DEAR DR. DONOHUE: What brings on severe constipation? My movements are six to eight days apart. The doctor says milk of magnesia is no good. I am 85. Any help? — C.Y.

ANSWER: A diet too low in fiber, not drinking enough fluids and lack of physical activity are the main ingredients for constipation. Sometimes, prescribed medicines are at fault.

Fiber is the indigestible part of foods. It holds on to water as food passes through the intestinal tract, and keeps the food residue moist and soft. Fruits, vegetables and whole grains are fiber sources. “Whole grains” mean the grains haven’t been refined. They still have their outer coat, the bran. You can find many whole-grain breads and cereals. One cereal is All-Bran. It’s not the only one. If you can’t get enough fiber in foods, then turn to such things as Metamucil, FiberCon or Citrucel. You’ll find them in every drugstore.

Older people often drink less fluid than they need. Their thirst sensation isn’t as strong as it once was. Make sure you’re taking in enough liquids. Water isn’t the only liquid that keeps you hydrated.

After breakfast, take a walk. Physical activity stimulates the digestive tract to move food through it more quickly. That also keeps undigested food moist and soft. Take more walks throughout the day.

Doctors used to be quite reluctant to suggest laxatives to their patients. They were afraid that patients would get into the “laxative habit” or that the colon would become dependent on laxatives. Neither of these things happens. No single laxative works for all. You have to find one that suits you. I don’t know why your doctor is down on milk of magnesia. It works for many. If it’s not working for you, try Miralax. Follow its directions for use. Once you have established a regular pattern to your movements, you can back away from laxatives so you’re not headed in the direction of too many evacuations. Stay on the regimen of fiber, fluids and activity.

The booklet on constipation provides other tips on how to combat this all but universal problem. Readers can order a copy by writing: Dr. Donohue — No. 504, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Some time ago, you wrote about a shrunken leg that was shaped like some kind of bottle. It has the word “teeth” in it. I have a dropped foot. My doctor doesn’t know what I am talking about but would like to see the article. Will you repeat it? — I.D.

ANSWER: The “teeth” in what I wrote referred to Dr. Tooth, an English doctor whose name is part of a nerve illness called Charcot (SHAR-coe)-Marie-Tooth disease. In spite of the fact that the name draws a look of puzzlement from most people, it’s the most commonly inherited nerve-muscle disorder.

The illness usually shows itself in teen years, but it can take many years before it’s diagnosed. The lower leg muscles become quite thin, so the leg looks like an upside-down champagne bottle. It makes walking difficult. People stumble. Often, they cannot lift the foot fully off the ground — a dropped foot.

A number of different varieties of this illness exist. I’ve described the most common one.

DEAR DR. DONOHUE: Lately I have noticed my friend’s head shaking when she is talking or just standing. This just started. I spoke to her about it, and she said she won’t see a doctor. She had a problem with her ear and got that taken care of. Could her ear have caused the shaking to happen? — Anon.

ANSWER: The head shaking most likely is due to essential tremor, also called familial tremor. It affects the head, the hands, the voice or all three. Your friend’s ear problem didn’t cause it; her genes did.

If the shaking doesn’t bother her, she can ignore it. It’s not going to harm her health or shorten her life. If it does bother her, then a medicine like propranolol (Inderal) usually can abolish it.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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