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Doctor insights on: Attempted Colonoscopy Modifier 74

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Do pars defects get worse over time? Left L5 pars defect. Pain since march 2014. OTC meds taken daily. Surgery options? Conservative options failed.

Do pars defects get worse over time? Left L5 pars defect. Pain since march 2014. OTC meds taken daily. Surgery options? Conservative options failed.

No: The defects themselves don't get any " worse" they represent stress fractures that occurred in the pars interarticularis that never healed. They sometimes can lead to a spondylolisthesis in which the vertebrae can start to shift over each other. Thankfully, a lot of people do respond to nonoperative care. Surgical option are either direct repair of the defect or a fusion. ...Read more

Dr. Charles Cattano
2,044 doctors shared insights

Colonoscopy (Definition)

Colonoscopy is the procedure of using a long flexible camera to visualize the entire colon from the inside with the option to take pictures, video, perform biopsies, remove polyps, etc. Generally people are sedated and do ...Read more


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Would oral prednisone help a thrombosed external hemorrhoid thats failed tx w/ hc suppositories & cream? What's best for pain control?

Would oral prednisone help a thrombosed external hemorrhoid thats failed tx w/  hc suppositories & cream?  What's best for pain control?

Hemrrhoid: Oral Prednisone has not been well documented in the literature in the treatment of hemrrhoids. Keeping on a strict schedule of nsaids for their anti-inflammatory effect, barring no contra-indications in your personal history, would be beneficial to you. I would recomment starting with Ibuprofen (motrin) 600mg 3 times a day for 30 days. The anti-inflammatory effects take a full week before benefit. ...Read more

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Intractable pain, scs implanted, high morphine equivalent for survival. Severe constipation.Switched to relistor (methylnaltrexone). Worked 3 times, now 7 days can't go. Was on 12 osmoprep, 2 miralax & 3 colace.What now?

Intractable pain, scs implanted, high morphine equivalent for survival. Severe constipation.Switched to relistor (methylnaltrexone). Worked 3 times, now 7 days can't go. Was on 12 osmoprep, 2 miralax & 3 colace.What now?

Constipation: You need to seek out the md who manages your scs. It needs to be adjusted. Also morphine may need to be changed to a different drug. Your body may not have the same response to fentanyl or oxycontin. You have to drink at least 8 glasses of water a day and eat foods high in fiber. In addition to the colace and MiraLAX (polyethylene glycol) the medicines are not substitutes for diet they are in addition. ...Read more

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Using clob/estrogen for lichen sclerosis -2 years constant fare ups- since menopause. Tried protopic. New dr. Started e&t and singular. Any feedback?

Using clob/estrogen for lichen sclerosis -2 years constant fare ups- since menopause. Tried protopic. New dr. Started e&t and singular. Any feedback?

Clobetasol 0.05%: If it's biopsy proven lichen sclerosis, clobetasol seems to be the best treatment. Estrogen is only used for atrophy (thin dry mucosal surfaces from low estrogen). Usually ls is a long term condition but if all else has failed, use the Protopic with careful follow-up with your doc. Testosterone rarely helps long term. Good luck with singular, i've not tried this for ls, interesting idea. ...Read more

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Dear Anesthesiologis: Any issue using 100 mg Fentanyl along with 100 mg Propofol & 50 mg Lidocaine for coming Endoscopy EGD. Is 1 mg Versed better ?

Dear Anesthesiologis: Any issue using 100 mg Fentanyl  along with 100 mg Propofol & 50 mg Lidocaine for coming  Endoscopy EGD. Is  1 mg Versed better ?

Need to speak to ane: An anesthesiologist should assess you prior to the procedure and they will make the decision for the types of meds and quantities many of which are based on weight, tolerance to pain meds. For an endoscopy sometimes the back of the throat is sprayed with cetacaine which is numbing medication so that the egd is better tolerated. ...Read more

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Colonscopy 2013 bright red rectal bleeding, diagnosis hemorrhoid . Appearing again & GI schedule colonscopy w/ anesthesia. suggesting incomplete last time?

Colonscopy 2013 bright red rectal bleeding, diagnosis hemorrhoid . Appearing again & GI schedule colonscopy w/ anesthesia. suggesting incomplete last time?

Not necessarily: There are many reason why this would be scheduled with general anesthesia. Talk to your GI Doctor, it may be different arrangements or requirements at the facility or the need for a longer exam. ...Read more

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Prilosec10yrs+ Short seg Barrett's.HALO ablation2015.Barrett's gone.Prefer stop PPI's. Endoscopy July '16. Wait? H2 blockers enough? Combo approach?

Prilosec10yrs+ Short seg Barrett's.HALO ablation2015.Barrett's gone.Prefer stop PPI's. Endoscopy July '16. Wait? H2 blockers enough? Combo approach?

