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<s>[INST] I got kicked by a horse on Sunday. I have a huge long bruise taking up the majority of the outside of my femur and on the side of my knee. On my knee I have a large lump and very dark colored bruise except in the middle is white. And it s super tender. What is this? [/INST] Hello, As I can understand from the history, I feel this is a blood clot happened due to muscle injury over the thigh. Since you mention the knee I will recommend you to get it examined and also an MRI on a safety basis as sometimes the inflammation in the tissues get septic and needs proper medical attention. For now, you can do quick icing to reduce pain and inflammation. Any ignored injury leads to problems in the latter stages of life. Hope I have answered your query. Let me know if I can assist you further. Regards, Jay Indravadan Patel, Physical Therapist or Physiotherapist </s>

<s>[INST] It started in my hands, mainly my middle finger on both hands. They don’t hurt all the time but when they do I have extreme pain in my wrists as well! I have to drive some days with wrists supports on. When I wake up in the morning and get out of bed I hobble like I’m 100 years old. It takes a few minutes before I can walk upright and normal without pain. My hands some mornings as well as my wrists hurt so badly I sit in the shower for 30 minutes running very hot water on them so I can function. I experience weakness on the days I have the pain which effects my forearm and upper arm strength and my shoulders ache during these times as well. [/INST] Hi, If the pain and tingling feeling is from the wrist down to your fingers worse at night then probably you have what is known as Carpal Tunnel Syndrome. Please get your thyroid and vit D levels checked too. Hope I have answered your query. Let me know if I can assist you further. </s>

<s>[INST] Are Ntheir anynsio other medications available for Narcolepsy besides gfillinAdderall and long acting Adderall? I've haddifficulty filling my scripts due to a supposed shortage of certain CII medications, such as Adderalls and the Methadone I take for chronic back pain. [/INST] Hello, Thanks for your query.** I suggest you to follow the below mentioned measures to reduce your back pain-- Usually 1-2 days of bed rest will calm severe back pain. Do not stay off your feet for longer, though.- Avoid lifting weights as it imparts more strain on your back- Change your daily activities so that you avoid movements that can cause further pain, especially bending forward and lifting as it will worsen the intervertebral disc problems. if you want to bend forwards, do it with your hips and knees flexed.- Use a lumbosacral back support to stabilize your spinal muscles and to provide support for your spinal column.- After the initial pain has subsided, remedial exercises to strengthen the spine are very important to restore normal spinal movements and muscle strength. The main aim of exercise is to encourage mobility, reduce muscle spasm, prevent further deterioration in the muscles and speed recovery.- You should maintain an optimum body weight to decrease the strain on your vertebral column causing more degeneration and arthritic changes.- At times, spinal steroid injections and Facet blocks will help in alleviating the lower back pain.I do hope that you have found something helpful and I will be glad to answer any further query.Take care </s>

<s>[INST] My father is 70 year old and is suffering from Parkinson's disease since 7 years. He used to take Syndropa CR, Ropark 0.5 and Parkin 2mg and Entacom as medicine. For last few days he has development a new symptoms of talking wrong imaginary things. Is this common to parkinson disease. [/INST] there are 2 possibilitiesa. this may be a part of the dementia. the dementia may make the person talk irrelevently. the dementia is present in a large number of patients and often it comes late. b. may be an effect of the medications, the dopamine based medicines may have simlar effects. it is known to cause such symptoms.best to meet a neurologist for the readjustment of the dose.Best of luckDr Mittal </s>

<s>[INST] Hi Doctor, I am taking duphaston 10mg after my ovulation date , 2 tablets in a day & 2 tablets in night from past 1 week and I have abdominal pain, Leg pain, cramping, back pain sometimes pain in left & right ovary side.....but there was no signs of implantation bleeding....Am I pregnant? [/INST] HiImplantation bleeding occurs when the fertilized egg attaches to the lining of the uterus. Implantation bleeding typically is a light spotting or bleeding that occurs about ten to fourteen days after conception.You need to wait for few more days.Urine pregnancy test should be done by 10 days of missed period.Hope I have answered your query. Let me know if I can assist you further. RegardsDr.Saranya Ramadoss, General and Family Physician </s>

<s>[INST] Last Thursday I went to the doctors after having a bad cough. I was told that I have acute bronchitis and I was given a nasal spray. however it does not seem to be working, I seem to be getting worse. I am now having chest and back pains and I am loosing breath quickly! I am supposed to be seeing my doctor again tomorrow but I am worried that it could be more serious and that it might need to be seen to quicker. Can you help me? [/INST] Yes I can certainly help you. Start steam inhalations three times daily for 10 mins each time.Start an inhaler like seretide/advair two puffs two times daily and you should feel relieved. I think you also should get a Xray chest to rule out any tuberculosis and CBC count to look for any infection.You can also take a terbutaline syrup sos to feel relieved </s>

<s>[INST] ive had shoulder pain for about 10 months now which goes down my arm to my hand some days its fine but other days i can hardly lift my arm and putting a coat on is not easy i have also noticed i have a hard lump on my collar bone near my shoulder blade was just wondering what thisw could be? [/INST] **1. initially seek an opinion of orthopedic surgeon, it might be possible that your range of motion/movement, might be/is compromised.2. shoulder pain can occur independently due to over exertion [strain], overuse [tendonitis] or due to certain disease state[rheumatoid arthritis, diabetes, over active thyroid], thus examination becomes necessary.PS. further testing may be required like plain X-ray, [revealing narrowing of space or damage to bones], MRI [reveal details of shoulder joint] and blood tests [ to rule out any inflammatory conditions]3. since collar bone fracture is one example of shoulder pain [as there is hard lump on collar bone in your history], so it could possible be example of pinched nerve pressing on the nearby structures.4. In Ayurveda we treat frozen shoulder on the line of Avabahuka:. Initially dry heat. . successful and result oriented prescription is:I. vatakulantak ras, rasraj ras,panchamrit lauha guggulu.II. rason sura,dashmoola arishta.III. erand pakIV. Lehsun ksheer pak. avoid eating spicy, fried, pungent and oily foods. [The aim of the Ayurveda treatment is to bring the vitiated vata in equilibrium. The most popular kerala therapy is pizhichil, you may ask an experienced Panchkarma Doctor about the same] </s>

<s>[INST] Hi. About 2 weeks ago, I started to itch along my arms and hands. I noticed about two bumps on my hand and several on my arms. I thought they were mosquito bites. They were very itchy and hurt just a little but went away after a couple of days. They left dark spots however, which I thought a bit odd, as a mosquito bite usually would not leave such dark marks on me. Then about last Thursday, I started to itch under my chin. A swelling that made me look like I had a double chin developed but by Monday, it had gone down and has left a dark mark. Last night, my two upper arms started to itch and I have two large swellings on each arm now! What could this be? Can someone help please. [/INST] HIThank choosing HCMI would be happy to answer your query, from the history given here I could say that this is the allergic condition and it can be due to many things among that the first could be auto-immune response, second environmental, food allergy, medicine allergy, psychological, and others, in rare case it could be due to systemic disease and all of these condition anti-histamine and steroid can be tried like Tab Levocetirizine 10 mg three times in day, Tab Dexamethasone 10 mg three times in day for 5 days, hope this helps you. </s>

<s>[INST] I am 28,5'2, 130-135. I was diagnosed with a heart murmur when I was 14 but it comes and goes. I recently have been having problems. My breathing has really decresed, my pulse is lower than usual, and my heart feels like it stops then starts again. It feels like I am not breathing enough. [/INST] Hi,If you have heart murmur, I would advise you to undergo echocardiography. If it comes back normal, then nothingto worry. Young people frequently have such complaints without any abnormality. Follow healthy lifestyle abd it will disappear gradually.Take careCome back if you have any further questions </s>

<s>[INST] I felt an electric shock in my left front thigh while doing knee lifts with my right leg. I was standing up shadow boxing and when I bent backwards and threw out my right knee my left leg had an incredible electric shock and I felt a tear in the front muscle in my left thigh. [/INST] Hello, The electric shock feeling can be due to nerve and not due to muscle. I think you have a nerve entrapment in the lumbar spine and that's the cause for electrical shock feelings. As any Injury to the nerve may lead to abnormal sensations. When it's related to muscle there will be a dull ache and not the sharp shooting pain. Take the McKenzie maneuver position while the shocks come and see if reduced. If so than it is nerve pathology. McKenzie maneuver you can find online easily. Do core stability, spinal muscle strengthening exercises this should help reduce the symptoms. Hope I have answered your query. Let me know if I can assist you further. Take care Regards, Jay Indravadan Patel, Physical Therapist or Physiotherapist </s>

<s>[INST] I was diagnostic with Guillain Barre SyndromeI got about 75%better from my paralyzation, then about 18 months later I started getting worse. (Way worse). The weakness and drastic weight.change I can handle, it's the.pain in my hands & feet, and the severe anxiety like I'm not going to get another breath. I was diagnosed after waking up paralyzed fron gallbladder surgery & my DR. retiered. Which was.3states away. I live in Reno, NV. Area. Please help me with a DR. That takes Medicaid. Sincerely M. Bohannan (775)443-1984 [/INST] HIThank fro asking to HCMSorry to hear that but GB syndrome is one time game, after attack of virus it start doing its job and finished it soon and go away and this is emergency phase right treatment and in time medical care brings good result and it takes few weeks,,, then what ever happen to patient later on must not be because of GB syndrome, and that can be managed accordingly and for this any family physician will take care of this , no need to worry you will get alright, discuss it with your doctor have nice day. </s>

<s>[INST] At the base of my spine and like above the anal opening, but still in the butt crack there is something hard right at the ending of the spine and it has been hurting for a while now. When I squeezed it tonight a light yello mucous like substance shot out and now there is just clear fluid. Is this a cause for concern? Could the clearish fluid be spinal fluid? [/INST] Hi,Dear,Thanks for your query to HCM.Dear I read your query and reviewed it with context to your query facts.Based on the facts of your query, you seem to suffer from-Pilonidal Cyst with abscess,which ruptured and formed Pilonidal Sinus.Treatment-USG / CT study of the Pilondal sinus and Second expert Opinion from Surgeon would help plan further treatment for you.As the recurrence is more with this sinus-I would suggest following options-Debridement of the Pilonidal Sinus with Excision of the Sinus or Marsupilisation of the Pillonidal Sinus.Coccygectomy-Removal of SacroCoccygeal / or tail bone would end the possibility of the recurrence of such pilonidal sinus with recurrent abscess.Hope this would help you to plan further treatment with your family and specialist doctors there.Welcome for any further query in this regard.Good Day!!Dr.Savaskar M.N.Senior Surgical SpecialistM.S.Genl-CVTS </s>

<s>[INST] My sister, has had a "wound" that started in the middle of her head. She had very bad dandruff and has a nervous habit at picking at her scalp, which is why this wound was created. She has had this for about a year now. Constantly picking and the wound moving slowly up her scalp to her forehead. It is now in the middle of her forehead and she has been doing very well at not picking at it, for obvious reasons, she is embarrassed of it and now people can see it. However, over the past few days it has gotten progressively worse. There is now two wounds, relatively close together. The skin around the wounds are red and she is claiming that they feel numb. Should she be worried? Is it possible that she has gotten bacteria in there and now has some bacteria that is flesh eating? Should she seek medical attention? What are the concerns her for MRSA? She has a small child, 3 years old, I'm concerned for transmission for my neice as well. [/INST] Thanks for posting your query to health care magic.you need to take care for wound . immediately contact to local surgeon for proper cleaning and dressing of wound as if infection can worse the condition .you also consult to dermatologist for dandruff problem as scratching will again create wound .I suggest to collect wound swab for culture and sensitivity examination and send to microbiology lab . It will suggest you organism responsible for infecion and treatment option for it . You will require systemic medication along with local care of wound .Feel free for any furher query.Regards,Dr.Manish PurohitInfectious disease specialist </s>

