December 11th, 2011 by KennyLinMD in Health Tips, Research
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Family physicians who care for terminally ill patients must manage a wide range of bothersome symptoms, including pain, fatigue, dyspnea, delirium, and constipation. According to a Cochrane for Clinicians article in the December 1st issue of American Family Physician, constipation affects up to half of all patients receiving palliative care and nearly 9 in 10 palliative care patients who use opioid medications for pain. Unfortunately, a Cochrane systematic review found limited evidence on the effectiveness of laxatives in these patients, as Dr. William Cayley Jr. comments:
“For patients with constipation, especially those with opioid-induced constipation, there is insufficient evidence to recommend one laxative over another. The choice of laxatives should be based on past patient experience, tolerability, and adverse effects. Methylnaltrexone is a newer agent that may be useful especially for patients with opioid-induced constipation that has not responded to standard laxatives, but there is limited evidence of potential adverse effects. Therefore, judicious use preceded by a discussion with patients about known risks and benefits is warranted.”
The Cochrane Library recently discussed this review in its Journal Club feature, which includes open access to the full text of the review, a podcast by the authors, discussion points, and a Powerpoint slide presentation of the review’s main findings.
Additional resources for physicians and patients on advanced directives, hospice care, and ethical issues are available in the AFP By Topic collection on End-of-Life Care.
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The above post was first published on the AFP Community Blog.
*This blog post was originally published at Common Sense Family Doctor*
August 7th, 2010 by Bryan Vartabedian, M.D. in Better Health Network, Health Tips, Humor
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This “Fletchers Castoria” ad from 1941 is priceless. And as someone who spends his days working with bound-up grumps like Mary, I was reassured to know that horrific constipation is not a me-generation problem born of chicken fingers and Goldfish. ”Laxative tantrums,” however, are new to me. I seem to have pretty good luck with Miralax and Kristalose in my office. Your mileage (or tantrums) may vary.
*This blog post was originally published at 33 Charts*
April 6th, 2010 by DrRob in Better Health Network, Health Tips, Opinion
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April is “Embarrassing Subject Month” for my podcast. I am covering the following problems:
- Hemorrhoids
- Digestive problems (constipation/diarrhea)
- Urinary incontinence
- “Male problems”
It should be fun, and it will be promoted on iTunes, so it should drum up more subscribers and downloads.
But it begs the question: Why are certain conditions embarrassing to people? Why can people open up to me about so many personal things, yet be embarrassed to discuss hemorrhoids? Why is it easier to talk about your marriage falling apart than your urinary “accidents?” Why is diarrhea more embarrassing than vomiting? Read more »
*This blog post was originally published at Musings of a Distractible Mind*
January 8th, 2010 by Emergiblog in Better Health Network, True Stories
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Constipated since childhood, but after 63 years, she decided to deal with it on Christmas at 0400.
Okay, not really.
Apparently, if you are constipated you should eat yeast.
Plain squares of yeast.
I don’t get the mechanism.
Yeast rises in a warm environment.
So, if you eat it, does it keep expanding until it explodes everything in front of it out the, uh, exit door?
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I will say that the most interesting chief complaints tend to cluster around the holidays.
It goes something like this: Read more »
*This blog post was originally published at Emergiblog*
