AboutDr Alan Galbraith Expertise I can answer most questions on most drugs. Answers can be given in either technical or layperson terminology. My main areas of interest are psychiatric, gastrointestinal and cardiovascular drugs.
Experience I have been a university lecturer/head of department for almost thirty years, but am now retired. My research interests were alcohol, smoking and cardiovascular disease. I am already a well established and highly rated expert in the pharmacy section of this site.
Publications Principal author of "Fundamentals of Pharmacology" Editions 1-4 published between 1994 and 2004 by Pearson Education, Australia. Author of the 5th edition published 2007.
Author of many scientific papers.
Education/Credentials BSc(Hons);MSc;PhD;HECert
Awards and Honors The 4th edition of my textbook was awarded the the Educational Book of the Year Award in Australia.
Past/Present Clients See my profile in the pharmacy section.
You helped me recently with a question related to the use of Amitiza for my mom. Caucasian: 81YO; PD and LBD; doesn't walk - shuffles sideways several steps when transferring from bed to chair to toilet - otherwise bed or chair-bound; cognition still decent. Meds: baby aspirin daily; 8 mg Razadyne bid; Seroquel 12.5 mg hs, OTC vitamin.
No other significant physical issues, except chronic and severe constipation. We had run the gamut of treatments, and found only Miralax 3X/day with frequent enemas useful.
Lubiprostone is helping, although she needs manual assistance, as the muscular ability to evacuate the bowels seems impaired. She doesn't have complete BMs, and goes back and forth tothe toilet frequently until the rectal area is clear.
As she is quite sensitive to meds, we started Lubi a few weeks ago at 1 8mcg tab daily, increased to 2 daily, and have now added a third in the AM, while decreasing the amount of Miralax.
I do understand you can't prescribe here, but will pose two questions and will appreciate your thoughts/suggestions: 1) The new med seems to be causing significant gas cramps/pressure, which is painful. OTC meds don't help. Releasing the gas via tubing does, but is also uncomfortable and I'd guess not good as a routine measure. Finds the seated-on-toilet position somewhat helpful, butr going back and forth is exhausting. I hesitate to add yet another strong med. What might be useful to alleviate this painful flatulence? 2) Might adding a 4th Lubiprostone might help with the final "push" needed to fully evacuate the bowels? She is exhuasted with all this, making for restless nights and days spent napping. I will be grateful for your thoughts.
Many thanks for sharing your knowledge here.
Lin
ANSWER: Dear Lin
As you know I have no experience with lubiprostone but from my knowledge of it it may help top increase the dose with your prescribers permission. Another thought I have is to use the very old-fashioned liquid paraffin which may also ease the emptying of the rectum. It acts as a lubricant and if only taken at night it will not interfere with vitamin absorption as it is prone to do if used for prolonged daytime use. At you mom's age the very long term adverse effects should not be a problem.
Regards
Alan galbraith
---------- FOLLOW-UP ----------
QUESTION: Dear Dr. Galbraith,
Once again I say "thank you" for sharing your knowledge at this site. We will raise the dose of Amitiza. Meanwhile, two quick follow-up Qs, please: 1) Is liquid paraffin what in the US is labeled mineral oil? It's OTC here, andthe label says there is a risk of aspiration pneumonia for the debilitated and bedbound. I think I understand this, but wonder "in general" how to weigh the risk/benefits. Does the individual's ability to sit up when swallowing - and to swallow without difficulty - affect the decsion-making?
2) Mom continues to get gas pains, which I'm guessing are related to the cycle of constipation, laxatives and immobility. When mild, warm tea seems to help, but they are sometimes extremely painful. OTC meds such as simethicone, charcoal, etc. have no effect. Given her senstivity to meds, I hesitate to add more to the mix, but more than that want her to be comfortable. Any thoughts?
Again, deepest appreciation for your assistancew.
Lin
Answer Dear Lin
Yes, it is the same. It can cause aspiration pneumonia when used for a long time and in a recumbent position. Standing or sitting up while taking it helps avoid this. If your mom's swallowing reflex is OK and taken as said it is definitely worth a try. Long term use can also lead to fat soluble vitamin deficiencies so if it helps supplemental vitamin A and D could be taken but only if it helps and is used long term. It is not absorbed in the gut and works by lubricating the bowel walls making the expulsion of faeces much easier. In Australia it is available in a chocolate flavour which is more palatable than the straight oil.
Re the flatulence, there is nothing more that I can add to what you have already tried apart from the tea. I believe some herbal teas are also good, check in a natural therapies shop for brands.
