----------------------------------------------------------- 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 * * * * * * * * * * * * * * * * * * Ask me about the CARE list for* * Parkinson's caregivers ! * * * * * * * * * * * * * * * * * *