Dr. Rex L. Mahnensmith

Greetings,

Good question - COPD is a chronic lung condition, which results from repeated irritants inhaled into the lungs. COPD includes large bronchi inflammation and mucus production, smaller
bronchiole thickening and tightening, plus scarring down at the alveoli. The condition varies from person to person and may be mild, moderate, or severe. The clear diagnosis requires a breathing test - called Spirometry - and this can be done at an ordinary office appointment. Spirometry these days is easily done with a hand held device (just a little bit thicker and larger than a cell phone) and you hold the device and wrap your lips around a firm one inch mouth piece and exhale completely and rapidly into the spirometer. The spirometer measures your exhaled breath 'volume' per second and 'speed' of air movement. The spirometer produces a reading and a graph. The reading states FORCED EXHALED VOLUME of 1 second and FORCED EXHALED VOLUME OVER Entire exhalation, too. A graph shows the exhaled volume per second. COPD has a characteristic reduced FEV during the first second and a
characteristically reduced FEV Complete. The exact reading of FEV during first second declares mild, moderate, or severe, as does the total FEV Complete over the entire exhaled breath. This is done in a lung specialist's office, some primary care practices, all asthma offices, and typically in ER and URGENT Care clinics. Your FEV1/FVC ratio informs you of no or yes mild/moderate/or severe. Symptoms vary - some shortness of breath with walking/cough are typical, and response to an inhaler. Improvement with an inhaler is important, too. A chest X-ray is helpful, but not specific.

Rex Mahnensmith, MD

Hydroxychloroquine has been widely and commonly and thoughtfully prescribed for over 20 years to control inflammatory arthritis in Systemic Lupus and in Rheumatoid Arthritis. In this usage, the medicine is prescribed daily for long periods of time. Months and years day by day. It also has been occasionally prescribed for a traveler who is traveling to a region where malaria is common. In this use, only three days or so are prescribed.

For Covid, a French physician tried this medicine for a few days and his study showed occasional benefits. So many many people decided to get this medicine and supplies ran out. However, additional studies have not demonstrated clear benefit. Still many pharmacies have run out. It is a medicine that has clear benefits for Lupus and Rheumatoid Arthritis, but not Covid.

Rex Mahnensmith

Spinal fusion surgeries are virtually 100% successful - meaning - the surgeon is always able to accomplish the purpose of the surgery, which is to re-align and stabilize vertebra upon vertebra. Particulars are very important - 1 - where - 2 - which vertebrae 3 - how many vertebrae - 4 - - - and more - - - the surgical team can and will re-align and fixate - - - then recovery is critically important - to achieve muscle flexibility - strength - equal balance - -

Rex

Kyphosis is forward curvature of the spine. Causes include vertebral compressions, small burst fractures, disc degenerations, muscle instabilities and muscle weakness; kyphosis also can develop as a congenital formation defect. Nonoperative therapies in reducing kyphosis include physical therapies, weighted posture aids, external brace supports, and bisphosphonate osteoporotic therapies, if osteopenia is a factor. Medication without anatomical adjustment is not well studied -- potentially helpful medications include baclofen, tizanidine, cholecalciferol, magnesium, and bisphosphonates.

Rex

Good evening -
I appreciate your concerns - you are enduring a lot of body changes and discomforts and abnormalities. What you describe centers on your gastrointestinal system -stomach upset, small bowel upset, large bowel upset, and abnormal stool character. You describe blood-tainted stool. You exhibit significant weight loss - MS does not center on the gastrointestinal system.
And I am wondering why you mention leukemia. What are your blood count values and your blood chemistry results? Does your stool ever test positive for blood? Are you taking a blood thinner? Have you had an upper endoscopy and Upper GI series? Have you had a CT scan of the abdomen with oral contrast? These are important tests for you.

Hi - thank you for your question.

Dental X-ray is important to have done - The softer lump is likely a resolving bone infection - now a cyst - filled with fluid - and it likely will resolve slowly - Abscesses are common in dental bones - and if not drained by root canal or other method, then the abscess softens to a cyst. Antibiotics are important - and the duration matters - at least 14 days - sometimes 21 to 28 days is necessary.

