DEAR DR. DONOHUE: For the past two years, my husband has been trying to deal with constipation. We have tried everything — lots of fruits and vegetables, prunes and fiber. He takes a spoonful of mineral oil daily. He is active and plays golf twice a week and walks 2 miles on the other mornings. A lifelong fear of becoming dependent on laxatives prevents him from taking any. We are at a loss about what to do. Any suggestions you make are appreciated. — J.H.

ANSWER: A lack of fluids, too little fiber and inactivity are the major causes of constipation. Laxatives used to be thought of as dangerous remedies, to be used sparingly if at all. People do not develop a “laxative habit,” and their colons are not harmed by them. Your husband has done all he can without any results. It is much unhealthier for him to strain to eliminate than it is to take a laxative. He can use whichever one he wants. MiraLAX is a reliable one. Mineral oil is not great idea. If the oil goes down the wrong way and enters the lungs, it can cause big trouble. Once the laxative has restored normal movements, your husband ought to stay on his high-fiber diet. Fiber doesn’t always end constipation, but it does keep one regular.

Establishing a morning routine often works. Feeding a baby calls for a diaper change shortly thereafter. The brain sends a signal to the infant’s colon to empty. The same reflex works in adults, but we have dulled it deliberately. It can be restored by drinking a caffeinated beverage for breakfast and then taking a walk after eating.

Have your husband try this homemade remedy: Mix 2 cups of bran (obtained at a health-food store) with 2 cups of applesauce and 1 cup of prune juice, sweetened or unsweetened. Refrigerate the mix. Your husband can take up to three tablespoons twice a day. He should start with a smaller dose.

The pamphlet on constipation and laxatives provides other ways to treat this common 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: I am a 75-year-old woman who has been on Actonel (risedronate) for a number of years. The results of my bone density test are worse than they were two years ago. Prolia has been recommended. Having read about it, I am concerned about its side effects and its cost. What is your opinion? — M.M.

ANSWER: Prolia (denosumab) is a new osteoporosis medicine, completely different from all others now on the market. It stops the daily breakdown of bone. Possible side effects include a raised susceptibility to infections, an increase in cholesterol and pain in the back, arms and legs. It could produce jaw osteonecrosis — death of a part of the jaw. None of these happens with any regularity. I wouldn’t let them frighten me into not using it. About its cost, I can’t say anything.

You have other treatments available — Evista, Miacalcin and Forteo. The last two are injected in the same way diabetics inject insulin. And don’t forget about taking calcium and vitamin D daily.

DEAR DR. DONOHUE: Can a person have bursitis and arthritis at the same time?

My doctor diagnosed me with bursitis. Then I fell and crushed my kneecap. I had to have surgery for it. After a while, the knee started giving me pain. The surgeon X-rayed it, and said I had developed arthritis.

My neighbor says you cannot have bursitis and arthritis at the same time. — S.L.

ANSWER: Your neighbor is wrong.

A bursa is a little sac outside of the joint. It lies between a tendon and a bone. It prevents irritation when the tendon rubs against the bone. Bursitis is an inflammation of a bursa.

Arthritis is something that happens within the joint. Your trauma damaged the cartilages within the joint, and they have become frayed and slightly inflamed.

There is no law that says you can’t have both bursitis and arthritis at the same time.

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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