Atkins Constipation

[robyn]

The nursing home is - I'm sure - doing its best - considering the realities of dealing with 200 patients in a skilled nursing facility

His physician should be able to refer you to a nutritionist. Is there a nutritionist on board? Why should he be suffering from constipation? What else besides meat and cheese are included in all his meals at this facility? Can he eat whole grains in the form of breads? Salads? Does he like these foods? Does he chose his own meals from a menu? Lots of unanswered questions here....

They have everything at this nursing home except a GI specialist and an 18 hole golf course (they do however have a 3 hole putting green ).

He does eat bread (including whole grain) and salad. There's a fixed menu at all meals - but people can get things like sandwiches or salads if they don't like what's on the menu. Certain residents are - to say the least - somewhat peculiar. Like there's one lady who'll only eat bologna sandwiches for dinner. Before you all scream that the nursing home isn't doing its job - it really is. It has a philosophy that its residents who don't have serious dementia are competent adults - not children. And they have every right to eat in their end of life home - the nursing home - the way they would eat anyplace else (as long as they comply with the dietary laws). Its job isn't to prolong life at any expense. It's to make the last years of its residents' lives - however many - a dignified and pleasant experience.

As for constipation - I think that just comes with the territory of being old - fairly inactive - not being able to drink too much fluid - and suffering from diverticular disease (just about everyone over 80 in the US has it to some degree). Robyn

[robyn]

What's the problem with water consumption for congestive heart failure patients?

Just to add to what Mudpuppie said - one area the fluid can build up is the lungs. When someone is having an acute attack of congestive heart failure - it feels like you're drowning (which basically - you are - because of the fluid in your lungs). The fluid retention is also apparent in other areas when CHF isn't under control - like the ankles (some people wind up with ankles that look like tree trunks). Robyn

[mpav]

Can he eat nuts? Almonds or peanuts seem to be effectuve. Beer. Olive oil.

[robyn]

Even though he's not Jewish -

I guess I am confused at all the dietary restrictions? Stupid question maybe...but... Why must he adhere to dietary rules in the facility when he is not Jewish? It seems that his health is being compromised and now with the holidays coming...it's being further stressed?

To make a long story short - this facility was established in North Florida almost 60 years ago as a place where Jews from north Florida and south Georgia could spend the last years of their lives observing Jewish law. These days - a non-profit like this one can't and doesn't discriminate against anyone in terms of admissions. But everyone who decides to live there must follow the rules. A little over a third of the residents there now aren't Jewish. They choose to live in this place because it's simply one of the best skilled nursing facilities in the US.

Also - to make things clearer - people can be Kosher (i.e., they follow Jewish dietary laws) - and kitchens can be Kosher (i.e., food prepared in them complies with Jewish dietary requirements). The kitchen in this place is a Kosher kitchen. E.g., it has completely separate kitchens to prepare meat dishes and dairy dishes - only Kosher foods can be used in the kitchens - etc. People who live in this place must therefore eat Kosher. Note that there are certain dietary dispensations in Jewish law for the elderly - but violating the Kosher rules isn't one of them.

Anyway - no one forces anyone to live here. So it's a personal choice. And there is a very long waiting list due to the overall quality of the facility. Robyn

[robyn]

Has he started any new medications? Sometimes meds will exacerbate or cause constipation. Just a thought...

I don't think so - but we'll go over the (extensive) list with the doctor. Thanks for the idea. Robyn

[robyn]

I take a diuretic to prevent high blood pressure and have been encouraged to drink plenty of water, but that's clearly a different situation. Congestive heart failure seems like a very painful condition. I'm wondering what the minimum amount of water per day necessary to survive for weeks or months would be.

I don't know what the absolute minimum is - but my FIL is restricted to 1.2 liters a day. That's everything - water - coffee - juice - soup (assuming he can eat it because of the salt) - even ice cream (which is basically a liquid). He seems to do fine - except we try not to take him out for extended periods in the summer heat in Florida where you can sweat a lot just doing nothing. Robyn

[robyn]

I was on constipating medicines for years after being in a car accident. Personally, prunes never worked for me.

High fiber bread always did. Nature's Own Whole Wheat is available in the groceries around where I live and has 3g per slice. A type I get from a local bakery has more like 5g. A couple of pieces a day should help.

As far as medicines, the best stool softener on the market is Senokot (Colace is also good.) There is a type of Senokot that has both drugs in it, I believe.

Good luck,

SML

He is on a stool softener. I will mention these names to the GI doc and ask which one he thinks would work best. Thanks. Robyn

[robyn]

I have a sister who is a nurse in a nursing home, and from what she says, dried fruit + very little water = much worse constipation.  The fruit swells, absorbing any fluid available, and further blocks the intestines.  I'm probably not explaining it medically correct, but you get my drift -- no dried fruit without plenty of water, and since that's not possible, don't do the prunes!

