Dear Dr. Roach: I am writing to you about my 62-year-old wife, in the hope that you can provide an opinion on a question she has and also provide us with some advice in her quest for relief from constipation and her stomach problems. It is not unusual for her to go three to four days without a bowel movement. She has been told by two different doctors who she sees regularly (an endocrinologist and a colorectal surgeon) that it is “perfectly OK” to take laxatives every day for extended periods of time.
I question this, as my own research says that this is not advisable and can potentially lead to other serious problems. Can you please provide your opinion on this?
M.M.
Laxatives can be abused. People can overuse laxatives, leading to diarrhea as well as fluid and electrolyte abnormalities. However, using laxatives to ensure a more regular bowel movement (every one to two days, for example) is safe. We used to teach students that laxatives of the stimulant type, like senna or bisacodyl, can lead to an inability of the colon to move properly if the laxatives are stopped, but this does not seem to be the case.
Although I generally start with fibre supplements for my patients with constipation, some people do not respond to fibre and need other treatments. I have also recommended surfactants like docusate (Colace), nonabsorbable solutions like polyethylene glycol (Miralax), or sugars like lactulose.
If your wife is seeing an endocrinologist, they will have been sure to check her thyroid level, but sometimes I see patients with longstanding constipation due to their low thyroid levels.
Dear Dr. Roach: I was wondering if you could address some of the causes and treatments for amyotrophic lateral sclerosis (ALS). I have a dear friend who appears to be in the final stages, although her symptoms only became obvious lastt October. She refused vaccination and got COVID last September. Could this have been a triggering factor? No one could figure out why she was so sick at the beginning, since the symptoms came on so rapidly, and ALS, in my understanding, takes years to develop.
C.M.
ALS, also called motor neuron disease or Lou Gehrig’s disease, is a progressive degenerative disease of the nervous system. In most cases, the cause is not known. A subset of people with ALS (5%-10%) have a family history and at least two genes that have been identified. Much progress has been made in understanding how the disease causes nerve damage at a molecular level. Unfortunately, ALS is, at this time, incurable, although there are treatments to slow progression (edaravone and riluzole).
Age (74 is the highest incidence) and family history are the only proven risk factors, although smoking increasingly looks like a risk factor as well. COVID has not been reported as a risk factor. Many other risk factors are suspected but unproven.
ALS tends to progress from one limb to another, then to the swallowing and breathing muscles. However, the rate of progression is highly variable. Fifty percent of people with symptomatic ALS will succumb to the disease within three to five years. Ten percent will live more than 10 years, but another 10% will live less than a year from their diagnosis.
I have lost patients and a very dear friend to ALS as well. It’s a horrible disease.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
