Rx for Readers

My 88-year-old father has great difficulty walking. His legs just don't seem to want to go - so we push him to do exercises while lying down and to walk.

By JUDY SIEGEL-ITZKOVICH
old man 88 (photo credit: )
old man 88
(photo credit: )
My 88-year-old father has great difficulty walking. His legs just don't seem to want to go - so we push him to do exercises while lying down and to walk. He complains his legs are tired; he says they don't hurt, but they bother him, and his ankles and sometimes his toes hurt. So we massage his feet daily. He also has heart problems, including an irregular heartbeat that can cause blood clots. A year ago he had a mild stroke. All these things considered, I want to know if massages can cause blood clots. - L.G., Kadima Prof. A. Mark Clarfield, head of the geriatrics department at Soroka University Medical Center, replies: Gentle massage will not do any harm and can often provide some comfort, depending of course on the source of the problem. Be guided by common sense: If the massage relieves the symptoms of pain, keep on; if it causes discomfort, stop. I have never heard of gentle massage causing blood clots. About the exercise, encourage, but don't force it on your dad. He needs to have his legs and back examined by a specialist to see if the problem is orthopedic (for example, spinal stenosis, in which the bones of the spinal canal shrink and press on the nerves), vascular (not enough blood getting to the leg muscles) or problems with the joints. I suggest a good exam by your family doctor with referral, if necessary, depending on the above. I am a 66-year-old man who enjoys good health. I take medications for high blood pressure that balance it, but they gave me constipation. What can I do to have normal bowel movements, preferably using a natural remedy rather than more pills? - C.M., Tel Aviv Dr. David Lipschitz, a leading US geriatrician and director of the Reynolds Center on Aging at the University of Arkansas for Medical Sciences, comments: Constipation is the most common gastroenterological symptom treated by physicians. It is defined as fewer than three spontaneous bowel movements weekly; if stools are too hard or too small; or if there is an excessive need to strain or the sense that even after a movement there is incomplete emptying of the bowel. Constipation becomes more common as we grow older, with as many as a third of those over 65 and over half at age 80 suffering from it. Often no cause can be found, but a diet containing inadequate fiber and too few calories are major contributing factors. The problem is made worse by lack of exercise and trying, on numerous occasions, to suppress a bowel movement because it occurs at an inconvenient time. Usually bowel movements are stimulated by eating a big meal, the so-called "gastro-colic" reflex. Suppressing this urge can lead to constipation. There are numerous medications that lead to constipation, including antacids containing aluminum, calcium channel blockers used for high blood pressure, antidepressants and pain relievers. Your doctor must take a careful history and physical examination, blood tests may be needed and illnesses such as thyroid problems, diabetes, irritable bowel syndrome and cancer must be excluded. In most cases, no cause is identified. The best possible treatment is to regularize and obtain normal bowel movements naturally. This includes eating a diet rich in fruits and vegetables or cereals. The bulk content of your diet can be increased by taking psyllium (Metamucil) or methylcellulose. The dose for both is one tablespoon up to three times daily in a full glass of water. Unfortunately, finding the best natural method to end constipation is not easy. A fellow geriatrician, Dr. Jerry Malott, told me about a powerful recipe to ease constipation that has really helped many patients. At any health food store buy flaxseed, sesame seed and shelled sunflower seeds. Mix them equally. Take a tablespoon up to three times daily alone or in cereal, fruit, salad or any other appropriate foods. While this cocktail helps many people, the cure rate is nowhere near 100 percent. It it fails, a laxative may be needed, but since these are stimulants, overuse can lead to a vicious cycle of constipation followed by diarrhea and potentially dangerous metabolic changes. Newly developed constipation can be the harbinger of a serious illness, so go to your doctor for a checkup. If nothing serious is present, stay natural if at all possible. Rx For Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx For Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.com, giving your initials, age and residence.