<s>[INST] Hello doctor, I just got home from a mission trip. Three days into the trip, I started getting chills accompanied by diarrhea once or twice a day, usually in the morning. I took Imodium each day and continued doing activities. Three days after diarrhea, I got a scratchy throat. The next day, I got a stuffy nose as well. The day after that, I flew home. My throat felt less scratchy, but my glands swelled up and it was painful to swallow. I still had diarrhea that morning. The next day (yesterday) I got a fever of 100.8, chills, fatigue, and coughs. I had a stuffy and runny nose throughout the day, and the left side of my nose got congested that there was painful pressure in my sinus. On the bright side, there was no diarrhea yesterday and the swelling in my glands went down. But last night diarrhea came back and then happened again this morning. It is now been a week since diarrhea first started. I still feel feverish and I am still very congested. Should I be concerned? I am currently taking Ibuprofen, Sudafed and Mucinex. [/INST] Hello. I went through your post, you have mentioned the duration of illness as one week which makes it an acute illness. The characteristic features of your illness are loose motion, fever, congestion in nose and sore throat. All these are features of acute viral infection, because of loose motion the possibility of influenza are high. Viral infections of this kind are self-limiting and settles in one to two weeks. I would suggest to stop Ibuprofen as it causes rashes and platelet dysfunction in viral infection. You can take Paracetamol 650 mg eight hourly. Last but not least, take plenty of fluids and go for CBC (complete blood count) to see whether there is any decrease or increase in cell count. </s>

<s>[INST] Hi I was having inefficient vitamin D and I was not aware about that and taking penadol frequently as I was feeling temperature after some days I visit doctor and come to know that my vitamin D is 16 and sgpt was 77. Please help me is there any medicine required for it [/INST] Hello, The low levels of Vitamin D can be corrected with the help of proper supplements. You can start with vitamin D3 supplements. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Praveen Tayal, Orthopaedic Surgeon </s>

<s>[INST] im 22 n 1 year married but i cant concieve bcz my gynae says i have a PCOS n i have irregular periods before my marriage. im taking DIANE 35 and GLUCOPHAGE 1500 MG daily n last month i take clomid 50mg but now on thiz month same problem i had irregular period. my dr. recomment again diane 35.. kindly tell me what can i do?? [/INST] HelloIf I were your treating doctor for this infertility case ( not getting pregnant ) and also having PCOD ( Poly Cystic Ovarian Syndrome or Disease) I would come up with these measures , these include.1 Clomid or clomiphene or clomifene 50 mg daily for 5 days starting on the 5th day of menstrual cycle or at any time if there is amenoorhea ( or wait for menses date in spite of irregular date and count 1st day of bleeding as day one ) .Now get in folliclular study on 14-15 day for ovulation . Keep watch over size of dominant follicle and its release date ( it must attain 19-20 mm ) . Sex on these days on regular basis from 13th to 15th days.If ovulation does not occur, a 2nd course of 100 mg for 5 days may be used as commencing as early as 30 days after the previous therapy. Further treatment may not be recommended if pregnancy has not occurred after a total 6 treatment cycles . Glucophage 1500 mg you can take but in my opinion diane 35 ( cyproterone +ethinylestradiole ) tablet don't use it.2 Also get in SEMEN analysis of your husband .Hope these measures will be helpful for you. </s>

<s>[INST] Hi doctor, I am a 26 year old male. I am 5 feet and 9 inches tall and weigh 255 pounds. When I eat spicy food, I poop blood. Sometimes when I have constipation as well, I poop a little bit of blood. I am really scared that I have colon cancer. I do have diarrhea often. I do not have a family history of colon cancer. I got blood tests done last night. Please find my reports attached. [/INST] Hello. I have gone through your information and test reports (attachment removed to protect patient identity). So, in view of that, there are a couple of things that I can opine upon: Hope that helps. For more information consult a general surgeon online --> </s>

<s>[INST] My belly button is swollen and there is a small hard lump under the skin. It is painful and red. I was initially worried that I might have a hernia, but then thought it could be chaffing. I am a carpenter and had just finished a job where I was sweating heavily and bent over all day. What would explain this? [/INST] Hi,Dear thanks for the query to HCM virtual clinic.I studied your query in all the details you gave.I understood the concerns you have.Treatment-Don't be anxious and panicky.You seem to have boil of the belly button,as it with pain and redness.But it could also be tense umbilical hernia,which could be painful and red due to stretching.I would advise you to cool down and wait till you consult with ER Surgeon ,which would fix the cause and treat for your belly button lump.Welcome for any more query to HCM in this regard.Write Excellent review and hit thanks if this reply Helps you out.Have a Good Day.Dr.Savasakr M.N. </s>

<s>[INST] My daughter is 8 months old. She fell last night and bumped the side of her head. We went to the ER and they did X rays no fracture but she has a squishy lump on the right side of her head towards the back. She is acting herself I m just still concerned. [/INST] Hi, dear. I have gone through your question. I can understand your concern. she may have some hematoma on her scalp. Scalp soft tissue is very vascular so its common in that region. No need to worry. It will heal by itself within few days. Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health. </s>

<s>[INST] just found out I have a lump on my groin area . Its the size of a walnut and this is the first time I noticed by taking a bath . I will be going to the doctor but could it be a herena . I am 68 years old and scared to find out if it is CANCER. just need a peace of mind thank you [/INST] Hi,From history it seems that you might be having direct inguinal hernia.At this age due to lax abdominal and pelvic floor muscle one gets hernia.There might be possibility of having enlarged inguinal lymph node as well./Nothing to worry about cancer.Consult surgeon and get examined.Ok and take care. </s>

<s>[INST] Hi my child is 13 months old and is suffering from high fever 103.5 F doctor has advised foll medicines he is suffering from fever since last 4 days kindly suggest wheather the prescription is right or not,Calpol 250VizylacAtarexDistaclor 125Tustel txThanks,Jitendra Jadhav [/INST] Hi... I feel it is too many medicines for a simple viral illness. Fever of few days without any localizing signs could as well a viral illness. Usually rather than fever, what is more important is the activity of the child, in between 2 fever episodes on the same day. If the kid is active and playing around when there is no fever, it is probably viral illness and it doesn't require antibiotics at all. Once viral fever comes it will there for 4-7 days. So do not worry about duration if the kid is active.Paracetamol can be given in the dose of 15mg/kg/dose (maximum ceiling dose of 500mg) every 4-6th hourly that too only if fever is more than 100F. I suggest not using combination medicines for fever, especially with Paracetamol.Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health.Dr. Sumanth MBBS., DCH., DNB (Paed)., </s>

<s>[INST] Hello doctor,My son is 13 years old. We are based in Greater Noida which is in the outskirts of Delhi.Since he was five years old he as been suffering from asthma whenever there is season change during March/April and October during which he generally starts getting allergic cold. I used to earlier give him Asthalin inhaler but since last 4-5 years he is using Levolin inhaler to resolve the attack. Lately I have started nebulizing him at home using 0.63mg Levolin respule morning and evening and inhaler several times during the day. I have also started giving 0.5mg Budecort respule along with that recently, as his asthma is not coming under control for the last almost 1.5 weeks now. He wakes up in the middle of the night after 2 hours of nebulization and complains of feeling breathless and needs to take multiple puffs using the inhaler, sometimes much more than the prescibed dose as mentioned in the medicine leaflet. I have being trying to get him to inhale steam as well as that gives him temporary relief. He is really breathless when he wakes up at 6:00 in the morning and even had to miss school 2 days last week. I need your help to advice me on the right dosage of inhaler and nebulization to get the asthma attack under control. Do you suggest any other medicines? I definitely would want to avoid oral steroids or any strong medicines. [/INST] Hello. It seems your son is suffering from bronchial asthma. It is known to aggravate with seasonal changes. You need to understand that by nebulizing him regularly, he will get dependent on nebulizers. In my opinion, he should be nebulized with the doses you are already doing only in case of acute attack. Once the acute attack settles, which usually takes 5-7 days, he should be weaned off nebulizers. Revert back to a pulmonologist online for further follow up --> </s>

<s>[INST] my daughter is 7 and has had siezures since she was 1. She usually has 4-8 siezures a year. had EEG had MIR found nothing. She has had 3 siezures in the last 2 weeks and now has a throbing pain in upper left leg. She says it feels like her heart is beeting in her leg. complians her heart beats fast at times. the pounding as she calls is has been off and one since her siezure this morning. [/INST] your child is experiencing tinitus. it may be because of valproate toxicity..right now what is the weight of your childwhich medication is your child is taking and which dosage? </s>

<s>[INST] dear doctor i got suprazole 200mg x2 tab , amoxil 500g and brufan 500mg for every 8 hrs for my one of upper jar teeth infection, when i take this together i fell like lifeless, then i stop brufan , while brushing blood also bleeding from gum, pls advice me for this ,i did root cannal for infected teeth. but still lit bit pain there. [/INST] Thanks for using Health Care Magic.Read your query.Having gone through your query,I would advice you to take the medication on full stomach and take lots of fluids and keep yourself hydrated.You can stop Brufen if you do not have pain or take a paracetamol for it.Do continue the dose of antibiotics,if the tiredness is increasing please consult your dentist and have the antibiotics changed.Bleeding gums is due to the inflammation of the gums,which will reduce once you get your scaling done .Pain after root canal or some discomfort which usually remains will go down gradually.Hope this was helpful and you have a speedy recovery.Thanks and regards. </s>

<s>[INST] Hello, I had an Adenopathy in October with fever (39 max) for about 5 days, I did blood tests back then for CMV, EBV, Hepatitis A IgM & HBs, they were negative whereas results for SGOT, SGPT, Phosphatases alcalines & GGT were respectively 78, 101, 240 & 67. They were high. The doctor asked me to redo the liver tests this month and the levels are now even higher with no fever or any specific symptoms. The new levels are: SGOT: 145, SGPT: 241, Phosphatases alcalines: 222 & GGT: 62. My doctor asked me today to visit a gastroenterologist to diagnose the problem. I have an appointment next week but i'm terribly concerned now. What can really be the problem? Can it be hepatitis? HIV? An STD? I did my Pap test 2 month ago everything is normal.I take lots of ponstant forte during period. I've also been taking pills to lose weight (forte pharma minceur.It's worth mentioning that I had an unprotected sexual relation more than 2 years ago and I had hepatitis B and HIV tests twice, 5 month and one year and a half after the potential risk, but they were all negative. Please advise! [/INST] Hi,Usually ALT or AST values higher than "two times the upper normal limit", is considered abnormal (in some countries, ALT or AST values of more than 100 are considered abnormal). Value of AST or ALT greater than 85 or above maybe investigated further. Viral hepatitis ( HAV, HBV, HCV) are common cause of elevated liver enzymes. Typhoid fever may also affect liver and cause high liver enzymes. Advice:- abstinence from "Alcohol"- AVOID junk food and beverages- decreased oil consumption (oily food)- NO red meat- green vegetables should be ingested daily- use lemon juice (lemonade) once in a day- reduce weight if overweight/obeseIf HbsAg is positive also test for HBV DNA and HbeAg. HBsAg can not be completely eradicated in a patient suffering from HepB. However, complications maybe prevented if proper medication is taken and proper diet plan is followed. Treatment is advised IF high values of liver enzymes AND high viral LOad on a PCR.If HBV DNA count in PCR are not high, liver enzymes should be monitored regularly while HepB markers maybe checked every 6 to 12 months. Hope to answer your concern. Any further questions are welcome. Wish you good health.Regards,Dr Tayyab Malik </s>

