Dear Lynne,
Re the constipation, prolonged constipation can definitely affect an
individual's response to PD medications. However, a BM every other day
is usually adequate. However her age, and being 17 years diagnosed with
PD, may mean that her response to medications along with her advancing
PD is affecting her differently.
> She cannot give herself meds because of peripheral neuropathy. I give
> her the last Sinemet CR at 1:30 AM and then I wake up at 4 or 5 AM to
> give another, but I'm getting exhausted. We cannot pay for another
> person to help. The hired caregiver is already working long hours.
> Usually I am on duty in the evenings until about 1:30 AM. I need to
> sleep a full 8 hours so I can work during the day. Is there anything
> that might safely and comfortably extend my mother's sleep at night?
Is her diet adequate? Deficiencies of some nutrients, particularly B
vitamins, can contribute to neuropathy, as well as weakness, and such
deficiencies are not at all uncommon as PD advances, especially with
long-term use of levodopa.
> She gets less sleep and she
> feels worse of course when constipated. When she is not constipated,
> she wakes up with fewer bad feelings and sleeps slightly longer.
>
> Her current drugs are as follows:
> One-half Sinemet regular 25/100 at 6:30 AM.
> One Sinemet CR 25/100 about every 3 hours (except after 10 PM,
> she seems to feel fine if they are slightly further apart).
> Two Dilantin 100 mg per day.
> Two ordinary Tylenol 500 mg every 6 hours.
> An antibiotic 2 x daily for two weeks (SMZ-TMP
> sulfamethoxazole/trimethoprim) for a urinary infection.
Her constipation, along with the urinary tract infection, make me wonder
if she is getting enough fluids daily. I know this is difficult
especially when she is weak and fatigued, but she needs about two quarts
of fluids daily, most of which should be non-caffeinated. Chronic mild
dehydration occurs very frequently in people with PD, and can lead to
UTIs, kidney stones, weakness/fatigue, dizziness, confusion, and other
conditions. UTIs can also lead to weakness and confusion.
>
> For various reasons, she does not have a neurologist now. She does have
> a thoughtful general physician who listens to her and to me.
She needs a neurologist who specializes in movement disorders most
urgently right now. A GP rarely has enough experience with PD to be able
to design a good medication regime, especially as PD advances.
For more help, I suggest you go to the the NPF website:
http://www.parkinson.org/index.htm
Scroll down the page to "Ask Dr. Lieberman." Here, follow directions,
and you'll be able to e-mail your questions. Dr. Lieberman may be able
to provide some insight or direct you to a neurologist in your area.
My very best regards to you and your mother,
Kathrynne
--
Kathrynne Holden, MS, RD
Author: "Eat well, stay well with Parkinson's disease"
"Constipation and Parkinson's" -- audiocassette & guidebook
"Guidelines for Medical Nutrition Therapy for Parkinson's disease"
& Risk Assessment Tools
"Risk for malnutrition and bone fracture in Parkinson's disease,"
J Nutr Elderly. V18:3;1999.
http://www.nutritionucanlivewith.com/
