The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.
Posting this under the heading it deserves: Constipation management, with a dietitian's contribution Everything below is what sits behind that.
Constipation management: setting out the arithmetic in full, because I have had to do it twice and I would rather nobody else did.
Every step is shown. If the answer is wrong the error will be visible, which is the point of writing it out rather than posting the result.
Summarising the constipation management thread so far, since it is long and the answer is buried: the first reply has the method, the fourth has the correction to it, and the rest is people agreeing at length.
Useful. I have added it to my own notes with the date on it.
The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.
One more thing on constipation management that took me far too long to see: the two figures people quote are not measuring the same quantity. Once you notice that, the apparent contradiction disappears.
The failure mode on constipation management is boring rather than dramatic. It is almost always the step everyone assumes was done correctly because it is too simple to get wrong.
I had written a reply contradicting post #6 and deleted it. Here is what survived.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
Somebody will have a better source than mine, and I hope they post it.
Genuine question rather than a rhetorical one: has anyone here actually observed constipation management, as opposed to read about it? The thread is long and I cannot tell.
Recognition and grading: nausea ranges from "noticeable" to "limiting". Constipation ranges from mild to severe. Having language to describe the magnitude helps you track whether something is worsening or stable and helps your clinician understand what you are reporting.
The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.
I would put the burden of proof on the interesting explanation, not the dull one.
On post #9 — agreed on the reasoning, with one qualification.
Reframing constipation management slightly, because I think the disagreement is about the question rather than the answer. If the question is "does it happen", yes. If it is "how often", nobody here knows.
Picking up post #13: that is the part I would want checked first.
Something worth flagging about constipation management: the strongest-sounding claims in this thread are the ones with no source attached, which is the usual pattern and not a coincidence.
Grateful for the specificity. Vague answers to this question are what sent me looking.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
That is the honest state of it as of this week.
Post #13 describes the usual case. This is about the unusual one.
Second-hand on constipation management, so weight it accordingly — someone whose method I trust told me this and I have not verified it myself.
Offering a way to settle constipation management rather than another opinion about it. Two measurements, taken the same way, a fortnight apart. If the difference is within the noise, the question was not answerable at this precision.
Post #17 put the caveat in the right place and I want to underline it.
The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.
The mechanism is plausible, which is not the same as established.
Building on post #17 rather than restating it.
A note on how constipation management gets discussed rather than on constipation management itself: the confident posts get the replies and the careful ones get ignored, and the careful ones have been right more often.
Post #18 is the version of this I will quote in future. One addition.
Constipation management looks different depending on whether you are reading the primary literature or the summaries of it, and the difference is not in our favour.
Where I part company with post #20, and it is a narrow parting.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
Constipation is reported at least as often as nausea and is discussed a fraction as much. Fluid, fibre and movement are the boring answers and they are the ones that work.
I am not the right person to answer the follow-up to this.
Having read the whole constipation management thread before replying: the question in the first post has not actually been answered yet, and three of us have answered a nearby one instead.
Building on post #22 rather than restating it.
Two questions I would want answered before drawing anything from the constipation management data above: how were the cases selected, and what happened to the ones that dropped out.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
A single observation, in a thread that deserves better than single observations.
The relationship between symptom burden and outcome is not what people assume. Feeling worse is not evidence of a larger effect and feeling nothing is not evidence of an inactive preparation.
Worth reading the earlier posts in this thread before acting on mine.
Helpful, and short, which on this subject is harder than long.
An update on my earlier constipation management post: the pattern held for another six weeks and then stopped, which I did not predict and cannot explain.
The published rates come from populations that were titrated on a defined schedule with clinical supervision. Rates from a forum are not comparable and are biased by who chooses to post.
The reasoning is more useful than the number, which is why I have shown it.