<s>[INST] I am a 29 yr old female. I had anal sex 4 days ago. It was very dry and he ended up tearing me a little. It didn t hurt much. He ended up lubricating both our parts with his saliva. At the time he had a large cold sore on his mouth, that kept opening whenever he ate. The next day I had itching and irritaion on my anus. The next day this was accompanied by nasuea and headache. Now i have bumps around and in my anus, a fever, headache, nausea, chills, and my bum hurts so much I can barely move, sit, or lay on my back. Do I most likely have herpes now? [/INST] Hello Miss,Welcome to Health Care Magic. I have gone through your query and I understand your concern. The possibility that you may be infected with Herpes Simplex Virus (HSV) is very high. You also mentioned that you had also a little fissure on your anus, and it could also be the site of entering various bacteria and infect you. In order to give a definite diagnose, you have to visit your local physician, who may order cultures (blood, tissue, and fluid samples) of the sores and send them to a laboratory for examination. Your doctor can typically diagnose a herpes infection by a visual examination of the herpes sores. Although they are not always necessary, your doctor may confirm his or her diagnosis through a laboratory test.Genital herpes is not the only condition that can produce these symptoms. Sometimes, HSV is mistaken for vaginal yeast infections, bacterial infections, or bladder infections. The only way to know whether they are the result of HSV or another condition is to be checked by a health care provider.Hope I answered your question. If you have other question, don't hesitate to ask again.Take Care,Dr. Ina Zaimi </s>

<s>[INST] Hello Doctor i am 30 years old.when i was at the age 17 i was detected for jaundice and the doctors told liver was badly affected and i was suggested liv52. by that time i was in normal weight.but after i was continuously putting on weight and now i am 79kgs and my height is 5 1 only after taking so many medications i am not decreasing my weight.and my scan is telling Grade I Fatty liver . i am having type II diabetes also.(when i was pregnant i got but after 3 years it is not in control). doctors are saying if i reduce my weight surely sugar will comes under control. want advice to overcome fatty liver and reduce weight. Thanks [/INST] hi liver is an organ that can well revert back to normal even though its been affected some part of the life. Fatty liver grade 1 as reported to you is quite common if BMI is more. It can be reverted back to normal on having control over fatty diets and over food stuffs containing high content of triglycerides. </s>

<s>[INST] Hi doctor, 1. I recently had full body health checkup. I am uploading the reports. Can you please review and suggest me required medical care or treatment? It seems lipid profile and ultrasound reports are not satisfactory. Please review and advice. 2. And one more thing is I am suffering from urticaria (Getting red rashes on skin which scratch or apply pressure on skin. These rashes disappear in few minutes) from last 1.5 years. I am taking Desolor 5 mg tablets thrice a week. Can you advice me if any advanced and permanent treatment to this problem instead of prolonged usage of tablets? I do not have any smoking or drinking habit. [/INST] Hi. I can understand your concern. I have gone through the reports you have attached (attachment removed to protect patient identity). You are having grade 1 fatty liver. You are also having elevated cholesterol which justifies fatty liver. So you need start lipid lowering drug like Rosuvastatin 10 mg once a day at night before going to sleep for 30 days. Get done repeat Lipid profile after 30 days. Avoid oily and spicy food. Avoid junk food. Avoid cheese, butter, etc. Do regular exercise like walking, running, cycling and swimming, etc. For urticaria, take Montelukast and Levocetirizine combination (Montek LC). </s>

<s>[INST] Are night sweats common after the flu? I had flu symptoms - fever, aches, chills, headache and cough for four days. Last night my fever finally subsided and was 99.1 at 8pm. I was and am still battling, a now worse, cough (now terrible chest cold), but thankfully fever is gone. I woke up four times drenched in sweat, flipping my pillows and moving to a diff section of the bed. The 4th I had to get up and change the sheets and pillows. I've had the flu, but it's been years. I must say, I don't recall ever experiencing anything like this afterwards. Is this normal? How many nights could this potentially last? Thank you! [/INST] Hello dear,Thank you for your contact to health care magic.I read and understand your concern. I am Dr Arun Tank answering your concern.Sweating is the bodies response to cover up the temperature in the fever.So whenever you have fever in the end of fever you will have sweating this will counteract the body temperature or you can say it will bring down the temperature.So this will continue until you are cured with the infection or in other word without infection cured this cycle will continue.If you are having sputum culture and sensitivity can be helpful for diagnosis and treatment of the organisms isolated.Please start doing the respiratory exercise. This will be helpful in clearing the chest rapidly.Please maintian good local hygiene this will equally helpful in curing the infections as antibiotics do.I will be happy to answer your further concern on bit.ly/DrArun.Thank you,Dr Arun TankInfectious diseases specialist,HCM. </s>

<s>[INST] Could an abscessed tooth be causing muscle pain and cramping in other areas of the body than the mouth? [/INST] Hi, An abscess can result in muscle pain only in the Head and Neck region. An abscessed tooth can also give rise to fever. A dentist should be consulted and antibiotics and treatment for the tooth should be obtained. </s>

<s>[INST] Last night I noticed an irregular-shaped brown spot on the head of my penis. It does not appear to be raised and is painless. I am sixteen and not sexually active although I frequently simulate sex while clothed with my partner. I also regularly masturbate and it was while doing so that I noticed the spot. I am worried as to what this is and if it will go away. [/INST] Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice.You might be suffering from Zoon's balanitis or Plasma cell balanitis which occurs due to irritation of foreskin over glans penis. Apply Fusidic acid cream for 2 weeks. If you do not get any improvement or if you are having other symptoms such as urethral discharge or genital ulcer, immediately consult your Dermatologist/Venereologist.Hope I have answered your query. Let me know if I can assist you further. </s>

<s>[INST] hi doctor ,presenlty i was residing in kuwait for work purpose,but actually iam an indian.Sir/madam whenever i go back to india on my vocation i feel my health condition pretty good and also my breathing is well but whenever iam in kuwait i felt hard to breath in mornings as well as while walking on the roadsides...also i have more cough when iam in kuwait (iam male,age:26 and my body weight 85 kg 5.75 height).iam using rotahaler-rotacaps it giving me the freedom from my breathing struggle.i cant understand what is my problem exactly...i did my x-ray tests in india everything was normal...pls give me a fine solution...also tell me can i continue with the rotahaler or not? also can i know the names of anti allergic drugs for bronchitis [/INST] Hi, mohammed Ali, Thanks for query, Usually it should not happen it is likely that if atmosphere in Kuvait is of humid then you may get breathing problem. Go for blood test for eosinophilia, which may produce this type of problem. You may take antiasthmatic drugs like Eto-salbetol tab. As an antihistamine you can take Cetrizine or levo-cetrizine. ok and bye. </s>

<s>[INST] Hi doctor, I am a 22 year old female. I have a dusky skin that is brown skin. I want to become fair. Can I use Kojivit gel? Or any other dermoatology cream can I use? My hands are also brown in color and full of tan. Do you suggest any creams to get fair? I want to become fair as my marriage is going to get fixed by next year. Please suggest me some creams, so that it should not show any side effects. Also, how long I should use it? If I use anything, then will it have any effect in case of pregnancy, etc? Please help me. Thanks in advance. [/INST] Hi. One's skin color has 2 components. First one is genetic, which cannot be changed. Every skin color is beautiful in its own way and we should learn to love our skin color and augment it and not hide or lighten it. The second component is acquired, which is due to the influence of environment, sunlight, hormones, aging, etc. We can only target the acquired component of fair skin color while attempting lightening procedures. I suggest you antioxidant capsules like capsule Antoxid HC (Beta-carotene) and apply sunscreen lotion Lashield gel at 8 AM and 12 PM. Also, you can apply Glyaha koj lotion (Hydroquinone) at night time. Start with an alternate night application initialy as it may irritate your skin a bit and after a week or so, shift to daily night application. Consult your specialist doctor, discuss with him or her and take the treatment with consent. You can go for chemical peeling or microdermabrasion from your dermatologist which will help in exfoliating and give you a clearer skin tone. All these treatments are free of side effects. You may use them for three months. For further information consult a dermatologist online --> </s>

<s>[INST] yesterday on my left hand my finger next to my thumb locked up and would not move. my hand swelled and it hurt so bad. after about five minutes my finger was able to me but i was still in some pain. i took ibrofen. this is the second time this is happend. I am 42. [/INST] Hello,I read carefully your query and understand your concern. The symptoms seem to be related to tendonitis which is an inflammation of the tendon in the finger.I suggest using anti-inflammatory medications such as Ibuprofen to relieve the symptoms.I also suggest using cold compresses for local application.I recommend using a splint to maintain the finger immobilized.Hope my answer was helpful.If you have further queries feel free to contact me again.Kind regards! Dr.Dorina Gurabardhi General &Family Physician </s>

<s>[INST] My husband has pulmonary fibrosis, has brackets and rod in his back, and has had replaced both knees and shoulders. He is in constant pain. What can be done to relieve this pain? He has been taking oxycodone 10-325 ace, six per day, but that does not stop the pain [/INST] Hello and welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. Apply cold pack when it hurts. Don't apply hot packs as they are contraindicated to be used where implants are settled. Put emphasis on positioning while sitting and standing. Right positioning and ergonomics like sitting straight can work wonders. Do isometric exercises of back, hip, knee, it will also relieve the pain and discomfort. Once pain gets subsided then feel free to contact for further exercises regime and that can be discussed later on.Hope I have answered your query. Let me know if I can assist you further.Regards, Dr. Harsh Swarup </s>

<s>[INST] I have inflamation in different joints that comes and goes. I will be sore for a couple of days and then fine for a few more and then it will come back in a different joint. It also includes the hands - specifically the index finger becomes sore and tight - I can t squeeze my hand shut and don t have any strength in the hand. Blood tests only show a rise in some liver enzyme everything else is fine. Any ideas what this might be? Thanks for your help. Felicity [/INST] Hi As per your description it appears to be fleeting arthritis ( Transient synovitis) in which only one joint is involved at a time. The treatment for this condition is anti inflammatory pain killers only when required. If it is very frequent then i suggest medical check up. </s>

<s>[INST] Pain in right posterior knee upper and lower leg on weight bearing.have been going to pt for 3 months .am told it is my muscles .and need to strengthen them. X-ray ...no arthritis. Fell Jan that s when pain started.told by PT I did not need mri.....6 months of pain and no progress [/INST] Hi, Once the arthritis has been ruled out, it can be due to ligament or tendon injury. You can try analgesics like Ibuprofen or Diclofenac for pain relief. If symptoms persist, you can consult an orthopedic and plan for an MRI scan. Wishing you good health. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Shinas Hussai </s>

<s>[INST] Hi I am a 30 year old Male. I am having tightness in my head. NO Pain. the tightness is majorly in the back side of my head..back upper & middle side. I have anxiety issues. this tightness started last evening. i have carried out my daily activities today. But i have been feeling it most part of the day. No other symptoms. Should I be worried? do I need any medication? How much time will this take to get fine? Please advise. Thanks. [/INST] HiWhen you have already acknowledged that you have anxiety issues, this explains the tightness in head. It should not be a danger to life so you can relax in that sense. You certainly need to be evaluated by a psychiatrist for anxiety issues . These symptoms may stay for a couple of days , go away and come back so permanent relief is by management of anxiety issuesTAKE CAREDR SAATIISH JHUNTRRAA </s>

