Dr. Rex L. Mahnensmith

Expert evaluations are essential. Leukopenia may result from viral syndromes. Leukopenia may result from autoimmune diseases. Leukopenia may reflect a lymph disorder. So, hematology evaluation is essential.

Most commonly this type of ache or pain is from costochondritis, which is a harmless chest wall rib cartilage centered pain. It derives from a minor strain of the rib cartilage that exists where the rib unites with the sternum.

Your symptoms are real and indicate a lingering persisting problem; yes expert specialist evaluations are warranted; broad lab testing is warranted.

Your concerns run deep. Yes, the exact causation of your reflux and acid indigestion is important to determine. Daily regular acid reflux is very unusual in a young person. Gastroenterology Consultation with special tests is warranted. Possible causes are: 1 - gastric emptying slow down due to chronic inflammation from chronic high acid secretion; 2 - peptic ulceration and peptic gastritis; 3 -chronic infection such as Helicobacter Pylori infection in the stomach; 4 - duodenal inflammation with swelling and ulcer formation; 5 - gastrin hormone overproduction; So, evaluation is warranted and needed: ultrasound, gastric emptying studies, blood tests. Meanwhile, Recommendations: -eat small portions of food; chew thoroughly; minimize sweet foods; minimize processed carbohydrates; consume fresh fruits and vegetables daily; chew thoroughly and eat slowly and do not eat too much at once; avoid coffee; avoid alcohol; exercise after eating by
walking or cycling; stay active; make each meal small; no after-supper foods except liquids; walk after supper; walk after lunch; evacuate bowel daily; drink juices; avoid soda drinks; add Pepto Bismol tablets.

Yes. The allergy shots are effective and helpful. They are specifically composed to desensitize the person’s immune responses against specific allergen triggers. Examples are tree pollens, grass pollens, mold pollens, dust mite pollens, and others. Each injection is specific and proven to work.

Your questions and concerns run deep. First, the exact causation is important to determine. Is there one deep cause or are multiple problems coexisting within your stomach and intestine? This may require Gastroenterology Consultation with blood testings and diagnostic imaging tests. Possible causes are 1- chronic constipation with incomplete emptying of the colon with bowel movements; 2-chronic colon inflammation; 3- irritable bowel syndrome which has mixed symptoms of constipation and slow intestine and sometimes rapid movements; 4-food allergies, subtle, moderate, or major; 5-gastric emptying slow down due to chronic inflammation; 6 - duodenal inflammation with slow transit; 7- inflammatory bowels such as Crohn's or Ulcerative Colitis or Celiac Disease; 8-Leaky Gut Syndrome; 9-Hormonal changes such as Diabetes; 10-chronic infection such as Helicobacter Pylori infection in the stomach; 11-Colon Bacterial Colony changes. So, an evaluation that runs deep and broad may be warranted and needed. Meanwhile, Recommendations: -eat small portions of food; chew thoroughly; minimize sweet foods; minimize processed carbohydrates; consume fresh fruits and vegetables daily; chew thoroughly and eat slowly and do not eat too much at once; exercise after eating by walking or cycling; stay active; make mid-day meal your larger meal; breakfast second-largest, and supper small; and no after-supper foods except liquids; walk after supper; walk after lunch; evacuate bowel daily; if needed take a Fiber supplement daily; an apple or whole oatmeal daily is essential; walk after; drink juices; avoid soda drinks; take an omega fatty acid supplement daily; maintain a healthy pattern and set of habits once achieved.

A physical exam and blood testing are essential immediately.

Galantamine is helpful for memory and is prescribed to help memory impairment as one ages; the usual dosing is twice daily; and one can gradually increase the dose up to 12 mg; there can be side effects so be aware of side effects: rash of skin, nausea stomach cramps, muscle weakness or spasm, increased urination or bowel movements, sweating, feeling
light-headed, spasms, or seizure; thus keep talking with your doctor.

Rex

This is done to assess size, growth, uterine fluid, and placental position over time. Fetal heart is observed also. Three times is usual. More may be done if anything is unusual.

Several factors affect survival with a heart transplant. Factors include underlying vascular disease, presence of diabetes or not, level of kidney function, age of the person getting a transplant, plus donor variables too: including age, time between removal and implant, other illnesses in the donor. On average, survival is over 70% after one year of receiving a heart transplant; clinical care must be tight with frequent follow-up visits and blood tests and heart function evaluations; medication matters as well.

Rex

It is a wise and appropriate concern. The prescribing physician must be involved with her overuse. Overuse is dangerous.

