        "Ask me about the CARE list for
                        Caregivers of Parkinsonians ! "