<s>[INST] last 2 year we are trying for a baby. but steel now i m dose not able to conceive. so my doctor suggst me for HSG test. but in present scenario she is not available. my HSG report is like that. uterine cavity is normal. Right tube not opacified. Left tube opacified with peritoneal spillage. my question is is there any problem for pregnancy? if yes, then what is the remedy of this problem? [/INST] Hello Thank you for your query. Your HSG shows that your right tube is blocked ( not open ). This definitely is a problem for pregnancy, because with only one Fallopian tube open, chances of pregnancy are diminished. The further treatment depends on many factors. Your age, semen analysis of your partner, your ovulation studies and your hormonal tests. Pregnancy is technically possible with one tube open, however, since you are trying for 2 years now, please consult an Infertility Specialist and undergo the above evaluation. In presence of any abnormality, you should consider a hysteroscopy and laparoscopy, as HSG is not 100 % confirmatory and during laparoscopy, attempt can be made to open the blocked tube. If the laparoscopy also confirms tubal disease, you can go in for IVF/ IUI as per the results. take care. </s>

<s>[INST] Hello doctor,I am 36 years old, male, 6'1", 265 lbs. I have a question about total bilirubin. I had it checked four weeks ago and it was at .41 mg/dl and one month later it jumped to .82 mg/dl. My alkaline phosphatase is at 1.173 ukat/l and four weeks ago was at 1.003 ukat/l. The doctor was not concerned by this but the highest I have seen it was three years ago when it was at .53 (total bilirubin).However, during the last month, I went from 282 lbs to 265. I have been extremely stressed out about it. Health problems and my anxiety are high. I barely slept the night before the tests and am possibly dehydrated. Could these factors have contributed to the increase? I am concerned about bile duct obstruction. [/INST] Hello. Since this question was posted under diabetology, I am wondering if you have any endocrine issues. The question asked here is about gastroenterology. The liver tests would be concerning for a liver process like gallstone if the enzymes were not coming back down or if you had pain in your right abdomen. Any fever? Dehydration can sometimes cause the numbers to be slightly up. It is important to have a follow up with your GP. You can also run the query through a gastroenterologist on icliniq. </s>

<s>[INST] Hi Doctot quick question. I just got my upper left mollar extracted around 2:30pm today. Around 6:45 i got up to go to the bathroom and change gauze because i was still bleeding. I also use some salt water to clean my mouth. I almost fainted and my hubby rubbed alcohol on me so that helped. Is this normal? Should i seek medical help? Should i stay home and rest all day instead of hoong to work? I have had 2 mollars extracted about 5 yrs ago and i never went through this. What should i do, i don't want it to happen again. [/INST] Hi Dear,Welcome to HCM.Understanding your concern. As per your query you have fainting spell post extraction of molar tooth . The symptoms you mention in query can occur due to blood loss , side effects of anesthesia or due to other reasons like inner ear infection, eustachian tube dysfunction, Meniere's disease. I would suggest you to drink plenty of water eat healthy , take proper rest and avoid bending forward . If condition doesn't get well. then consult dentist again . Doctor may also reefer you to ENT specialist for ear problem.Hope your concern has been resolved.Best Wishes,Dr. Harry Maheshwari </s>

<s>[INST] Hi sir, Am lavanya. I have PCOS for last 10 yrs. got marriage 1 1/2 yrs back.. Me & my husband trying for baby.. currently am taking clomid 50mg.. this is 2nd month am taking.. last month bleeding was veyr low & also it was different (no stomach pain).. can i increase clomid dosage? can i take metformin daily? [/INST] Hi,I understand your concerns.Following is my reply:1)     Dont self medicate yourself.2) Please see your fertility SpecialistYou can contact me anytime directly to ask question by pasting following link in your browser:XXXX </s>

<s>[INST] hi. I actually just had the nerve conduction test done where they used the electrodes and zapped my hands and arms and once that test was done they did the one with the needles where there stuck em in several places on the hands and up around the elbow ect. I just cant remember the exact names of both tests but at the end of the test I was told I do have carpal tunnel but he couldn t tell me yet as to what severity. if I have to have surgery how long does it usually take to recover? also can they do both hands at the same time? I m real worried about missing time from work. [/INST] Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. After a carpal tunnel surgery it can take 2-3 weeks to recover fully. Regular physiotherapy is needed. Hope I have answered your query. Let me know if I can assist you further. </s>

<s>[INST] For the past two weeks my entire body has been itching extremely bad..i m miserable..and theres little raised bumps where i have been constantly itching now..I dont know if this is because of stress or what else it could be from?? I m not anymore stressed than i normally would be and I have no allergies I am aware of. What could it be??? [/INST] Hi thanks for your question.The small raised bumps whcih your mentioning could be due to constant itching. Itcung could be due to some allergens present in your environment or you might be consuming some food to which you are allargic Other common cause of itching include scabies ,which is infection and involves whole body. I would suggest you to consult some physician to differentiate between allergic reaction amd scabies further management will depenf on diagnosis. Hope this answer your question. </s>

<s>[INST] I had bells palsy 2 yrs ago and it didn t heal! Now when I get hot my eye draws shut my right side of my face pulls up, the right temple hurts bad and my left arm hurts and starts to tingle!! It s weird that all this happens as soon as I walk outside when the temperatures are high!! [/INST] Hi, The onset or worsening of neurological symptoms involving cranial nerves with heat as a trigger is called Uhthoff's phenomenon. It is not clear to me that the Bell's palsy is exactly tied to what is happening and in fact, there is a chance that you are not suffering from true Bell's palsy to begin with but rather a central nervous system mimicker. My recommendation is that you speak with your primary doctor and ask to be referred to a Neurologist for the purpose of going back and relooking at the diagnosis of Bell's Palsy in the light of your neurological symptoms which are exacerbated by heat. There is a good chance the neurologist will order tests and studies on you such as an MRI of the brain and cervical spinal cord with Gadolinium contrast. This may disclose the reason for these problems. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Dariush Saghafi, Neurologist </s>

<s>[INST] 34 year old female with elevated white blood cell count after month of vancomycin treatments. Leukocyte alkaline photophase test came back elevated as well as elevated liver enzymes. severe fatigue with occasional left rib pain and some hip pain...any suggestions? [/INST] Hi,Thanks for asking.Based on your query, my opinion is as follows.1. Elevated white blood cell count possibly indicates inflammation. Liver enzyme elevation indicating liver injury could be the cause.2. Leukocyte alkaline phosphatase score is elevated due to white cell count. 3. Exact counts is necessary along with evaluation of Arneth count to evaluate for leukemia or inflammation. Severe fatigue with bone pain indicates possible associated anemia. Check for hemoglobin levels.Hope it helps.Any further queries, happy to help again. </s>

<s>[INST] My 14 year old daughter has ran a fever going on four days now. I just took her temperature and it s 103 under the arm but 103 orally. Not to sure which to go with. She was diagnosed with Influenza A and I m debating on whether to take her to the ER due to her ongoing fevers. I am making sure she is hydrated. Her heart rate is very high. Is it due to the fever? Should I take her to the ER? I m so confused on what to do. I know they said Influenza lasts for a week or two. [/INST] Hi,It seems that there might be having viral fever but since fever remains very high, it requires some investigations like,complete blood test like TC, DC, Platelet count, MP etc and routine urine check up to know other infection if present.Meanwhile continue antipyeretic medicine clockwise to control fever.Give plenty of water and liquids.Give light diet.Ok and take care. </s>

<s>[INST] About a month ago a red, dry patch appeared on my shoulder . I originally thought it was ringworm , but the anti fungal medication only made it worse. After applying the medicine, the patch grew from the side of a dime to the size of a quarter. It does not itch and is not painful. It is simply and red, scaly patch. What do you think it could be? [/INST] Hi, Thanks for writing in. The condition can be xerotic eczema,discoid eczema, ringworm etc. As it has worsen after antifungal application it is likely that it is eczema. You can apply a good moisturizer with shea butter twice daily along with mild steroid like hydrocortisone cream.Continue this for 2-3 weeks for visible effects. Hope this helps. Regards DrSudarshan MD </s>

<s>[INST] I have just noticed on my 6 year old forehead some not a cable veins I ve never seen them there before and they led down to the inner corner of his eye on one side two days ago he was off school due to having head pains he gets headaches a lot cus he was born with genetic syndrome which has made his head grow in a different shape to other children s. The veins seem to of only lasted 5 minutes what do I do? [/INST] Hi...If you can provide with the details of the syndrome which he was diagnosed with and a photograph of the veins whenever they become prominent it will be helpful for me to guide you.Any skin condition is best diagnosed after directly seeing it. Kindly upload a photo and other details requested and I will get back to you.Regards - Dr. Sumanth </s>

<s>[INST] I ve been woken up by pain in right forearm for the past couple nights. It s not extremely crippling pain but it s enough to the potent where I can t ignore it and sleep through it until it s gone. I recently sprained this wrist and I m not sure if that has something to do with it. [/INST] Hello, Yes, you guessed it right. it is related to a wrist sprain. Due to injury at the wrist, there will be muscle wasting in the Forearm muscles which needs attention to regain the normal strengthening. As sprain in the wrist always makes the Forearm muscles weaker. Once done things should be fine. Hope I have answered your query. Let me know if I can assist you further. Regards, Jay Indravadan Patel, Physical Therapist or Physiotherapist </s>

<s>[INST] Hello SirI am Shiv Vinay Sharma From Faizabad.I am suffring form Kidney problem,since Nr.abt back 2-Months.,My Creatinine. Has been.9.1 m/dl,Urea after treatment 105 Now, (Before-136M/dl), Now Albumine-100 ( Before-Very More Than), & Hb.8.3 M/m/dl,-presently My Treatment running form Lko A Nephrology Doctor, So want to Your Important Consult. [/INST] Hello Shiv and welcome to HCM.As an Urologist,i understand your anxiety.You're having kidney failure,which may need dialysis,depending on electrolytes and kidney function tests. Anemia is a result of that.Now a kidney biopsy is needed,to find out the cause of the failure.Further treatment will depends on reports.You also need to do these tests :1. 24 hours urine protein and culture.2. RBS,LFT,platelets,electrolytes and uric acid,with IgA anti-body tests.3. ultrasound scan-KUB,with residual urine.If you've any doubts,send all reports to me,as a direct question.Dr.Matthew J. Mangat. </s>

<s>[INST] I have these random bumps on body that itch very bad and I scratch them and when they break open a clean liquid comes out and they scab over but each day I am getting more and more. at first I thought they were mosquito bites but now I have a few on my fingers my nipple my back arms feet top groin etc just random. [/INST] Hi, The rash could most probably due to an insect bite hypersensitivity reaction. But other possible diagnosis is scabies. You could take an antihistamine tablet and apply an antibiotic ointment for a week. If you do not get any improvement in a week or your rash worsens during the course of treatment, I request you to consult your dermatologist for further management. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Siva Subramanian, Dermatologist </s>

