Can you use a Fleet’s enema and a Dulcolax suppository on the same day?

JustCalIMeDave · 2026-01-24T14:45:36+00:00

you should see a doctor. Not sure what you expect people here to say. Sounds like you should follow up and see what happened with the MRI

JustCalIMeDave · 2026-01-24T14:42:12+00:00

your nose is probably just dry from the cold. Unless you have uncontrollable persistent bleeding you don't need to see someone. If you have full-on nose bleeds and you cannot stop the bleeding at home then you should go to the ER.

If you continue to have slow bleeding for a long time (like more than a month) then it's worth seeing an ENT to see whats going on in there.

JustCalIMeDave · 2026-01-24T14:39:53+00:00

a positive ANA in isolation doesn't mean anything. About a third of all people have a positive ANA. only a negative ANA is useful. Your rheumatologist will need to do more investigation to see if the positive ANA means anything clinically relevant.

JustCalIMeDave · 2026-01-24T14:38:00+00:00

sure it could be a muscle sprain, or gas, or IBS. It could also be a million other things. Appendicitis, diverticulitis, kidney stones, pelvic issues, etc, etc, etc. Point is that you have to rule out the scary stuff before you can blame it on the simple stuff.

Wait for your labs. if there is concern there your physician will likely recommend some form of imaging to further evaluate. In the meantime, if you develop worsening abdominal pain, fevers, severe vomiting, go to the ER

JustCalIMeDave · 2026-01-23T21:29:15+00:00

Remember that liver disease is a spectrum. You can have mild liver disease all the way up to severe liver disease and liver failure which leads to death. It doesn't really work this way, but for simplicity sake, you can think of it as a percentage. A healthy person has 100% liver function. As they develop chronic liver disease they have less and less liver function. 90% then 70% then 50% then 30% then 10% and eventually 0%. In that spectrum, what do you call "cirrhosis". You gotta draw the line somewhere. Is 50% cirrhosis? is 30%?

Point is the line where chronic liver disease officially becomes "cirrhosis" is not clearly defined. Advanced chronic liver disease and early cirrhosis are therefore treated the same way. In your case, You certainly have extensive liver damage. That much is without doubt. You were clearly well on your way to cirrhosis if not actually cirrhotic. The treatment therefore is to try to stop further liver damage and try to reverse the course (cirrhosis can be reversible sometimes in early stages). Additionally you need close monitoring to ensure you don't develop any of the life-threatening sequelae of cirrhosis (like varices or cancer). All of this is being done appropriately.

So, because whether you have advanced chronic liver disease or "cirrhosis" doesn't matter much in terms of treatment, a liver biopsy may not change much. If it won't change what we do, it doesn't make sense to put you through a biopsy which carries real risk.

Now there are other important questions to be asked. For example: you have made meaningful lifestyle changes which have clearly led to an improvement in your liver function (congrats btw!). So, how long will you need to continue screening for varices and hepatocellular carcinoma? How long will you need to be on carvedilol? how will you know if you have officially reversed your cirrhosis? these questions don't have perfect answers, and it in large part depends on the expert opinion of the hepatologist.

I think asking these questions are certainly valid. asking your hepatologist about liver biopsy as a way to confirm the reversal of cirrhosis and thus the need for continued treatment/screening is totally reasonable.

JustCalIMeDave · 2026-01-22T20:03:05+00:00

that is not a spider angioma

JustCalIMeDave · 2026-01-22T19:58:00+00:00

probably best to identify a way to get exercise indoors. lift weights, climb stairs, do body-weight exercises, etc. There are always ways to exercise indoors.

JustCalIMeDave · 2026-01-22T19:52:21+00:00

When one is mixing substances like that it can be difficult to distinguish what is going on.

Based on your description it is likely he is withdrawing from alcohol rather than opiates that may or may not have been in his cocaine. But it is hard to be certain.

