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### Instruction: Answer this question truthfully ###Input: Hello doctor,I have already talked to my very own Cardiologist but have not really gotten much. They just told me I have been having a lot of tachycardia lately but with a normal rhythm. They told me I should be fine but I feel I am not. Three months back, I had gone into cardiac arrest due to a drug overdose when I got a laced pill full of Fentanyl when I tried to get the old medication I was once prescribed, Adderall. It took 12 mg of Naloxone to bring me back to life. Then about six months ago I had an ER visit because I decided to take what I thought was MDMA with some friends for a party. I do not take drugs anymore. The drug test only came back for Amphetamine and I took around 200 mg of the drug Methamphetamine. I started to go into cardiac arrest again but was luckily brought back to normal levels. It was a scary experience which haunts me now causing anxiety whenever I notice my heart rate go up. Three months ago I started to display worse symptoms. My cardiologist only put me on a heart monitor for three weeks but said I had a lot of tachycardia with a normal rhythm. I am not quite sure whether it is just anxiety or if my heart may actually have problems. I am only 18 but I feel these close calls might have put a toll on my heart. I just need somewhat of an answer on whether these experiences could have caused one term problems to my heart at my age. I do not do any drugs anymore. I vape but that is all. I get chest pains through the day and sometimes will get light headed and cannot think clearly. I will space out and not pay attention to anything else around me. I am worried it is a heart problem or could be PTSD cause from those events. Any information will help. ### Response: Hello, Welcome to Chat Doctor forum. Likely it is an anxiety only causing you tachycardia. If possible please attach your reports like monitoring report, and echo if you have. Echo will tell us whether there are any residual effects on the heart of your previous problems. You should get a thyroid test done to rule out hyperthyroidism if did not have recently. You may use a portable monitor which is a mobile-based portable system to keep watch over heart rhythm. It is better you get started on Ciplar which is a beta-blocker that help to control heart rate and anxiety. Consider regular exercises to tone your heart. For more information consult a cardiologist online

Hello doctor,I have already talked to my very own Cardiologist but have not really gotten much. They just told me I have been having a lot of tachycardia lately but with a normal rhythm. They told me I should be fine but I feel I am not. Three months back, I had gone into cardiac arrest due to a drug overdose when I got a laced pill full of Fentanyl when I tried to get the old medication I was once prescribed, Adderall. It took 12 mg of Naloxone to bring me back to life. Then about six months ago I had an ER visit because I decided to take what I thought was MDMA with some friends for a party. I do not take drugs anymore. The drug test only came back for Amphetamine and I took around 200 mg of the drug Methamphetamine. I started to go into cardiac arrest again but was luckily brought back to normal levels. It was a scary experience which haunts me now causing anxiety whenever I notice my heart rate go up. Three months ago I started to display worse symptoms. My cardiologist only put me on a heart monitor for three weeks but said I had a lot of tachycardia with a normal rhythm. I am not quite sure whether it is just anxiety or if my heart may actually have problems. I am only 18 but I feel these close calls might have put a toll on my heart. I just need somewhat of an answer on whether these experiences could have caused one term problems to my heart at my age. I do not do any drugs anymore. I vape but that is all. I get chest pains through the day and sometimes will get light headed and cannot think clearly. I will space out and not pay attention to anything else around me. I am worried it is a heart problem or could be PTSD cause from those events. Any information will help.

Hello, Welcome to Chat Doctor forum. Likely it is an anxiety only causing you tachycardia. If possible please attach your reports like monitoring report, and echo if you have. Echo will tell us whether there are any residual effects on the heart of your previous problems. You should get a thyroid test done to rule out hyperthyroidism if did not have recently. You may use a portable monitor which is a mobile-based portable system to keep watch over heart rhythm. It is better you get started on Ciplar which is a beta-blocker that help to control heart rate and anxiety. Consider regular exercises to tone your heart. For more information consult a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 21 year old male, and I am studying nutritional science. Over the past year, I have been experiencing these symptoms. I have a fast pounding heart, especially after a night of drinking. The following morning, I always wake up early to a pounding heart, and it scares me. This happens after big meals and while exercising also. When I exercise, my heart feels like it is going to explode. I also have fatigue and mental fogginess, my concentration is low, and I feel like I am just overall slow or have low energy. I have anxiety, and I have been diagnosed with anxiety in the past. I was in a dark place for awhile, but things seem to be getting better. The doctor wanted to put me on Zoloft, but I declined and had thankfully found peace with daily meditation.I have a low libido, and I am just not that interested anymore. My testosterone levels are low for my age. My last readings were 302 ng/dL, 290 ng/dL, and 270 ng/dL, which were all taken in the morning. As a person who exercises a good amount, I find it hard to gain strength or any muscle. I want to fix this, and I have consulted many doctors, but none are willing to help me. I honestly believe that my testosterone level is the main cause with all this. I have thought about taking matters into my hands and starting a treatment regimen but, I would rather do so under the supervision of a doctor. ### Response: Hello. As your BMI (body mass index) is 34, in obesity, the decreased levels of testosterone-binding protein cause a decrease in the total testosterone levels, but not the normal free level. Before we evaluate you for low testosterone, we need to confirm it by doing free testosterone levels. If free is also low, then we need to find the cause, for that, we need FSH (follicle-stimulating hormone) and LH (luteinizing hormone) level. So, you first get free testosterone levels done. Also, any anxiety, depression, or any psychological issues can cause loss of libido. You can visit an endocrinologist for the same. Secondly, regarding your heart rate, it is certainly not related to testosterone. But it can be related to anxiety, alcohol, and heart. There are two possibilities, one is anxiety related and secondly due to heart arrhythmia. Many individuals who ChatDoctor.

Hi doctor,I am a 21 year old male, and I am studying nutritional science. Over the past year, I have been experiencing these symptoms. I have a fast pounding heart, especially after a night of drinking. The following morning, I always wake up early to a pounding heart, and it scares me. This happens after big meals and while exercising also. When I exercise, my heart feels like it is going to explode. I also have fatigue and mental fogginess, my concentration is low, and I feel like I am just overall slow or have low energy. I have anxiety, and I have been diagnosed with anxiety in the past. I was in a dark place for awhile, but things seem to be getting better. The doctor wanted to put me on Zoloft, but I declined and had thankfully found peace with daily meditation.I have a low libido, and I am just not that interested anymore. My testosterone levels are low for my age. My last readings were 302 ng/dL, 290 ng/dL, and 270 ng/dL, which were all taken in the morning. As a person who exercises a good amount, I find it hard to gain strength or any muscle. I want to fix this, and I have consulted many doctors, but none are willing to help me. I honestly believe that my testosterone level is the main cause with all this. I have thought about taking matters into my hands and starting a treatment regimen but, I would rather do so under the supervision of a doctor.

Hello. As your BMI (body mass index) is 34, in obesity, the decreased levels of testosterone-binding protein cause a decrease in the total testosterone levels, but not the normal free level. Before we evaluate you for low testosterone, we need to confirm it by doing free testosterone levels. If free is also low, then we need to find the cause, for that, we need FSH (follicle-stimulating hormone) and LH (luteinizing hormone) level. So, you first get free testosterone levels done. Also, any anxiety, depression, or any psychological issues can cause loss of libido. You can visit an endocrinologist for the same. Secondly, regarding your heart rate, it is certainly not related to testosterone. But it can be related to anxiety, alcohol, and heart. There are two possibilities, one is anxiety related and secondly due to heart arrhythmia. Many individuals who ChatDoctor.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have a 16-month-old child. When she was 10 months old, she banged her head between her eyes, inner left brow rather firmly on a blunt object. She was attempting to stand up holding onto a chair, and when she quickly sat, her head firmly bumped the bottom of the portion of the chair which is made of metal. She cried immediately and vomited once but otherwise seemed fine and in a short time was back to play. From all, I read online, and the other family around there was no need to go to emergency.A few weeks later, I started to notice subtle changes. She developed a deep scowl that seemed to favor her left side where she hit. Also, the mark where she hit still came out when she was upset (it still does) and rubbing ensued. I took her into her Pediatrician and told him all three weeks after it happened. I Showed him pictures of the chair where she hit as well as images of her the day after and tried to explain the scowl, the rubbing, and just how I felt something was amiss.He assured me she had none of the symptoms associated with severe head trauma. Six months later and a few visits then all for the same thing I am still unsure and wish we could have look to make sure no tissue or other damage has been done. My question is, if internal damage was done to a vessel or two or a small fracture occurred, is it possible for the symptoms to be slight at this time and if there is a minor ever so slight bleed inside, could it take months if not years for visible signs to occur and irreversible damage to follow suit? Would it not then be too late? Should I push for cranial sonography or MRI? ### Response: Hello, Welcome to Chat Doctor forum. The mark on eyebrow may be some superficial injury. Your kid is not having any symptom of deep brain injury. Your kid was back to play shortly after an injury. Did she have any headache or vomiting or weakness of one side of body or seizure? If not, she is unlikely to have any internal brain injury.Slight bleed inside brain/ small undisplaced fracture heal spontaneously and in the long term may or may not cause a seizure. Might be you are a very anxious mom. If you are much worried, you can go for MRI brain, if it comes out to be normal, your anxiety level will decrease. But if no such symptom in kid, there is no need for doing tests.

Hello doctor,I have a 16-month-old child. When she was 10 months old, she banged her head between her eyes, inner left brow rather firmly on a blunt object. She was attempting to stand up holding onto a chair, and when she quickly sat, her head firmly bumped the bottom of the portion of the chair which is made of metal. She cried immediately and vomited once but otherwise seemed fine and in a short time was back to play. From all, I read online, and the other family around there was no need to go to emergency.A few weeks later, I started to notice subtle changes. She developed a deep scowl that seemed to favor her left side where she hit. Also, the mark where she hit still came out when she was upset (it still does) and rubbing ensued. I took her into her Pediatrician and told him all three weeks after it happened. I Showed him pictures of the chair where she hit as well as images of her the day after and tried to explain the scowl, the rubbing, and just how I felt something was amiss.He assured me she had none of the symptoms associated with severe head trauma. Six months later and a few visits then all for the same thing I am still unsure and wish we could have look to make sure no tissue or other damage has been done. My question is, if internal damage was done to a vessel or two or a small fracture occurred, is it possible for the symptoms to be slight at this time and if there is a minor ever so slight bleed inside, could it take months if not years for visible signs to occur and irreversible damage to follow suit? Would it not then be too late? Should I push for cranial sonography or MRI?

Hello, Welcome to Chat Doctor forum. The mark on eyebrow may be some superficial injury. Your kid is not having any symptom of deep brain injury. Your kid was back to play shortly after an injury. Did she have any headache or vomiting or weakness of one side of body or seizure? If not, she is unlikely to have any internal brain injury.Slight bleed inside brain/ small undisplaced fracture heal spontaneously and in the long term may or may not cause a seizure. Might be you are a very anxious mom. If you are much worried, you can go for MRI brain, if it comes out to be normal, your anxiety level will decrease. But if no such symptom in kid, there is no need for doing tests.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 29-year-old male and in need of some reassurance over my serious health anxiety re MND (ALS). I am not normally anxious or depressed, married with a young daughter and a wife who is pregnant. It stared with an entire all day leg ache (left leg). Two days later my arm started to fell weird, tingles and biceps hurt. Since then (three weeks ago now) I have had the following symptoms. Numb or tingle fingers, feeling of weakness (but not actually weak), pain in hands, feeling of stiffness in fingers, lots of muscle twitches across body but mainly legs, feet, hands and arms, cramp type feeling in both big toes and calf muscles (not full on cramp), nausea and dull headache, dry throat, lump in front feeling, and a scratchy throat feeling. I keep looking for atrophy, though nobody thinks I have that. A sore skin feeling across my lower ribs and upper back like sunburn but without the burn, fatigue.I have seen three GP\\s. All three have said they think I am fine, they do not have worries and one said I do not have MND. I have had a complete blood test which had come back as normal. At my third GP appointment, I was tested for strength and reflexes. She could find nothing clinically wrong, no weakness but did mention some quite brisk reflexes but they were symmetrical. Is this normal? a referal was made, she said she does not think it is MND or anything bad basically. I was diagnosed with health anxiety two weeks ago and I am currently taking each day 50 mg Sertraline.Can you please confirm that the symptoms I mentioned are not MND or ALS related? That the twitches are nothing to worry about using your expertise? Confirm that the brisk reflexes on both sides (symmetrical) are nothing to worry about. That the type of cramp I am experiencing is not related to ALS or MND using your experience. ### Response: Hello. Your symptoms are not typical of ALS (amyotrophic lateral sclerosis). You should know that at your age ALS is a very exceptional diagnosis. But there are also a lot of other conditions that may mimic this clinical situation. For this reason, I would recommend performing some tests. Complete blood count for anemia, blood electrolytes for possible imbalances, thyroid hormone levels for thyroid dysfunction, vitamin D levels and vitamin B12 levels for a possible deficiency, nerve conduction studies would help exclude ALS and calm your anxiety.

Hello doctor,I am a 29-year-old male and in need of some reassurance over my serious health anxiety re MND (ALS). I am not normally anxious or depressed, married with a young daughter and a wife who is pregnant. It stared with an entire all day leg ache (left leg). Two days later my arm started to fell weird, tingles and biceps hurt. Since then (three weeks ago now) I have had the following symptoms. Numb or tingle fingers, feeling of weakness (but not actually weak), pain in hands, feeling of stiffness in fingers, lots of muscle twitches across body but mainly legs, feet, hands and arms, cramp type feeling in both big toes and calf muscles (not full on cramp), nausea and dull headache, dry throat, lump in front feeling, and a scratchy throat feeling. I keep looking for atrophy, though nobody thinks I have that. A sore skin feeling across my lower ribs and upper back like sunburn but without the burn, fatigue.I have seen three GP\\s. All three have said they think I am fine, they do not have worries and one said I do not have MND. I have had a complete blood test which had come back as normal. At my third GP appointment, I was tested for strength and reflexes. She could find nothing clinically wrong, no weakness but did mention some quite brisk reflexes but they were symmetrical. Is this normal? a referal was made, she said she does not think it is MND or anything bad basically. I was diagnosed with health anxiety two weeks ago and I am currently taking each day 50 mg Sertraline.Can you please confirm that the symptoms I mentioned are not MND or ALS related? That the twitches are nothing to worry about using your expertise? Confirm that the brisk reflexes on both sides (symmetrical) are nothing to worry about. That the type of cramp I am experiencing is not related to ALS or MND using your experience.

Hello. Your symptoms are not typical of ALS (amyotrophic lateral sclerosis). You should know that at your age ALS is a very exceptional diagnosis. But there are also a lot of other conditions that may mimic this clinical situation. For this reason, I would recommend performing some tests. Complete blood count for anemia, blood electrolytes for possible imbalances, thyroid hormone levels for thyroid dysfunction, vitamin D levels and vitamin B12 levels for a possible deficiency, nerve conduction studies would help exclude ALS and calm your anxiety.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 33 year old female. I have been getting shingles since I was 6 years old. Until high school, I would get it once a year around the same time. Then, I began getting it twice a year. As I got older, I started getting multiple outbreaks in a year. I have had shingles for 27 years. This year, I had four outbreaks that occurred once in every three months. In the past, my doctor was against vaccinating me because it was not tested on anyone under the age of 50 or 60. With the multiple outbreaks over the past two to three years, we discussed it again and we decided that it might help. Previously, I had taken Famvir and Hydrocodone. Currently, I am continuing the same medicines for shingles outbreak. I had undergone a wellness checkup a few months back and all my laboratory test results were normal. In your opinion, do you think that the vaccination would help me? Are there any concerns or issues about a person of my age getting the shingles vaccine? I am not currently pregnant, but could possibly want another child in a couple years from now. Could the vaccination have any effect on future pregnancy or children? I trust my doctor and know he has my best interest in mind; I just wanted a second opinion as this vaccine has not been tested on anyone in my age group. ### Response: Hi, Welcome to Chat Doctor forum. From the history, it is apparent that you are getting frequent recurrences of shingles, which have increased in the recent past. Shingles occur when your body immune system is low. I am not aware if you are on medication as that may lower your immune system (except for steroids that you are taking for acute attacks). As your physician rightly said, varicella vaccine is not recommended below the age of 50. Logically, vaccination at this age may provide relief from frequent recurrences, but I do not have enough literature or evidence to support this. You may go ahead with the vaccination after detailed discussion with your doctor. The point of caution is to make sure that the vaccination is given when an acute attack is not there and when you are not on steroids or any medicines which considerably reduce body\\s immune system as it is a live vaccine. As far as pregnancy is concerned, you can plan the same. But, you may require frequent visits to your obstetrician for close supervision as the effects on the fetus cannot be ruled out.

Hello doctor,I am a 33 year old female. I have been getting shingles since I was 6 years old. Until high school, I would get it once a year around the same time. Then, I began getting it twice a year. As I got older, I started getting multiple outbreaks in a year. I have had shingles for 27 years. This year, I had four outbreaks that occurred once in every three months. In the past, my doctor was against vaccinating me because it was not tested on anyone under the age of 50 or 60. With the multiple outbreaks over the past two to three years, we discussed it again and we decided that it might help. Previously, I had taken Famvir and Hydrocodone. Currently, I am continuing the same medicines for shingles outbreak. I had undergone a wellness checkup a few months back and all my laboratory test results were normal. In your opinion, do you think that the vaccination would help me? Are there any concerns or issues about a person of my age getting the shingles vaccine? I am not currently pregnant, but could possibly want another child in a couple years from now. Could the vaccination have any effect on future pregnancy or children? I trust my doctor and know he has my best interest in mind; I just wanted a second opinion as this vaccine has not been tested on anyone in my age group.