<s>[INST] I just woke up and I have a pain in and under my rib cage on left side three inches from my sternum, in the ribs and under, like a rib is out maybe, it hurts more when I inhale but hurts all the time, like something is stuck or lodged under there, I very dizzy and my arms feel a little weak, I feel whoozy... Anxious too [/INST] Thanks for your question on HCM.I can understand your situation and problem.Your chest discomfort is on left sided with arm weakness, so we need to rule out cardiac cause first.So get done ECG first to rule out cardiac cause.If ECG is normal than no need to worry much for cardiac cause.Chest pain on inhalation is also seen in pleurisy (inflammation of pleura). So get done chest x ray to rule out possible causes of pleurisy like pneumonia, pleural effusion, tuberculosis etc.If chest x ray is also normal, I think it is musculoskeletal pain mostly due to muscle pull.So try to follow these for better symptomatic relief.1. Avoid strenuous exercise and heavyweight lifting.2. Avoid movements causing pain.3. Avoid bad postures in sleep.4. Take good painkiller and muscle relaxant.5. Apply warm water pad on affected site. </s>

<s>[INST] Hi, I have query related to my father who is diagnosed with Conus cauqda syndrome; he is suffering from this since Dec 2011. We had MRI, NCV and EMG initially doctors said its GBS tests but later once it was reveladed he is having bladder and bowel incontiennce they said it's motor axonal polyneuropathy with myletis paraplgesis. He is unable to stand, walk and have bladder, bowel incontinence. We have tried multiple hospitals however; his condition is still the same; he is under psychotherapy from last 8 months however recovery seems to be very slow; in last 8 months he is just able to move his right leg little bit but cant lift it normally. Please suggest if we/doctors are missing something and something can be speed up his recovery. [/INST] hi,Conus cauda syndrome is a condition in which tip of end of spinal cord and neighbouring roots are effected .There are many causes of such involvement.It can be secondary to disc prolapse,local tumour compressing these structures or can even infection of spinal cord covering that is meninges which can be treated.So I suggest you to consult neurologist and proper investigation to be done to know the cause and treat accordinglyregardsDr Sandhya ManorenjNeurologist hyderabad </s>

<s>[INST] Hello doctor,I have health anxiety and migraines. I have started seeing after-images quite frequently, especially when inside and looking outside to a road or across the road. I am blinking and seeing a positive after-image for less than a second. This is extremely worrying for me as I am unsure why this is happening. I do not know if this is caused by something else. But, I have had my eyes checked and everything was fine. Could this be symptoms of migraine aura? I have had a sore head for a while now in both temples. [/INST] Hello. I understand your concerns. Your symptoms are most likely due to migraine which cause severe headache, mainly on one side that lasts for few hours (up to 72 hours) may be associated with other features like limb numbness, nausea, photophobia, and other different symptoms. In many cases, migraine is preceded by aura which could be auditory or visual symptoms like the one you described. The other possible causes include: Please provide me with more details in order to reach the appropriate diagnosis: I suggest: Medications are required to abort acute attacks and to prevent attacks if frequent.Follow up is required to confirm the diagnosis and to exclude any serious conditions.Neurological assessment is recommended. For more information consult an internal medicine physician online --> </s>

<s>[INST] I am diagnosed with osteoporosis. I also have curvature of spine. Most recently and today being the absolute worse pain started when I got out of bed. I took a hot shower but did not ease pain. It is prominent at the lower left pelvic area but in my backside. After driving my car getting out of car after being seated is excruciating until I can get my bearings to walk. My regular primary care physician is telling me to ice it and rest and of course take Aleve and Tylenol. I m worried I may have fractured. I did make appointment to see an Orthopedic surgeon on March 24th but would appreciate any added suggestions. I am 62 year old woman . Can any of you doctors help me? [/INST] Hi, Consult an orthopedician and get an MRI scan done. As a first line management, analgesics like Aceclofenac or Tramadol can be taken for pain relief. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Shinas Hussain, General & Family Physician </s>

<s>[INST] My 3 1/2 year old has been complaining on and off of pain in his penis. Usually he complains during car rides and says it s squishing his penis. A week ago he got very sick and his pediatrician examined him. He has the flu and strep. He is on antibiotics for the strep. During this week he has been exceedingly irritated, understandably so. However, his chief complaint is penis pain. He squirms in bed, kicks his legs and grabs at his penis crying that it hurts. This has been going on for three days straight. His pediatrician examined his penis and did a urinalysis without any findings. I am at my wits end. Thank you [/INST] he might be having urinary tract infection or acute dehydration which might be the cause of penis pain.. urine analysis is negative,so go for urine culture is more sensitive and reliable, do blood urea and creatinine to rule out UTI and renal infection, in some condition,flu will be associated with UTI also which can be diagnosed only by culture </s>

<s>[INST] Hello doctor,I sometimes see flashes or running light in my eyes since last one and a half year. They come once in 3 to 4 months. I can see only flashes for 10 minutes, after then my vision is back to normal. I consulted a doctor around a month back she even checked my retina and vision both were fine and gave no medicine. After that, four days ago, it happened again. So, I consulted a new doctor. He prescribed Toba DM and Flur eye drops. I am 18 years old boy, 5’4", weight 45 kg. I am fearing about whether it is a retinal tear. [/INST] Hi. Flashes are seen in retinal tears, but they are also seen in various other conditions. It is great that you have got your retina evaluated. But in the prescription (attachment removed to protect patient identity), there is nothing mentioned which requires Toba DM or Flur for management. I would recommend that you discuss with your doctor why those medications have been started or you stop using them immediately. Long-term use of steroid drops may lead to high intraocular pressure and damage to vision due to glaucoma. Take care. </s>

<s>[INST] I am having problem in passing urine. I am takaing Urimax 04 mg in the morning and was taking Roliflo in the evening. Now that Roliflo is not available, I was prescribed Trofame XR cappsuslels but these capsules perhaps do not suit me as it seems to block urine free flow. Which medicine I should use in its place Thanks [/INST] Oh are you having Prostate issue. If you are not gettin help frm medicines, then you will need to undergo surgery as the ultimate treatment. But with timely medicines, they say that surgery can be prevented. </s>

<s>[INST] Hello. I have been taking medications for pain for several years. Always going through a pain management dr because that is their specialty. In February I changed my pain management dr because I didn t think I was getting the level of care I needed. I found a new dr that not only prescribed medications but also did procedures which seemed to help me more than just being on medication. I have had several drug screens over the years all of which I ve never had a problem with. Recently one of my drug screens came back with methadone and morphine. I didn t even know what methadone was until it was explained to me. I have NEVER misused my medications or taken ANYTHING other than what has been prescribed to me. I guess my question is how would I test positive for medications that I have never taken? [/INST] Hello, The usual test done is a dipstick. There is some animal serum that was immunized against a particular drug and made to light up if it binds the drug. BUT it can bind to similar compounds that are not a drug and sometimes it just misfires. A better and far more expensive test is MASS SPEC. It is less likely to misfire. Hope I have answered your query. Let me know if I can assist you further. Take care Regards, Dr Matt Wachsman, Addiction Medicine Specialist </s>

<s>[INST] I just started using herbalife products. Just today I have had many instances where it had felt like my heart is skipping a beat. It has been happening all day and has happened as many times as 6 times in a minute. Should I go to the er? Is this type of thing common? Do you think it is related to the headline herbalife products? [/INST] Hello,Herbal life products can cause various types of problem like headache,dehydration,bloating,hypertension anxiety etc and this could be due to the component of caffeine in it.However these symptoms may be there in you independent of consumption of herbal life.Whatever the reason,you should go to ER snd get yourself examined and it would be better to stop using these products as they don't suit you.Thanks </s>

<s>[INST] sir my father is 67 and he is having acute pain in his left leg downwards. in mri it was detected that L4 and L5 disc has slightly come out of his normal position which is compressing the nerve passing there from and creating acute pain we have undergone the treatment of pain killers and injecting gel but it has not worked amd it was all for short term relief and now six to seven months have passed and there is no correction plz plz plz you suggest me the best way to overcome this problem [/INST] Hello,Since all that time passed and no improvement with conservative therapy, surgery should be considered. The surgery aims to decompress the nerve and in most cases results in immediate improvement. Discuss with a Neurosurgeon for these issues.Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Erion Spaho, Neurologist, Surgical </s>

<s>[INST] Hello doctor, I was suffering from hair fall. My hair is very thin. Then I used Mintop 10, Finasteride 1 mg tablet for one month. After starting this prescription for 20 days hair is not falling. But for the last 10 days, so much hair is falling. Can I continue or stop Mintop and Finax? [/INST] Hi. I read your query and I saw your pictures. (attachment removed to protect patient identity). The hair problem you are having this problem is called androgenic alopecia. It is common in this age group. It is due to hormonal changes in the body especially testosterone and DHT (dihydrotestosterone). The medicines you are taking is very good. The only side effects of Minoxidil are there which is an increase in hair fall initially which eventually will subside in the next 20 to 30days. So do not worry. Continue your treatment. It will take two to three months to show a decrease in hair fall and five to six months to show an increase in hair density. Age, hormonal changes, stress. Not required at present. Androgenic alopecia. Androgenic alopecia. Morr F 10% (Minoxidil) at night, tablet Finax (Finasteride) 1 mg at night, tablet Keraglo men (Gamma linolenic acid) one in the morning and one at night. And use Anaboom shampoo. After one month. </s>

<s>[INST] My leg always feels numb and now it is starting to give me a really bad sharp pain running up my hip, I had an ultra sound because my doctor wanted to see if i had maybe a blood clot, but nothing...this pain is really interferring with me walking...and sometimes i have to stop because the pain in so sharp [/INST] hi,thank you for providing the brief history of you.A thorough clinical neuromuscular assessment is advised.As you have a sharp shooting pain and numbrness you need to undergo a Neuromuscular assessment along with MRI of lumbar spine as this may be due to pinched nerve.post which taking a physical therapy like therapeutic ultrasound therapy and TENS therapy will help reduce the pain. Later stages exercises will be implemented to improve the stability of the spine and strengthening of the muscle to improve the quality of life.As your symptoms are classical for suspecting the pinched nerve I will recommend to undergo physical therapyin my clinical experience patients with similar complaints are majorly having pinched nerve and respond well to physical therapy.RegardsJay Indravadan Patel </s>

<s>[INST] My husband has been complaining of throbbing full pains in his upper chest, right below his collarbone area. After exertion it is worse and seems to go up his neck and into his ears as well. Does this sound like a serious problem or will it go away in time? [/INST] Hello,Possibility of musculoskeletal pain is more likely because it is throbbing type and worsening with exertion. So tell him to follow these steps for better symptomatic relief in musculoskeletal pain. 1. Avoid heavyweight lifting and strenuous exercise. 2. Avoid movements causing pain. Avoid sudden jerky movements of chest and shoulder.3. Apply warm water pad on affected areas.4. Take painkiller and muscle relaxant drugs like ibuprofen and thiocolchicoside. Don't worry he will be alright with all these. Hope I have answered your query. Let me know if I can assist you further.Regards, Dr. Kaushal Bhavsar </s>

<s>[INST] I have been off the depo shot for 7 months and throughout those 7 months I have had brown discharge every single day. Is there a way to stop this discharge. It is medium brown color , has an oder and is heavy enough for a pad. The OBGYN says its normal but how can I stop this?!! [/INST] Hi,Thanks for the query. After stopping the depo, it may take some time for regularization of hormonal levels. That may be responsible for your brown discharge. Usually this discharge will subside soon. But having discharge for seven months is somewhat abnormal. So, once go for ultrasound and coagulation profile. These will help in ruling out any abnormality. If no abnormality is detected, you can take anti fibrinolytic drugs to control the brown discharge with your doctor's advice. If the discharge still persists, you may need hormonal pills for one month to regularize the cycles. Take care. </s>

