Thank you for sharing your expertise here. My Q is re my mom: 81YO, 115#, 5'6", unexplained weight loss 15# in past 5 mos. She can stand with help, doesn't walk, comlains 2-3 X/wk of pain, primarily of back and hip. Diagnoses of PD, mid-stage Lewy Body Dementia, osteoarthritis, and severe chronic constipation, which has been progressive for years. Slow colon transit time, no bowel obstruction noted on CT, labs WNL, no other significant health issues. Meds are 8 mg Razadyne bid, 81 mg aspirin daily, 200 mg Provigil daily, 17 gm Miralax tid, and tylenol PRN (averages 3 tabs/week). 1200 - 1500 cal intake daily, adequate hydration. We rely on Ensure and soy milk for sufficient calories and nutrition. Constipation and related painful gas cramps no longer respond to any standard treatment, only to enemas. The constipation/enema cycle is very fatiguing, which affects her quality of life.
My former personal physician was a DO, but he has retired. While she has dementia, her cognitive skills are sufficiently intact that she refuses to see anyone but her own long-term MD. He is open to discussion of care options.
My primary concern is the debilitating constipation.While I know you cannot diagnose or prescribe for mom, I would appreciate your thoughts on cases such as this. Again, many thanks.
Lin
ANSWER: Hi Lin, I'm very sorry to hear that your mom is not doing very well. As I'm sure you know, it is possible the Razadyne could be contributing to the constipation (often causes diarrhea but constipation is a possibility). But if her dementia is adequately controlled one has to weigh benefits vs risk. One possibility is atonic colon where the large intestine gives up and doesn't squeeze anymore. Without knowing your mom I can't give specific recommendations, but usually walking is helpful (which she can't do), in some people abdominal massage around in a clockwise manner can help, eating some fiber filled or bulking agents could help, probiotics (good bacteria eg yogurt etc) could be of assistance. But as you know, without knowing your mom I can't make any recommendations for her particular case. I wish you both the best health possible. Tom
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QUESTION: Dear Doctor,
Thank you so much for the prompt reply and your attentive tone. Both are meaningful. I would like to ask a follow-up question or two, please.
Razadyne does help mom's dementia, so I do want to continue it. I failed to mention in my first message that she takes a probiotic daily. My sense is her constipation stems from the PD, as it's been progressive for so long. Does osteopathy treat constipation in other "alternative" ways in addition to your suggestions? And, "in general," what does it teach about the use of enemas; e.g., is one sort preferred over others, etc.
I do understand fully you cannot prescribe for my mom, but will appreciate your sharing any other thoughts from your training. Finally, are there specific osteopathic-specific websites available to health care consumers?
Thank you, again, for your assistance. I'm grateful.
Lin
Answer Ok, as far as osteopathy is concerned, yes there are some things that can be done to help her, and some home abdominal massage (around in clockwise manner) etc that could be taught to you and her to keep the intestines moving as much as possible. Enhancing the parasympathetic nervous system helps the intestinal motility. Good luck. Tom