Hi, Welcome to Chat Doctor forum. From the history, it is apparent that you are getting frequent recurrences of shingles, which have increased in the recent past. Shingles occur when your body immune system is low. I am not aware if you are on medication as that may lower your immune system (except for steroids that you are taking for acute attacks). As your physician rightly said, varicella vaccine is not recommended below the age of 50. Logically, vaccination at this age may provide relief from frequent recurrences, but I do not have enough literature or evidence to support this. You may go ahead with the vaccination after detailed discussion with your doctor. The point of caution is to make sure that the vaccination is given when an acute attack is not there and when you are not on steroids or any medicines which considerably reduce body\\s immune system as it is a live vaccine. As far as pregnancy is concerned, you can plan the same. But, you may require frequent visits to your obstetrician for close supervision as the effects on the fetus cannot be ruled out.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 49-year-old woman and last month I was hospitalized with a necrotizing soft tissue infection on my thigh. I had two debridement surgeries and was discharged after 5 days. I was treated with about 4 IV antibiotics. I do not remember them all, I recall seeing Vancomycin and Penicillin. I was told that the infection was not MRSA, but a \"slower moving bacteria\" they did not tell me what it was. I was swabbed for MRSA in my nose and butt before both surgeries and was told I did not have it. For the last day of my stay, I had a roommate who had a bad MRSA infection on her butt and sometimes had diarrhea incontinence during dressing changes. I had no physical contact with her, but we had the same nurse. I was discharged with a five day course of Augmentin.The wound has been healing very well and has not gotten infected, but three weeks after discharge I got an abscess under my arm. I went to an urgent care and was prescribed Clindamycin and told to return in three days for drainage. The abscess did not improve or get worse over the three days. I got it drained and was prescribed Augmentin and told to also continue the clindamycin. That was a week ago and the wound is healing well. They called today and said cultures show it was MRSA and they prescribed Bactrim and told me to stop the other antibiotics.I am feeling devastated by this and wanting to understand why it happened. Could I have gotten it in the hospital? I am concerned that it will not go away. Are those swabs at the hospital conclusive and mean for sure I did not have MRSA a month ago? I have never had any medical problems before and these experiences have been very frightening. Is there anything else I can do to prevent recurrence? I have read about everything from bleach baths and hibiclens to antibiotics in the nose. ### Response: Hi, I am sorry for what you have had to go through. As you previously did not have MRSA strains, it is possible that now you have hospital-acquired strains in your blood. It is a superbug and superdifficult to treat as it is resistant to ChatDoctor. As you were told to stop other antibiotics and start Bactrim, this means the strain you have got is sensitive to Bactrim. If there is anything else you want to ask, please feel free to contact me.

Hi doctor,I am a 49-year-old woman and last month I was hospitalized with a necrotizing soft tissue infection on my thigh. I had two debridement surgeries and was discharged after 5 days. I was treated with about 4 IV antibiotics. I do not remember them all, I recall seeing Vancomycin and Penicillin. I was told that the infection was not MRSA, but a \"slower moving bacteria\" they did not tell me what it was. I was swabbed for MRSA in my nose and butt before both surgeries and was told I did not have it. For the last day of my stay, I had a roommate who had a bad MRSA infection on her butt and sometimes had diarrhea incontinence during dressing changes. I had no physical contact with her, but we had the same nurse. I was discharged with a five day course of Augmentin.The wound has been healing very well and has not gotten infected, but three weeks after discharge I got an abscess under my arm. I went to an urgent care and was prescribed Clindamycin and told to return in three days for drainage. The abscess did not improve or get worse over the three days. I got it drained and was prescribed Augmentin and told to also continue the clindamycin. That was a week ago and the wound is healing well. They called today and said cultures show it was MRSA and they prescribed Bactrim and told me to stop the other antibiotics.I am feeling devastated by this and wanting to understand why it happened. Could I have gotten it in the hospital? I am concerned that it will not go away. Are those swabs at the hospital conclusive and mean for sure I did not have MRSA a month ago? I have never had any medical problems before and these experiences have been very frightening. Is there anything else I can do to prevent recurrence? I have read about everything from bleach baths and hibiclens to antibiotics in the nose.

Hi, I am sorry for what you have had to go through. As you previously did not have MRSA strains, it is possible that now you have hospital-acquired strains in your blood. It is a superbug and superdifficult to treat as it is resistant to ChatDoctor. As you were told to stop other antibiotics and start Bactrim, this means the strain you have got is sensitive to Bactrim. If there is anything else you want to ask, please feel free to contact me.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have been trying to conceive since 9/11/2014, which is when I stopped birth control pills and started prenatal vitamins.My cycles before BCP (Birth Control Pills) were always regular, about 30 days +/- 1 day with a 7 day period.And on BCP, my cycles were always 28 days, with a 5 day period.When I stopped BCP, I had a 5 day period, which began my first cycle of 31 days.The next cycle began with a 6 day period and the cycle lasted 37 days.Then this current cycle, which began with a four day period, a bit lighter than normal.I am currently on CD 27 and I believe I ovulated 3-4 days ago.So, the problem here is that I start spotting on CD 25, along with light cramping.It was only a very little bit of light brown blood, so I did not think much of it.Yesterday, CD 26, I had a little more throughout the day, then quite a bit right before bed.This morning, I am still spotting but much heavier than the past two days, and am starting to get a little alarmed by this.The blood is still brown. Any ideas on why this is happening, presumably 3-4 days past ovulation?Is this cause for concern? I have never spotted ever before.Also, I started taking Vitex at the beginning of this cycle in hopes of shortening my cycle a bit.Thank you in advance for any advice. ### Response: Hi, Welcome to Chat Doctor forum. This could be ovulation bleeding. Usually it may take about 6 months to conceive after stopping the birth control pills. But your cycle has become irregular after stopping the pills and it is difficult to predict the ovulation time now. If spotting does not stop or if you experience pain, then you should get an internal scan done to see the cause of spotting. There is possibility of DUB (Dysfunctional Uterine Bleeding) or ectopic pregnancy or threatened abortion. It can be seen once your period date is over. Or you may get beta HCG levels tested to confirm this along with the scan (TVS - Transvaginal Scan). If everything is fine, then you may take progesterone support in the second half of cycle to clear this. Revert back with the reports to an obstetrician and gynaecologist online

Hello doctor,I have been trying to conceive since 9/11/2014, which is when I stopped birth control pills and started prenatal vitamins.My cycles before BCP (Birth Control Pills) were always regular, about 30 days +/- 1 day with a 7 day period.And on BCP, my cycles were always 28 days, with a 5 day period.When I stopped BCP, I had a 5 day period, which began my first cycle of 31 days.The next cycle began with a 6 day period and the cycle lasted 37 days.Then this current cycle, which began with a four day period, a bit lighter than normal.I am currently on CD 27 and I believe I ovulated 3-4 days ago.So, the problem here is that I start spotting on CD 25, along with light cramping.It was only a very little bit of light brown blood, so I did not think much of it.Yesterday, CD 26, I had a little more throughout the day, then quite a bit right before bed.This morning, I am still spotting but much heavier than the past two days, and am starting to get a little alarmed by this.The blood is still brown. Any ideas on why this is happening, presumably 3-4 days past ovulation?Is this cause for concern? I have never spotted ever before.Also, I started taking Vitex at the beginning of this cycle in hopes of shortening my cycle a bit.Thank you in advance for any advice.

Hi, Welcome to Chat Doctor forum. This could be ovulation bleeding. Usually it may take about 6 months to conceive after stopping the birth control pills. But your cycle has become irregular after stopping the pills and it is difficult to predict the ovulation time now. If spotting does not stop or if you experience pain, then you should get an internal scan done to see the cause of spotting. There is possibility of DUB (Dysfunctional Uterine Bleeding) or ectopic pregnancy or threatened abortion. It can be seen once your period date is over. Or you may get beta HCG levels tested to confirm this along with the scan (TVS - Transvaginal Scan). If everything is fine, then you may take progesterone support in the second half of cycle to clear this. Revert back with the reports to an obstetrician and gynaecologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I will first summarize my case, and then I will put my query. I had been diagnosed to have GAD and social phobia before 10 years, and I was taking Paxil 20 mg daily in the evening along with CBT. The result was excellent. The anxiety and depression went away, but with a very high level of weight gain, significant fatigue and some sexual dysfunction (low libido). Due to the side effects of the drug, I tried to withdraw it all together around two years back, and there was a relapse. Therefore, I have come back to the medication with some changes. Initially, my doctor replaced Paxil with Prozac and Wellbutrin XL, and then replaced Prozac with Zoloft. Wellbutrin had many side effects on me. Hence, I avoided it altogether. He also avoided Effexor. I am currently on Zoloft 50 mg in the evening along with Buspar 10 mg four times daily.The query now is, which of the following strategies will have few side effects like fatigue, weight gain, impotence, decreased libido, and to delay the ejaculation?A combination of 20 mg Prozac during the evening time along with Buspar 10 mg every six hours daily.A combination of 10 mg Lexapro in the evening along with Buspar 10 mg every six hours a day.A combination of 50 mg Zoloft every evening along with Buspar 10 mg every six hours daily.How would you arrange the side effects? I would like you to mention the side effects regarding impotence, libido, weight gain, fatigue, drowsiness, negative impact on the system and liver in long-term usage, control GAD, SAD and social shyness, delayed ejaculation as a positive side effect, interfere with food, other medicines and supplements etc., in a descending order. Please discuss every question in detail according to your practical experience. Best regards. ### Response: Hi, Welcome to Chat Doctor forum. I read your query. Out of the three options, the third option would be the best possible concerning the balance between the effectiveness and side effects. Zoloft (Sertraline) and Lexapro (Escitalopram), both are almost equal regarding the side effects and efficacy. Based on my experience, Prozac (Fluoxetine) is a weaker ChatDoctor. With my practical experience, impotence and loss of libido are known side effects of all the three

Hi doctor,I will first summarize my case, and then I will put my query. I had been diagnosed to have GAD and social phobia before 10 years, and I was taking Paxil 20 mg daily in the evening along with CBT. The result was excellent. The anxiety and depression went away, but with a very high level of weight gain, significant fatigue and some sexual dysfunction (low libido). Due to the side effects of the drug, I tried to withdraw it all together around two years back, and there was a relapse. Therefore, I have come back to the medication with some changes. Initially, my doctor replaced Paxil with Prozac and Wellbutrin XL, and then replaced Prozac with Zoloft. Wellbutrin had many side effects on me. Hence, I avoided it altogether. He also avoided Effexor. I am currently on Zoloft 50 mg in the evening along with Buspar 10 mg four times daily.The query now is, which of the following strategies will have few side effects like fatigue, weight gain, impotence, decreased libido, and to delay the ejaculation?A combination of 20 mg Prozac during the evening time along with Buspar 10 mg every six hours daily.A combination of 10 mg Lexapro in the evening along with Buspar 10 mg every six hours a day.A combination of 50 mg Zoloft every evening along with Buspar 10 mg every six hours daily.How would you arrange the side effects? I would like you to mention the side effects regarding impotence, libido, weight gain, fatigue, drowsiness, negative impact on the system and liver in long-term usage, control GAD, SAD and social shyness, delayed ejaculation as a positive side effect, interfere with food, other medicines and supplements etc., in a descending order. Please discuss every question in detail according to your practical experience. Best regards.

Hi, Welcome to Chat Doctor forum. I read your query. Out of the three options, the third option would be the best possible concerning the balance between the effectiveness and side effects. Zoloft (Sertraline) and Lexapro (Escitalopram), both are almost equal regarding the side effects and efficacy. Based on my experience, Prozac (Fluoxetine) is a weaker ChatDoctor. With my practical experience, impotence and loss of libido are known side effects of all the three

### Instruction: Answer this question truthfully ###Input: Hello doctor,My mother is 64 years old and diabetic for 12 years. Recently she visited a dentist to get a denture. The dentist told that two pre-molars (1 up and 1 down on left side) have to be root canalled even though there was no pain in them because those teeth were not in good condition which he said after looking at an x-ray. I do not have any of those x-rays. So, the root canal was done on those two teeth, and cotton was placed there and asked to wait for one week. There is no pain at all. After one week, the cotton was removed, and the cement was placed. Within a few hours, the pain started, and it was increasing pain. The dentist then removed the cement and again placed cotton and asked her to wait for one week. No pain at all. Again on cementing, within few hours pain started a lot. Again cement was removed, and cotton was placed. This cement and cotton alternation has been going on three times (for three weeks), and the dentist says it will work at some point in time, and the cement will be permanent. He says the pain during cement is due to the gas pressure from the gas release by the microbes sitting on the remaining disintegrated pulp. If even finally it does not work and pain does not go away while with cement, he said he would make an antibiotic injection or spray on those teeth. I do not have any x-rays, so this is the only information I can give.My question is, Does this procedure look normal and logical? ### Response: Hello, Welcome to Chat Doctor forum. I need those pre-operative x-ray to make any comment, but as you do not have them, I can only make decisions based on your explanation. Through your explanation, it does not seem normal. There was no need for a root canal; rather, the dentist could use those teeth for denture support. But as she is a diabetic and periodontal loss of attachment is common in diabetics, so maybe those teeth did not have enough strength to support, that is why all this procedure has been done. Be sure before the final cementation of those teeth, cementation should not be done with pain. If pain persists, there is no other solution for a root canal treated tooth other than extraction, and then full mouth or complete dentures will be provided to your mother. Kindly reply me back with the x-ray if you find it.

Hello doctor,My mother is 64 years old and diabetic for 12 years. Recently she visited a dentist to get a denture. The dentist told that two pre-molars (1 up and 1 down on left side) have to be root canalled even though there was no pain in them because those teeth were not in good condition which he said after looking at an x-ray. I do not have any of those x-rays. So, the root canal was done on those two teeth, and cotton was placed there and asked to wait for one week. There is no pain at all. After one week, the cotton was removed, and the cement was placed. Within a few hours, the pain started, and it was increasing pain. The dentist then removed the cement and again placed cotton and asked her to wait for one week. No pain at all. Again on cementing, within few hours pain started a lot. Again cement was removed, and cotton was placed. This cement and cotton alternation has been going on three times (for three weeks), and the dentist says it will work at some point in time, and the cement will be permanent. He says the pain during cement is due to the gas pressure from the gas release by the microbes sitting on the remaining disintegrated pulp. If even finally it does not work and pain does not go away while with cement, he said he would make an antibiotic injection or spray on those teeth. I do not have any x-rays, so this is the only information I can give.My question is, Does this procedure look normal and logical?

Hello, Welcome to Chat Doctor forum. I need those pre-operative x-ray to make any comment, but as you do not have them, I can only make decisions based on your explanation. Through your explanation, it does not seem normal. There was no need for a root canal; rather, the dentist could use those teeth for denture support. But as she is a diabetic and periodontal loss of attachment is common in diabetics, so maybe those teeth did not have enough strength to support, that is why all this procedure has been done. Be sure before the final cementation of those teeth, cementation should not be done with pain. If pain persists, there is no other solution for a root canal treated tooth other than extraction, and then full mouth or complete dentures will be provided to your mother. Kindly reply me back with the x-ray if you find it.

### Instruction: Answer this question truthfully ###Input: Hello doctor, I am a 23-year-old male. Two years ago, I had intense palpitations, and I was diagnosed with anxiety disorder. I had panic attacks, but then I was able to recover by myself. From a few days, I had two panic attacks. And I am afraid if this is anxiety, or if my diagnosis was wrong as if I had some serious health issues.I worry that I have a heart problem. Even if someone touches my chest I feel uncomfortable. I do not think a lot. I try to calm myself, but somehow I am not able to calm myself no matter what I try. The main problem now is my anger. I suddenlt feel so much angry, on very stupid things like I am walking on a road and a car blows horn continuously I feel very irritated and angry, if my girlfriend does not pick my call I get so much angry and it is not normal.If I try to control my anger I feel numbness, and hand shakes, I even have palpitations. This is very worrying for me as I think this is very serious this time. My heart palpitations go away only when I am in deep sleep or when I am doing something so deeply without noticing anything. I had palpitations two days before my exams, I tried calming technique but it did not went away. But when I was in the examination center, when I started writing my answers I was so deeply busy in writing, that my palpitations go away. And then after the exam I was fine. But anger is ruining my life. I want to change the way I am. Please help. I am currently taking Sertraline, and Beta-blockers. ### Response: Hello, Welcome to Chat Doctor forum. Panic attacks often mimic a heart attack. In fact one of the common differential diagnosis for panic attack is cardiac arrest. If it is happening often it is advisable to get an ECG (electrocardiogram) done. Please tell me from last how many days are you taking anti-anxiety medications? Secondly, I would advise you to start cognitive behavior therapy. Anxiety is caused by negative thoughts called cognitive distortions these can be improved with various techniques used in the therapy. Once you learn how to cope up with these negative thoughts you will be able to control your anxiety. Find a local therapist or you can opt for online therapy via video consultation. The relaxation techniques such as box breathing and progressive muscle relaxation help in long-term efficacy. I hope this helps.

Hello doctor, I am a 23-year-old male. Two years ago, I had intense palpitations, and I was diagnosed with anxiety disorder. I had panic attacks, but then I was able to recover by myself. From a few days, I had two panic attacks. And I am afraid if this is anxiety, or if my diagnosis was wrong as if I had some serious health issues.I worry that I have a heart problem. Even if someone touches my chest I feel uncomfortable. I do not think a lot. I try to calm myself, but somehow I am not able to calm myself no matter what I try. The main problem now is my anger. I suddenlt feel so much angry, on very stupid things like I am walking on a road and a car blows horn continuously I feel very irritated and angry, if my girlfriend does not pick my call I get so much angry and it is not normal.If I try to control my anger I feel numbness, and hand shakes, I even have palpitations. This is very worrying for me as I think this is very serious this time. My heart palpitations go away only when I am in deep sleep or when I am doing something so deeply without noticing anything. I had palpitations two days before my exams, I tried calming technique but it did not went away. But when I was in the examination center, when I started writing my answers I was so deeply busy in writing, that my palpitations go away. And then after the exam I was fine. But anger is ruining my life. I want to change the way I am. Please help. I am currently taking Sertraline, and Beta-blockers.