<s>[INST] Hi doctor, My 18 month old daughter has had problems since birth and I am desperate for a second opinion. The history is complicated trying to explain the symptoms but I will do my best. It was detected polyhydramnios in pregnancy. My daughter born at 36 weeks 4 days through emergency C-section due to pre-eclampsia. Her weight was 3070g. NG tube passed three times due to polyhydramnios. We went home on day two. Readmitted on day five for phototherapy. Till 4 months of age, several visits with health visitor and GP for colic like symptoms and constipation. She will scream in pain which opening her bowel and only opening her bowels every four to five days. Over this time they tried Colief, Infacol, Lactulose, Glycerin suppositories, Ranitidine, Gaviscon and Domperidone, nine different formulas and we also tried all common natural remedies for reflux like keeping upright after feeding, etc. No alleviation of symptoms at all with exception of glycerin suppositories which did seem to help the constipation. In 8 months pediatric consultant suggests functional constipation and recommends higher dose of Lactulose and Movicol for 16 weeks. He suggested that we are giving her too many glycerin suppositories and that is making her dependent on glycerin to open her bowels. And so Glycerin was stopped. We delayed weaning whilst waiting for appointment. At this point, her symptoms completely changed to intermittent diarrhea and constipation, bowel frequency increased to once a day, colic like pain and she does not start vomiting until the consistency of the food moves up to a more solid consistency. The laxatives made absolutely no difference. In her 10 months of age the constipation has turned to diarrhea. The doctor is happy that it was functional constipation and discharged her. At 11 months, she had first acute episode of chronic diarrhea and forceful vomiting lasted for 16 days which coincides with the introduction of cow's milk. During 11-14 months of age she was introduced to solid food. Chronic forceful vomiting which does not seem to follow any pattern. A food diary is followed for several weeks and there does not seem to be any consistent non-IgE allergy as a cause. During her 14 months of age we had an appointment with dietician and switched from normal formula to Pepti and then Neocate. Her chronic wheeze disappears overnight but chronic vomiting continues. She troubleshoots overfeeding as a cause. We are feeding her more as she is vomiting. When we did not substitute the feeds she lost weight. So, if she vomited a feed we gave her another one hour later, we fed her small quantities throughout the day to try and prevent vomiting. Again in 15 months consulted her dietician and he suggested definite non-IgE cow's milk protein allergy and to try trial and error with other three common allergies- soy, wheat and dairy. So, then for a month we followed strict elimination of those three. This month she had only Neocate liquid diet plus corn snacks (organix) and one paella meal. Symptoms improved but sporadic forceful vomiting remains. She tolerated only one baby paella meal well which is overcooked rice, very mushy consistency. Now again we attempted to challenge the three foods back in and move beyond this one meal. All attempts were failed. Her reaction to us seems to be much more about the consistency of the food rather than what the food is. She can tolerate a large amount of breadcrumbs, but cannot tolerate a piece of toast. We continue with food diary and there really is no clear pattern which isolates one food. Again in her 17 months age when we consulted her dietician he was unsure whether the symptoms fit FPIES at all and suggests gastro referral. Then she had second acute episode. We went A and E on day five and was sent home with suggestion of gastroenteritis. Chronic vomiting and diarrhea lasted 15 days. She lost 10% of her body weight. Sent home on Neocate as the only diet. But, there is no evidence of gagging, choking or problem swallowing. No fussing or wriggling during feeding. Four months back, her weight was 12.3 kg and now 10.9 kg. Her barium x-ray showed mild malrotation but at MDT it was decided this was not explanation of symptoms. We have recently tried Omeprazole to rule out severe reflux and it made no change. Genetic blood tests, kidney and abdominal ultrasound were normal. For us her symptoms now are identical to what they were like before the onset of weaning. Again, she is suffering from intermittent colic pain and constipation, but there is no vomiting. She is not sleeping well at all. We have increased her water intake and added Lactulose and the stools are no longer hard, but she still seems uncomfortable. Stools are very dark green. We have tried a couple of solids. She prefers crunchy food. She tolerates corn-based crisps as they basically dissolve into crumbs into your mouth. We tried peas, grapes and she passed all of the peas, grapes and beans completely undigested in her feces. Without solids she does not sleep well at all, because the Neocate just does not fill her up for long enough and so she is screaming all night because she is hungry. So, we tried a few solids and she is still screaming half the night with colic like pain. She is clearly in pain because she is absolutely screaming. She is pretty inconsolable, but the only thing that does relieve it is sucking on something like a bottle of water. She is waking up about every 20 to 30 minutes throughout the night. During the day she still has this colic like symptoms and she is tired and clingy and uninterested in playing. She does tend to have one to two hours a day of good time where she will play happily. One month back we had consultation with SLT. Her elder sister is under SLT. [/INST] Hi. 1. Hirschsprung disease. 2. CMPA Barium enema study. Continue on same diet till further plan. Revert back with the previous investigation reports to a paediatrician online.---> </s>

<s>[INST] Hi I have had constant twitching in my upper right of my back presumably because of bad posture during wide-grip pull ups. Two weeks ago I heard a tear in my back when doing this the pain seemed to now shoot to my ribcage in my side it's hard to sleep and cough or tighten my abs. Afraid to exercise but anxious to get back to routine. Any idea of what I did or how long healing will take? Thanks! [/INST] Hi,You probably have pulled a muscle or there might be a tear. You need to rest for 2 weeks. Apply ice if there is swelling. After 2 weeks slowly start exercising under the guidance of a physiotherapist. Give him a visit now for further management. </s>

<s>[INST] Hello, I m having difficulty breathing through my mouth after I sneeze or cough. I feel my chest tighten and then I start wheezing. I have seen my doctor and he said it was bronchial asthma. He prescribed some medication for three days with an inhaler. I finished taking the medication and only took the inhaler one time (four times that day, as prescribed). I later went back and he said everything was gone and now have tracheitis. I had another appointment with him today and he said that I now have a cold and what I am feeling is coming from my throat. Should I be worried? As I explained to him again and again... every time I sneeze or cough or even laugh (hard) I end up with a wheezing (while breathing in through my mouth). [/INST] Your symptoms are suggestive of bronchial asthma and you have to take inhalers on a regular basis especially the controller ones like seroflo or foracort. Consult your local physician for correct dosage and technique of taking inhalers. </s>

<s>[INST] Hi Doctor, my husband has spermcount - 13 million/ml motility - active -20% Sluggish -20% Dead -60% Pus cells - 26-28 Redblood cells - 0-2 Epithelial cells - nil please tell me what all this mean. Is it possible to conceive normally? or if he should undergo treatment ? then what are the treatments? [/INST] Hello, Welcome to HCM, I am Dr. Das Firstly, the sperm count is lower than required ( normal is 15 million / ml as per WHO 2010). Secondly, motility is lower than required ( normal is > 50% as per WHO 2010). Thirdly, pus cells are increased. It indicates presence of lower urinary tract infection. So, take some broad spectrum antibiotics, for the infection. It will improve the sperm report. Regards. </s>

<s>[INST] My 6 year old daughter feel sick all the time-for several months now. Almost in waves several times per day. She aches and says her head and tummy hurShe has not had a fever but the glands in her neck are lumpy. I suspect she has anxiety because when I massage her and have her breathe deeply it helps. Any other ideas? thanks--uninsured and worried mom [/INST] DearWelcome to HCMWe understand your concernsI went through your details. I am sure that anxiety and obsession in young children do produce such symptoms as is mentioned here. But before attributing these behavior to anxiety, a thorough physical investigation is needed. I hope you had consulted a pediatrician in this regard. Let the doctor assess the condition and diagnose. Please consult pediatrician. If you require more of my help in this aspect, please use this URL. Make sure that you include every minute details possible. Hope this answers your query. Available for further clarifications.Good luck. Take care. </s>

<s>[INST] I have been having a problem with either a nerve along the outside and along the side of my right knee cap. It rarely hurts while walking or moving around. It is VERY painful if I kneel down ON the knee to do anything at all unless I massage the area first. I have never injured it any time as far as I can remember. I suspect arthritis or something in that family. Just wondered what remedy your could suggest to alleviate the soreness? Thanks. Ron [/INST] Hi RonNothing to worry.Just apply voltaren gel twice a day and take Aleve tab twice a day after meals for 10 days.wear a knee support or knee cap .it will settle.Only wait and watch that no swelling comes </s>

<s>[INST] Hello doctor, I have anxiety and panic attacks from last six years. My doctor prescribed Nexito Forte 10 mg. My doctor tapered the tablet to Nexito Plus 5 mg three years back. My questions are: Is the relapse due to decreasing the dosage? Should I increase it again? [/INST] Hello. The dose of the particular drug depends upon many reasons. So, it is difficult to tell that this dose is effective or not for the particular person. Now coming back to your questions, first Nexito Plus (Escitalopram and Clonazepam) has only half of the dose compared to Nexito Forte (Escitalopram and Clonazepam). So, when tapering the dose, few persons may relapse. If you develop the symptoms of anxiety, you need to increase the dose again. And it is quite difficult to predict who is going to relapse. Secondly, as the Nexito Plus has a lower dose of the drug, it is quite prudent that it may not be effective in all persons. So, increasing the dose is a good option. Similarly, when one is tapering the dose, some symptoms may reoccur. Then one has to slow down the pace of tapering as to avoid the relapse. So, if you are stable on Nexito Plus, then no need to increase the dose, but if you have symptoms then you need to increase it. The dose is basically changed according to the response and side effects, one is tolerating. It is individually designed to meet the requirements of that particular person. Thanks and regards. For more information consult a psychiatrist online --> </s>

<s>[INST] Hi Doctor, my father is diabetic & left his insulin used syringe on bed. The used syringe were taken by my son, who is 20 months old now, and pricked in his hand. yes, syringe does not contain any insulin, however, it was used multiple time by my father. Now, I m too worried & don t know what should I do... Can you pleaseeeee suggest & guide me. [/INST] HelloThank You for contacting HCM.First of all, did you wash your son's hand with any antiseptic solution afterwards?? Secondly, is your father suffering from any disease like Hepatitis or any other prolonged illness? Whenever there is any such scenario then multiple things are checked. e.g for how long it was in contact. Was there bleeding afterwards. Is patient suffering from any prolonged disease & was that area washed with antiseptic solution.In most of the cases it is unlikely that such pick will cause any problem. Also it depends in above mentioned questions. If above mentioned questions are -ve then you need not to worry. He will be fine. Thank You </s>

<s>[INST] Hi, My 7 year old daughter complains of stomach ache and or back ache at night. Occasionally she complains of a headache instead. And it is mostly at night. She also occasionally gets cold when it is 85 degrees. Not normal. She has had blood work done, a back scan, stool sample. Everything has come back normal. I don t think she is making this up, which has crossed my mind. She eats lots of fruit so I don t think it is constipation. Is there something else that this could be? Thanks, Annette [/INST] ANNETTE,GOOD QUESTIONTHIS IS NORMAL NEEDS ONLY ANTISPASMODIC DRUGS IT CAN BE TAB MEFTAL SPAS TWICE A DAY FOR 5 DAYS ,WITH THIS SHE WILL BE ALLRIGHT </s>