Hello -
Responding to your question and concern about repeated throw up - - A sudden onset of such a problem is unusual - you are right to wonder why -- And to have no other symptoms is also unusual as well - - So, possibilities include:

1. A partial obstruction in your upper GI tract -
1. Locations that are more common are:
1. Stomach - duodenum junction - - where strictures can occur without much pain
2. Esophageal - stomach junction - - where strictures can also occur without much pain
3. A "pouch" at the end of the esophagus, which is a wall-weakness - and food gets "stuck" - then upchucked -
4. Upper small bowel - from forming ulcer or from a growth - -
2. Then, we would worry about a change in your smooth muscle functions of the esophagus and/or stomach - -
1. Esophagus can become weak - and soft - and bloated - and dilated - and not propel food down - -
2. Stomach muscle can also become weak - and soft and bloated - called gastroparesis - -
3. The causes vary - - diabetes/hiatal hernia/chronic reflux of acid - -
4. And, rarely - some diseases do produce lining changes of the stomach - - and gastroparesis
3. Common causes with other symptoms include:
1. Acid reflux - heartburn - vomiting
2. Stomach gastritis from acid - vomiting
3. Duodenal ulcer from acid - vomiting
4. Gall stones and bile duct inflammation - vomiting
5. Pancreatitis - vomiting
6. These typically have other symptoms - - pain, discomfort, spasms - -
7. Irritable bowel syndrome - which features discomfort and rare vomiting - and irregular BM -
8. Inflammatory bowel syndrome - which only rarely features vomiting
4. Rare causes
1. Growths - benign tumors or malignant tumors
2. Intestinal blockage from adhesions -
3. Twisted intestine - volvulus
4. Constipation - lower down - - - stomach weakens - -
5. Central Nervous System changes - - inner ear changes - - vertigo - - postural vertigo -

Hoping this helps - -

Next steps are important - - either wait it out - - see if resolution happens - - or think these through - and have testing done to evaluate - -

Dr. Rex M

Good evening,

These medicines that you mention will not clash and will not counter each other. Yes, you may take them all at the same time.

My advice - Be sure to take each with fluid. It is best also to have a bit of food - just enough to ease your stomach - taking meds on a completely empty stomach can be a reason for a nausea response. So - about 4 oz with each pill - and some gentle food, like crackers, or pudding or yogurt.

Best regards,
Rex M

You need a professional clinical evaluation - this can be done via telephone, telemedicine, such as Call-a-Doc, or go into a walk in center - it seems that you are ailing and need help to get back into good health.

Thank you for asking this question. It is an important consideration.

First, realize that Geriatricians are Internal Medicine Physicians who have additional and focused training and ongoing education in the care of persons over the age of 65 years old.

A Geriatrician can discern and can assess the special needs of an older person - and manage them expertly.

Thank you for asking this question to me - -

Floppy Colon is also called "Redundant Colon."

The average colon is roughly 45 to 60 inches in length.

A Floppy Colon or a Redundant Colon (same) refers to an abnormally long colon. When this condition exists, the extra length is usually in the final section of the colon - referred to as our descending colon. The descending colon is typically less than 24 inches in length, but it can develop additional loops and even twists.The descending colon is where stool is "stored" awaiting final evacuation.

The descending colon is the section of our colon that is most prone to develop diverticulosis - which refers to small pouches in the wall of this part of the colon - and these small pouches can be a place where stool sits for a long time and hardens. The descending colon has the purpose and function to absorb water from our "stool" so that evacuation is a "formed"
stool. Stool moves through the colon as a gravy form in the beginning of the colon and then water is absorbed out of the stool slowly as the stool moves along. The stool stays gravy form until it enters the descending colon - normally - and then firms as it passes through and enters the sigmoid, just prior to evacuation.

Some persons never experience symptoms from a longer floppy descending colon - others do experience constipation, bloating, even crampy discomforts if the stool sits in this colon portion for too long - and then the stool becomes larger, bigger, longer, hard, and dry - and may not pass. Then the colon enlarges even further - and this is when diverticula form - as the colon squeezes to pass - the stool does not move much.

Actual cause of this condition includes poor diet habits, inactivity, low fiber in one's diet, low liquid intake, and the social habit of "holding".

Lisinopril does not adversely affect male fertility. Lisinopril does not adversely affect sperm motility. Lisinopril does not cause or promote sperm mutations. Lisinopril does not promote or cause any birth defects in males. Lisinopril is one BP med in a family called ACE inhibitors. For any male, there is no infertility risk nor birth defect risk associated with any ACE inhibitor. The lisinopril is not deposited in semen and does not enter the female at all, and the male is unaffected.

And, no other BP medication has fertility compromise for the man.

Additionally, there is no chance that Lisinopril would affect or compromise fetal development if the baby is conceived while the man is taking the medication - - only a small risk exists if the woman is actually taking the medication daily, and the medicine has sustained blood levels in her circulation. This is not relevant for the man - he delivers no risk to the woman or to any fetus, be assured.

Rex Mahnensmith, MD