Endoscopy: I would wait for July's endoscopic results before making any changes in your management. If there's no sign of Barrett's, your gastroenterologist may agree with avoiding more long-term ppi therapy in view of recent reports of adverse potential side effects. On the other hand long term ppi treatment does protect against malignant transformation. ...Read more

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I've been asked to ignore iliopsoas snap. V painful. Tried modalities, modification, weeks of intensive pt & steroids. Pls help. 17yrs f?

I've been asked to ignore iliopsoas snap. V painful. Tried modalities, modification, weeks of intensive pt & steroids. Pls help. 17yrs f?

Hang in there: If it does not get better in the future options would include arthroscopic tendon release but at age 17 i would try the non surgical method as long as you can. ...Read more

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Patient controlled years with UC without flares on Asacol (mesalamine).Now, Insurance won't pay unless patient fails trial of generic balsalazide.Refer back to GI?

Patient controlled years with UC without flares on Asacol (mesalamine).Now, Insurance won't pay unless patient fails trial of generic balsalazide.Refer back to GI?

What a shame!: You may have success getting Asacol (mesalamine) HD or a suitable similar 5-ASA approved on appeal for health plan coverage as a policy exception since the patient has done so well with it for so long. Or, prescribe the balsalazide (Colazal) alternatively. As an aside, is the patient with ulcerative colitis in question due for dysplasia surveillance now, in which case he/she deserves a GI referral anyway? ...Read more

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Had endoscopy Fri, hiatal hernia & 2 minor errosions. Biopsies 2 check 4 Barrett's. I'm on Prevacid (lansoprazole) 30 mg, constant acid since endo. What do I do?

Had endoscopy Fri, hiatal hernia & 2 minor errosions. Biopsies 2 check 4 Barrett's. I'm on Prevacid (lansoprazole) 30 mg, constant acid since endo. What do I do?

Be patient: I know it is tough but give your doctor time to get all the results and then call you back for your understanding and subsequent treatment. ...Read more

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Redundant colon,candidate for elective colon resection. Linzess, miralax no help. Milk of mag or Sennokot 2-3x week helps.Use instead of surgery?

Redundant colon,candidate for elective colon resection. Linzess, miralax no help. Milk of mag or Sennokot  2-3x week helps.Use instead of surgery?

Chronic constipation: Most often, surgery is only considered as a last resort. For some people, having a bowel movement 2 to 3 times per week is normal. If you are able to achieve this using milk of magnesia, then I would not consider surgery at this time. It is always possible to have complications of surgery, and in your situation, it doesn't sound absolutely necessary. Fiber and hydration are key. Good luck. ...Read more

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Recent UC flare, on 750 ml balsalazide 3 capsules 3 times day. dr prescribed canasa suppository.Will canasa work immediately overnight or in a week?

Recent UC flare, on 750 ml balsalazide 3 capsules 3 times day. dr prescribed canasa suppository.Will canasa work immediately overnight or in a week?

Not overnight: But hopefully soon! It'll probably take time to calm things down but if you haven't had any improvement by a week, you should let your GI doc know. Hope you feel better soon! ...Read more

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Cant afford titanium diagnosed with disk sequestration c6-c7. Dr plan corpectomy C7 n fusion anterior c6-t1 with gretting. Are der any options? Usin

Cant afford titanium diagnosed with disk sequestration c6-c7.  Dr plan corpectomy C7 n fusion anterior c6-t1 with gretting.  Are der any options? Usin

Options: Hard to answer without seeing films. However, alternative management with acupuncture has provided my patients with excellent relief even when surgeons want to cut. The most important aspect of choosing an acupuncturist for this is that he/she is knowledgeable of spine medicine: when it spine is stable and when surgical stabilization is essential If stabilization is not an issue, try acupuncture ...Read more

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Chronic post-nasal drip 1 yr. Tried everything allergy & reflux. ENT given me Claritin-D (240mg pseudo) & oral steroid 5 wks to break cycle. Thoughts?

Chronic post-nasal drip 1 yr. Tried everything allergy & reflux. ENT given me Claritin-D (240mg pseudo) & oral steroid 5 wks to break cycle. Thoughts?

Allergist evaluation: if you have access to an allergist, kindly seek their evaluation, you may very well have allergic rhiosinusitis, the medications you used would have some benefit, but need to be taken on regular basis, not as needed basis or for short courses, of course the systemic steroids can't be for long course unless really indicated, but local steroid sprays would do the trick, meanwhile. Good luck ...Read more

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12 years post op rny, iron 20 & vitamin d at 10. Seeing a new dr that hasn't worked with deficient gastric bypass, is 325ferrous 3x and 2000d 1x okay?

12 years post op rny, iron 20 & vitamin d at 10. Seeing a new dr that hasn't worked with deficient gastric bypass, is 325ferrous 3x and 2000d 1x okay?

Nutrition!: A gastric bypass is a very complex nutrition situation. If your physician has not dealt with it much i would suggest asking for a referral to a nutritionist or a bariatric center. That being said, the dosage of iron is fda approved treatment for iron deficiency, and the vitamin d is a reasonable amount. You have many nutrient levels that should be monitored and carefully watched! ...Read more