Hello, Welcome to Chat Doctor forum. Panic attacks often mimic a heart attack. In fact one of the common differential diagnosis for panic attack is cardiac arrest. If it is happening often it is advisable to get an ECG (electrocardiogram) done. Please tell me from last how many days are you taking anti-anxiety medications? Secondly, I would advise you to start cognitive behavior therapy. Anxiety is caused by negative thoughts called cognitive distortions these can be improved with various techniques used in the therapy. Once you learn how to cope up with these negative thoughts you will be able to control your anxiety. Find a local therapist or you can opt for online therapy via video consultation. The relaxation techniques such as box breathing and progressive muscle relaxation help in long-term efficacy. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I had unprotected anal and oral sex with a guy. This makes me very stressful. The symptoms I encounter after the incident are as follows. I am feeling very tired from day 10, and I think it as stress. From day 12, I am having some sort of difficulty in breathing and numbness all over the body. On day 14, I have experienced itch inside the penis with clear watery discharge like urine, and it lasted only for a few days. On day 17, I had fever and headache which was cured in a day with treatment. I got an itchy rash on the chest, back, face and scalp on the 19th day. It lasted for about five days and got reduced, but still remains some. Then other symptoms persist till date which occurred gradually are sore throat, lower back pain, abdominal pain, joint pain, coating on tongue, bumps on back of tongue, red spot on tongue with irritation, itchy legs and hands without rash, blurred vision, painful itchy and sore armpit, thigh, genital area and buttock areas. I have attached the photos, please have a look. Do these symptoms suggest acute HIV infection? Or can it be other STDs?I have undergone the following tests to check HIV. Rapid blood test on day 19 and the result was negative, and I repeated the same test on day 35 and that too negative. My partner tested in front of me one day before sex, and it was negative. He claimed that he is clear and safe. But, he said that he had one partner three or four months ago and also many partners before. If my partner is truly clear and safe and I am HIV negative, then what cause all these symptoms?My doctor said I have very similar symptoms of acute HIV which makes me freaked out and nervous. I made mistake to have unprotected sex with him. I am going to get married soon. I will decide my marriage according to my HIV test result only. Please answer my questions and give advice. Thank you. ### Response: Hi. Thanks for providing the clinical pictures (attachment removed to protect patient identity). I would try to provide you with the best possible answers to your questions. The symptoms you have mentioned for example fever, general feeling of not being well, vague body aches may be a hint of acute HIV (human immunodeficiency virus) syn ChatDoctor. They may also, in reality, be hypochon Take care.

Hi doctor,I had unprotected anal and oral sex with a guy. This makes me very stressful. The symptoms I encounter after the incident are as follows. I am feeling very tired from day 10, and I think it as stress. From day 12, I am having some sort of difficulty in breathing and numbness all over the body. On day 14, I have experienced itch inside the penis with clear watery discharge like urine, and it lasted only for a few days. On day 17, I had fever and headache which was cured in a day with treatment. I got an itchy rash on the chest, back, face and scalp on the 19th day. It lasted for about five days and got reduced, but still remains some. Then other symptoms persist till date which occurred gradually are sore throat, lower back pain, abdominal pain, joint pain, coating on tongue, bumps on back of tongue, red spot on tongue with irritation, itchy legs and hands without rash, blurred vision, painful itchy and sore armpit, thigh, genital area and buttock areas. I have attached the photos, please have a look. Do these symptoms suggest acute HIV infection? Or can it be other STDs?I have undergone the following tests to check HIV. Rapid blood test on day 19 and the result was negative, and I repeated the same test on day 35 and that too negative. My partner tested in front of me one day before sex, and it was negative. He claimed that he is clear and safe. But, he said that he had one partner three or four months ago and also many partners before. If my partner is truly clear and safe and I am HIV negative, then what cause all these symptoms?My doctor said I have very similar symptoms of acute HIV which makes me freaked out and nervous. I made mistake to have unprotected sex with him. I am going to get married soon. I will decide my marriage according to my HIV test result only. Please answer my questions and give advice. Thank you.

Hi. Thanks for providing the clinical pictures (attachment removed to protect patient identity). I would try to provide you with the best possible answers to your questions. The symptoms you have mentioned for example fever, general feeling of not being well, vague body aches may be a hint of acute HIV (human immunodeficiency virus) syn ChatDoctor. They may also, in reality, be hypochon Take care.

### Instruction: Answer this question truthfully ###Input: Respected doctor,My 63 year old mother was diagnosed with tuberculosis meningitis (TBM) 10 months ago when she complained of a severe headache. She has undergone CSF study and the report of the study is attached. She has been taking ATT medicines since then. The list of all the medicines she is taking is also attached. The medicines had come down to only one tablet (R-Cinex) in the last 10 months. But, now for the last two months, she started having back pain in the spine area and is now suspected to have a TB infection in the spine. She has a history of L3-L4 collapse four years ago, but that was due to osteoporosis. Her BMD score was -3.2. The spine has been severely infected from L1 to L5. The MRI revealed an abscess with a pus collection in it (report attached). The doctor says it could be Pott\\s spine and may be because of a drug resistance (MDR), and they wanted to perform a USG aspiration for Xpert plus SRL, culture and sensitivity of pus. But, the test did not happen because the location of the pus was very deep in the muscle and could not be extracted. So, they extracted some tissues near by the infection area and sent for a small biopsy. The report of the histopathology (small biopsy) is also attached. It says mild nonspecific chronic inflammation. Since no strong evidence of drug resistance could be found in the small biopsy, the doctor has restarted the medicine of AKT-4 plus STM 0.75, and they want to see whether this reduces the problem or not. They said we cannot start DR/MDR treatment without any strong evidence of drug resistance. The current OPD card is also attached in which the medicine has been restarted. Now please guide us about what should be the treatment plan of the disease based on the information submitted. Can anything can be done to get a strong evidence of drug resistance since the ATT medicine is very heavy and the doctor has restarted this medicine only on the basis of his opinion? How can we assess the recovery from the disease apart from relying only on the reduction of pain? Does she require any further MRI or any test after some time? ### Response: Hello, Welcome to Chat Doctor forum. I went through your post which has nicely described the events. Also, I reviewed her reports (attachment removed to protect patient identity). For more information consult an internal medicine physician online

Respected doctor,My 63 year old mother was diagnosed with tuberculosis meningitis (TBM) 10 months ago when she complained of a severe headache. She has undergone CSF study and the report of the study is attached. She has been taking ATT medicines since then. The list of all the medicines she is taking is also attached. The medicines had come down to only one tablet (R-Cinex) in the last 10 months. But, now for the last two months, she started having back pain in the spine area and is now suspected to have a TB infection in the spine. She has a history of L3-L4 collapse four years ago, but that was due to osteoporosis. Her BMD score was -3.2. The spine has been severely infected from L1 to L5. The MRI revealed an abscess with a pus collection in it (report attached). The doctor says it could be Pott\\s spine and may be because of a drug resistance (MDR), and they wanted to perform a USG aspiration for Xpert plus SRL, culture and sensitivity of pus. But, the test did not happen because the location of the pus was very deep in the muscle and could not be extracted. So, they extracted some tissues near by the infection area and sent for a small biopsy. The report of the histopathology (small biopsy) is also attached. It says mild nonspecific chronic inflammation. Since no strong evidence of drug resistance could be found in the small biopsy, the doctor has restarted the medicine of AKT-4 plus STM 0.75, and they want to see whether this reduces the problem or not. They said we cannot start DR/MDR treatment without any strong evidence of drug resistance. The current OPD card is also attached in which the medicine has been restarted. Now please guide us about what should be the treatment plan of the disease based on the information submitted. Can anything can be done to get a strong evidence of drug resistance since the ATT medicine is very heavy and the doctor has restarted this medicine only on the basis of his opinion? How can we assess the recovery from the disease apart from relying only on the reduction of pain? Does she require any further MRI or any test after some time?

Hello, Welcome to Chat Doctor forum. I went through your post which has nicely described the events. Also, I reviewed her reports (attachment removed to protect patient identity). For more information consult an internal medicine physician online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have type 1 diabetes at 27 years old (diagnosed around eight years). Recently I was somewhat nauseous, and today diarrhea with a lime green tint. I read about diabetic enteropathy, but this is the first time I feel like it could be diabetic-related diarrhea mostly because I had not had much to eat other than peanut butter and jelly sandwich for breakfast and a juice box for lunch.I was 79 around 11 am, and at 8 am I was 118. The last few days I have been consecutively around 150-to-mid 200\\s (but mostly in the 150 to 190 range). Otherwise, my numbers are generally stable overall, and I believe my last A1C was 6.8. I had two bowel movements today with diarrhea. I took my blood sugar just a few minutes ago, and it was 290, and going down (I gave myself a shot of Humalog to keep me steady for dinner). I was just a little worried because of the article I read on diabetic enteropathy. It is treatable by just keeping the blood sugar tighter, and I was a bit scared if it might be fatal. I assume it is, but I do intend to keep things better regulated after this. I need to be a bit more at ease after what I read. I did not want to contact my doctor if it is something I can fix with regulation. ### Response: Hello. Diabetic enteropathy is not diagnosed after a single episode of diarrhea. Usually, it is chronic and intermittent with regular bowel movements in between. Constipation can also be present. Diarrhea can occur during the night. There are other causes for acute diarrhea-most commonly infections, food poisoning, or adverse reactions to medications. I suggest you wait and see how this whole thing pans out. As long as there is no blood in the feces and no abdominal pain or fever, I would not worry about some serious underlying condition. Tighter control using insulin is possible but can be difficult due to hypoglycemic episodes. However, if you cut down on carbohy ChatDoctor. I suggest you go through these articles about this. Also, if you can afford or if your insurance covers it, try getting a CGM (continuous glucose monitor). I hope this helps. Please let me know if you have any other questions.

Hello doctor,I have type 1 diabetes at 27 years old (diagnosed around eight years). Recently I was somewhat nauseous, and today diarrhea with a lime green tint. I read about diabetic enteropathy, but this is the first time I feel like it could be diabetic-related diarrhea mostly because I had not had much to eat other than peanut butter and jelly sandwich for breakfast and a juice box for lunch.I was 79 around 11 am, and at 8 am I was 118. The last few days I have been consecutively around 150-to-mid 200\\s (but mostly in the 150 to 190 range). Otherwise, my numbers are generally stable overall, and I believe my last A1C was 6.8. I had two bowel movements today with diarrhea. I took my blood sugar just a few minutes ago, and it was 290, and going down (I gave myself a shot of Humalog to keep me steady for dinner). I was just a little worried because of the article I read on diabetic enteropathy. It is treatable by just keeping the blood sugar tighter, and I was a bit scared if it might be fatal. I assume it is, but I do intend to keep things better regulated after this. I need to be a bit more at ease after what I read. I did not want to contact my doctor if it is something I can fix with regulation.

Hello. Diabetic enteropathy is not diagnosed after a single episode of diarrhea. Usually, it is chronic and intermittent with regular bowel movements in between. Constipation can also be present. Diarrhea can occur during the night. There are other causes for acute diarrhea-most commonly infections, food poisoning, or adverse reactions to medications. I suggest you wait and see how this whole thing pans out. As long as there is no blood in the feces and no abdominal pain or fever, I would not worry about some serious underlying condition. Tighter control using insulin is possible but can be difficult due to hypoglycemic episodes. However, if you cut down on carbohy ChatDoctor. I suggest you go through these articles about this. Also, if you can afford or if your insurance covers it, try getting a CGM (continuous glucose monitor). I hope this helps. Please let me know if you have any other questions.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 31-year-old female. I think I have pinworms. My butt (perineal and anus area) kept vibrating like a cellphone, about once every two seconds, all day. I started taking probiotics and now it is not as constant, but happens many times a day still. I researched it, and some people say it could be worms. I took Reese\\s Pinworm medicine and there were a few small half to one-inch white worms. My anus itches every now and then. Two days in a row it was very itchy. But it is not extra itchy at night, which is supposed to be the main symptom. I do feel them especially at night and it disgusts me.Do you think the cellphone-like vibrating is because of the worms? I am very disgusted, upset, and terrified. I think I got it from eating kale and spinach that I did not wash. I do work in a school, too. I heard apple cider vinegar is supposed to create an uninviting atmosphere for them. Does that mean if I drink it they will start coming out of me in various places, and alive or will I just poop them out?And garlic and carrots, would I just poop them out dead after eating these? I want to take lots of things to be rid of them, but do not want to see anything come out except my anus, and must be dead. I took the medicine only for four days. Will they take a while to go away? ### Response: Hello, Welcome to Chat Doctor forum. I understand your concern. I will advise not to use the apple cider vinegar, but garlic and carrots can be taken, and they will help in further elimination of the pinworms. It will come out only through your anus, and not through anywhere else. You have taken the pinworm solution, so that complete elimination may take around a week. Since there was almost immediate evacuation the next day, it is a good sign and it will keep coming out. I will also advise you to take Mebendazole 150 mg separately, and that will also help in the treatment. It can be taken as a single dose at bedtime. This excessive itching could be due to the concentration of the organisms in the tract and it will slowly get better. You have already taken medicine and a course of Mebendazole will further help in the treatment.

Hello doctor,I am a 31-year-old female. I think I have pinworms. My butt (perineal and anus area) kept vibrating like a cellphone, about once every two seconds, all day. I started taking probiotics and now it is not as constant, but happens many times a day still. I researched it, and some people say it could be worms. I took Reese\\s Pinworm medicine and there were a few small half to one-inch white worms. My anus itches every now and then. Two days in a row it was very itchy. But it is not extra itchy at night, which is supposed to be the main symptom. I do feel them especially at night and it disgusts me.Do you think the cellphone-like vibrating is because of the worms? I am very disgusted, upset, and terrified. I think I got it from eating kale and spinach that I did not wash. I do work in a school, too. I heard apple cider vinegar is supposed to create an uninviting atmosphere for them. Does that mean if I drink it they will start coming out of me in various places, and alive or will I just poop them out?And garlic and carrots, would I just poop them out dead after eating these? I want to take lots of things to be rid of them, but do not want to see anything come out except my anus, and must be dead. I took the medicine only for four days. Will they take a while to go away?

Hello, Welcome to Chat Doctor forum. I understand your concern. I will advise not to use the apple cider vinegar, but garlic and carrots can be taken, and they will help in further elimination of the pinworms. It will come out only through your anus, and not through anywhere else. You have taken the pinworm solution, so that complete elimination may take around a week. Since there was almost immediate evacuation the next day, it is a good sign and it will keep coming out. I will also advise you to take Mebendazole 150 mg separately, and that will also help in the treatment. It can be taken as a single dose at bedtime. This excessive itching could be due to the concentration of the organisms in the tract and it will slowly get better. You have already taken medicine and a course of Mebendazole will further help in the treatment.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have been taking 4 mg of Xanax a day to treat severe panic attack syndrome and associated high levels of general anxiety for 15 years. My doctor arrived at the 4 mg per day amount gradually and it works very well along with CBT from a therapist. Before two months, when I received the medication from the pharmacy it was for 3 mg /day. I asked them to double check and that was the quantity that my doctor had written. I call his office and the office manager said that she would ask him about it. When I called the next day she said that he did not make a mistake and I asked for an explanation and was told that he did not give one.I started to feel sick a few days later and panic attacks actually started to increase the day that I talk to his office manager. I suffered minor but disruptive withdrawal symptoms physically and mentally for about two weeks and then they subsided but panic attacks continued to occur at random every day and my GAD symptoms increased to the point where CBT methods were not working.Then last month, the script was back to 4 mg per day normal dosage. I thought yes, back to normal. But again this month the script was back down to 3 mg per day which means I am going to experience a minor hell again.I am a defense and aerospace engineer who works on a contract basis through an agency and the client had noticed a drop in my performance before month but back to normal last month, now they are going to see it again and I will probably lose the contract job. I also started online system engineer classes and I am freaking out over being able to handle the exams and homework as I typically work on the class at night and am now without my evening dose. I again asked for an explanation and was not given any.My question is a 25% cut in dosage physically dangerous and I am well aware of the strong psychological addition issues, so will this settle down before my career and social life and general well being take a hit and I revert to hiding in my apartment with my dog and my employer and friends will give up on me. ### Response: Hello, Welcome to Chat Doctor forum. There are a few clarifications and advice that I need to make. Reducing the dosage of Alprazolam results in Alprazolam with ChatDoctor. A reduction by 25% is unlikely to be physically dangerous but the with

Hi doctor,I have been taking 4 mg of Xanax a day to treat severe panic attack syndrome and associated high levels of general anxiety for 15 years. My doctor arrived at the 4 mg per day amount gradually and it works very well along with CBT from a therapist. Before two months, when I received the medication from the pharmacy it was for 3 mg /day. I asked them to double check and that was the quantity that my doctor had written. I call his office and the office manager said that she would ask him about it. When I called the next day she said that he did not make a mistake and I asked for an explanation and was told that he did not give one.I started to feel sick a few days later and panic attacks actually started to increase the day that I talk to his office manager. I suffered minor but disruptive withdrawal symptoms physically and mentally for about two weeks and then they subsided but panic attacks continued to occur at random every day and my GAD symptoms increased to the point where CBT methods were not working.Then last month, the script was back to 4 mg per day normal dosage. I thought yes, back to normal. But again this month the script was back down to 3 mg per day which means I am going to experience a minor hell again.I am a defense and aerospace engineer who works on a contract basis through an agency and the client had noticed a drop in my performance before month but back to normal last month, now they are going to see it again and I will probably lose the contract job. I also started online system engineer classes and I am freaking out over being able to handle the exams and homework as I typically work on the class at night and am now without my evening dose. I again asked for an explanation and was not given any.My question is a 25% cut in dosage physically dangerous and I am well aware of the strong psychological addition issues, so will this settle down before my career and social life and general well being take a hit and I revert to hiding in my apartment with my dog and my employer and friends will give up on me.