Good luck--I remember my mother had this problem, and she was prescribed heavy duty laxatives by her doctor after she ended up in the hospital.  It got better over the course of several weeks.

Now that's interesting - hadn't thought of that. We started bringing him prunes about the same time he was forced into a wheel chair - so it will be hard to untangle what's responsible for what. But it's worth a try just to stop the prunes for a week or so. Just have him stick to fresh fruit - which he hasn't been eating a lot of - winter is a bad time for fresh fruit - except maybe pears (he doesn't like to eat fresh fruit if it doesn't taste so good). Perhaps less fresh fruit - and more dried fruit - could have changed the situation from a minor to a major problem. Will ask the doc.

My FIL got a major dose of laxatives yesterday - and they did give him some temporary relief. But it would be nice to get his problem back to minor nuisance. Guess I'm not the only person with elderly relatives who has this problem (think I knew that). But I appreciate your sharing your experiences with me. Thanks. Robyn

[robyn]

There's no reason why anyone's constipation problems would be worse over Passover...

Given your father-in-law's multiple health problems and your statement that the facility's doctor has already tried all the remedies at his disposal -- which I assume include the various over-the-counter options, like Metamucil -- I'd suggest that you'd be much better off taking him to a good GI than trying to get advice online.

Good luck with it.

The Passover stuff is just what some staff at the nursing home told us. I tend to agree with you that it doesn't make a whole lot of sense. On the other hand - perhaps they have problems with residents like the lady who insists on her daily bologna sandwich.

I agree 100% about the doctor. I am just getting some ideas we can toss around with him during our discussion. Haven't mentioned even half of the health problems (e.g., my father-in-law also has cancer - and an implantable cardiac defibrillator due to other heart problems). My husband and I have a fair amount of medical knowledge - but it's even hard for us to keep the history straight (much less have opinions about what to do about problems as they arise). And he's only 1 of our 3 surviving parents (the other 2 are similar in that they have extensive medical histories). Think everyone who has elderly parents should be forced to go to medical school! Robyn

[foodie52]

Flax oil is helpful, I think. I mix a tablespoon of it into oatmeal every morning. You could do oatbran cereal with flax oil.

All to best to your father in law. My mother in law is in a nursing home here in Texas and we try to make life as comfortable for her as you are doing for your father in law. He is blessed to have you.

[helenjp]

Just a thought...is the constipation in any way related to the inability to walk?

My mother-in-law was hospitalized a few months ago with a blockage in the intestine. Just a lump of food residue, basically. She has chronic, bad constipation, and basically, her intestines have just stopped pushing and shoving the food through, and the constipation has stretched the intestines, making it easy for food to pile up too...

We were told that the usual remedies for constipation in the young and healthy were *not* recommended here...as her intestines are not "pulsating" any more, food with a lot of fiber will just worsen the blockage rather than move things along.

We were encouraged to keep her food soft, with a high water content, and get her to drink plenty of fluids as well. She is back to eating dry crackers and pickles as usual, but we try, we try...

Sounds as if a word with your father in law's doctor and the nutrition staff of the nursing home could be helpful...

[tsquare]

If you are interested in a non-traditional option, look into F.O.S. You can get this in Stevia Plus packages - "Don't sweeten your coffee, supplement it." Here's a link to some info:

F.O.S.

I use Sweet Leaf Company Stevia Plus - started as a sweetener and immune system enhancer when I was getting sick too much. Didn't actually realize the fiber connection to later - seems to be very mild, but effective.

[dumpling]

Wish you well with FIL, Robyn

My dad has a rare disease that has forced him into a wheelchair too. He has always had a problem with constipation. My mother has congestive heart failure since 1991. I help take care of them.

My dad takes Miralax and Dulcolax, Sunsweet prunes(that we order from the company). He is not fluid restricted however and drinks a lot. My mother doesn't restict her fluids but she also doesn't take a lot- 1 coffee, some milk on cereal, maybe some soup and an herb tea. She does however have two cups of Chinese medicinal tea for her congestive heart failure. Within this tea are various herbs such as cornsilk which operates as a diuretic.

You might try some Chinese herbs if you have access to a Chinese doctor. Have kept my mother alive all this time when western doctors thought she was a goner.

And pursuant to your thought that all people with eldery sick parents should go to medical school, I have been studying Chinese medicine and am a Qi Gong Healer and instructor. There are various herbs he could take that might be helpful. If the problem is a stagnation problem which is likely you may try acupuncture or acupressure. There are various points that you can hit that might help.