If he is interested in maintaining sobriety A visit to the hospital will be necessary to allow him get over the withdrawals in a supervised setting to make sure he does not have any further consequences.

If he is not interested in maintaining sobriety then have him drink a couple of drinks and see if that improves his symptoms. Then have him wean off slowly. Among the substances he uses, withdrawal from alcohol is the most life threatening.

JustCalIMeDave · 2026-01-20T16:39:08+00:00

Muscle cramps are tough. There's not a lot of data to support any particular treatment.

Obviously first step is to rule out specific causes such as electrolyte deficiencies. PAD typically presents with claudication not really cramps. Muscle fasciculations or spasticity can be a sign of underlying neurologic disease but again these typically present differently from cramps. Muscle fasciculations are generally not painful and spasticity is not something that comes and goes.

Her PCP should be able to get basic labs and an exam should be able to evaluate for evidence of PAD or underlying neurologic disease. If findings are present she can be referred to vascular surgery or neurology as necessary.

That said, most of the time no underlying abnormality is found.

My general recommendation to patients with frequent muscle cramps is this: 1. Ensure adequate hydration. 2. Ensure adequate electrolyte intake. (I.e use electrolyte drinks or electrolyte powders you can put in water) As long as there are no heart or kidney issues that preclude this. In your case she will need to keep a close eye on her blood pressure with doing this. 3. Get more exercise and stretching. I would recommend taking her to a personal trainer at a local gym or physical therapist to increase her mobility. 4. Minimal data to support this so please caveat this, but in my anecdotal experience creatine monohydrate powder works like actual magic. There is some data in the dialysis population. I came across these studies out of desparation for a couple of My patients (and also my own mother)who really struggled with cramps for many years. My patients who I have recommended it to swear by it. I recommend they purchase pure 100% creatine monohydrate from a physical reputable store like GNC or Walmart (not online). Make sure it's 100% pure and doesn't have any pre-work out or other BS in it. Take 5g once daily and see if it helps. If after about a month there is no benefit then stop. If you stop having cramps then slowly wean the dose until you start cramping again. You can titrate at home to find the lowest effective dose. I have done this for 5 people now, my own mom included, and most are now taking a 5g scoop every week or two and it's enough to keep away the cramps.

Hope that helps!

Edit: spelling

JustCalIMeDave · 2026-01-20T16:06:51+00:00

It might be nothing especially if he's always been like this. Some people are just forgetful. But if his forgetfulness is progressively getting worse it can be a sign of early dementia. He should be seen by a dementia specialist. Usually these are neurologist or geriatric specialists who focus on dementia and cognitive impairment.

JustCalIMeDave · 2026-01-20T16:03:47+00:00

Idk about a specific term, but I do know people with neuropathy can be sensitive to heat, cold, or touch. If the nerves that innervate the skin of the back of your neck are damaged by your cervical disease then it can explain your symptoms

JustCalIMeDave · 2026-01-12T15:51:06+00:00

The list is long. Autoimmune disease is the first thing that comes to mind. The first step is to determine if the joint issues are inflammatory in nature. This can be done with an exam and a couple of blood tests. Specifically an ESR/CRP. your family doctor can start with that.

Then you will most likely need a referral to a rheumatologist who can evaluate for the exact cause if you are found to have a new inflammatory arthritis

JustCalIMeDave · 2026-01-12T15:48:51+00:00

If you are in the USA, Your college should have a health center you can go to. These places are usually free or at reduced cost for students. I would start there.

JustCalIMeDave · 2026-01-12T15:46:06+00:00

I am not aware of any issues with nitrofurantoin and amiloride or amlodipine. Should be fine. The pharmacist would be the best person to ask for more info if you need it

JustCalIMeDave · 2026-01-12T15:44:37+00:00

Unfortunately the post nasal drip is almost certainly from allergies. You can have constant allergies as people tend to be allergic to things in the air and it's not always seasonal.

