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A/P
No concerning findings to suggest secondary causes of constipation
No recent weight loss, no blood in stool, no change in caliber of stool
Patient is still passing gas, having BM daily
Discussed common medications that can cause constipation such as: TCA’s, anticholinergics, CCBm NSAIDS, diuretics, iron
Also discussed common metabolic issues that can cause constipation such as: DM, hypothyroid, , hypercalcemia, low potassium, low magnesium, as well as neurological conditions such as MS, parkinsons, or myopathies
Given that patient does not have any alarm symptoms and no symptoms of MS, Parkinson’s, or myopathies (no resting tremor, no upper or lower motor neuron signs/symptoms, no central muscle weakness), I think patient is safe for a trial of medications as below and I will check labs as below
Discussed extensively with patient to increase fiber in diet, increase fluid intake
-CMP
-CBC
-magnesium level
– start miralax
– start docusate senna
– consider colonoscopy if worsening, or patient develops hematochezia, melena, abnormal stool caliber
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