You’ve done an excellent job of describing and outlining your concerns, and that helps a great deal. Constant hard stools, despite stool softeners and adequate water and a diet rich in high-fiber foods is very often due to slowed movement of the large intestine. The Miralax may very well help, as it is designed for constipation due to slowed intestinal movement, and it sounds as though that is the case for you.
You might also consider use of probiotics – yogurt or kefir (if milk protein is a concern with regard to levodopa, you can obtain water kefir, or make it with coconut milk) can help greatly to keep the colon healthy and balanced, and regulate bowel movements.
However, let me also ask whether your gastroenterologist has ruled out small intestinal bowel overgrowth (SIBO). Your bloating, cramping, gas, and constipation could be signs of SIBO, a condition in which dangerous bacteria are able to grow in the small intestine. A healthy intestine does not contain unfriendly bacteria, because its normal movement prevents bacteria from attaching to the walls of the intestine. Of concern, a study found that SIBO was far more common among subjects with PD than control subjects. This may be because PD can affect the autonomic nervous system, which guides movement of the gastrointestinal tract.
SIBO causes a condition called “malabsorption syndrome (MAS)". The attached bacteria compete with the human host for nutrients. The bacteria may inflame and damage the walls of the small intestine, so that nutrients cannot cross the walls and enter the bloodstream. They also produce gas and abdominal distention. The damage may cause carbohydrate and protein malabsorption as well as malabsorption of vitamin B12 and fat-soluble vitamins A, D, and E. Common signs of SIBO include constipation, bloating, cramping, and flatulence.
Your doctor can test for SIBO using a test called the “hydrogen breath test.” If SIBO has not been ruled out, I would definitely ask that this be done. Print out the following and take it to your doctor:
Mov Disord. 2011 Apr;26(5):889-92. doi: 10.1002/mds.23566. Epub 2011 Feb 1.
Prevalence of small intestinal bacterial overgrowth in Parkinson's disease.
Gabrielli M, Bonazzi P, Scarpellini E, Bendia E, Lauritano EC, Fasano A, Ceravolo MG, Capecci M, Rita Bentivoglio A, Provinciali L, Tonali PA, Gasbarrini A.
Internal Medicine Department, Catholic University of Sacred Heart, Rome, Italy.
BACKGROUND: Parkinson's disease (PD) is associated with gastrointestinal motility abnormalities that could favor the occurrence of small intestinal bacterial
overgrowth. The aim of the study was to assess the prevalence of small intestinal
bacterial overgrowth in PD patients.
METHODS: Consecutive PD patients were enrolled. The controls were subjects without PD. All patients and controls underwent the glucose breath test to assess small intestinal bacterial overgrowth.
RESULTS: Forty-eight PD patients and 36 controls were enrolled. The prevalence of small intestinal bacterial overgrowth was significantly higher in PD patients than in controls (54.17% vs 8.33%; P < .0001; OR, 2.24; 95% CI, 3.50-48.24). Multivariate analysis showed Hoehn and Yahr stage (OR, 3.07; 95% CI, 1.14-8.27) and Unified PD Rating score (OR, 1.12; 95% CI, 1.02-1.23) were significantly associated with small intestinal bacterial overgrowth in PD patients.
CONCLUSIONS: Small intestinal bacterial overgrowth is highly prevalent in PD. Gastrointestinal motility abnormalities might explain this association.
PMID: 21520278 [PubMed - in process]
With regard to your second problem, I can certainly see and sympathize with your concerns. Three hours of commuting time daily, by itself, would make it very difficult to time meals and medications, as well as get regular exercise. The constant interruptions at work are an additional distraction. I cannot change these factors, but I will comment as able:
- There are pill timers that both contain the day’s supply of pills and have an alarm that goes off when the pill is due. You probably have a water bottle at your desk and with you on the commuter train; place the pill timer next to this. When the alarm goes off, your water will be handy so that you can take the pill on time.
- You must discuss your situation with your boss; let him/her know that timing of your meds is vital in order for you to do your work. So if he/she is talking to you when your timer alarm goes off, you will need time to stop and take the pill. If the alarm goes off while you’re on the phone, then when the call is over, you’ll be able to check your pill timer container and tell whether or not you took the pill.
I hope this is useful, but if not, write back and let me know; I will help as much as I can. Also, if you are taking any other meds besides Sinemet and Neupro, that would be helpful.