 |
 |
SJS-OnTheNet wrote: > My mother (late 80s) has had PD for perhaps 25 years, > > 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, Dear SJS-- The problem you describe, if I understand it correctly, is called "fecal impaction" and is not infrequent among older adults. Your mother's former neurologist was likely aware that bromocriptine (and other PD meds) can cause constipation, but, like many other specialists, dismissed constipation as a significant problem. As we age, "peristaltic motion" (the action of the intestines that moves matter through GI tract) begins to slow in many people. Older adults in general are therefore at greater risk of constipation. This can be counteracted by physical activity, which stimulates peristalsis, and by getting plenty of fluids, which softens the stool; also by a fiber-rich daily menu, which adds bulk to the stool. Unfortunately, many older adults cannot remain as active as they formerly were; and many get too little fluid and fiber. Add to this the PD meds, which often lead to constipation, followed at last by bromocriptine, and simple constipation may worsen. The intestinal movement slows; the stool remains in one place, and fluid is drawn out, leaving the stool dry and hard. At this point, even normal peristaltic movement might be too little to move the stool through the bowel. The intestine is blocked, as you say; and matter backs up, causing the distention you describe. Hospitalization, sometimes surgery, is necessary to relieve the impaction. The ensuing hospitalization frequently does cause further problems; it's not widely known, for instance, that women suffering from osteoporosis often die in the hospital from pneumonia, following a fractured hip. It's possible that similar problems occurred with your mother. I think the hospital probably treated your mother correctly with regard to nutrition, unless she received no hydration initially. She was probably put on a low-residue diet, so that minimal fecal matter would arrive at the colon. Her problems at the rehab facility could indeed be due to some damage to the colon, possibly to the nerve endings there. It sounds, though, as if they are taking the proper medicinal steps. Her doctors are no doubt weighing the possibility of laxative dependence against the likelihood of another episode of impaction. > (1) Could the Sinemet (even at the presently lower-than-pre-hospital-admission > dosage-level) be hindering her intestines from working properly? Possibly; Sinemet can lead to constipation. Her doctor may be hoping this new low dose will be less likely to effect constipation. But with her recent experience, it's possible that even a low dose may have this effect. > (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? Without her medical records, it would be difficult for healthcare professionals to offer recommendations. The facility should be monitoring her daily, keeping records of her food intake, medications used and their effectiveness, and bowel movements. It is possible, as you suggest, that her intestine has suffered damage that may or may not heal. Current care is to try to avoid long-term use of laxatives, and allow the intestine to regain former mobility. If your mother is able to walk, that may help stimulate the colon. I imagine the facility is encouraging her to drink plenty of fluids, but if you have any doubts you could encourage this yourself. A balanced daily menu with plenty of fiber is also very important, and should be standard at her facility. > I'm open to whatever reasonably may help, whether it's from standard > "Western medicine", or "alternative" medicine, and so on. While I cannot make recommendations on specific herbs, you might wish to read appropriate text from "The Honest Herbal" by Varro Tyler, Ph.D, or "Herbs that Heal" by Michael Weiner, Ph.D. My very best wishes for your mother's health. -- Kathrynne Holden, MS, RD Editor-in-Chief, "Spotlight on Food--nutrition news for people 60-plus" Tel: 970-493-6532 Fax: 970-493-6538 http://www.fortnet.org/~fivstar You may wish to contact: Better Business Bureau of the Mountain States, < [log in to unmask]> for further information.