Hello, Welcome to Chat Doctor forum. There are a few clarifications and advice that I need to make. Reducing the dosage of Alprazolam results in Alprazolam with ChatDoctor. A reduction by 25% is unlikely to be physically dangerous but the with

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 19 year old girl. I have a very stupid habit that has caused a lot of problem for me, I have met a lot of psychologists, but I could never talk about my exact problem with them. It seems to be a ridiculous problem, but I ask your sincere help. When I was 15 years old, I watched a romantic movie which caused my problem, since then I made an imaginary life with an imaginary man in my mind. I have got involved with this problem for years. When I was a child, I had difficulties which I could not solve at that time, so I started fantasizing and tried not to involve myself in real life\\s problem. But then, there was no love in my imagination, I was a very happy successful girl, and I was a famous, respectful person.But after I got defeated at a state level game, I understood that I am not intelligent enough to achieve such goals, I was so depressed with no enthusiasm in studying. I got to know about sex and intercourse, I was confused and hated my gender, I thought of changing my gender. I had depression, and I was so disappointed about life. Then I started to imagine a man who lived with me, and I loved him so much. Instead of facing my life problems, I used to fantasize about him. From last year I have imaginary sex with him.The problem I have is that my life is interrupted by my imagination. I cannot deal with other students, especially boys. I have lost my confidence, do not have the enthusiasm to study. I cannot focus when I am in the class, and I do not take any efforts to solve my problem. I just keep imaging a peaceful life with no problems, sometimes when I cannot control my anxiety and stress, I start having sex in my mind. I do not know what to do, and I want to stop this imaginary life. How do I stop this imaginary life and love? I know this man is not real, and whenever my imaginary life becomes sad, it has an influence on my real life. I currently take tablet Levebel 500 mg, two tablets a day. ### Response: Hi. Thanks for sharing your problem with me. I can understand your problem. You have given a complete elaborated history regarding your problem. Hope my answer helped you, and feel free to ask whenever you need my help.

Hi doctor,I am a 19 year old girl. I have a very stupid habit that has caused a lot of problem for me, I have met a lot of psychologists, but I could never talk about my exact problem with them. It seems to be a ridiculous problem, but I ask your sincere help. When I was 15 years old, I watched a romantic movie which caused my problem, since then I made an imaginary life with an imaginary man in my mind. I have got involved with this problem for years. When I was a child, I had difficulties which I could not solve at that time, so I started fantasizing and tried not to involve myself in real life\\s problem. But then, there was no love in my imagination, I was a very happy successful girl, and I was a famous, respectful person.But after I got defeated at a state level game, I understood that I am not intelligent enough to achieve such goals, I was so depressed with no enthusiasm in studying. I got to know about sex and intercourse, I was confused and hated my gender, I thought of changing my gender. I had depression, and I was so disappointed about life. Then I started to imagine a man who lived with me, and I loved him so much. Instead of facing my life problems, I used to fantasize about him. From last year I have imaginary sex with him.The problem I have is that my life is interrupted by my imagination. I cannot deal with other students, especially boys. I have lost my confidence, do not have the enthusiasm to study. I cannot focus when I am in the class, and I do not take any efforts to solve my problem. I just keep imaging a peaceful life with no problems, sometimes when I cannot control my anxiety and stress, I start having sex in my mind. I do not know what to do, and I want to stop this imaginary life. How do I stop this imaginary life and love? I know this man is not real, and whenever my imaginary life becomes sad, it has an influence on my real life. I currently take tablet Levebel 500 mg, two tablets a day.

Hi. Thanks for sharing your problem with me. I can understand your problem. You have given a complete elaborated history regarding your problem. Hope my answer helped you, and feel free to ask whenever you need my help.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a female in my 20s. I have been having obsessive worries, so please do not judge my rather paranoid concerns, since I cannot get them off my mind. A week ago, during a night out, I received a kiss on the cheek by a male stranger, and also gave him a kiss on his cheek. Initially, I was not alert because I thought the person was a friend of my friend\\s, but later I realized that he was a total stranger, who was acting weird and asking everyone in the nightclub for a kiss on the cheek. For some reasons, I kept thinking that this weird person had some sort of contagious disease and was just desperate to pass the disease to as many people as possible. About three days later, I started having symptoms similar to those of a cold. I felt tired and had a runny nose. I stopped feeling tired after two days, but the runny nose has not completely stopped until today, which is four days later from the start of the symptoms. From my own knowledge and some researching, I learned that early HIV symptoms include flu-like symptoms. And although I did not have any a sore throat, fever or swollen lymph nodes, my runny nose has been worrying me and making me have thoughts that I may have contacted HIV from the weird stranger. From my memory, when he and I exchanged kisses on the cheek, his lips, and cheeks, as well as my lips and cheeks, did not have any open cuts or sores, so I have almost zero chance of HIV exposure. However, I cannot seem to put my mind at ease, as I have been having obsessive worries for about three days. Therefore, I want to seek consultation from a professional. Please give me some advice, so I can get some peace of mind. ### Response: Hello. As you have mentioned, there were no cuts in his and your lip, then 80 % problem is solved. Touch and light kiss do not transfer HIV. Saliva is their least chance of transmission, which is not known or does not have a reported case though. So, this is just a quick response, nothing else. The common cold is very common in your place. Do not worry. Take tablet Montek FX (Montelukast and Fexofenadine) one at night for three to five days. There is no HIV contamination. For more information consult a HIV AIDS specialist online

Hello doctor,I am a female in my 20s. I have been having obsessive worries, so please do not judge my rather paranoid concerns, since I cannot get them off my mind. A week ago, during a night out, I received a kiss on the cheek by a male stranger, and also gave him a kiss on his cheek. Initially, I was not alert because I thought the person was a friend of my friend\\s, but later I realized that he was a total stranger, who was acting weird and asking everyone in the nightclub for a kiss on the cheek. For some reasons, I kept thinking that this weird person had some sort of contagious disease and was just desperate to pass the disease to as many people as possible. About three days later, I started having symptoms similar to those of a cold. I felt tired and had a runny nose. I stopped feeling tired after two days, but the runny nose has not completely stopped until today, which is four days later from the start of the symptoms. From my own knowledge and some researching, I learned that early HIV symptoms include flu-like symptoms. And although I did not have any a sore throat, fever or swollen lymph nodes, my runny nose has been worrying me and making me have thoughts that I may have contacted HIV from the weird stranger. From my memory, when he and I exchanged kisses on the cheek, his lips, and cheeks, as well as my lips and cheeks, did not have any open cuts or sores, so I have almost zero chance of HIV exposure. However, I cannot seem to put my mind at ease, as I have been having obsessive worries for about three days. Therefore, I want to seek consultation from a professional. Please give me some advice, so I can get some peace of mind.

Hello. As you have mentioned, there were no cuts in his and your lip, then 80 % problem is solved. Touch and light kiss do not transfer HIV. Saliva is their least chance of transmission, which is not known or does not have a reported case though. So, this is just a quick response, nothing else. The common cold is very common in your place. Do not worry. Take tablet Montek FX (Montelukast and Fexofenadine) one at night for three to five days. There is no HIV contamination. For more information consult a HIV AIDS specialist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 33 years old and weighs about 86 kg. My whole body hurts. I got pain all over the body, pain in legs and hands. Pain is persistent all the time mostly in the lower feet and hand. I am having pain for the past three months. I just had an appointment with my doctor. He ordered some blood work and told me everything is fine. And he told me to see the rheumatologist once for my peace of mind.I have attached my report. Do you see anything abnormal in my blood report? What is the cause of my body pain? Is anything wrong with my body? Do I have any underlying conditions such as leukemia, lymphoma, or any other cancer? Do I have any liver disease or thyroid disease that can lead me to pain? Before three months I did a blood test and my rheumatoid factor was 8.1 iu/ml and now it is 11 iu/ml. Why it is going up with a short duration of time? What do I need to do?I am eating healthy and getting good sleep but I am not losing weight. My vitamin D level is 40ng/ml and I am taking vitamin B12. I am taking vitamin D for almost one year. I m taking 4000 IU for five days a week. Please explain in detail the treatment plan. ### Response: Hello. Well, I have gone through your history and the reports attached.(attachment removed to protect patient identity). All the reports are normal. I could not find the reports of liver function tests there, but I suppose your doctor had already looked into it. Do not worry, you don\\t have any cancers at the current time. If any cancer would cause pain, it surely would have affected your blood counts as well. As for Rheumatoid factor, 8 or 11, can be lab variation or instrument variation, but as long as you do not have joint swellings or pain it is insignificant. My diagnosis for pain would go for fibromyalgia. It is more of a diagnosis of exclusion and one only considers it after ruling out the other causes, which they have done so far. I will give you a link, you can go through it and let me know if your symptoms match this. As treatment will depend on your being convinced about the diagnosis. I hope this helps. Fibromyalgia.

Hello doctor,I am 33 years old and weighs about 86 kg. My whole body hurts. I got pain all over the body, pain in legs and hands. Pain is persistent all the time mostly in the lower feet and hand. I am having pain for the past three months. I just had an appointment with my doctor. He ordered some blood work and told me everything is fine. And he told me to see the rheumatologist once for my peace of mind.I have attached my report. Do you see anything abnormal in my blood report? What is the cause of my body pain? Is anything wrong with my body? Do I have any underlying conditions such as leukemia, lymphoma, or any other cancer? Do I have any liver disease or thyroid disease that can lead me to pain? Before three months I did a blood test and my rheumatoid factor was 8.1 iu/ml and now it is 11 iu/ml. Why it is going up with a short duration of time? What do I need to do?I am eating healthy and getting good sleep but I am not losing weight. My vitamin D level is 40ng/ml and I am taking vitamin B12. I am taking vitamin D for almost one year. I m taking 4000 IU for five days a week. Please explain in detail the treatment plan.

Hello. Well, I have gone through your history and the reports attached.(attachment removed to protect patient identity). All the reports are normal. I could not find the reports of liver function tests there, but I suppose your doctor had already looked into it. Do not worry, you don\\t have any cancers at the current time. If any cancer would cause pain, it surely would have affected your blood counts as well. As for Rheumatoid factor, 8 or 11, can be lab variation or instrument variation, but as long as you do not have joint swellings or pain it is insignificant. My diagnosis for pain would go for fibromyalgia. It is more of a diagnosis of exclusion and one only considers it after ruling out the other causes, which they have done so far. I will give you a link, you can go through it and let me know if your symptoms match this. As treatment will depend on your being convinced about the diagnosis. I hope this helps. Fibromyalgia.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 57-year-old female. Here is my question constant heart palpitations and fluttering, continuous feeling of adrenaline rushing along with palpitations very bad at night but also during the day when sitting in doing nothing palpitations often make you feel nauseous on a 1 to 10 scale they are about an eight. All labs are normal ECG, echo, and Holter monitor are all normal.Doctor cannot figure it out and prescribed Propranolol 10 mg, told me to try these once a day. Yesterday after doctor visits heart palpitations for four hours got fed up and took one tablet one hour later, all palpitations and adrenaline rush was gone. Slept for the first time without being woke up having to cough to stop the palpitations. Had angio done approximately two years ago due to suspected heart attack or arrhythmia at home with all classic signs crushing chest pain jaw neck left arm down to the floor nauseated?Even with that lab test came back good the next day. Had carotid artery surgery two years ago to remove a piece of plaque in right carotid artery none found anywhere else no stent needed. Again all labs are good cholesterol not high on statins and warfarin. I must be perplexing to all doctors because they cannot figure it out. Was put on warfarin approximately 15 years ago due to DVTs as a result of a surgery, always therapeutic. So I had a heart attack or arrhythmia a few years back the angio came out the great doctor said everything looked fine now I have these crazy heart palpitations that would not stop. They go away as soon as I take the beta-blocker. I am told that beta-blockers even though anti-arrhythmic can also be pro arithmetic as well should I take this every day or should I only take this when I start to feel palpitations. ### Response: Hello, Welcome to ciliniq.com. So palpitations may be due to cardiac arrhythmia, anxiety, and psychological problems or due to increased awareness of one\\s heartbeat. Now, since your holter was normal during your palpitations, it rules out the possibility of cardiac arrhythmia. So, these are likely benign palpitations in you. Propranolol is an anti-anxiety medicine, and it also opposes the A ChatDoctor. It is not an antiarrhythmic Take care.

Hello doctor,I am a 57-year-old female. Here is my question constant heart palpitations and fluttering, continuous feeling of adrenaline rushing along with palpitations very bad at night but also during the day when sitting in doing nothing palpitations often make you feel nauseous on a 1 to 10 scale they are about an eight. All labs are normal ECG, echo, and Holter monitor are all normal.Doctor cannot figure it out and prescribed Propranolol 10 mg, told me to try these once a day. Yesterday after doctor visits heart palpitations for four hours got fed up and took one tablet one hour later, all palpitations and adrenaline rush was gone. Slept for the first time without being woke up having to cough to stop the palpitations. Had angio done approximately two years ago due to suspected heart attack or arrhythmia at home with all classic signs crushing chest pain jaw neck left arm down to the floor nauseated?Even with that lab test came back good the next day. Had carotid artery surgery two years ago to remove a piece of plaque in right carotid artery none found anywhere else no stent needed. Again all labs are good cholesterol not high on statins and warfarin. I must be perplexing to all doctors because they cannot figure it out. Was put on warfarin approximately 15 years ago due to DVTs as a result of a surgery, always therapeutic. So I had a heart attack or arrhythmia a few years back the angio came out the great doctor said everything looked fine now I have these crazy heart palpitations that would not stop. They go away as soon as I take the beta-blocker. I am told that beta-blockers even though anti-arrhythmic can also be pro arithmetic as well should I take this every day or should I only take this when I start to feel palpitations.

Hello, Welcome to ciliniq.com. So palpitations may be due to cardiac arrhythmia, anxiety, and psychological problems or due to increased awareness of one\\s heartbeat. Now, since your holter was normal during your palpitations, it rules out the possibility of cardiac arrhythmia. So, these are likely benign palpitations in you. Propranolol is an anti-anxiety medicine, and it also opposes the A ChatDoctor. It is not an antiarrhythmic Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I love myself and think I am a great guy, but feel no one else sees that. I have feelings of pending failure, feelings of inadequacy, fear of rejection, fear of police, fear of persecution, lots of mental ambition but no energy to actually do anything because I am convinced I would fail, near constant nightmares about being in jail often without knowing why or being hunted down by people determined to kill or imprison me again without knowing why. Occasional ED which I attribute to the antidepressants, obesity, cholesterol and sleep apnea, and fear of emotional intimacy and talking about my private self. I have been diagnosed by the VA with dysthymia depression and at a non VA psychiatric hospital after a suicide attempt with PTSD, which the VA says I am not. My research tend to point more towards C-PTSD and I have an inability to trust people especially authority, I often feel as though there is an orchestrated conspiracy against me, but grounded enough in reality to know that makes little sense, but often cannot shake the feelings and have a number of instances in my life that simply reinforce that thinking. I fear criticism and rejection from those I should be closest to like my wife and mother. Desire intimacy but have none, being more emotionally intimate, but not cybersex just erotic conversation, with strangers on the internet because of anonymity. I never use my real name online. That is background information.Anyway my question is about the medicines but it just seems like so much and I tend to distrust the VA doctors but have no other healthcare options. Just looking for someone else\\s opinion. ### Response: Hi, Welcome to Chat Doctor forum. Yes, you are on right medication. Bupropion is a good antidepressant and very safe although it can cause insomnia, anxiety and dizziness as side effects in few patients but it would decrease on its own. Sertaline is an SSRI ChatDoctor. As an antidepressant, Sertraline is so potent at stimulating the brain that it can cause anxiety with initial use. But it goes off after some time. Using a Benzodiazepine like Alprazolam for the initial 10 days of treatment with Sertraline. Once you get used to it you may taper the Alprazolam and stop it. Sertraline would continue. You can talk to your psychiatrist regarding this. But you have to comply with medication and you have to reduce your weight.

Hello doctor,I love myself and think I am a great guy, but feel no one else sees that. I have feelings of pending failure, feelings of inadequacy, fear of rejection, fear of police, fear of persecution, lots of mental ambition but no energy to actually do anything because I am convinced I would fail, near constant nightmares about being in jail often without knowing why or being hunted down by people determined to kill or imprison me again without knowing why. Occasional ED which I attribute to the antidepressants, obesity, cholesterol and sleep apnea, and fear of emotional intimacy and talking about my private self. I have been diagnosed by the VA with dysthymia depression and at a non VA psychiatric hospital after a suicide attempt with PTSD, which the VA says I am not. My research tend to point more towards C-PTSD and I have an inability to trust people especially authority, I often feel as though there is an orchestrated conspiracy against me, but grounded enough in reality to know that makes little sense, but often cannot shake the feelings and have a number of instances in my life that simply reinforce that thinking. I fear criticism and rejection from those I should be closest to like my wife and mother. Desire intimacy but have none, being more emotionally intimate, but not cybersex just erotic conversation, with strangers on the internet because of anonymity. I never use my real name online. That is background information.Anyway my question is about the medicines but it just seems like so much and I tend to distrust the VA doctors but have no other healthcare options. Just looking for someone else\\s opinion.

Hi, Welcome to Chat Doctor forum. Yes, you are on right medication. Bupropion is a good antidepressant and very safe although it can cause insomnia, anxiety and dizziness as side effects in few patients but it would decrease on its own. Sertaline is an SSRI ChatDoctor. As an antidepressant, Sertraline is so potent at stimulating the brain that it can cause anxiety with initial use. But it goes off after some time. Using a Benzodiazepine like Alprazolam for the initial 10 days of treatment with Sertraline. Once you get used to it you may taper the Alprazolam and stop it. Sertraline would continue. You can talk to your psychiatrist regarding this. But you have to comply with medication and you have to reduce your weight.

