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83 year old mom eats mass food, but hardly drinks fluids for years due to incontinence issues (possibly from a botched surgery for cancer 20+ years back or may also be related to parkinsons) to avoid peeing diaper initially started by herself and then get worse from my dad telling her not to drink as he was getting sick of dealing with her diapers and the smell.
Now she has a fractured hip and had a blood clot so her exercise which was walking a mile a day, sometimes more, plus light senior workout 4x a week has gone done to 0 and she now has impacted poop which causes her pain. I am lucky if she is drinking 12 oz of water a day.
She had another stroke and now barely speaks but seems she can understand quite a bit and catch her reading a lot of things so unclear if intentional not talking or some type of aphasia that really fluctuates from minute to minute.
I am trying to understand how to manage the situation as extracting poop situation will be tiring weekly and worried this can damage her rectum. I have tried all kinds of fluids - water, various nummy juices, ensure, herbal teas etc. I started to give her a bit more soup and making more stews, continued oatmeal, not sure what else to do.
Since she is eating so heartily it seems she may want to live or wouldn't she stop eating and the non-drinking has been a chronic condition going on for 10-20 years now.
I am not sure how to deal with this. I tried some stool softeners they gave us at hospital discharge after the stroke and that is what hospice is advising and she complained some were bitter when I ground them, I did test them myself and yes even the tiny little drop I had on my finger was very bitter. However even with having some of these, I was reading that some of these don't work without drinking enough water and some things like senna can actually cause constipation to be worse if not enough fluids.
Exercise has always been a great way to ensure she had bowel movements but now this is no longer possible until I can even figure out how to deal with her leg which I just found out 3 days ago has a severe hip fracture - I thought she only had a severe blood clot from groin to foot diagnosed mid July and actually gone early August after being on blood thinner a few weeks - and had been rehabbing her waiting for her insurance to kick in (as she had to switch insurance due to move) and was on the wait list to start pt next week. I thought the blood clot was what was preventing her from walking as when I picked her up her leg was double the size of the other one and i thought the edema was causing the pain and reason she didn't want to walk. Now I am on waitlist trying to get into an orthopedist..

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An ER doc suggested we try polypropelyne glycol 3350 (PEG), (Miralax, but generics are much less expensive and work just as well), it was a real game changer for us and is gentle enough to use every day.
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corinb Sep 9, 2024
oops I thought I replied to your response, but seems I replied to the overall post, so please see my response above:-(
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Have you tried to incorporate prunes into her diet? Chopped and added to the oatmeal perhaps? Regularly massaging the abdomen will also help stimulate the bowels. Maybe offer small amounts of water more frequently. Does she have difficulty swallowing? A straw would make drinking water easier or a thickener added to the water.
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corinb Sep 9, 2024
I just did buy wet prunes today. Thought these may be better than dry and trying to soak but haven't given them to her yet. We do regularly massage the bowels and try to offer water and multitudes of liquids. She sometimes will drink a small bit, but mostly she rejects. I think she has some difficultly swallowing, she is slow to swallow but passed the swallow study in the hospital. She had a prior hospital visit in Dec and one week in rehab where she had a cold and she wasn't moved the entire time in the hospital and even though she was walking 1+ mile before she went in, she couldn't walk at all when she came out. There were multiple days of skipped meds from what I understand from my sister who was with her as she quickly had swallow problems and took a while to have her meds switched to ones that could be crushed. When she came out I had to puree foods for at least a week and add thickit to her water/juices/tea which also created a challenge as that made her even want to drink less as she kept complaining about the stuff in the water. I finally got her off all this and was able to rehab her to walking before I left and in a few weeks she was walking quite quickly with assistance and now we are back to where we were after last hospital visit, unable to walk or stand on own, but with better swallowing/eating but now with fractured hip and even more cognitive decline. We've gone back and forth with a straw to see if it helps and she just had her first speech therapy last week and the lady advised not to currently use a straw.
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Have you tried an enema yet? Perhaps that may help.
You also mention hospice in your post. If your mother is under hospice care and on narcotic pain medication, they can order Relistor for her which is given in shot form in the arm for constipation, and it usually kicks in in about 15-20 minutes. And it will clean her out really well.
But the fact that you mention getting your mother in to an orthopedist at the end of your post, leads me to believe that perhaps she's not under hospice care, so just try the enema.
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corinb Sep 9, 2024
it seems there are different levels of hospice and she is under hospice care, but we are still trying to determine her status. She was admitted to hospice initially as her insurance/case worker at hospital/Good Sams couldn't figure out how to setup a single case agreement out of state for SNF at Good Sams that had been bought out by another facility. The only option was to put her on hospice until her new insurance would kick in and we are trying to understand what her true state is. As I mentioned she is eating a lot of food still but has some definite cognitive issues from the stroke(s), prior DVT and now also discovered a fractured hip that may have occurred late May. The hip was surprising as my dad and sister had her into the hospital for all major falls, particularly if any bleeding and none of those showed any fractures and then a more minor fall where they didn't think anything had occurred may have caused this latest fracture that potentially caused the DVT either from the injury itself or combination of not walking following shortly thereafter. I will need to read up on Relistor and ask hospice about this. Today was not a great day, her bp went way up and temp was up possibly as she was way dehydrated. I called hospice but no one was available for some time, but got some fluids in her and a popsicle and then things started to subside and subsequently also gave a half a losartan and then she ate dinner.

We did give her an enema yesterday followed by two warm water enemas since the purchased saline fleet enema was small. We got some stool out and once again had to manually extract the past two days.

