Subject:
Constipation Protocol (fwd) (fwd)
Several have asked recently about dealing with constipation--while we
know that NOTHING works ALL the TIME for EVERYONE, this may be helpful.
Camilla Flintermann, CG for Peter, 78/7, Oxford,Ohio
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----------------------------Original message----------------------------
Date: Wed, 3 Jan 1996 19:21:03 GMT
From: Brian Symonds <[log in to unmask]>
Subject: Constipation Protocol-Corrected
Here is the corrected Constipation Protocol.
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. 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.
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.
INFORM YOUR DOCTOR - AS SOON AS CONVENIENT - AT THE ONSET OF:
Severe and persistent constipation.
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.
Camilla Flintermann, CG for Peter 82/70/55
Oxford, Ohio
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on PDWebring at
http://members.tripod.lycos.nl/genugten/flinterm.htm
"Ask me about the CARE list for
Caregivers of Parkinsonians ! "
And visit the CARE webring at
http://www.crosswinds.net/~caregivers/index.html