### Instruction: Answer this question truthfully ###Input: Hello doctor,My crown has become loose as there is decay inside the crown and around half the edge but not visible. I was told that tooth is stable underneath. I saw one endodontist who said to rule out implant and he would do root canal but bone and gum are less than ideal and 50-50 chances are there that it will work. He also did not clear all the decay, did not take the crown off but drills straight through. (A wobbly decayed tooth underneath crown?), did not do the post or crown. There is a long standing chronic abcess at root for years. Current root canal was done 7 years ago. I do not have any other molars left in lower. I am in shocked, sad, anxious and 60 years old.I feel tempted to go to an unknown dentist just to see if he could do a hemisection as the Endodontist I talk to \"no longer do them as implants are available and hemis tend not to last long\". Does anyone reading this please see any hope for this tooth? I chew on it and have no sensitivity and no pain; no symptoms at all. There is gum recession I have complained to dentist about for the last couple of years. I am concerned I will regret not trying to save this tooth if at all possible. Also told to see prosthodontist to ensure a crown could be made if I get the retreatment. I have two tracks I am pursuing. I will see an oral surgeon tomorrow to rule out implant and then see prosthodontist. I am attaching X-rays. Concerned in this decision making process about any further damage being done to gum and or bone. Impeccable hygiene history. ### Response: Hello. Seeing the recent X-rays (attachment removed to protect patient identity) it is obvious that the distal root has abscess and should be removed. Hemisection might be a good idea but it alone cannot withstand the biting force and if you can afford, then go for a molar implant behind this tooth so that you will get one extra molar to chew on. A hemisection to retain the mesial root of this tooth along with another implant behind it will give adequate tooth structure to have a normal biting force. If you cannot afford both then go for extraction of this abscessed tooth and an implant as hemisection alone is not strong unless it has more support behind it.

Hello doctor,My crown has become loose as there is decay inside the crown and around half the edge but not visible. I was told that tooth is stable underneath. I saw one endodontist who said to rule out implant and he would do root canal but bone and gum are less than ideal and 50-50 chances are there that it will work. He also did not clear all the decay, did not take the crown off but drills straight through. (A wobbly decayed tooth underneath crown?), did not do the post or crown. There is a long standing chronic abcess at root for years. Current root canal was done 7 years ago. I do not have any other molars left in lower. I am in shocked, sad, anxious and 60 years old.I feel tempted to go to an unknown dentist just to see if he could do a hemisection as the Endodontist I talk to \"no longer do them as implants are available and hemis tend not to last long\". Does anyone reading this please see any hope for this tooth? I chew on it and have no sensitivity and no pain; no symptoms at all. There is gum recession I have complained to dentist about for the last couple of years. I am concerned I will regret not trying to save this tooth if at all possible. Also told to see prosthodontist to ensure a crown could be made if I get the retreatment. I have two tracks I am pursuing. I will see an oral surgeon tomorrow to rule out implant and then see prosthodontist. I am attaching X-rays. Concerned in this decision making process about any further damage being done to gum and or bone. Impeccable hygiene history.

Hello. Seeing the recent X-rays (attachment removed to protect patient identity) it is obvious that the distal root has abscess and should be removed. Hemisection might be a good idea but it alone cannot withstand the biting force and if you can afford, then go for a molar implant behind this tooth so that you will get one extra molar to chew on. A hemisection to retain the mesial root of this tooth along with another implant behind it will give adequate tooth structure to have a normal biting force. If you cannot afford both then go for extraction of this abscessed tooth and an implant as hemisection alone is not strong unless it has more support behind it.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I had a thermal shock and I felt like I am dying. They took me to the hospital and she was there and saw me and the whole situation. I was not able to move my body. She was shocked, she was not able to say a single word just watching them taking care of me. She spent all the night crying. She could not stop herself. I called her all the night and tried to calm her down and tell her that I am okay and everything is fine but she could not stop herself from crying and she told me that she feels guilty because she was not able to do a thing while we were in the hospital.Since that day till now every night before going to sleep she starts feeling scared and sometimes she starts crying and when I ask her why are you crying she says I feel scared and I cannot forget the day I saw you in hospital. I thought it is just a matter of days till she forgets the whole thing but yesterday they called me and told me that she has lost consciousness while working. I went to her and she told me she felt like choking and her heart beats rate were so high and she felt cold. The doctor told her that she is fine and she may be so stressed and would have had a panic attack and this could have lead to such behavior. I told her that we need to go to a psychologist but as expected she refused and she told me that she can handle but I need to be around all the time whenever she calls or looks for me. I thought of taking her out to change her mood, going to walk or the gym to release the stress but she keeps refusing and telling me that she wants to stay in her room and she does not want to be around people. She just wants me next to her. That is all. What scares me the most is that she might have physical issues, feeling tired, and panic attacks add to the random high heart beating rate. Please help me. ### Response: Hello. The condition of your electric shock is stress for her and guilt is also present that she did not do anything to save you. These are creating severe stress to her. Maybe she is having flashback episodes of those events in the night time. Internally she has accepted that she is responsible for all those events. The best way of treating her is psychotherapy and medications. Stress. Depression. Psychotherapy with pharmacotherapy.

Hello doctor,I had a thermal shock and I felt like I am dying. They took me to the hospital and she was there and saw me and the whole situation. I was not able to move my body. She was shocked, she was not able to say a single word just watching them taking care of me. She spent all the night crying. She could not stop herself. I called her all the night and tried to calm her down and tell her that I am okay and everything is fine but she could not stop herself from crying and she told me that she feels guilty because she was not able to do a thing while we were in the hospital.Since that day till now every night before going to sleep she starts feeling scared and sometimes she starts crying and when I ask her why are you crying she says I feel scared and I cannot forget the day I saw you in hospital. I thought it is just a matter of days till she forgets the whole thing but yesterday they called me and told me that she has lost consciousness while working. I went to her and she told me she felt like choking and her heart beats rate were so high and she felt cold. The doctor told her that she is fine and she may be so stressed and would have had a panic attack and this could have lead to such behavior. I told her that we need to go to a psychologist but as expected she refused and she told me that she can handle but I need to be around all the time whenever she calls or looks for me. I thought of taking her out to change her mood, going to walk or the gym to release the stress but she keeps refusing and telling me that she wants to stay in her room and she does not want to be around people. She just wants me next to her. That is all. What scares me the most is that she might have physical issues, feeling tired, and panic attacks add to the random high heart beating rate. Please help me.

Hello. The condition of your electric shock is stress for her and guilt is also present that she did not do anything to save you. These are creating severe stress to her. Maybe she is having flashback episodes of those events in the night time. Internally she has accepted that she is responsible for all those events. The best way of treating her is psychotherapy and medications. Stress. Depression. Psychotherapy with pharmacotherapy.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have a question about a herniated disc in my back (L5 - S1) MRI confirmed about a year ago. I went to physical therapy, the pain resolved, and I continue to do the exercises for 10 minutes every other day. No more pain though. The thing is even before the pain (years before) and still now after the pain is gone, I seem to have a slight numbness or I guess I would not call it a numbness but rather I have less feeling on the left scrotum and penis area in comparison to the right side. Maybe 25 % less. Could this be from the herniated disc? It was there years before the pain and is still there now after the pain from the herniated disc has resolved.I have also noticed other parts of my body have more sensation on the right side as apposed to the left. The more sensitive the area the more of a difference there is up to 25 %. Is that normal? Is it possible to have a herniated disc only cause slight numbness for years without any pain at all? Also it should be noted this sensation of lessened feeling on the left side compared to the right presented itself a few months after I had a varicolectomy on the left side. Maybe the incision caused a little nerve damage? I would hate to think that this lessened sensation was getting worse over time at such a slow rate that I did not notice it until it was too late. I do not think it is getting worse. Should I worry about this? Also, now that the pain is gone does that mean that the disc is back where it should be or did the exercises only get rid of the symptoms? ### Response: Hello. Varicolectomy on the left side might have damaged some nerve twigs which may be the reason for this kind of diminished sensation over left scrotum and penis. This will not cause any problem and you need not worry about it.The herniated disc is of small magnitude which is not expected to cause neurological damage except for lower back pain. It might not have gone back to its original position though pain subsided. You should avoid strenuous activities (lifting heavy weights, extreme bending, etc.). But if you have diminished sensation in whole of your left side of body, you should look into spinal cord lesion in neck region or brain lesion.

Hi doctor,I have a question about a herniated disc in my back (L5 - S1) MRI confirmed about a year ago. I went to physical therapy, the pain resolved, and I continue to do the exercises for 10 minutes every other day. No more pain though. The thing is even before the pain (years before) and still now after the pain is gone, I seem to have a slight numbness or I guess I would not call it a numbness but rather I have less feeling on the left scrotum and penis area in comparison to the right side. Maybe 25 % less. Could this be from the herniated disc? It was there years before the pain and is still there now after the pain from the herniated disc has resolved.I have also noticed other parts of my body have more sensation on the right side as apposed to the left. The more sensitive the area the more of a difference there is up to 25 %. Is that normal? Is it possible to have a herniated disc only cause slight numbness for years without any pain at all? Also it should be noted this sensation of lessened feeling on the left side compared to the right presented itself a few months after I had a varicolectomy on the left side. Maybe the incision caused a little nerve damage? I would hate to think that this lessened sensation was getting worse over time at such a slow rate that I did not notice it until it was too late. I do not think it is getting worse. Should I worry about this? Also, now that the pain is gone does that mean that the disc is back where it should be or did the exercises only get rid of the symptoms?

Hello. Varicolectomy on the left side might have damaged some nerve twigs which may be the reason for this kind of diminished sensation over left scrotum and penis. This will not cause any problem and you need not worry about it.The herniated disc is of small magnitude which is not expected to cause neurological damage except for lower back pain. It might not have gone back to its original position though pain subsided. You should avoid strenuous activities (lifting heavy weights, extreme bending, etc.). But if you have diminished sensation in whole of your left side of body, you should look into spinal cord lesion in neck region or brain lesion.

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am an 18 year old male. I am 5 feet 5 inches tall and weigh 46 kg. I have been masturbating for the past 6 years and now I am sick. If I masturbate now for 5 to 6 times per month then I get jaundice. I have this problem since 3 years. I am suffering from night fall. Sometimes, it happens 3 times a week sometime 2 and 1. I cannot control my ejaculation. It happens within 30 second or less than a minute. I ejaculate 3 times in a day. Sometimes, semen also comes out in urine. Before I used to masturbate 4 times a week, but now for past two years I masturbate 2 times sometimes 3 times. These days I had little pain in my penis. I use both hand and pillow to masturbate. I also watch porn videos. Before I used to watch a lot, but from now I had minimized it. Nearly five months, I have been facing lots of health issues like jaundice, loss of appetite, weight loss, stomach problem, pneumonia and weakness. I have taken treatment for these, but jaundice is not getting cured. Now, I am suffering from pneumonia and under treatment.Before 6 years or before masturbation I had no history of health issues. But after masturbation life is like a hell. Before I was addicted to masturbation, but now I am trying to control. When I masturbate then the day after pimples comes out in my face but from 1 year it has started to come on my chest and back. I search in the internet that masturbation do not cause any harm and it is completely natural and safe. But, this is not working on me. So, please help me to get rid of these problems. I want to masturbate and do not want to quit. So, please give me a way so that I can masturbate and stay healthy. My penis size is 5 inch long and foreskin is completely out. I get easily erected. I have attached the pictures of my penis. I am not very comfortable in sharing this, hence not discussed with anyone. ### Response: Hello. Thanks for using this platform. I read your query and understand your concerns. Revert back with the investigation reports to a sexologist online

Hi doctor,I am an 18 year old male. I am 5 feet 5 inches tall and weigh 46 kg. I have been masturbating for the past 6 years and now I am sick. If I masturbate now for 5 to 6 times per month then I get jaundice. I have this problem since 3 years. I am suffering from night fall. Sometimes, it happens 3 times a week sometime 2 and 1. I cannot control my ejaculation. It happens within 30 second or less than a minute. I ejaculate 3 times in a day. Sometimes, semen also comes out in urine. Before I used to masturbate 4 times a week, but now for past two years I masturbate 2 times sometimes 3 times. These days I had little pain in my penis. I use both hand and pillow to masturbate. I also watch porn videos. Before I used to watch a lot, but from now I had minimized it. Nearly five months, I have been facing lots of health issues like jaundice, loss of appetite, weight loss, stomach problem, pneumonia and weakness. I have taken treatment for these, but jaundice is not getting cured. Now, I am suffering from pneumonia and under treatment.Before 6 years or before masturbation I had no history of health issues. But after masturbation life is like a hell. Before I was addicted to masturbation, but now I am trying to control. When I masturbate then the day after pimples comes out in my face but from 1 year it has started to come on my chest and back. I search in the internet that masturbation do not cause any harm and it is completely natural and safe. But, this is not working on me. So, please help me to get rid of these problems. I want to masturbate and do not want to quit. So, please give me a way so that I can masturbate and stay healthy. My penis size is 5 inch long and foreskin is completely out. I get easily erected. I have attached the pictures of my penis. I am not very comfortable in sharing this, hence not discussed with anyone.

Hello. Thanks for using this platform. I read your query and understand your concerns. Revert back with the investigation reports to a sexologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,Can you please tell me if a unilateral posterior polar cataract has a congenital onset or develops after birth? I am desperately seeking answers as my daughter who is 5 years old has been diagnosed for the first time with a congenital polar cataract. The doctor who originally diagnosed her stated with confidence that it has been there since she was born. My daughter has been diagnosed with 20/300 vision and deprivation amblyopia. I took her to another doctor to get a second opinion and he stated there is really no way to tell if it has been there since birth but stated it could have been. How was the first doctor able to make this diagnosis with such confidence when another doctor stated there is really not a way to tell? From what I have researched online, posterior polar cataract is very rare and has a congenital onset, is this true?The second doctor has started her on a patching regimen for half of her waking day. Her vision has not improved since she has started wearing her eyeglasses and I am wondering how much or if at all it will improve, with such a late diagnosis. Also, I, unfortunately, contracted HSV type 1 during my third trimester while I was pregnant with her and I have also read that this could be a cause, is this a potential cause? If it is a cause in your professional opinion, would you recommend that a newborn born to a mother with HSV 1 developed during late pregnancy with an ophthalmological issue due to the risk? Any input you can offer will be greatly appreciated. Thank you in advance. ### Response: Hello, Welcome to Chat Doctor forum. Since you had an HSV (herpes simplex virus) infection, there are increased chances that this polar cataract is congenital (since birth). Now, during initial years, if there is a hin ChatDoctor. Your ophthalmologist has correctly started patching therapy but my question here is why has he not thought about surgery because then we can remove the cause of amblyopia, get a clear visual axis, and start patching again. In my opinion, that would yield a much better result. Please consult a pediatric ophthalmologist who does pediatric cataract surgeries and discuss the case there because I think removing the cataract and implanting a lens is a very good choice and it will help in amblyopia therapy very much. For more information consult an eye care ophthalmologist online

Hi doctor,Can you please tell me if a unilateral posterior polar cataract has a congenital onset or develops after birth? I am desperately seeking answers as my daughter who is 5 years old has been diagnosed for the first time with a congenital polar cataract. The doctor who originally diagnosed her stated with confidence that it has been there since she was born. My daughter has been diagnosed with 20/300 vision and deprivation amblyopia. I took her to another doctor to get a second opinion and he stated there is really no way to tell if it has been there since birth but stated it could have been. How was the first doctor able to make this diagnosis with such confidence when another doctor stated there is really not a way to tell? From what I have researched online, posterior polar cataract is very rare and has a congenital onset, is this true?The second doctor has started her on a patching regimen for half of her waking day. Her vision has not improved since she has started wearing her eyeglasses and I am wondering how much or if at all it will improve, with such a late diagnosis. Also, I, unfortunately, contracted HSV type 1 during my third trimester while I was pregnant with her and I have also read that this could be a cause, is this a potential cause? If it is a cause in your professional opinion, would you recommend that a newborn born to a mother with HSV 1 developed during late pregnancy with an ophthalmological issue due to the risk? Any input you can offer will be greatly appreciated. Thank you in advance.

Hello, Welcome to Chat Doctor forum. Since you had an HSV (herpes simplex virus) infection, there are increased chances that this polar cataract is congenital (since birth). Now, during initial years, if there is a hin ChatDoctor. Your ophthalmologist has correctly started patching therapy but my question here is why has he not thought about surgery because then we can remove the cause of amblyopia, get a clear visual axis, and start patching again. In my opinion, that would yield a much better result. Please consult a pediatric ophthalmologist who does pediatric cataract surgeries and discuss the case there because I think removing the cataract and implanting a lens is a very good choice and it will help in amblyopia therapy very much. For more information consult an eye care ophthalmologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 31 year old male. My height is 6 feet and weight is 84 kg. My medical history includes psoriasis, hyperuricemia and essential primary hypertension. I am taking Cilacar 10 mg (Cilnidipine) one tablet daily after dinner at 9 PM for hypertension. For psoriasis I am applying Propygenta NF cream - combination of Clobetasol propionate and Neomycin sulfate cream. For scalp topical 3% lotion - Clobetasol propionate 0.05% and Salicylic acid 3% lotion. My uric acid is under control by drinking 3.5 to 4 liters of water regularly. My current blood pressure is 120/80 mmHg. For the last 14 months, there are flat hard lumps at the base of the penis just under the shaft. For this reason, I had visited a local urologist last year, but he suggested me to clean my penis under the shaft. This is to inform you that I have not cleaned my penis till the age 30. I am an uncircumcised male. As advised by the doctor I have cleaned my penis under the shaft with water. I do not masturbate regularly. But, since eight months the intensity of masturbation increased to four times a week till date. But for the last two weeks, I am feeling mild pain at the side of the lump. The size of the hard flat lump is more or less the same. Even if I press, there is no pain on the lump. My urinary flow is very good. No blood, discharge or foul smell under the shaft. The penile shaft is smooth. There is no burning sensation during urination and ejaculation. I am very much concerned. How to get rid of this occasional mild pain? What is this lump all about? Is this years of smegma deposition? Please help me out. ### Response: Hi, Welcome to Chat Doctor forum. I think the lumps that you able to feel are nothing but smegmoliths. These are nothing but concretions of smegma, if not cleaned for a long time. Are you able to retract your foreskin completely? If you cannot, then you may be having phimosis, which can be managed by circumcision. This will also prevent further accumulation of smegma.

