Saturday, May 4, 2013

Alzheimer's and the Dreaded Bowel Movement

I already wrote about how I beat urinary incontinence and bladder infections. That solution is not perfect. Poop. No enema, no pills, no laxatives. How I won the Poop-E war.

By Bob DeMarco
+Alzheimer's Reading Room

Alzheimer's and Bowel Movement
I really wanted to entitle this article Alzheimer's and the Magic Elixir. However, I am not using anything to mask the taste of my solution so it just didn't fit.

I also considered Alzheimer's and the Poop Panacea. Panacea does fit -- panacea is a literary term to represent any solution to solve all problems related to a particular issue.

Note:I wrote the first version of this article years ago. This article is being republished and re-opened for new comments and discussion. Like most Alzheimer's caregivers, I did give up more than once in my early years as a caregiver.

This article is about implementing a solution to a problem with someone living with Alzheimer's disease and having a problem with bowel movements.

I knew the solution to the dreaded bowel movement problem for years. I couldn't get my mother to cooperate. When she wouldn't cooperate, I would give up. At least three or four times over a two year period.

I was finally able to implement my solution for one simple reason -- I was learning new and better techniques as an Alzheimer's caregiver over time.

In this case I married pattern of behavior, with some singing (music), and a good positive attitude. Throw in some good solid positive reinforcement and some good communication and you get a solution to a problem. You also need patience and intestinal fortitude. You develop these over time as part of the caregiving process.

Time for some background and then I'll get to it.

I tried all the possible solutions under the sun to deal with the dreaded Alzheimer's bowel movement problem. I tried so many that I can't describe all of them to you. For example, somebody told me about a certain kind of tea. I tried it and a couple more, didn't work for us.

I tried everything: Citrucel, Benefiber, Dulcolax, overnight relief, stool softener, and the industrial strength stuff. You know that pill that gives you a stomach ache when you wake up in the morning and then the explosion. For some reason I don't understand, a lot of women I know use that pill and recommended it. They all describe it the same way with the same look on their face. I also learned that these same women don't poop when nature calls. When their body tells them its time to poop, they don't do it. They hold it in. They get clogged up.

I should add here, I don't like poop-E pills of any kind.

Finally here is what happened. My mother was so clogged up she was on her bed moaning. Her stomach was so hard that if I had punched her, I would have broken my hand. Let's just say this, she had the maximum amount of poop stored in her body. I knew the answer to this problem -- Citrate of Magnesia (COM). Works like a miracle. The only problem, she wouldn't drink it. I used every idea I could come up with at the time to get her to drink the Citrate of Magnesia. Nothing worked.

Next I drove down to the pharmacy to get an enema. On the way there and back, I debated with myself on whether or not to take my mother to the emergency room. The only thing holding me back was our previous trip to the emergency room -- over ten hours. As an aside, I learned an important lesson later on. You don't take someone to the emergency room. You call  911. Why? Then they go right in, they go to the front of the line. I finally learned this after a call to 911.

Back to the enema. While I was buying the Fleet enema, I decided to ask the pharmacist for some advice. I had never given or received an enema so it was beyond my frame of reference. He told me exactly how and where to do it. He gave me some good advice. He told me not to get directly behind my mother while executing the enema drill. Later on I realized this was good advice. No doubt, I would have ended up coated in poop if I had used the enema without the advice.

When I got home, I showed my mother the enema. She decided she would drink the Citrate of Magnesia. I knew how COM worked because I used it previously on my mother. So I figured 30-45 minutes and the problem will be solved. I also learned a good lesson as an Alzheimer's caregiver --sometimes the lesser of two evils approach does work. She preferred drinking the COM to the enema.

Well it didn't take long. Next thing I knew I heard my mother crying and yelling. I went into her room. There was poop-E everywhere. When I say everywhere I mean everywhere.

I got mom in the shower and cleaned her up. I stripped the bed, got all her cloths, cleaned up the floor and sighed a big sigh of relief.

Later that night I told my sister about the whole affair from beginning to end with all the details, some of the details I left out in this version. She said, "it must have been horrible!"

Well, the hours before the great poop-E explosion where horrible. Cleaning up the Poop-E was not horrible. I was so happy I didn't mind cleaning up mom or the poop. I am telling you, I was so happy I couldn't see straight. Relieved also.