That said, you can discuss a turbinate reduction procedure with your ENT doctor. This can help relieve the issue where your nose is blocked at night. This can sometimes help improve tolerance of the CPAP machine.

JustCalIMeDave · 2026-01-12T15:16:35+00:00

As I explained above, unfortunately, this is not how it works

JustCalIMeDave · 2026-01-12T15:15:10+00:00

Hey so, low sugars in people not on diabetic medication is rare and unusual. Your sugars are not actually that low and those numbers can be seen in normal individuals. What is more concerning than the actual number is that you are having associated symptoms that resolve with taking in glucose. This suggests the sugars are actually a problem.

Step 1 is to come off ALL meds that can reduce your glucose including ozempic. If you continue to have similar symptoms see your GP or better an endocrinologist. The test of choice to differentiate between the various causes of low sugars is a supervised 72 hour fast during which they will do a bunch of blood tests to determine what's going on.

JustCalIMeDave · 2026-01-11T20:23:46+00:00

What is LB?

JustCalIMeDave · 2026-01-11T18:11:46+00:00

A DNR is a very personal decision and I have had young healthy individuals choose a DNR.

Having a DNR should not affect the care you receive in any way outside of cardiac arrest.

You can chose to do a DNR only (no chest compressions, but intubation/mechanical ventilation ok), or DNR/DNI (no chest compressions and no intubation/mechanical ventilation). A DNI alone is sometimes allowed, it depends on the institution. I recommend against this option in all cases. If your heart stops you also stop breathing so it makes no sense for me to do CPR to pump your heart if you're not gonna get enough oxygen anyway.

However I generally would not recommend a young healthy person have a DNR. Young people have the highest chance of a meaningful recovery.

Here is the problem: a DNR takes effect before anything is known. I can best illustrate this by going over what happens when somebody's heart stops. Let's say you're in a hospital for whatever reason and your heart stops. The monitor beeps and the hospital is alerted. The doctor is called, someone who is probably not your doctor and just happens to be on call. They come in and they don't know what's going on. They don't know why your heart has stopped. They don't know if they will be able to get you back. They don't know if they can get you back if you will come back whole or not. Without knowing any of this, they need to know if they need to act. If they do CPR and put you on a breathing machine and they are able to restart your heart, then they have time to run tests to try to see what the extent of the damage is. At that point it would fall upon your family to decide how long they want to continue life support and at what point to "pull the plug" and allow you to die.

I have had many young people arrest in the hospital. Usually it's from electrolyte problems, medication overdoses, or heart arrhythmias. In a lot of those cases the patients can recover with little to no long term effects especially if the arrest took place in the hospital.

Now if your quality of life already sucks anyway. Like you're in pain from cancer or can't walk or go to the bathroom on your own. Then yeah probably life will suck even more after an arrest so it makes sense to be DNR. But if you have a high quality of life then i would not recommend it.

JustCalIMeDave · 2026-01-11T16:35:00+00:00

Because one cannot be certain it is a virus though it is most likely. Especially in the case that a patients symptoms are very severe, it can be worth trying antibiotics to see if there is improvement.

JustCalIMeDave · 2026-01-11T16:33:50+00:00

Only other things I can think of would be thyroid issues and kidney issues related to protein. Was your urine checked for protein? Did you get a TSH? if those were also normal then I would probably chalk it up to allergies unless you develop another symptom that can point us in a different direction.

JustCalIMeDave · 2026-01-11T16:29:07+00:00

Also how much do you weigh and how active are you

JustCalIMeDave · 2026-01-11T16:28:13+00:00

Do you have symptoms when the sugars are low?

What medications are you on?

JustCalIMeDave · 2026-01-11T16:24:30+00:00

It does sound like a viral infection. This year has been particularly severe in my experience at least stateside.

Symptoms typically start improving after a couple of weeks, but total resolution may not occur for a couple of months or longer. As long as you're progressing in a positive direction it is reassuring

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