<s>[INST] Hello doctor,As I have PCOD problem and also cyst, I take tablets for period. My friend suggested Kalachikai powder. I used it for 30 days continuously, but no use. How many days should I take that powder and how to overcome this problem? [/INST] Hello. For PCOD (polycystic ovarian disease), powder Kalachikai has a good effect, but the duration of treatment is long (more than three months). For proper evaluation of disease, please go for USG whole abdomen and other investigations. If the size and number of cysts are more, then I suggest consulting a gynecologist as you may require surgery. If the number and size of cysts are less, you may continue treatment along with syrup Evecare 10 ml BD and Kanchnar Guggulu two BD. For more information consult an ayurveda specialist online --> </s>

<s>[INST] Hi Doctor, 5 months ago I fell on my back awkwardly while playing basketball and ever since the center of my chest has been hurting whenever i do activites, i can reduce the pain by popping my chest but it never goes away, what do you believe may be the problem? [/INST] Thanks for your question on HCM.In my opinion it seems muscular pain only but since it is chest pain, we have to rule out cardiac causes. So better to get done ECG first.If this is normal than it must be musculoskeletal pain only.And chances of musculoskeletal pain are more as you are having trauma history.Try to follow these for musculoskeletal pain.1. Avoid heavy weight lifting.2. Avoid strenuous exercise. 3. Avoid bad postures in sleep.4. Take good painkillers and muscle relaxant.5. Apply warm water on affected part.6. Wear chest belt so that minimal movements occur. </s>

<s>[INST] sure...patient with pseudomonas in knee replacement, on cefepine, sudden obtundation, hypercalcemia to 13.4, hypokalemia to 3.1, hyperventilation with Pco2 20, HCO3 18, bumped creatinine from 0.8 to 1.8, no CNS response to normalization of those electrolyte abnormalities. [/INST] Hi, Welcome to HealthCareMagic.com I am Dr.J.Mariano Anto Bruno Mascarenhas. I have gone through your query with diligence and would like you to know that I am here to help you.this is probably due to sepsisa blood culture and sensitivity would confirm the diagnosisHope you found the answer helpful.If you need any clarification / have doubts / have additional questions / have follow up questions, then please do not hesitate in asking again. I will be happy to answer your questions. In the future, for continuity of care, I encourage you to contact me directly in HealthCareMagic at Best Wishes for Speedy Recovery Let me know if I can assist you further.Take care. </s>

<s>[INST] Hello: I am 37 years old of pregnant on 2009 I gave birth to a premature boy baby on my 6 month he stayed for 20 days in the incubator intensive care but passed away .i suffered ....on 2012 I got pregnant again knowing that my last delivery was ceaserean and again on my first week of the the 7 month I delivered a premature girl baby who stayed 20 days in nice but sadly passed away ,no one can diagnose the reasons behind ,everything was normal my BP , blood glucose level ...I am depressed ,sad and it was ceaserean again.I need your help and advice I decided not to repeat to be pregnant again because it is heart breaking severely although I get pregnant so easily and continue till my 6 or 7 month in pregnancy.what I have to do Thanks to ur support Goiania [/INST] hi, preterm labor can occur because of many causes, the possible risks factors are elderly age group, either under or over nutrition, stressful life, strenuous activity etc, repeated preterm labor can be seen in case of structural abnormalities like incompetent cervix or uterine anomalies, chromosomal abnormalities, maternal infections can also lead to preterm labor, for more details and for preventive measures you can read my article: take care. </s>

<s>[INST] Hello doctor,I have been experiencing mild depression since I was a child. My family problem made me extra depressed. After three years, I fell in love with a girl, but then she left me. This created a check for me, so I wanted to study more to prove myself. The depression kept increasing, but I started to be more talkative.I used to see the light coming outside people faces. Also, the depression stayed there. I also experienced wondering mind. There was an episode of racing thoughts once. I had to take massive, sleeping pills to sleep. In the end, a psychiatrist diagnosed me as bipolar type 2. He put me on Seroquel, but it was not sufficient. Sometimes it took the depression off, but other times the depression was still here.My parents took me to see a psychiatrist overseas, and he also diagnosed me with bipolar. He did put me on Lithium and Abilify 10 mg. I never felt this good before. My question is, do I only have depression? And not bipolar. Lithium can help improve depression symptoms, so maybe that is the case of what is happening. If I only have depression, I should be put on antidepressants. [/INST] Hello. It is good to know that you are feeling better on your current medication of Lithium and Abilify (Aripiprazole). From the information you have given, it is difficult to provide a comprehensive opinion, but it does look like you have experienced some hypomanic symptoms in addition to depressive features. That is why your doctor would have diagnosed you with bipolar 2. Often people get diagnosed with depression, and it is easy to miss bipolar 2 unless a comprehensive assessment is done. So I presume you had a thorough assessment. I will suggest discussing your queries with your doctor during your next review so that he can explain as well. Continue your medication as prescribed. Also, try to get some psychological therapy as well. In due course, when you continue to be stable, your doctor may consider decreasing the medication gradually under close supervision. It may not happen for at least a year. Avoid habits that can destabilize your mood. Avoid alcohol. It helps to exercise regularly. </s>

<s>[INST] Hi, recently at work I have been experiencing excess stress, irritability, cry at the least bit of stress, filling like I am backed into a corner. I feel like I cannot remember anything when stressed. Like my brain has gone to mush. My family says I do not remember things or timelines correctly. I am a 61 yr. old female. At my job for over 34 years. [/INST] Dear userWe understand your concernsI went through your details. Stress naturally brings on the symptoms you have described here. But stress is normal, natural and is inevitable unless you learn to overcome it. Your problem is stress disorder. Stress disorder needs to be treated with counseling and stress therapy. If you require more of my help in this aspect, please use this URL. Make sure that you include every minute details possible. Hope this answers your query. Available for further clarifications.Good luck. </s>

<s>[INST] hello, i smashed my left thumb two weeks ago and it it is still swollen abd the nail looks like ts doing to fall off and is still very sore. a week ago my left shouder started aching badly and wont stop. can this be related? i had a heart attack in march of 2007 and i know shoulder pain can be a symptom. im 6 foot and weigh 220 lbs [/INST] shoulder pain can be angina but it shouldn't be at same pin point place. your pain is muscular or skeletal. you should take some analgesic if pain is severe </s>

<s>[INST] I am still having pain in my right bottom calf leg. I have had land therapy, three cortisone shots, and am now in water therapy. I am slightly better but am still plagued by not being able to stand for more than ten minutes in a shoping line nor walking for more than fifteen minutes before pain in calf returns. I have been seeing my regular orthopedic surgeon who does not recommend surgery due to two discs, L4 and 5 protruding and my stenosis condition. Will continuation of cortisone shots repeated this September compromise the tissues or muscles in my spine do harm? Should I get second opion from neurosurgeon? [/INST] Yes you vocal visit a neuro surgeon and take secondary opinion about surgery. If the problem is too much then need to take a chance and neuro surgeon is the best doctor to take opinion in your case. Apart from this you can also have omega 3 and vitamin c and do tablets to support the bone as well as circulation in body. Omega 3will help to support the spinal cord too. Hope you got your answer. Take care </s>

<s>[INST] Hello doctor,My mother is having cancer. Please find the details below and advise.Details :-------- Here is the details of the problems and treatment done for my mother.1. She reported itching,fatigue and jaundice. 2. She got admitted in hospital for treatment of jaundice.3. Doctor did CT scan, sonography of abdomen and found cholangiocarcinoma.4. Doctor has done ERCP and put sten on right side to reduce jaundice 5. Doctor has done CT guided biopsy .     Biopsy report says :      CINICAL :      CT mass involving liverlobe and neck of gallbladder (carcinoma gall bladder)           GROSS : Single core 1.5 cm (All)           MICRO IMPRESSION : Liver Biopsy : Metastatic AdenocarcinomaCurrently the bilirubin level is 4 mg/dl which was 10mg/dl 10 days ago, now the doctor has advised to reduce the bilirubin and come back after three weeks for further treatment for cholangiocarcinoma.Currently my mother is very weak due to jaundice, we have not yet informed her about cholangiocarcinoma. We are not sure what should be good for her whether we should go for chemo or surgery since she is very weak.Please advise us what should be the next step. We heard there are lot of side effects of chemo ,we feel that she may not have the strength for chemo side effects.Is there any good treatment in ayurvedic or homeopathy which will be good for her.Thanks. [/INST] **     Since the said condition [cholangio carcinoma] is surgical, thus it is best to have your Doctor to look into the matter, what can be initiated is Dietary Regime in such cases:1. Take:. Cucumbers, Green beans, Sweet potatoes, Avocados, Vinegars [all types], Garlic, ripe tomatoes, lemon juice in the morning with hot water, apples, berries, papaya, pear.. Vegetable juices - Beet and cucumber are especially helpful to gallbladder, avoid cabbage.. Avoid all fruit juices except organic grape juice and organic apple: fresh, self-juice is best [ dilute with water before drinking]. High fibre [fresh fruits and vegetables] and low fat diet [skimmed milk], hing, old brown rice, barley, horse gram, moong dal, ginger, green leafy vegetables, oil massage, boiled water,2.Avoid:. Eggs, Onions, Beans and legumes,Coffee,Oranges, grapefruit,nuts,fried Foods, Spicy foods,Chocolate,Ice cream, Carbonated water, Tap water, artificial sweeteners, sugar, preservatives, refined and bleached foods .. Fried foods, urad dal, tomato, turnip, milk and milk products, constipating/heavy food, soda, alcohol, tea, potato, beet root, dry raisins, sour food, cashew nuts.. Take 3 gm ajwain [carom] seeds and eat, thereafter drink warm water.. Chew sugarcane pieces and keep swallowing the juice.. Drink 1 cup spinach leaf juice daily for 1 month.. Drink 1 cup of radish leaves for 14 days.. Take 3-4 spoons of olive oil in evening with warm water or milk.. Grind onion and extract 20 gm juice and to it add 50 gm sugar candy powder [mishri] and drink.PS. Take vitamin-C-rich foods in your daily diet: like amla, orange, grapefruit, kiwi, cantaloupe, mango, strawberries, broccoli, red pepper, or tomato juice. [Since vitamin C is needed to properly synthesize bile; and deficient intake causes bile to become cholesterol-rich and increasing the likelihood of stone formation].. Do check with baseline Investigations. </s>

<s>[INST] my sister is suffering from minimally invasive follicular carcinoma of thyroid left lobe...she is undergoing surgery of total thyroidectomy today...what is the prognosis of the disease???? which are the possible immediate metastasis areas of this cancer [/INST] Hello,For follicular carcinoma prognosis is good , after surgery pt has to undergo radioactive iodine therapy for remaing bit of cancer.thanks </s>

<s>[INST] there is white deposition between foreskin n glans penis....its bit sticky.....white deposition is there when i skip bath for even one day otherwise its only sticky....it smells when i skip bath....i m taking alcohol regularly for 2years n i m 30yrs old....i took 4 fluconozol tablets n even applied hcl cream but its has only reduced the problem but did not altogether finished it.....i have no sexual contact for last 13 months.....n i got this problem 4 months back....is this any thing to do with HIV.... [/INST] Hi, The white normal deposition is smegma which is normal, if it is excessively deposited, it can be due to bacterial or fungal infection. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. S. R. Raveendran, Sexologist </s>

<s>[INST] i have recently had blood work done for low B12 my levels are at 70. but my iron is fine and i have kidney pain...any ideas? [/INST] Welcome to healthcaremagic, Deficiency is vit B 12 levels is probably because of yourself being vegetarian. you sholud see physician and get treated for the same. Kidney pain has nothing to do with vit B 12 levels and you should get further investigated with ultrasound KUB </s>