After this episode, I declared war on poop. Like most wars, you have to win a series of battles over a long period of time before you get to declare victory.

At the top I mentioned that I knew the solution to the dreaded Alzheimer's Bowel Movement from near the beginning. I obtained this information from a long list of senior citizens that were pooping daily like clock work. PRUNE JUICE. Not prunes, prunes juice. I tried the prunes and Dotty would eat the prunes, and they didn't work. Not for us anyway.

Now my sister Joanne was here while I was in the last few battles of the Poop-E war. Mom was still fighting every day about drinking the prune juice. But, I was making headway.

Finally with victory in site I stumbled on one last thing I needed to make the solution work. The Poop-E and Prune Juice song. I should say songs.

Everyday I start out the same way. I start by extolling the virtues of prune juice to mom. How wonderful and delicious it tastes (yeah sure), and how God made prune juice as a special gift to everyone. And then, I start singing one of my many prune juice or poop songs. Pick a song, any song and just put in the words prune, juice, love, and then describe how wonderful it is.

It worked. Pretty much. Some days mom shoots down her 3 ounces of prune juice in one shot. Sometimes it takes like ten sips. Sometimes she holds her nose while she drinks it. Some days she tells me its poison. She makes faces. I just keep singing away and extolling the virtues of prune juice.

Prune juice is the solution. Getting someone with Alzheimer's to drink prune juice is the implementation phase of the solution. It took me years to get my mother to drink the prune juice. And maybe a year after I declared war to get her to do it everyday. I did quit and give up on getting her to drink prune juice several times before I declared war.

By the time I started the war, I understood I had to establish a pattern in order to implement a solution to a problem with mom. Prune juice, every day before lunch. If for some reason we miss because we are out, or for any reason we can't do prune juice at lunch -- no prune juice that day. Stick to the pattern under any and all circumstances. Pattern of behavior. A key to successful Alzheimer's caregiving.

I figured if they can say the same thing over and over, you can get them to do the same thing over and over. Works.

Establishing the pattern: When, Where, How, Why. This is critical to success in my opinion if you want to change undesirable Alzheimer's behaviors.

When mom starts making the face at the prune juice, I start handing her one at a time, one by one, and in this order -- aspirin, Benecar, daily vitamin, fish oil, garlic, antioxidant, folic acid. Sip, pill, bottoms up, sip, pill, bottoms up, sip, pill, bottoms up, (I say bottoms up). I sing the prune juice song again and again if necessary. We really don't get far on the list of pills anymore. Maybe to the garlic on a real bad day.

Once again, Joanne was here when I was in the Poop-E war. When I finally told her on the phone that I had mom drinking prune juice everyday, she had trouble believing it. She saw mom and her anti-prune juice attitude in person.

Now, maybe you will be lucky. Maybe your Alzheimer's patient will drink the prune juice without resistance. Lucky you. Maybe they won't.

They will drink the prune juice if you give them the right stimulus, positive reinforcement, and encouragement. Three ounces a day, every day. Three ounces is all you need. Might take a week or so before the prune juice starts working effectively. Be patient. Let the prune juice do its job.

Oh yeah before I forget. Right after mom finishes the prune juice, I put my head on her head and say something nice. Like you are sweet. I also give her a little hug. Mom is sitting in the same chair at the kitchen table, in the same position every time she drinks the prune juice.

I already wrote about how I beat urinary incontinence and bladder infections. Those solutions are not perfect.

Poop? No enema, no pills, no laxatives. I won the Poop-E war.

Its really mind over matter, believing in yourself and your Alzheimer's patient.

I did it, I know you can do it, and that is the message.

Special note: Not long after I wrote this I started giving Dotty the probiotic Align. I would usually give it to her for 3 or 4 days in a row and then stop. I also kept her on the prune juice. Let's just say Dotty got into the flow. I can't remember any problems with Poop-E in the last two years of Dotty's life. She went almost every day. If she missed a day, I started the probiotic.

Magic really.

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Bob DeMarco is the Founder of the Alzheimer's Reading Room and an Alzheimer's caregiver. The ARR knowledge base contains more than 4,600 articles with more than 353,100 links on the Internet. Bob lives in Delray Beach, FL.

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