Hi doctor,I am a 31 year old male. My height is 6 feet and weight is 84 kg. My medical history includes psoriasis, hyperuricemia and essential primary hypertension. I am taking Cilacar 10 mg (Cilnidipine) one tablet daily after dinner at 9 PM for hypertension. For psoriasis I am applying Propygenta NF cream - combination of Clobetasol propionate and Neomycin sulfate cream. For scalp topical 3% lotion - Clobetasol propionate 0.05% and Salicylic acid 3% lotion. My uric acid is under control by drinking 3.5 to 4 liters of water regularly. My current blood pressure is 120/80 mmHg. For the last 14 months, there are flat hard lumps at the base of the penis just under the shaft. For this reason, I had visited a local urologist last year, but he suggested me to clean my penis under the shaft. This is to inform you that I have not cleaned my penis till the age 30. I am an uncircumcised male. As advised by the doctor I have cleaned my penis under the shaft with water. I do not masturbate regularly. But, since eight months the intensity of masturbation increased to four times a week till date. But for the last two weeks, I am feeling mild pain at the side of the lump. The size of the hard flat lump is more or less the same. Even if I press, there is no pain on the lump. My urinary flow is very good. No blood, discharge or foul smell under the shaft. The penile shaft is smooth. There is no burning sensation during urination and ejaculation. I am very much concerned. How to get rid of this occasional mild pain? What is this lump all about? Is this years of smegma deposition? Please help me out.

Hi, Welcome to Chat Doctor forum. I think the lumps that you able to feel are nothing but smegmoliths. These are nothing but concretions of smegma, if not cleaned for a long time. Are you able to retract your foreskin completely? If you cannot, then you may be having phimosis, which can be managed by circumcision. This will also prevent further accumulation of smegma.

### Instruction: Answer this question truthfully ###Input: Hi doctor,My 18 weeks old second daughter was diagnosed to have congenital glaucoma with aniridia and corneal opacities bilaterally at birth for which she underwent bilateral trabeculectomy within 15 days of birth. She achieved peripheral clearance of cornea in both the eyes within few days of surgery after which there is not much improvement. Her photophobia has reduced now and she is attracted by lights, reflective surfaces, hanging toys in the baby gym, musical toys, etc. Her other milestones are normal except reaching for toys which she does occasionally. Her eye movements seem to be coordinated, at times shake while trying to fix.At 14 weeks of age, EUA was done after which doctors advised to wait for further corneal clearance as she does not require any surgical intervention for glaucoma right now and procedures like PKP has guarded prognosis till two years of age. Her IOP was variable during EUA but the corneal diameter and axial length of the globe were within normal range. She has a tongue tie, anteriorly placed anus, mild redundant periumbilical skin. Echocardiography and USG abdomen done were normal. We are planning to do a genetic test for her. There is no family history of such illness. We parents are E.N.T specialists practicing in India.I was 37 years old during my delivery and obstetric history was uneventful. Amniocentesis done during pregnancy showed normal FISH report. I would like to know about the prognosis of the disease, availability of advanced treatment options and about any early intervention services required for her. Currently, she is taking Timolol and Dorzolamide eye drops BD, Atropine eye drops and steroid eye drops OD. ### Response: Hi, Welcome to Chat Doctor forum. It is a good sign that glaucoma is under control and cornea has started clearing out. But the main problem here is to stop development of amblyopia which is basically a state where due to prolong blurring of vision brain. Basically starts rejecting images after a certain time if the hin ChatDoctor. I am of an opinion that if we wait for two years chances of amblyopia are too high. You can consult a specialist for the management. Let me tell you in advance, chances of corneal transplant in infants is low and that too combined with glaucoma makes. Prognosis is poor. For more information consult an eye care ophthalmologist online

Hi doctor,My 18 weeks old second daughter was diagnosed to have congenital glaucoma with aniridia and corneal opacities bilaterally at birth for which she underwent bilateral trabeculectomy within 15 days of birth. She achieved peripheral clearance of cornea in both the eyes within few days of surgery after which there is not much improvement. Her photophobia has reduced now and she is attracted by lights, reflective surfaces, hanging toys in the baby gym, musical toys, etc. Her other milestones are normal except reaching for toys which she does occasionally. Her eye movements seem to be coordinated, at times shake while trying to fix.At 14 weeks of age, EUA was done after which doctors advised to wait for further corneal clearance as she does not require any surgical intervention for glaucoma right now and procedures like PKP has guarded prognosis till two years of age. Her IOP was variable during EUA but the corneal diameter and axial length of the globe were within normal range. She has a tongue tie, anteriorly placed anus, mild redundant periumbilical skin. Echocardiography and USG abdomen done were normal. We are planning to do a genetic test for her. There is no family history of such illness. We parents are E.N.T specialists practicing in India.I was 37 years old during my delivery and obstetric history was uneventful. Amniocentesis done during pregnancy showed normal FISH report. I would like to know about the prognosis of the disease, availability of advanced treatment options and about any early intervention services required for her. Currently, she is taking Timolol and Dorzolamide eye drops BD, Atropine eye drops and steroid eye drops OD.

Hi, Welcome to Chat Doctor forum. It is a good sign that glaucoma is under control and cornea has started clearing out. But the main problem here is to stop development of amblyopia which is basically a state where due to prolong blurring of vision brain. Basically starts rejecting images after a certain time if the hin ChatDoctor. I am of an opinion that if we wait for two years chances of amblyopia are too high. You can consult a specialist for the management. Let me tell you in advance, chances of corneal transplant in infants is low and that too combined with glaucoma makes. Prognosis is poor. For more information consult an eye care ophthalmologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My age is 39 years. I have quit smoking, cold turkey after smoking for almost 18 years. It is my 29th day of being smoke-free. Everything was going fine until last 7 to 10 days my bowel movement has been strainful. Few days I have seen very small sized hard stools and sometimes small stool with very little water. I started taking Metamucil. However, the stomach felt bloated severely after eating anything. I sometimes feel a sudden hunger spike that becomes uncontrollable and once I eat, the stomach swells like a balloon. I also started taking one capsule of Triphala to ease out my symptoms. From past 4 to 5 days, I have started feeling fatigue and a very strong one like light handedness and no energy in my legs. I had a sore inside my mouth and that has healed significantly now. The acid reflux is there, especially while making out with my partner I felt food coming up. The consistency of stool after eating Metamucil has been more like rubber shaped long zig zag sausage with uneven and weird cracks and sometimes mucus as well. I feel gas below my stomach and sometimes have to strain hard to pass. I got my CBC done two days back (normal report), kidney, liver, thyroid (normal), Hb (normal), sugar (normal). I also got my FOBT stool test done (negative report). Are the above symptoms cigarette withdrawal symptoms? Or stomach bug? or IBS? I take the following tablets daily. one Magnesium tablet, one Menevit tablet (for sperm health and male fertility), one Omega 3 1000 mg capsule, one 64 Billion Probiotic capsule. ### Response: Hello, Welcome to Chat Doctor forum. I went through your post, it is normal to have hard stools after quitting smoking for that you have to add a salad, do exercise, and take enough water. It is a temporary phenomenon which usually settles in three months till intestines adapt nicotine free blood. You have started laxative Metamucil which has caused gastritis. You need to stop that and continue Nexium at least 10 days daily before breakfast. That will take care of the issue. There is no need to take omega, probiotics, Menevit or Magnesium tablets. Do not take unnecessary medicines. It is not IBS.

Hello doctor,My age is 39 years. I have quit smoking, cold turkey after smoking for almost 18 years. It is my 29th day of being smoke-free. Everything was going fine until last 7 to 10 days my bowel movement has been strainful. Few days I have seen very small sized hard stools and sometimes small stool with very little water. I started taking Metamucil. However, the stomach felt bloated severely after eating anything. I sometimes feel a sudden hunger spike that becomes uncontrollable and once I eat, the stomach swells like a balloon. I also started taking one capsule of Triphala to ease out my symptoms. From past 4 to 5 days, I have started feeling fatigue and a very strong one like light handedness and no energy in my legs. I had a sore inside my mouth and that has healed significantly now. The acid reflux is there, especially while making out with my partner I felt food coming up. The consistency of stool after eating Metamucil has been more like rubber shaped long zig zag sausage with uneven and weird cracks and sometimes mucus as well. I feel gas below my stomach and sometimes have to strain hard to pass. I got my CBC done two days back (normal report), kidney, liver, thyroid (normal), Hb (normal), sugar (normal). I also got my FOBT stool test done (negative report). Are the above symptoms cigarette withdrawal symptoms? Or stomach bug? or IBS? I take the following tablets daily. one Magnesium tablet, one Menevit tablet (for sperm health and male fertility), one Omega 3 1000 mg capsule, one 64 Billion Probiotic capsule.

Hello, Welcome to Chat Doctor forum. I went through your post, it is normal to have hard stools after quitting smoking for that you have to add a salad, do exercise, and take enough water. It is a temporary phenomenon which usually settles in three months till intestines adapt nicotine free blood. You have started laxative Metamucil which has caused gastritis. You need to stop that and continue Nexium at least 10 days daily before breakfast. That will take care of the issue. There is no need to take omega, probiotics, Menevit or Magnesium tablets. Do not take unnecessary medicines. It is not IBS.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 16 year old. I have social anxiety and depression. I find it hard to talk to people, especially in public. I also have a problem with talking about my feelings face to face, making the idea of a therapist very nerve-wrecking. I am not sure if I would talk. I would probably just be too nervous to talk to him/her.I love animals. I love the company of them and feel safe around them. I am homeschooled, so I do not have any real-life friends. My family does not treat me the best, often blaming me for everything, insulting me and putting me on the spot in uncomfortable situations instead of getting me help. I am very lonely, but my anxiety makes it really hard to interact with people face to face, and very difficult to get a job. I have the idea to get a therapy dog. I believe it would help me in many ways, such as increase my exercise (which is a known depression-reliever), build self-confidence, offering a distraction, making me more courageous in public, enabling me to work, and much more. With that in mind, here are my questions.Do you believe that, for my case, a therapy dog would be a better form of therapy than an in-real-life, face-to-face therapist? Or, at least to begin with, then I could move on to a real therapist.If not better, do you think that a therapy dog is still a good idea?If so, what can I say to my mom to get her to allow me to get help for my mental issues?Thank you for your time. ### Response: Hello, Welcome to Chat Doctor forum. A therapy dog can help in relieving anxiety. But, since your anxiety is related to social situations, I do not think that a therapy dog will relieve your social anxiety. The anxiety will go away with exposure or by systematic desensitization. You have to take the first step for that. Talk to your parents about this and convey to them that you find it hard to interact with people and tell them directly that you have anxiety. This will be the first step towards treatment. Once you see the doctor, with time, your anxiety will go away and your conversation skills will improve. For more information consult a psychiatrist online

Hello doctor,I am a 16 year old. I have social anxiety and depression. I find it hard to talk to people, especially in public. I also have a problem with talking about my feelings face to face, making the idea of a therapist very nerve-wrecking. I am not sure if I would talk. I would probably just be too nervous to talk to him/her.I love animals. I love the company of them and feel safe around them. I am homeschooled, so I do not have any real-life friends. My family does not treat me the best, often blaming me for everything, insulting me and putting me on the spot in uncomfortable situations instead of getting me help. I am very lonely, but my anxiety makes it really hard to interact with people face to face, and very difficult to get a job. I have the idea to get a therapy dog. I believe it would help me in many ways, such as increase my exercise (which is a known depression-reliever), build self-confidence, offering a distraction, making me more courageous in public, enabling me to work, and much more. With that in mind, here are my questions.Do you believe that, for my case, a therapy dog would be a better form of therapy than an in-real-life, face-to-face therapist? Or, at least to begin with, then I could move on to a real therapist.If not better, do you think that a therapy dog is still a good idea?If so, what can I say to my mom to get her to allow me to get help for my mental issues?Thank you for your time.

Hello, Welcome to Chat Doctor forum. A therapy dog can help in relieving anxiety. But, since your anxiety is related to social situations, I do not think that a therapy dog will relieve your social anxiety. The anxiety will go away with exposure or by systematic desensitization. You have to take the first step for that. Talk to your parents about this and convey to them that you find it hard to interact with people and tell them directly that you have anxiety. This will be the first step towards treatment. Once you see the doctor, with time, your anxiety will go away and your conversation skills will improve. For more information consult a psychiatrist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I often have elbow pain due to spending more time with computer and using a mouse or keyboard. I work 7 to 8 hours daily in computer and pain is gradually increasing. The pain earlier used to reduce by taking Voveran tablet and using Voveran gel. The pain has become frequent now and I am taking Tendoshot capsule for the last few days. I also use tennis elbow strap in both hands while working and that gives some comfort. I do a few elbow exercise but that seems not sufficient in reducing pain. What is the treatment for elbow pain due to computer use?Whether should I take Voveran 50 or Tendoshot for pain relief?Is there any other medicine to use for pain relief?Whether tennis elbow strap or sleeve will be appropriate for this purpose?How to prevent elbow pain while using the computer?How serious can be this elbow pain in future? ### Response: Hello. It happens due to excessive use of muscle which causes stretch over the tendon at the origin giving rise to pain. So obviously, best treatment is to somehow restrict the use of muscle as much as possible. Now, you will not be able to avoid computer use but try to restrict other activities like the lifting of heavy weights, and all the motion which involves the use of these muscles like twisting or rotatory motion till it heals. It is not at all serious, it may trouble you, may settle with time or at extremes may need some local injection for the pain to subside. Next thing, you should support your elbow as much as possible during use of computer like keeping on the edge of the chair or using pillows or some other support so as to reduce stress. Also, rather than any medicines, you should use sleeves or brace as much as possible. If not adequately helpful then may have a local Voveran gel (Diclofenac). Tablet Voveran should be avoided as much as possible, and only have if absolutely painful. Tendoshot (Chon ChatDoctor. ) you may have. In painkillers, if you need, safest is Paracetamol like tablet Dolo 650 or Ultracet if it is not helpful then comes Voveran. You may use hot water fomentation. Also, visit local physiotherapists and get some exercises learned for it. For more information consult an internal medicine physician online

Hello doctor,I often have elbow pain due to spending more time with computer and using a mouse or keyboard. I work 7 to 8 hours daily in computer and pain is gradually increasing. The pain earlier used to reduce by taking Voveran tablet and using Voveran gel. The pain has become frequent now and I am taking Tendoshot capsule for the last few days. I also use tennis elbow strap in both hands while working and that gives some comfort. I do a few elbow exercise but that seems not sufficient in reducing pain. What is the treatment for elbow pain due to computer use?Whether should I take Voveran 50 or Tendoshot for pain relief?Is there any other medicine to use for pain relief?Whether tennis elbow strap or sleeve will be appropriate for this purpose?How to prevent elbow pain while using the computer?How serious can be this elbow pain in future?

Hello. It happens due to excessive use of muscle which causes stretch over the tendon at the origin giving rise to pain. So obviously, best treatment is to somehow restrict the use of muscle as much as possible. Now, you will not be able to avoid computer use but try to restrict other activities like the lifting of heavy weights, and all the motion which involves the use of these muscles like twisting or rotatory motion till it heals. It is not at all serious, it may trouble you, may settle with time or at extremes may need some local injection for the pain to subside. Next thing, you should support your elbow as much as possible during use of computer like keeping on the edge of the chair or using pillows or some other support so as to reduce stress. Also, rather than any medicines, you should use sleeves or brace as much as possible. If not adequately helpful then may have a local Voveran gel (Diclofenac). Tablet Voveran should be avoided as much as possible, and only have if absolutely painful. Tendoshot (Chon ChatDoctor. ) you may have. In painkillers, if you need, safest is Paracetamol like tablet Dolo 650 or Ultracet if it is not helpful then comes Voveran. You may use hot water fomentation. Also, visit local physiotherapists and get some exercises learned for it. For more information consult an internal medicine physician online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I had eye checkup nine months back as I had light pain in right eye. The doctor advised me to get OCT and CCT. With the test reports he said that I have glaucoma. He advised me to take an eye drop named Lumigan one drop daily at night in both eyes. I am not satisfied with his opinion and so went to another doctor. He said no glaucoma and advised to take vitamin tablet daily. After a week consulted another doctor and he said that the OCT report is normal and no need to take any eye drop. After a week I went to a famous eye hospital and consulted there. Again took an OCT and reported to have glaucoma and advised to take Brimosun 0.15% drops twice daily with a gap of 12 hours. A month later went to another hospital and the doctor said he is in confused state and asked me to check my eye regularly and take OCT for every six months. Then two months later I visited a glaucoma expert and he examined my eye deeply and done another OCT. After all tests he said I am a glaucoma suspect patient and advised to take eye drop Timolast 0.5% or Timolet od every morning one drop in both eyes. My eye pressure is always between 20 and 24 in both eyes. My first and second time CCT reports are 502-503 and 533-534 respectively. My OCT reports showed 10% area in red figure and balance in green figure in the left eye and 10% area in yellow and balance in green in the right eye. Is it necessary to take glaucoma drop? If yes, which one to take from the above? Is Timolet a highly concentrated one in comparison of Brimosun 0.15%? My mother suffered with glaucoma. I am taking Thyronorm 75 daily. Please advise me in detail. Thank you. ### Response: Hi, Welcome to Chat Doctor forum. First of all please relax. There is nothing to worry. All the doctors are correct. Now let me explain you. Glaucoma is a very slowly progressive disease. You are glaucoma suspect means you are at risk of glaucoma or have many predisposing factors for glaucoma, but there is no conclusive evidence to diagnose glaucoma. Predisposing factors present in you are as follows

Hi doctor,I had eye checkup nine months back as I had light pain in right eye. The doctor advised me to get OCT and CCT. With the test reports he said that I have glaucoma. He advised me to take an eye drop named Lumigan one drop daily at night in both eyes. I am not satisfied with his opinion and so went to another doctor. He said no glaucoma and advised to take vitamin tablet daily. After a week consulted another doctor and he said that the OCT report is normal and no need to take any eye drop. After a week I went to a famous eye hospital and consulted there. Again took an OCT and reported to have glaucoma and advised to take Brimosun 0.15% drops twice daily with a gap of 12 hours. A month later went to another hospital and the doctor said he is in confused state and asked me to check my eye regularly and take OCT for every six months. Then two months later I visited a glaucoma expert and he examined my eye deeply and done another OCT. After all tests he said I am a glaucoma suspect patient and advised to take eye drop Timolast 0.5% or Timolet od every morning one drop in both eyes. My eye pressure is always between 20 and 24 in both eyes. My first and second time CCT reports are 502-503 and 533-534 respectively. My OCT reports showed 10% area in red figure and balance in green figure in the left eye and 10% area in yellow and balance in green in the right eye. Is it necessary to take glaucoma drop? If yes, which one to take from the above? Is Timolet a highly concentrated one in comparison of Brimosun 0.15%? My mother suffered with glaucoma. I am taking Thyronorm 75 daily. Please advise me in detail. Thank you.

