Atkins Constipation

[robyn]

OK - I admit it - I got your attention by a cheap marketing ploy - using the Atkins name to get you to read this.

But I have a problem - my father-in-law. In a nursing home. He has recently basically lost his ability to walk - which means he doesn't get much exercise. And his diet is glatt kosher. It's not quite Atkins - but it's heavy on meat and fat (there's one "meat meal" a day - one "dairy" meal - which frequently is cheese based). Even though he's not Jewish - this is very similar to the kind of diet he ate most of his life - lots of meat - not much in the way of fresh fruit/veggies - etc. Anyway - like a lot of elderly people - he has wound up with a massive case of constipation. Won't bore you with the ugly medical details. The lack of physical activity was probably the straw that broke the camel's back.

Now this is apparently a problem that plagues a large % of the US population judging from the TV commercials I see. It also appears to be a side effect of the Atkins diet. And - although I have certain health problems (who doesn't) - this isn't one I with which I'm personally familiar.

So do any of you have ideas based on personal or family or professional experience about ways to deal with this in terms of diet - or drugs - or exercise you can do if you're in a wheelchair (particularly the diet area because I suspect that's the easiest). The nursing home is - I'm sure - doing its best - considering the realities of dealing with 200 patients in a skilled nursing facility. But what I'm looking for is a couple of easy things we might try to help. Bran? Metamucil? I don't know (I'm not familiar with these things). Note that most foods are kosher - so we can probably try just about anything except stuff like shrimp cocktail and sausage gumbo .

Also note that we have an added complication. He has congestive heart failure. So he's fluid restricted. Those 8 glasses of water a day that are supposed to help - he can't drink them.

We have a GI appointment this week - and I'd like to go to the appointment armed with some decent ideas (I'm sure the doctor will have some ideas too). Robyn

[Pickles]

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....

[Pan]

I find prunes helpful. Is there any reason why he shouldn't eat some?

[jcsaucey]

Seaweed in a fruit smoothie is my cup of regularity.

[Katherine]

If he, like me, has a non-working gall bladder, then a tablespoon of olive oil will do it.

[Mabelline]

Prunes. I know,I know, sounds corny, but they work with minimal complication. Seeing as how he's restricted on his fluids, I'd really consult the GI Doc, because the fibers and psyllium require a certain amount of fluids. Otherwise I would suggest strong lemon juice with salt in it (works in 1/2 an hour, but of course the acid and the salt are probably both bad). So you need to get the doctor to order up his medically determined cure.

But surely, robyn, the facility has this problem in abundance, wouldn't you think? Or do they refrain from anything until doctor-ordered? Then there's always that teeny little 'thunder' pill the hospital gives you before an operation. Good luck to you with your FIL.

Edit because GI's do not give very good answers.

Edited February 23, 2004 by Mabelline (log)

[robyn]

Prunes. I know,I know, sounds corny, but they work with minimal complication. Seeing as how he's restricted on his fluids, I'd really consult the GI, because the fibers and psyllium require a certain amount of fluids. Otherwise I would suggest strong lemon juice with salt in it (works in 1/2 an hour, but of course the acid and the salt are probably both bad). So you need to get the doctor to order up his medically determined cure.

But surely, robyn, the facility has this problem in abundance, wouldn't you think? Or do they refrain from anything until doctor-ordered? Then there's always that teeny little 'thunder' pill the hospital gives you before an operation. Good luck to you with your FIL.

We have tried the prunes (we bring him the little cans of the high end Sunsweet prunes). He says he's eating them. Sometimes I wonder. We'll have to check his drawers for partially eaten containers.

Salt is a no-no for the congestive heart failure. Sometimes I think that the lack of water to get everything moving is the biggest problem.

And yes - this facility has problems with almost everyone. And it does have a doctor in house (internist). He's there 5 days a week - 9/5 - University of Florida medical school. And he has already done what he thinks he can do. That's why we set up a GI consult.

I'd like to get this in somewhat manageable mode before Passover in April. That's when all the bread and related food products disappear for 8 days. We understand from last year (which was our first year) - that it is pure hell on the nursing staff. Because if 50% of the patients usually have constipation problems - it goes up to 100% at Passover. And whoever has problems - well they are worse at Passover.

So keep the ideas coming. I feel sorry for the poor old guy. Robyn

[robyn]

Seaweed in a fruit smoothie is my cup of regularity.

What kind of fruit do you use? Note that I can bring anything to the nursing home. If it's "tref" (not Kosher) - we can eat it outside on the patio. Robyn

[redfox]

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.

[Mabelline]

Ah,jeez, I nearly fell out of the chair laughing, redfox!

[Pan]

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

[Pickles]

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?

[Mudpuppie]

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

My grandmother has CHF also. (Sorry, no advice on the problem at hand.)

Congestive heart failure is the heart's inability to pump fluids away from the vital organs. Diuretics are regularly prescribed to help solve the problem -- i.e., ridding the body of fluids that the heart isn't able to handle. Therefore, excess consumption of liquids only exacerbates the problem.

[Pan]

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?

You can't bring treyfe (unkosher) food into a kosher restaurant, because that violates kashrut laws. So the same conditions would obtain in this nursing home. The same is true of Islamic halal laws, by the way.

Good luck to your grandma, Amanda.

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.

Edited February 23, 2004 by Pan (log)

[Toliver]

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

[Pickles]

I'm wondering what the minimum amount of water per day necessary to survive for weeks or months would be.

