ArcaMax

DEAR DR. ROACH: I'm a 66-year-old male in good health. I've always had very regular bowel movements, usually spending less than 5 minutes in the bathroom daily. About six months ago, I had a colonoscopy. Since then, I've been constipated with very hard stools. My doctor recommended fiber supplements three times a day and Colace. I've been doing this for four months without relief. My diet hasn't changed in the past year. I drink more than the recommended amount of water and exercise daily. What can I do to get back to normal? -- B.L.

ANSWER: Constipation for a few days after a colonoscopy is expected. The bowel preparation for a colonoscopy removes more than 99.9% of your colon bacteria, and the entire suite of microbes that help your bowel stay healthy need to replenish. I agree with your doctor's management for the short-term future. I'd also have considered polyethylene glycol (MiraLAX).

Since your microbiome is strongly related to what you eat, I'd have expected your bowel function to have returned to normal long ago. A trial of probiotics might be worthwhile, with supplements that contain multiple species of healthy bacteria having better data to prove their effectiveness.

If this doesn't help, it's time to think about what else might be going on. Medications are a common cause of constipation; antidepressants, some blood pressure medicines (especially calcium channel blockers like verapamil), bladder medicines, and calcium supplements are the most usual agents. Blood tests to look for thyroid disease, high calcium and other problems are warranted here.

If none of these are the issue, it's probably time to see a specialist in gastroenterological motility issues and possibly get a manometry test.

DEAR DR. ROACH: What can I do to make my life easier when my test results show a completely torn biceps tendon? In addition, I have two important shoulder tendons that are torn, wear and tear damage to my bones, and muscles that have weakened and shrunk.

I'm 80 years old, and my doctor said "no" to surgery and suggested cortisone injections, which I refused. I also have pulmonary fibrosis. I'm as active as I can be, although I do rest when I'm exhausted. -- T.H.

ANSWER: The biceps muscle has two distinct heads ("biceps" literally means "two heads") -- the short head and the long head. Most biceps tendon ruptures are of the long head, and these ruptures are often managed conservatively (without surgery).

With time and critical physical therapy, the short head of the biceps can take over much of the job that the long head did, although there will always be some loss of strength. Even complete tears of the short head are usually managed without surgery and with physical therapy.

Pulmonary fibrosis can make surgery much more dangerous, so this may be an additional reason that your doctor recommended against surgery. I'm not sure why you refused the cortisone injections. These injections can help reduce pain in your arm and improve your function, and they are generally well-tolerated by patients.

Physicians only have a limited repertoire of interventions. Surgery, medications, physical therapy, therapeutic (not diagnostic) radiation and ultrasound are on the short list, with a few other interventions for highly specific indications. Physical therapy is a critically important part of our tool set, and many patients -- and even physicians -- underestimate its value.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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