Hi, Welcome to Chat Doctor forum. First of all please relax. There is nothing to worry. All the doctors are correct. Now let me explain you. Glaucoma is a very slowly progressive disease. You are glaucoma suspect means you are at risk of glaucoma or have many predisposing factors for glaucoma, but there is no conclusive evidence to diagnose glaucoma. Predisposing factors present in you are as follows

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 28 year old female nurse, I have been having severe menstrual pain throughout my life, and sadly each year the pain increases. Since I was a college student, each month for all the four days of my period, I had to stay home lying in the fetal position, had to keep a heating pad on my lower abdomen and used to take some serious pills. I have seen so many doctors, and each one of them gave me the diagnosis of endometriosis. After I had done a deep search about this medical condition, I was not happy at all. I even tried contraceptive pills for six month, which reduced my pain but made me gain 9 kg due to pure water retention. So, I stopped the pills, and the pain returned more aggressively.Since I start working as a nurse, I am having problems to keep up with the working time during my periods. And my colleagues cannot always help me out to switch working days with me. So, I had a laparoscopy, and they found inflammatory things, but they could not determine what exactly it is. So, I changed my doctor and did an RMI, according to it they found some endometriosis tissues. And I also have a retroverted uterus. I am tired and sick of this issue, and lately, I started taking medicines to help me endure my pain. According to the latest doctor that I consulted, I have only two options, a medication called Visanne or an injection called Decapeptyl. I am terrified from both, because of there side effects and unknown results. And these will make my body go through menopause. Please help me. ### Response: Hello. The diagnosis is indeed endometriosis. And yes, endometriosis causes very painful periods, and the only way to stop this pain is to stop your periods, which can be done through pills, injections or surgery. Surgery is not the answer for you, as you have already had one. And chances of recurrence are high post surgery unless we remove the uterus and ovaries too. But, we cannot do that at your age. These injections will cause menopausal problems. So, Visanne (Dienogest) is a better choice. Or an intrauterine system called Mirena can be inserted, which will save you from taking medicines daily. For more information consult an obstetrician and gynaecologist online

Hello doctor,I am a 28 year old female nurse, I have been having severe menstrual pain throughout my life, and sadly each year the pain increases. Since I was a college student, each month for all the four days of my period, I had to stay home lying in the fetal position, had to keep a heating pad on my lower abdomen and used to take some serious pills. I have seen so many doctors, and each one of them gave me the diagnosis of endometriosis. After I had done a deep search about this medical condition, I was not happy at all. I even tried contraceptive pills for six month, which reduced my pain but made me gain 9 kg due to pure water retention. So, I stopped the pills, and the pain returned more aggressively.Since I start working as a nurse, I am having problems to keep up with the working time during my periods. And my colleagues cannot always help me out to switch working days with me. So, I had a laparoscopy, and they found inflammatory things, but they could not determine what exactly it is. So, I changed my doctor and did an RMI, according to it they found some endometriosis tissues. And I also have a retroverted uterus. I am tired and sick of this issue, and lately, I started taking medicines to help me endure my pain. According to the latest doctor that I consulted, I have only two options, a medication called Visanne or an injection called Decapeptyl. I am terrified from both, because of there side effects and unknown results. And these will make my body go through menopause. Please help me.

Hello. The diagnosis is indeed endometriosis. And yes, endometriosis causes very painful periods, and the only way to stop this pain is to stop your periods, which can be done through pills, injections or surgery. Surgery is not the answer for you, as you have already had one. And chances of recurrence are high post surgery unless we remove the uterus and ovaries too. But, we cannot do that at your age. These injections will cause menopausal problems. So, Visanne (Dienogest) is a better choice. Or an intrauterine system called Mirena can be inserted, which will save you from taking medicines daily. For more information consult an obstetrician and gynaecologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I have been diagnosed with Hashimoto\\s five months ago. My anti-TPO and anti-TG were 115 and 33 respectively. My TSH was 1.5 and FT4 1.1, so normal function. Two months ago, I started having palpitations and tested my thyroid again. TSH was 0.0018 (suppressed), FT4 2.66 and FT3 7.8. I was hyperthyroid, so I had the TRAb test and it was 5.9. So, I was diagnosed with Graves\\ and overt hyperthyroidism. I was put on 15 mg Methimazole and 6 weeks later retested my thyroid and my results are, TSH 0.0026, FT4 0.86. So, normal but low range and FT3 is 2.8. Over the last 2-3 days including before these tests, I started having a nasty dull head pressure and lack of focus, similar to what I have had a couple of years ago when my TSH came out 4.1. I also had fatigue and brain fog, which I do not have now. I feel this pressure or tension around my ears, nose, head and throat. I feel my jaw and upper throat tense, had nightmares, irascible and emotionally unstable. It all started rather suddenly. Can it be thyroid related? It is my only known health issue. I do not feel sick and I do not have fever too. But, this sensation in my head and throat annoys me and makes me very anxious. Could it be related to my FT4 going too low? And why is my TSH still suppressed? Why should not it rise with this FT4? Are the TRAb antibodies keeping it suppressed? I will now half my Methimazole dosage to 7.5 mg per day for another three weeks and test again. Does this sound right? Do you have any other advice for me with these symptoms and test results? Please let me know if you need any more information. Thank you so much. ### Response: Hi, Welcome to Chat Doctor forum. You have written a very detailed and engrossing history. Well done! Revert back with the answers for the above questions to an endocrinologist online

Hi doctor,I have been diagnosed with Hashimoto\\s five months ago. My anti-TPO and anti-TG were 115 and 33 respectively. My TSH was 1.5 and FT4 1.1, so normal function. Two months ago, I started having palpitations and tested my thyroid again. TSH was 0.0018 (suppressed), FT4 2.66 and FT3 7.8. I was hyperthyroid, so I had the TRAb test and it was 5.9. So, I was diagnosed with Graves\\ and overt hyperthyroidism. I was put on 15 mg Methimazole and 6 weeks later retested my thyroid and my results are, TSH 0.0026, FT4 0.86. So, normal but low range and FT3 is 2.8. Over the last 2-3 days including before these tests, I started having a nasty dull head pressure and lack of focus, similar to what I have had a couple of years ago when my TSH came out 4.1. I also had fatigue and brain fog, which I do not have now. I feel this pressure or tension around my ears, nose, head and throat. I feel my jaw and upper throat tense, had nightmares, irascible and emotionally unstable. It all started rather suddenly. Can it be thyroid related? It is my only known health issue. I do not feel sick and I do not have fever too. But, this sensation in my head and throat annoys me and makes me very anxious. Could it be related to my FT4 going too low? And why is my TSH still suppressed? Why should not it rise with this FT4? Are the TRAb antibodies keeping it suppressed? I will now half my Methimazole dosage to 7.5 mg per day for another three weeks and test again. Does this sound right? Do you have any other advice for me with these symptoms and test results? Please let me know if you need any more information. Thank you so much.

Hi, Welcome to Chat Doctor forum. You have written a very detailed and engrossing history. Well done! Revert back with the answers for the above questions to an endocrinologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have had some urinary issues in the past from a slightly enlarged prostate (37-year-old male). Two months back I had some testicle discomfort. The doctor gave me 10 days Ciprofloxacin. Last month I had unprotected sex. About six days later I had a sudden strong tingling in my scrotum that stopped me in my tracks. I had a chlamydia and gonorrhea urine test a few days later but was urinating so frequently that I could not hold my urine at least an hour before the test, and the test was negative. Frequent urination continues till today. I also had Keflex last month, a full panel STD test this month, and everything was negative. But wondering if the antibiotic mixed with me filling up the cup way more than 30 ml could skew the test? I did contract genital warts, most likely from this encounter (showed up three weeks after). I started 28 days of Bactrim about a week ago and symptoms have not cleared. Frequent urination and tingling scrotum are still there. Also, my lower back by my spine hurts, but does not feel like a kidney thing. It hurts for a bit. Wondering if a spine injury could affect my urinary system. I guess even though I took two chlamydia and gonorrhea test, I am paranoid that the two negatives may have been skewed from urinating too soon before on test one and being on antibiotics or providing a large volume of urine on test two. And the partner is of medium risk. She has no symptoms. The urine test was done with the Aptiva Combo 2 RNA/TMA test. There is no discharge, just this persistent urination and unable to empty bladder. ### Response: Hi. I have noted your concern. I do not think that the tests for gonorrhea or chlamydia would have been affected due to a higher volume of urine or oral antibiotics as the urine test relies on the detection of the nucleic acid material of gonorrhea or chlamydia which would have been present. Your symptoms could either be due to urinary tract infection or they could be those of prostatism. I suggest a urine routine microscopy, urine culture sensitivity, PSA (prostate-specific antigen) levels, uroflowmetry and pelvic ultrasound to estimate the size and volume of the prostate. For more information consult a HIV AIDS specialist online

Hello doctor,I have had some urinary issues in the past from a slightly enlarged prostate (37-year-old male). Two months back I had some testicle discomfort. The doctor gave me 10 days Ciprofloxacin. Last month I had unprotected sex. About six days later I had a sudden strong tingling in my scrotum that stopped me in my tracks. I had a chlamydia and gonorrhea urine test a few days later but was urinating so frequently that I could not hold my urine at least an hour before the test, and the test was negative. Frequent urination continues till today. I also had Keflex last month, a full panel STD test this month, and everything was negative. But wondering if the antibiotic mixed with me filling up the cup way more than 30 ml could skew the test? I did contract genital warts, most likely from this encounter (showed up three weeks after). I started 28 days of Bactrim about a week ago and symptoms have not cleared. Frequent urination and tingling scrotum are still there. Also, my lower back by my spine hurts, but does not feel like a kidney thing. It hurts for a bit. Wondering if a spine injury could affect my urinary system. I guess even though I took two chlamydia and gonorrhea test, I am paranoid that the two negatives may have been skewed from urinating too soon before on test one and being on antibiotics or providing a large volume of urine on test two. And the partner is of medium risk. She has no symptoms. The urine test was done with the Aptiva Combo 2 RNA/TMA test. There is no discharge, just this persistent urination and unable to empty bladder.

Hi. I have noted your concern. I do not think that the tests for gonorrhea or chlamydia would have been affected due to a higher volume of urine or oral antibiotics as the urine test relies on the detection of the nucleic acid material of gonorrhea or chlamydia which would have been present. Your symptoms could either be due to urinary tract infection or they could be those of prostatism. I suggest a urine routine microscopy, urine culture sensitivity, PSA (prostate-specific antigen) levels, uroflowmetry and pelvic ultrasound to estimate the size and volume of the prostate. For more information consult a HIV AIDS specialist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,My daughter is in the ICU with pericardial effusion and multiple tumors. The fluid has been drained and there was blood mixed with the fluid. The regular blood test came back normal with no sign of cancerous cells. My question is, what are the chances that the tumors are benign? Through my research, there is a good chance that the tumors could be a rhabdomyoma. My daughter is only 9 years old and I want to take her to the best facility. They said her heart is weak and are unable to perform any test on the tumors. They have her on Coretec and albumin and said that it was not working and put her on something stronger. Could this be a result of the pericardial effusion? I am attaching the blood test reports. They said everything was normal with no sign of cancerous cells, but are still unable to say for certain if it is benign or malignant. I am just a very worried father. ### Response: Hello, Welcome to Chat Doctor forum. Firstly, there is a diagnostic dilemma. The reports you have uploaded (attachment removed to protect patient identity) are fine. But, you should upload the echo reports and the fluid investigations as well. Now, considering the pericardial effusion with multiple cardiac tumors, the possibilities of a rhabdomyoma or a teratoma are high. However, an effusion is not common with rhabdomyoma. It is possible to have some other cause for the effusion and it can also be as a result of a heart failure. Both of these are benign tumors. However, at this stage, we cannot rule out a malignancy. The next thing to be done is that she should undergo a cardiac MRI for further characterization of the lesions, which will give us a diagnosis and also resolve the issue of malignancy. Also, if the fluid is available, it should be tested for ADA (adenosine deaminase) and GeneXpert. She should also undergo a thyroid test. Rhabdomyomas usually occurs in patients with tuberous sclerosis, so she should be adequately examined by the doctor for the same. A definitive treatment is the excision of these tumors surgically. So, you can discuss this with the doctor as well. Hope this helps you. Do write back in case of doubts. Revert with more information to a cardiologist online

Hello doctor,My daughter is in the ICU with pericardial effusion and multiple tumors. The fluid has been drained and there was blood mixed with the fluid. The regular blood test came back normal with no sign of cancerous cells. My question is, what are the chances that the tumors are benign? Through my research, there is a good chance that the tumors could be a rhabdomyoma. My daughter is only 9 years old and I want to take her to the best facility. They said her heart is weak and are unable to perform any test on the tumors. They have her on Coretec and albumin and said that it was not working and put her on something stronger. Could this be a result of the pericardial effusion? I am attaching the blood test reports. They said everything was normal with no sign of cancerous cells, but are still unable to say for certain if it is benign or malignant. I am just a very worried father.

Hello, Welcome to Chat Doctor forum. Firstly, there is a diagnostic dilemma. The reports you have uploaded (attachment removed to protect patient identity) are fine. But, you should upload the echo reports and the fluid investigations as well. Now, considering the pericardial effusion with multiple cardiac tumors, the possibilities of a rhabdomyoma or a teratoma are high. However, an effusion is not common with rhabdomyoma. It is possible to have some other cause for the effusion and it can also be as a result of a heart failure. Both of these are benign tumors. However, at this stage, we cannot rule out a malignancy. The next thing to be done is that she should undergo a cardiac MRI for further characterization of the lesions, which will give us a diagnosis and also resolve the issue of malignancy. Also, if the fluid is available, it should be tested for ADA (adenosine deaminase) and GeneXpert. She should also undergo a thyroid test. Rhabdomyomas usually occurs in patients with tuberous sclerosis, so she should be adequately examined by the doctor for the same. A definitive treatment is the excision of these tumors surgically. So, you can discuss this with the doctor as well. Hope this helps you. Do write back in case of doubts. Revert with more information to a cardiologist online

### Instruction: Answer this question truthfully ###Input: Hi doctor,I am a 20 year old engineering student. Life has been good to me for all these years. Eight months ago I met a girl, and since I met her, I have not spent a day without talking to her, and it was a long distance relationship. Now, I was very inexperienced when it comes to love as it requires to trust another human being. I have fallen for her so deep that I have forgotten myself, my life, my habits, hobbies and cause in life. It is like a mind enslavement, other than physical slavery. This person has requested more and more from me, and I was unable to set boundaries. I have become a shadow of her, pick up her habits, her beliefs and fearing that she would love me less for who I was. I would try to comfort her, even if it was something that defies my logic.For eight months, I have been living encapsulated into another person. I have failed my exams and was unhappy that I could not stay with her all the time. Every night I would struggle to fall asleep. I have been wasting my energy on planning future with her. I jumped 10 years ahead and started worrying about things. I would hear someone talk and fail to follow after a couple of words, because of daydreaming. I have been on the verge of snapping several times and felt like death was the only solution.Until a few days ago, I chose to live and be myself again. I physically felt relief. I have stopped worrying so much about others and cared about me. Life felt different all of a sudden. I am on my way to recovery now, and my past haunts me. Whenever I remember how it was, I feel terrified. I also feel that I have done significant damage to myself. My brain has become more sloppy. I have taken depression drugs in the past and sleeping pills when I could not handle the pain. I am starting to learn about myself again, I have forgotten how I used to be. And it feels so weird to be in that place, but very healthy. I am caught up in all this mess, and I would like to hear from others. ### Response: Hello, Welcome to iciniq.com. I have read the details you provided, and I can understand your concern. For more information consult a psychiatrist online

Hi doctor,I am a 20 year old engineering student. Life has been good to me for all these years. Eight months ago I met a girl, and since I met her, I have not spent a day without talking to her, and it was a long distance relationship. Now, I was very inexperienced when it comes to love as it requires to trust another human being. I have fallen for her so deep that I have forgotten myself, my life, my habits, hobbies and cause in life. It is like a mind enslavement, other than physical slavery. This person has requested more and more from me, and I was unable to set boundaries. I have become a shadow of her, pick up her habits, her beliefs and fearing that she would love me less for who I was. I would try to comfort her, even if it was something that defies my logic.For eight months, I have been living encapsulated into another person. I have failed my exams and was unhappy that I could not stay with her all the time. Every night I would struggle to fall asleep. I have been wasting my energy on planning future with her. I jumped 10 years ahead and started worrying about things. I would hear someone talk and fail to follow after a couple of words, because of daydreaming. I have been on the verge of snapping several times and felt like death was the only solution.Until a few days ago, I chose to live and be myself again. I physically felt relief. I have stopped worrying so much about others and cared about me. Life felt different all of a sudden. I am on my way to recovery now, and my past haunts me. Whenever I remember how it was, I feel terrified. I also feel that I have done significant damage to myself. My brain has become more sloppy. I have taken depression drugs in the past and sleeping pills when I could not handle the pain. I am starting to learn about myself again, I have forgotten how I used to be. And it feels so weird to be in that place, but very healthy. I am caught up in all this mess, and I would like to hear from others.

