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>>> Posting number 56776 Date: Sat, 20 Feb 1999 12:26:22 -0500 From: janet paterson <[log in to unmask]> Subject: Re-post: Constipation Protocol ----------------------------------------------- Date: 04/08/97 16:06 From: Camilla Flintermann Subj: Constipation Protocol ----------------------------------------------- Several have asked recently about dealing with constipation - while we know that NOTHING works ALL the TIME for EVERYONE, this may be helpful. ----------------------------------------------- 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 =3D 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. ----------------------------------------------- 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 ----------------------------------------------- 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=20 (repeat in 2 hours if necessary) ----------------------------------------------- 3. If no results are achieved by the third day, give: - BISACODYL (DULCOLAX) : One 10 mg Suppository before Breakfast ----------------------------------------------- 4. If no results are achieved by the fourth day, give: - MAGNESIUM CITRATE (CITRATE OF MAGNESIA) : 5-10 oz. at Bedtime --------------------------------------------------- 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. --------------------------------------------------- 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. ----------------------------------------------- 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. ----------------------------------------------- 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.). ----------------------------------------------- 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. ----------------------------------------------- janet paterson 52 now / 41 dx / 37 onset 613 256 8340 po box 171 almonte ontario canada K0A 1A0 a new voice: <http://www.geocities.com/SoHo/Village/6263/> <[log in to unmask]>