I gave her more magnesium citrate today and her belly is now way bloated again and she doesn't seem to be doing that well but the bp went down quite a bit as well as temperature. I am hoping tomorrow will be a better day. She actually talked quite a bit more today, even though earlier the talk was about strange topics that did not make sense.

Tomorrow we get a follow-up CT from the stroke to see about continued bleeding/swelling etc and to determine what we need to do for anti-coag DVT (it was fully cleared 8/5 but could recur as she is not currently standing or walking) as currently just on a bit of aspirin.
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I'm coming back to add that my mom was laxative dependent for most of her life so regulating her bowels was a never ending nightmare for us, for her it was a challenge to keep things loose without having to resort to extremes. The advice about laxatives causing blockages only applies to bulking agents like psyllium husk (Metamucil), other laxative work differently. If she can't swallow pills there are many liquid laxatives; milk of magnesia or special teas for example. You are likely going to get lots of advice about foods that people have found helpful but they can only go so far, focus more on adding lots of fruits and vegetables plus smaller amounts of fluids more often. If she has difficulty swallowing has anyone suggested she try thickening her drinks?
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corinb Sep 9, 2024
someone did suggest thickener in earlier, but when we used this previously after a prior hospital visit where she was having problems swallowing due to reduced parkinsons meds, she really complained about the thickener as she didn't like it and started to drink even less at this point. I then left and my sister continued to monitor may dad working with her, but not sure if her drinking went back up to normal or this is when the even more reduced drinking may have started. She used to drink possibly more tea, but it is hard to tell as many times she didn't finish a cup and it was thrown out or went in the fridge so it is hard to tell how much she was truly drinking then vs now at my place. I did try a smooth move tea several times and it seemed she hardly drank any of it even though it was peppermint and she used to like peppermint and chamomile. Today I made some type of vanilla honey chamomile tea. I even started to add honey a few weeks back as she was complaining the tea was bitter (that may have been the smooth move or different brand of peppermint) as she used to primarily drink the tea without honey.
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which generics are you using - I started the 3350 a few days ago that we got in the hospital, but was just giving her a small amount at a time as did read it could be addictive and didn't want to end up with a huge diarrhea mess to clean up. I did give it once before a slightly larger portion (that may have been a third packet) and did have a smaller amount of diarrhea on her commode and a larger amount on the floor which almost seeped in between the hardwood planks which was concerning.

She has slightly elevated kidney values (possibly stage 3) and may have prediabetes for some time based on her A1C and we reduced sugar a year ago but now are giving her whatever. I was slightly worried about this being a large sugar molecule but I liked that this one didn't seem to add any bitter taste and was going down at least somewhat undetected/or at least not to the point where she was saying it was terrible or bitter but sometimes still cringes her face.

I then was also a bit worried if I needed to separate out her parkinsons pills as sometimes I was giving her the parkinsons pills with the applesauce or yogurt and then adding the 3350. I then thought maybe this is a bad idea as possibly she may not be absorbing the full dose of her meds if fed in conjunction? I then was also worried about less nutrient absorption if she is having this in small amounts throughout the day as heard this is similar to lactolose and was told you can't give this long term as then you can't absorb all the nutrients from food?
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cwillie Sep 10, 2024
I think you are overthinking this, it doesn't need to be so complicated. Talk to your pharmacist about any concerns you have about medication conflicts, that's literally what they went to school for.
One lesson I learned too late was to not go overboard and micromanage everything, I drove myself crazy (and no doubt mom as well) and when mom ended up in the nursing home she did just fine without any of the things I had been obsessing about.
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They make glycerin suppositories for constipation, too. May be more acceptable for her to try before going to an enema?
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Colace or other stool softeners. Oil retention enema (use only 1/2 of it) as needed; diapers for this as it is leaky mess for long time, but needed to ease out the stool.

Do not use fiber laxatives such as citrucel or metamucil because without enough fluid they clog things up with gelatinous mass that will not move.

I think there are many things going on here in terms of whole body generalized breakdown of many systems. This is a matter of addressing issues best you can understanding that things are getting worse, and unlikely to improve greatly as system after system is under barrages of problems. I am so sorry.
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corinb Sep 11, 2024
How do you know if there is a gelatinous mess that won't move? Her stomach is so bloated. I normally have a bit of fiber mix I put in pancakes or oatmeal for myself that consists of golden flax, chia and small amounts of acacia fiber is this bad?

I am trying to determine what the bloating is coming from if it is from the powdered magnesium citrate, that may be what is easiest to get down her but worried it causes the most bloating?

TO'Day I thought I'd try another gel cap stool softener but typically we grind meds now as otherwise she tends to spit them out or get stuck in her mouth. I think this was bad idea as then there was coughing 30 min after putting her to bed as she may have had pill in mouth and then started choking, had to get her up give some water and a popsicle, it was a bit better but the few words she spoke sounded very raspy.
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Do you think that your mother may enjoy these, to get a bit of liquid down? :

https://www.jellydrops.us
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corinb,

You mention bloating. This could now be an obstructed bowel which is an emergency situation. If she is not passing gas it is time to call EMS for transport to the ER. I do not know if you listen or can hear bowel sounds with a stethoscope? But I would suggest urgent care or ER today. EMS will get her into a cubicle at once for assessment. Elder's bowels are fragile. Don't delay.
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Anxietynacy Sep 11, 2024
Alva, I have a friend that was telling us of a story about his cancer. That he was constipated from meds.

Then got really sick, couldnt stop throwing up. Went to the ER, still throwing up. Then the nurses noticed he was throwing up fesices, is this possible?? Or was he telling stories
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