He might also try some Qi Gong exercise that he can do from his wheelchair. I'm in process of developing a curriculum for the elderly to do some Qi Gong classes for seniors. Within that program I have adaptations for people in wheelchairs or who have limited mobility. These movements are wonderful for the whole body and particularly targeted to the internal organs. They've been used in various forms for hundreds of years in China and are very gentle.

Let me know what you think and I can give you further info if you need it.

[ophelie]

I have only had this problem once, while traveling overseas. I know that you said that fruit and water are a problem. However, perhaps the following might not be too much. Squeeze the juice of one half of a lemon into a cup of warm water and drink. It was a tribal remedy given to me and worked the one time I needed it.

-Ophelie

[ophelie]

I have only had this problem once, while traveling overseas. I know that you said that fruit and water are a problem. However, perhaps the following might not be too much. Squeeze the juice of one half of a lemon into a cup of warm water and drink. It was a tribal remedy given to me and worked the one time I needed it.

-Ophelie

[ExtraMSG]

Interestingly, when I went off carbs I found that I was less often constipated. As people have mentioned, things like bread, rice, and pasta actually have very little fiber and I think they end up turning into bricks in the intestines. Meats have fats, and aren't fats, such as mineral oil, often used as laxatives? I wouldn't say that a low-carb diet is necessarily good at making you regular, but I also wouldn't say it's likely to make you constipated either. Whether you're regular seems to depend on the amount of fiber. Personally, I eat a lot of green vegetables. Now if I eat some carbs such as pasta or rice I'm almost guaranteed to get constipated (man, what a thread to give a bunch of near-strangers way more intimate information than they could possibly want).

Metamucil is a nice product because it's not a laxative. It just makes you regular. If you're constipated it acts like a mild laxative. However, if you're ... whatever the opposite of constipated is ... it adds bulk and makes you more regular as well.

[tryska]

metamucil uses psyllium husks. they are water attractants. so what it does is give you fiber, which soaks up the water from your food in your small intestine and forms a large soft stool that then gets evacuated because it's large and err..in the way, i guess.

i definitely stand by psyllium as the best way to get bowels moving, specifically because ti doesn't work as a laxative, it's softens stool and gives it volume. hell i trusted it enough to go cross-species with it. *lol*

i started using it when i was on a true ketogenic diet that limited all carbs including fibrous ones. it's good stuff.

[Mabelline]

Castor Oil. Cod liver oil. An enema. I'd be trying anything within the boundaries of interferring with the medical restrictions.

[tryska]

not all together, i hope mabelline. sounds like a recipe for a backside explosion.

[Mabelline]

[lamb]

Robyn,

My f-i-l was hospitalized for most of 2003 with congestive heart failure also. His main compliant was that he was constipated. Unfortunately, there are no easy answers to this because of the inability to consume liquids. What worked for him one week, seemed not to work the next. Sometimes too, he would get himself so worked up about it and it made the problem worse. Prunes were the most effective. Stewed, every other day or so, along with a softner was usually his best course of action. His dietician and physican worked well together to help him get through it.

Good luck to you and your family. It can be a difficult time. My thoughts are with you.

[tsquare]

how about acupuncture?

[robyn]

Can he eat nuts? Almonds or peanuts seem to be effectuve. Beer. Olive oil.

We take him out to eat at least once a week - frequently to a local microbrewery where he'll have a "small one". But we haven't been there in a couple of weeks. Hmmmm.....Guess where we'll be going next time we go out to eat dinner . Robyn

[robyn]

We'll have to check his drawers for partially eaten containers.

Oh dear. I read this so very much the wrong way the first time.

The nurses can look into his drawers - we'll check his drawers . Robyn

[robyn]

Just a thought...is the constipation in any way related to the inability to walk?

My mother-in-law was hospitalized a few months ago with a blockage in the intestine. Just a lump of food residue, basically. She has chronic, bad constipation, and basically, her intestines have just stopped pushing and shoving the food through, and the constipation has stretched the intestines, making it easy for food to pile up too...

We were told that the usual remedies for constipation in the young and healthy were *not* recommended here...as her intestines are not "pulsating" any more, food with a lot of fiber will just worsen the blockage rather than move things along.

We were encouraged to keep her food soft, with a high water content, and get her to drink plenty of fluids as well. She is back to eating dry crackers and pickles as usual, but we try, we try...

Sounds as if a word with your father in law's doctor and the nutrition staff of the nursing home could be helpful...

I'm sure the lack of exercise due to inability to walk isn't helping. My husband's favorite "keep regular" thing was running - and - when he had to give it up - it took him a while to find substitute activities that served the same purpose.

My FIL would kill to be able to eat a pickle (he can't because of the salt restrictions).

I think everyone is doing their best here (and I want to thank everyone for all of the ideas you've given us). As we can all see from this thread - this problem is far from uncommon in the infirm elderly. And there is - unfortunately - no "magic bullet". Robyn