People are over saturating themselves with water. A person doesn't have to be constantly sucking on, and/or unscrewing the cap from and drinking from, a bottle of water to be a healthy person. GAH!! You get plenty (of moisture) from your foods. IF you eat "normally." I see celebs on interviews with their baby bottles filled with water and I want to slap 'em! It's so annoying--the cap off....slurp...the cap back on....the cap off...slurp...cap back on. Drinking water has become a damned nervous habit!

Edited February 23, 2004 by Pickles (log)

[sml311]

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

[beans]

People are over saturating themselves with water. A person doesn't have to be constantly sucking on, and/or unscrewing the cap from and drinking from, a bottle of water to be a healthy person. GAH!! You get plenty (of moisture) from your foods. IF you eat "normally." I see celebs on interviews with their baby bottles filled with water and I want to slap 'em! It's so annoying--the cap off....slurp...the cap back on....the cap off...slurp...cap back on. Drinking water has become a damned nervous habit!

?

I kinda enjoy the target of the USDA 8 servings a day recommendation (I think that is the right amount, but I forgot the amount of ounces). It does do wonders for your skin.

But to reduce another's conscientious, healthful choices as annoying?

[tryska]

psyllium husks.

(the same fiber that's in metamucil - minus the flavoring)

i suppose you can use metamucil too. either way it adds bulk to the stool, which should increase bowel motility. make sure he drinks lots of wqater, to help the psyllium bulk up.

prune juice works too, but at least from my experience more like a laxative.

i've actually just had a recent experience with one of my cats, of all things, having a constipation problem. the vet gave him stool softeners, and sure it made his bms softer, but did nothign for volume, so he stayed constipated. i add psyllium husks to his canned food, and now he's got smooth moves every day. and his coat has gotten much better.

in any case i would suggest psyllium husk fiber, before going the prune juice route. or perhaps psyllium fiber with water at night - and then prune juice in the morning, so that it really cleans him out that first time.

[tryska]

ah - just read about the restricted fluid intake. well my cat doesn't drink a whole lot of water either, so he apparently gets the fluids from the food (why i mixed it with canned food in the first place) and either way it works. you don't have to drink any more lfuids than normal for it too work, but he must be getting some sort of fluids in his diet which the psyllium will work with.

[zennenn]

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.

[Pickles]

People are over saturating themselves with water.  A person doesn't have to be constantly sucking on, and/or unscrewing the cap from and drinking from, a bottle of water to be a healthy person.  GAH!!    You get plenty (of moisture) from your foods.  IF you eat "normally."  I see celebs on interviews with their baby bottles filled with water and I want to slap 'em!  It's so annoying--the cap off....slurp...the cap back on....the cap off...slurp...cap back on.  Drinking water has become a damned nervous habit! 

?

I kinda enjoy the target of the USDA 8 servings a day recommendation (I think that is the right amount, but I forgot the amount of ounces). It does do wonders for your skin.

But to reduce another's conscientious, healthful choices as annoying?

If you look at my post, you will see that I said the *constant on and off with the cap on the bottle* is annoying-- not their decision to guzzle water all day. People can do what they please when it comes to drinking water, I personally know it's uncessary to overload the body with it.

[Comfort Me]

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?

Just want to point out that it is not the dietary laws which are the problem. Kashrut can be just as healthy as any diet. But, as with any dietary regime, it can be poorly planned, also. I would seriously consult another physician and nutritionist. Most nursing homes have a nutritionist -- if not, they should still be able to accomodate a special diet. They are a nursing home, nu?

Are stool softeners contraindicated in patients with CHF?

I'm a dried fruit guy -- I love it. My problem is I've never been constipated a day in my life. So I have to limit my apricots and prunes (which I can eat like popcorn) or I can be assured of a nasty reaction.

And the reason Mudpuppie's dad is required to abide by kashrut inside the building, even though he is not Jewish, is because it is probably a requirement for residence. It is a kosher establishment, and anyone living in must follow kashrut inside the building. Non-Jewish children in the Jewish Day School nursery school my son attended had to bring kosher dairy lunches.

[jo-mel]

After his doctors get him out of the present pickle, he should try eating a bowl of old-fashioned oatmeal for breakfast (not instant or 1-minute), an apple during the afternoon and some metamucil once a day. That only requires one glass of water.

Constant constipation medication isn't good --- only makes the problem worse.

[mags]

I'd like to get this in somewhat manageable mode before Passover in April. That's when all the bread and related food products disappear for 8 days. We understand from last year (which was our first year) - that it is pure hell on the nursing staff. Because if 50% of the patients usually have constipation problems - it goes up to 100% at Passover. And whoever has problems - well they are worse at Passover.

Robyn,

There's no reason why anyone's constipation problems would be worse over Passover. A slice of white bread has less than 1 gram of fiber, and a piece of matzoh -- which will most likely replace the bread on your father-in-law's menu -- has about the same amount. While rice, corn and pasta will (most likely) also be absent during Passover, they, too, are almost entirely lacking in fiber. An apple, by contrast, has about 6 grams. Also, for what it's worth, there's no reason why a glatt Kosher establishment would provide a diet lower in fruits and vegetables than any other kind of nursing home: "meat" and "dairy" meals don't mean that meat and dairy are the only things that are served; the "meat" and "dairy" monikers simply describe the nature of the protein involved. Vegetables, fruits, and grains (except during Passover) make as much of an appearance as they would on any non-Kosher table.

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.