Rex

It is probable that rabies virus was transmitted to you. If the transmission was several months ago, then your infection has been neutralized by your own immune response.

Local anesthesia is possible for limited and superficial surgeries on one's ankle; general anesthesia is preferred and optimal for the deeper invasive ankle surgeries that include bone penetrations or deep connective tissue repairs.

Rex

Yes, you are able, but with special cautions and special considerations and special choices. The important decision is which exercises are safe for you with a hiatal hernia and which are potential risks. The hiatal hernia exists in your diaphragm where your esophagus joins your stomach. The hernia bulges there up into your chest. So, exercises which tense abdominal muscles and increase intra-abdominal pressures will push the stomach tissue through the diaphragm hernia up into your chest. Sit ups: no. Push ups: no. Weight training using large muscles of chest, back, shoulders, and thighs: no. One arm curls: yes. One arm tricep extensions: yes. Walking: yes. Running: no. Riding bike: with apparatus: yes; free bike riding with curled handlebars: no. Be care and be wary; you will sense when abdominal wall muscles are tightening, then stop and ease off.

This pattern likely is a result of menopausal associated hormone pattern changes. A second possibility is an endometrial cellular change with delayed response to hormone declines. It is important to report this to your gynecologist.

Gastric ulcers are serious and of great concern. Gastric ulcer only develops when there is breakdown of the inner stomach protective barrier. The stomach must have a completely intact barrier that protects against the strong gastric acid that is secreted within the stomach and is able to burn cell membranes and cellular connections. Mucus is a component of the protective barrier. Any disruption will lead to erosion and ulceration, which denotes burning by the acids and corrosion. Ulcers may be shallow and superficial. Ulcers may be deep and penetrating. Ulcers may erode blood vessels with bleeding. Ulcers may penetrate very deep through the stomach wall. Prevention is essential. Ulcers can evolve from aspirin, from other NSAID MEDICATIONS, from alcohol, from local infection of bacteria like Helicobacter pylori, or from other etiologies such as cancer. Discovering root basic causation is essential for basic corrective action. Preventive habits are essential. Avoiding compounding habits too is essential, like avoiding alcohol and aspirin and or NSAID MEDICATIONS together. Dietary habits that do not promote high acid secretion are important: strong spices, large meat intakes, overeating all stimulate acid secretions. And ulcers reoccur. So, be informed and take care to get help.

Happy to explain. Yes, your observation is accurate. You did consume tainted food. The green change to stool passage is evidence of mild colitis with inflammatory mucus secretion. Steps to take: if no fever or blood, an antibiotic is not essential; if symptoms worsen, then two days of antibiotics is helpful to resolve; at this moment in time, obtain probiotics and take right away. Florastor is optimal. Take two to three doses today and adjust diet today to bananas, whole grains, apples, and toast only for two days. No milk or dairy or animal fat. And take Pepto Bismol one ounce immediately and then one ounce at three-hour intervals while awake, for two days.

Yes, the guideline and practice of isolation with contagious infections is important and effective. Essentials are: not touching; not sleeping together; not eating at the same table; keeping six feet apart; separate beds and bedrooms; bathroom use spaced by several minutes with complete wipe over countertops, sinks, toilet, and separate towels; daily laundry of clothes and pillowcases and sheets and towels; paper towels for routine hand washing; mask if car riding; ideally separate sitting rooms. It is definitely a helpful practice too to clean face and lips and nostrils two to three times each day. Discard q-tips after cleaning. Clean hands. A q-tip wetted with hydrogen peroxide is very effective at cleaning and disinfecting nostrils. Do this three times each day also.

Hello,

The HDL of 46 is low and this permits atherosclerosis to evolve in mid-life years. HDL is a carrier of cholesterol from plasma and from blood vessel walls back into the liver where it is metabolized. Thus, HDL serves in a positive protective way. You have an opportunity to make it better. Your new chapter of living with smoking cessation and exercise and diet change
and aiming for weight reduction are all proven to benefit HDL plasma levels; your HDL will rise over time and the increased number of HDL carriers will scavenge bad cholesterol and move bad cholesterol back to the liver for metabolism. Diet is very important: more vegetarian foods: foods of color: reds, greens, purples, blues, orange make a positive difference; eliminating saturated animal fats also make a huge positive difference: eating very lean animal protein is healthy; fish oil and vegetable oils are healthy; fish oil can make a positive difference to HDL; omega-3 in particular; olive oil is beneficial; cumin oil is beneficial; astaxanthin is beneficial; and data are showing that vitamin K2 makes a huge beneficial impact on atherosclerosis; this can be added in capsule form.

Rex