<s>[INST] I HAVE BEEN SUFFERING FROM AR ,ECKO TEST IS AO-37MM,LA-41MM RVID-0.9CM,LVID(ed)-58mm,LVID(ES)-30MM,IVS/LVPW-11MM,EF-67%,LV&LA-DILATED,AORTIC VOLVE IS TRILEAFLET,LV end diastolic volume-208ml,LV end systolic volume-69ml,Aortic annulus-27mm ,Dr adv me to AVR, What is your opinion [/INST] Hello,I would like to tell that deciding whether to go for an aortic valve replacement (AVR) or not requires a lot of considerations to be made on the basis of history, clinical examination as well as other tests, not just on the basis of echo report. As mere the presence of aortic regurgitation, even when it is moderately severe, is not necessarily an indication for surgery. So my opinion to you is to go for second cardiologist opinion personally for proper evaluation and treatment plan.Hope I have answered your query. Let me know if I can assist you further.Regards, Dr. Bhanu Partap </s>

<s>[INST] I had a welt-like rash on my upper arms, shoulders and back last night after dinner. It spread rapidly and moved around those parts of my body. My wrists and hands were also itchy with bumps. This morning I woke up with a sore throat and runny nose, like I had a cold. What could it be? [/INST] Hi, It may be allergic urticaria and allergic rhinitis. Consult the dermatologist for the perfect diagnosis and proper treatment. I would recommend you to take antihistaminics like bepotastine under supervision of your doctor. Avoid contact with suspected allergens and also avoid dietary stuff which may precipitate the disease. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Ilyas Patel, Dermatologist </s>

<s>[INST] I donated plasma today, I used to do it regularly a few months ago but for some reason today my hands started swelling and I became very light headed and almost fainted. This has never happened before. My hands are still a bit swollen, Should I be concerned? [/INST] Hi Hope this message finds you in good health.I have gone through your complaints and understand your concern.U seem to have generalised weakness and deficiency of vitamins,calcium,minerals proteins and micro-nutrients.Though temporary,it will eventually heal.Take rest and some healthy protein powder.Physiotherapy,analgesics,anti-inflammatory drugs should help.Nothing to worry about.I hope your question has been answered.If you have any follow-up queries,feel free to consult me anytime.Thanks,Take care,God bless. </s>

<s>[INST] Hi my daughters rugae looks a bit inflamed. I remember mine feeling similar as a child for periods of time. Im wondering if this is normal and due to something, maybe just growth as shes able to eat fine etc or whether it could be anything serious. I will take her to the drs or dentist anyway but was just curious to see what you thought. Kind Regards [/INST] HiThanks for writing to health care magic.The rash could be atopic dermatitis or vitamin deficiencyThis needs constant application of moisturising oinments daily and good intake if fruits and vegetables.Try avoiding dairy products to see if that helps.Wishing your child good healthRegardsDr Arun </s>

<s>[INST] my son is 34 yrs old and obese(about 300lbs) and now his blood work shows elevated liver enzymes as well as a gallbladdder number that is not normal. his tryc.,his sugar,his colesterol are all high. what can he do quickly to get on the right track. the dr is doing a 2nd blood test to make sure the first one was correct.he is already on blood pressure pills,including fluid pills. I am so worried about him and knew his over weight problem was going to turn into something much worse. he is a very stubborn guy but he is scared now,really scared. He might see that a Mom does know best and he should have listened to me.help! [/INST] HelloElevated liver enzymes may indicate liver injury.It may be due to many reasons like hepatitis,alcohol intake,altered lipid profile,medicines,auto immune causes,obesity etc.High liver enzymes may be due to altered lipid profile in your son's case.Findings also suggests altered lipid profile.He may need few investigations like routine hemogram,viral markers,ultrasound of abdomen.I suggest tablet ursodeoxycholic acid 300 mg twice daily for three months to my patients.It helps in regeneration of liver cells.I also suggest combination tablet of atorvastatin 10 mg and fenofibrate 160 mg single dose at night after dinner.It will control increased lipid level.He also need diet and life style modification.He should avoid saturated aft and go for brisk walk regularly.He also need medicines for diabetes mellitus.Get well soon.Take CareDr.Indu Bhushan </s>

<s>[INST] Hi, I am 25 years old and I recently had a bump along my lower back that seems tense sometimes. Along with episodes of swelling in my left foot and shin and my penis and groin area also experience swelling but no pain on either. I recently stopped working out, but prior I did do exercises that consisted of heavy dead lifts. Do you know what this could be a result of? [/INST] Hi,Dear thanks for the query to HCM.Cause -for-a-the lump on lower back -a clinical check is required from your family doctor as the information from the query is non-commentable as its incomplete and very vague.Plz call back again with more information. And I would love to help you out from the complex query worrying you.So check up with family doctor and update that clinical check up data to me ASAP.Hope this would help your worry to take proper steps for health.Wellcome again if you have any more query in this regard.Have a Good Day. </s>

<s>[INST] Hi doctor, I am a 22 year old female. I have a dusky skin that is brown skin. I want to become fair. Can I use Kojivit gel? Or any other dermoatology cream can I use? My hands are also brown in color and full of tan. Do you suggest any creams to get fair? I want to become fair as my marriage is going to get fixed by next year. Please suggest me some creams, so that it should not show any side effects. Also, how long I should use it? If I use anything, then will it have any effect in case of pregnancy, etc? Please help me. Thanks in advance. [/INST] Hi. One's skin color has 2 components. First one is genetic, which cannot be changed. Every skin color is beautiful in its own way and we should learn to love our skin color and augment it and not hide or lighten it. The second component is acquired, which is due to the influence of environment, sunlight, hormones, aging, etc. We can only target the acquired component of fair skin color while attempting lightening procedures. I suggest you antioxidant capsules like capsule Antoxid HC (Beta-carotene) and apply sunscreen lotion Lashield gel at 8 AM and 12 PM. Also, you can apply Glyaha koj lotion (Hydroquinone) at night time. Start with an alternate night application initialy as it may irritate your skin a bit and after a week or so, shift to daily night application. Consult your specialist doctor, discuss with him or her and take the treatment with consent. You can go for chemical peeling or microdermabrasion from your dermatologist which will help in exfoliating and give you a clearer skin tone. All these treatments are free of side effects. You may use them for three months. For further information consult a dermatologist online --> </s>

<s>[INST] Hi doctor, My stomach was burning for three hours yesterday night. I took Gaviscon once, but the burning did not go, so I took it a second time. I have slight chills. From two days, I am eating out, which was normal, and I did not overeat. I have eaten in this place previously also. I used to get slight burning sensation before, but yesterday it was very severe. I had chills for the first time. Even now I have slight chills. Right now also I have slight chills. I have acid reflux and fatty liver grade 2. Currently, I take Nexpro RD 40 twice a day, and Ursocol twice a day. Please advise. [/INST] Hi. You seem to have developed acid reflux following intake of food from outside. In such cases, I recommend the following: I hope it helps you. If you have any further query, please ask me. For further queries consult a medical gastroenterologist online --> </s>

<s>[INST] Hi i am 25 year old. 3 year before i have got started hair fall seriously. Till now i have lost my half of my hair from the scalp. I have consulted many dermatologist and have tried many remedies like minoxidil biotin etc but all was invain. Please suggest me some idea 2 get rid from the such problems. Thank you. [/INST] Hi, As per your query you have symptoms of hair fall which seems to be due to improper cleanliness, environmental factors, hormonal changes, fungal infection and could be due to stress. Sometimes it is due to genetic factors as well. Need not to worry. I would suggest you wash your scalp 3 times a week with very mild shampoo containing least chemical ingredients. We have to find the exact cause and start treatment as per that. Avoid excessive stress and drink plenty of water to stay hydrated. Maintain proper hygiene of your scalp and wash hairs every alternative day and take Indian gooseberry powder half spoon. Consult dermatologist once for proper examination. The doctor may prescribe Finasteride preparations and along with that multivitamin preparations as well. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Harry Maheshwari, Dentist </s>

<s>[INST] Hello doctor, My right shoulder is excruciatingly painful. I play quarterback in football and I am 16 years old. Since I participate in a throwing sport, dead arm syndrome is something that I suspect may be the cause of my pain. I have also noticed that my upper right trapezius if lower than my left one. Please help. [/INST] Hello. As mentioned by you that you might be suffering from dead arm syndrome. At present I would suggest you to follow price protocol, that is protection, rest, ice, compression, and elevation. I would suggest you to stop doing any sports activities which aggravate your pain. Once pain subsides you need to strengthen the shoulder muscles as this condition develops due to weak shoulder muscles. I would suggest consulting any physiotherapist to learn how to strengthen your muscles. It is very important before you proceed to play otherwise you might get reinjury. If your condition does not improves within a week consult any physiotherapist. I hope this helps. </s>

<s>[INST] Hello, the left side of my lip is in a sort of paralysis , I can only half smile, half inhale on a cigeratte, I went to the densit because I had one of my right lower wisdom tooth pulled last Tuesday, this is on the Opposite side tho, he said this shouldnt be affecting my the lower left side of my lip, plus this happened yesterday And I had the tooth pulled a week ago, I have not eatten anything unusual or Been exposed to any differnt sort of chemicals, so my question is what could cause the left lower side of my mouth to be like this..? [/INST] hiii its nothing to do with your wisdom tooth extraction....as extraction was done of the opposite side. it seems that there might me some sort of infection on your left side of the oral cavity which is causing the compression of the nerve which is resulting in these symptoms. the neural tissue takes time to repair....from days to months & some times even years well it may also be bell's palsy.....it is facial paralysis of half side of the face.....its pretty much treatable condition. i would suggest that you should consult a dentist as soon as possible for the correct diagnosis & prompt treatment. </s>

<s>[INST] Hi, My 10 month old daughter was having fever and phelgm formation for last few days. We got her checked up by a pedoatrician, who prescribed meds for the same. The fever has almost dispappeared by yesterday, but cold/phlegm is still there. Today morning, we noticed tiny rashes all over her body, except the face. They look like the ones coming out of some allergic reactions. We are waiting till after noon to see if it gets worse, before running to hospital and loading the lil one with more meds. Please advice what this could be the result of. [/INST] Hi...by what you quote I feel it could be a viral illness with cough and cold. Am telling this because bacterial infections will not come down like that in matter of few days, though you have used antibioitcs. Even some antibiotics have the tendency to cause this type of rash and I suggest you take the kid to the pediatrician who has prescribed the antibiotic. Meanwhile the allergic rash you can give some over the counter anti-allergics.Regards - Dr. Sumanth </s>

<s>[INST] MAle , 51 years oldI had a full blood picture, VDRL and urine analysis.for med insurance purposes.Blood picture all normal, VDRL negative, 10-15 pus cells in urine is the only symptom not in normal range.I understand there are dozens of possible reasons for pus in urine, including kidney stones (that I had 15 years ago) and a urine culture is advisable.However on a simpler note: Urine analysis was midday, previous day had a vigorous masturbate, could that be the cause?Many thanks [/INST] Hello Thanks for writing to HCMYou are suffering from urinary tract infection(UTI).It is not related to masturbation done on previous day.UTI is indicated by presence of excess pus cells in urine.You need few more investigations like routine hemogram,Random blood sugar,Renal function test,Urine culture and sensitivity and Ultrasound of abdomen. Further investigations can be done if needed.At present you need proper antibiotics after culture and sensitivity report.Hope i have answered your query.Get well soon.Take CareDr.Indu Bhushan </s>