Hello, Welcome to iciniq.com. I have read the details you provided, and I can understand your concern. For more information consult a psychiatrist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am writing this letter for my mother-in-law. She is 65 years old and seems to be healthy. Recently she was suffering ill (fever, sleepless at night, body pain, etc.) thus visited a doctor (physician). After a physical examination and studying certain blood tests (that he was suggested to test), the physician advised us to consult with a hematologist ASAP. Soon, we consulted with hematologist. He advised us to check certain tests such as protein electrophoresis and free light chain, HbA1c, LFT, USG abdomen and pelvis. He also pointed out that she may undergo bone marrow examination subject to test results. The reports are as follows. We shall see the hematologist by next week. Before meeting him, we wish to know an expert opinion about the interpretation of the test results and further course of action.HbA1c- 6.65, bilirubin- 1.5, bilirubin direct- 1, SGOT-54, SGPT-30, alkaline phosphatase 04-304, T protein- 7.1, S. albumin- 3.8, S. globulin- 3.3, calcium- 8.3, phosphorus- 3, uric acid- 6.1. USG remarks ### Response: Hello, Welcome to Chat Doctor forum. Your electrophoresis report shows increased gamma globulin level (attachment removed to protect patient identity). So your doctor might suspect plasma cell dyscrasia, especially multiple myeloma like condition. So referred you to a hematologist. But in electrophoresis report, M band is not seen which is classically seen in plasma cell dyscrasia. Moreover, Kappa to Lamba chain ratio is normal in the report. So, the chance of multiple myeloma seems to be less. But increased gamma globulin need further work up in form of CBC, serum calcium level, etc. In the case of multiple myeloma, the osteolytic bone lesion is also present. For that X-ray can be done in the suspected area. The gamma globulin increased in infection or inflammation as well. So your physical examination is necessary. Moreover, your cirrhosis with portal hypertension needs treatment in the form of beta blocker to reduce portal hypertension. The elevated bilirubin can be due to liver damage by cirrhosis.

Hello doctor,I am writing this letter for my mother-in-law. She is 65 years old and seems to be healthy. Recently she was suffering ill (fever, sleepless at night, body pain, etc.) thus visited a doctor (physician). After a physical examination and studying certain blood tests (that he was suggested to test), the physician advised us to consult with a hematologist ASAP. Soon, we consulted with hematologist. He advised us to check certain tests such as protein electrophoresis and free light chain, HbA1c, LFT, USG abdomen and pelvis. He also pointed out that she may undergo bone marrow examination subject to test results. The reports are as follows. We shall see the hematologist by next week. Before meeting him, we wish to know an expert opinion about the interpretation of the test results and further course of action.HbA1c- 6.65, bilirubin- 1.5, bilirubin direct- 1, SGOT-54, SGPT-30, alkaline phosphatase 04-304, T protein- 7.1, S. albumin- 3.8, S. globulin- 3.3, calcium- 8.3, phosphorus- 3, uric acid- 6.1. USG remarks

Hello, Welcome to Chat Doctor forum. Your electrophoresis report shows increased gamma globulin level (attachment removed to protect patient identity). So your doctor might suspect plasma cell dyscrasia, especially multiple myeloma like condition. So referred you to a hematologist. But in electrophoresis report, M band is not seen which is classically seen in plasma cell dyscrasia. Moreover, Kappa to Lamba chain ratio is normal in the report. So, the chance of multiple myeloma seems to be less. But increased gamma globulin need further work up in form of CBC, serum calcium level, etc. In the case of multiple myeloma, the osteolytic bone lesion is also present. For that X-ray can be done in the suspected area. The gamma globulin increased in infection or inflammation as well. So your physical examination is necessary. Moreover, your cirrhosis with portal hypertension needs treatment in the form of beta blocker to reduce portal hypertension. The elevated bilirubin can be due to liver damage by cirrhosis.

### Instruction: Answer this question truthfully ###Input: Hello doctor,Six months ago, following a mild concussion, I started to have symptoms that were vaguely consistent with bilateral cervical radiculopathy. The cervical MRI showed severe stenosis and disc herniation at the C6-7 level going right and C5-6 going left. The worst symptoms were numbness, tingling, and weakness down the left arm. These symptoms really did not follow the C5-6 dermatome, however. They were all over the place in the left arm.Six months later, the numbness and tingling have resolved. I feel stronger overall. However, I have had body-wide fasciculations for four months. And I can see wasting of the first dorsal interossei muscle of the left hand. It is subtle, but I notice it. I have trouble holding a pot or a phone with elbow bent past 90 degrees.I have seen two neurologists including one neuromuscular specialist at an academic center. Both EMGs were clean. They needed the dorsal interossei muscle and all the other major muscles of the left arm. Clinical exams were also normal though benign fasciculations were noted. How do I know that I do not have ALS? What are the chances that these fasciculations are benign given the perceived weakness, atrophy, and fasciculations (body-wide)? How long does it take after the beginning of atrophy for an EMG to pick up ALS? What else could this be? Would not it be odd to develop ulnar neuropathy, worsening rotator cuff issues and bodyside fasciculations at the same time? I am not a doctor, but these seem like system wide problems.Currrently, I am taking Lamictal, Zaleplon and Lipitor. ### Response: Hi, Welcome to ChatDoctor. It is highly unlikely that the EMGs (electromyography) are clean in the presence of muscle wasting and fasciculations. I believe the symptoms and signs you are experiencing are due to cervical stenosis and not due to ALS. A C6-7 disc herniation can cause all the symptoms you have described. Is it possible for you to upload the MRI (magnetic resonance imaging) pictures? In ALS (amyotrophic lateral sclerosis), usually, EMG findings precede clinical symptoms such as fasciculations and muscle wasting. This is also the case in radiculopathy due to cervical stenosis. Take care.

Hello doctor,Six months ago, following a mild concussion, I started to have symptoms that were vaguely consistent with bilateral cervical radiculopathy. The cervical MRI showed severe stenosis and disc herniation at the C6-7 level going right and C5-6 going left. The worst symptoms were numbness, tingling, and weakness down the left arm. These symptoms really did not follow the C5-6 dermatome, however. They were all over the place in the left arm.Six months later, the numbness and tingling have resolved. I feel stronger overall. However, I have had body-wide fasciculations for four months. And I can see wasting of the first dorsal interossei muscle of the left hand. It is subtle, but I notice it. I have trouble holding a pot or a phone with elbow bent past 90 degrees.I have seen two neurologists including one neuromuscular specialist at an academic center. Both EMGs were clean. They needed the dorsal interossei muscle and all the other major muscles of the left arm. Clinical exams were also normal though benign fasciculations were noted. How do I know that I do not have ALS? What are the chances that these fasciculations are benign given the perceived weakness, atrophy, and fasciculations (body-wide)? How long does it take after the beginning of atrophy for an EMG to pick up ALS? What else could this be? Would not it be odd to develop ulnar neuropathy, worsening rotator cuff issues and bodyside fasciculations at the same time? I am not a doctor, but these seem like system wide problems.Currrently, I am taking Lamictal, Zaleplon and Lipitor.

Hi, Welcome to ChatDoctor. It is highly unlikely that the EMGs (electromyography) are clean in the presence of muscle wasting and fasciculations. I believe the symptoms and signs you are experiencing are due to cervical stenosis and not due to ALS. A C6-7 disc herniation can cause all the symptoms you have described. Is it possible for you to upload the MRI (magnetic resonance imaging) pictures? In ALS (amyotrophic lateral sclerosis), usually, EMG findings precede clinical symptoms such as fasciculations and muscle wasting. This is also the case in radiculopathy due to cervical stenosis. Take care.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am 29 years old. What would be the specific symptoms of alcoholic neuropathy? I am having some nerve issues, they conducted two separate neurological exams (no conductivity testing just the general exam) but the neurologist did not find anything abnormal. I am a mild to moderate drinker and have been drinking for about six years. I do not binge drink or drink more than a glass or two of alcohol every other day or so. I eat very healthfully and work out. I have had all sorts of bloodwork and nothing has come up (Ac1, B12, thyroid, etc.). My MRI is scheduled in five weeks to rule anything else out.Doctor says my symptoms are anxiety but want to make sure. Symptoms include some weakness in my hands when I wake up, tremors at night, feelings that have changed over time in my feet. No official pins or needles, just some general \"strange\" feelings in my feet that come and go and change from foot to foot. I only had a feeling of burning in my feet twice. Sometimes there is a region that feels like there is something in my shoe. This has all come up in the past two months. Would alcoholic neuropathy take longer? Will it have more consistent symptoms? Will it show up on a neuro exam?The neurologist insists that I do not need conductivity testing. I just want to rule out alcohol before I drink anything again. It seems like from the literature I have read that alcoholic neuropathy develops after a lot of drinking and poor nutrition. And it seems to be pain that is constant that develops first. Is it true? I am currently taking Spironolactone, Yaz, and Urex. ### Response: Hello. I read carefully your question and would explain that your symptoms are not typical of alcoholic neuropathy. Anyway, tremor is very common after years of alcohol intake. I would first recommend checking vitamin B1 plasma levels and vitamin D plasma levels for possible deficiency. I agree with your neurologist, on the fact that when reflexes are present we can exclude peripheral neuropathy. But sometimes, single-fiber EMG (electromyography) would give more information on possible small fiber neuropathy. In the meantime, I would recommend taking magnesium supplements in order to help to improve your situation. You should discuss it with your doctor on the above tests. I hope this helps.

Hello doctor,I am 29 years old. What would be the specific symptoms of alcoholic neuropathy? I am having some nerve issues, they conducted two separate neurological exams (no conductivity testing just the general exam) but the neurologist did not find anything abnormal. I am a mild to moderate drinker and have been drinking for about six years. I do not binge drink or drink more than a glass or two of alcohol every other day or so. I eat very healthfully and work out. I have had all sorts of bloodwork and nothing has come up (Ac1, B12, thyroid, etc.). My MRI is scheduled in five weeks to rule anything else out.Doctor says my symptoms are anxiety but want to make sure. Symptoms include some weakness in my hands when I wake up, tremors at night, feelings that have changed over time in my feet. No official pins or needles, just some general \"strange\" feelings in my feet that come and go and change from foot to foot. I only had a feeling of burning in my feet twice. Sometimes there is a region that feels like there is something in my shoe. This has all come up in the past two months. Would alcoholic neuropathy take longer? Will it have more consistent symptoms? Will it show up on a neuro exam?The neurologist insists that I do not need conductivity testing. I just want to rule out alcohol before I drink anything again. It seems like from the literature I have read that alcoholic neuropathy develops after a lot of drinking and poor nutrition. And it seems to be pain that is constant that develops first. Is it true? I am currently taking Spironolactone, Yaz, and Urex.

Hello. I read carefully your question and would explain that your symptoms are not typical of alcoholic neuropathy. Anyway, tremor is very common after years of alcohol intake. I would first recommend checking vitamin B1 plasma levels and vitamin D plasma levels for possible deficiency. I agree with your neurologist, on the fact that when reflexes are present we can exclude peripheral neuropathy. But sometimes, single-fiber EMG (electromyography) would give more information on possible small fiber neuropathy. In the meantime, I would recommend taking magnesium supplements in order to help to improve your situation. You should discuss it with your doctor on the above tests. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 30-year-old unmarried male. I am sexually active and I have been using commercial sex workers for the past few years. However, from last year, I started myself getting tested regularly for different STD infections etc. and all my reports have come negative. I have got HIV 1 and 2, hepatitis B, syphilis (VDRL) and HSV 1 and 2 tests done. The point of attention is the recent test result that I just got today. My HIV, hepatitis B, VDRL are all negative as usual. My HSV 1 IgG, HSV 1 IgM, HSV 2 IgM are all negative but my HSV 2 IgG is positive with a value of 3.61. Also, another problem is this specific jock itch type of infection that I am facing for the past two months. It itches terribly. I have tried all creams like itch guard, ring guard etc. but I get relief only by applying Betadine ointment on it two times a day. Betadine is helping me to ooze off my terrible itch in that area but the condition of the skin and symptom of the infection is continuously going on. I have clicked snaps of all my test reports and also I have clicked about three pictures of my infection in my thighs close to my penis. I am sending all these pictures in a hope that you would treat me only to have let me get a kind true genuine consultation. Please go through these pictures of my infection and all my test reports and then please answer my queries. Do I have active herpes? Can I transmit herpes to my future wife? Can this infection go to my child when I impregnate my wife? Can this herpes IgG count of 3.61 be forced to roll back to below 1.20 so that I can become normal using some medicines? What is this infection in my thigh area? Can it be cured permanently? What medicines and ointments etc. will I have to take to solve my problem? Please go through my questions, reports, and snaps nicely and then let me have your expert opinion. ### Response: Hello, Welcome to Chat Doctor forum. I have gone through your reports and clinical photographs (attachment removed to protect patient identity). Best regards. For more information consult a cosmetologist online

Hello doctor,I am a 30-year-old unmarried male. I am sexually active and I have been using commercial sex workers for the past few years. However, from last year, I started myself getting tested regularly for different STD infections etc. and all my reports have come negative. I have got HIV 1 and 2, hepatitis B, syphilis (VDRL) and HSV 1 and 2 tests done. The point of attention is the recent test result that I just got today. My HIV, hepatitis B, VDRL are all negative as usual. My HSV 1 IgG, HSV 1 IgM, HSV 2 IgM are all negative but my HSV 2 IgG is positive with a value of 3.61. Also, another problem is this specific jock itch type of infection that I am facing for the past two months. It itches terribly. I have tried all creams like itch guard, ring guard etc. but I get relief only by applying Betadine ointment on it two times a day. Betadine is helping me to ooze off my terrible itch in that area but the condition of the skin and symptom of the infection is continuously going on. I have clicked snaps of all my test reports and also I have clicked about three pictures of my infection in my thighs close to my penis. I am sending all these pictures in a hope that you would treat me only to have let me get a kind true genuine consultation. Please go through these pictures of my infection and all my test reports and then please answer my queries. Do I have active herpes? Can I transmit herpes to my future wife? Can this infection go to my child when I impregnate my wife? Can this herpes IgG count of 3.61 be forced to roll back to below 1.20 so that I can become normal using some medicines? What is this infection in my thigh area? Can it be cured permanently? What medicines and ointments etc. will I have to take to solve my problem? Please go through my questions, reports, and snaps nicely and then let me have your expert opinion.

Hello, Welcome to Chat Doctor forum. I have gone through your reports and clinical photographs (attachment removed to protect patient identity). Best regards. For more information consult a cosmetologist online

### Instruction: Answer this question truthfully ###Input: Hello doctor,I have rheumatoid arthritis. There is a long waiting list to see a rheumatologist in my place. I am thinking of seeing a private doctor but I have limited funds. How often would I need to see a rheumatologist? I cannot afford it every week or maybe every few months. How often do you think I need a doctor visit? I am hoping to be prescribed a DMARD like Methotrexate. Then when my slot comes up with the NHS I will go there.I take Naproxen which is not enough and I had a cortisone injection in my knee a couple of months ago. The swelling did not go down completely but I walked better. It has worn off now, and I have pain in more joints and a feeling of lumps under my feet. I am on a special diet and my CRP, ESR and high rheumatoid factor have gone down by half. But lately, I feel unwell. I would like to know the frequency of visits needed. ### Response: Hello, Welcome to Chat Doctor forum. I have gone through your history. The only part I did not get was, that how come there have been no DMARDs (disease-modifying anti-rheumatic ChatDoctor. It is a bit unusual. If you could throw some light on the history of arthritis, it would be helpful. If it was an intermittent one initially, or now it has become persistent? Well, as per the treatment, if it is confirmed rheumatoid arthritis, they will start you on Methotrexate straight away. The follow-up visits are usually within four to six weeks for the first time, and then after three months. But a lot depends on your treating rheumatologist. Most of them advise liver function tests after two weeks to see if the dose is not giving you side effects. But that can usually be followed up with rheumatology nurse. So once you are through with first visit and improvement comes, then a three months visit suffices. But if the disease keeps bouncing back, then a bit more frequent visits are needed. But hardly before six weeks as that much time, it takes for any new DMARD to act. So it is a bit tough to predict, but do not worry. No rheumatologist will call you back in a week or two. I hope this helps.

Hello doctor,I have rheumatoid arthritis. There is a long waiting list to see a rheumatologist in my place. I am thinking of seeing a private doctor but I have limited funds. How often would I need to see a rheumatologist? I cannot afford it every week or maybe every few months. How often do you think I need a doctor visit? I am hoping to be prescribed a DMARD like Methotrexate. Then when my slot comes up with the NHS I will go there.I take Naproxen which is not enough and I had a cortisone injection in my knee a couple of months ago. The swelling did not go down completely but I walked better. It has worn off now, and I have pain in more joints and a feeling of lumps under my feet. I am on a special diet and my CRP, ESR and high rheumatoid factor have gone down by half. But lately, I feel unwell. I would like to know the frequency of visits needed.

Hello, Welcome to Chat Doctor forum. I have gone through your history. The only part I did not get was, that how come there have been no DMARDs (disease-modifying anti-rheumatic ChatDoctor. It is a bit unusual. If you could throw some light on the history of arthritis, it would be helpful. If it was an intermittent one initially, or now it has become persistent? Well, as per the treatment, if it is confirmed rheumatoid arthritis, they will start you on Methotrexate straight away. The follow-up visits are usually within four to six weeks for the first time, and then after three months. But a lot depends on your treating rheumatologist. Most of them advise liver function tests after two weeks to see if the dose is not giving you side effects. But that can usually be followed up with rheumatology nurse. So once you are through with first visit and improvement comes, then a three months visit suffices. But if the disease keeps bouncing back, then a bit more frequent visits are needed. But hardly before six weeks as that much time, it takes for any new DMARD to act. So it is a bit tough to predict, but do not worry. No rheumatologist will call you back in a week or two. I hope this helps.

### Instruction: Answer this question truthfully ###Input: Hello doctor,I am a 36 year old, otherwise healthy (as far as I know) female.I was a smoker earlier. No history of heart disease.My mother has COPD, but has been a long time smoker. Two and a half weeks ago, I went on a hayride with my sons.I have a short stature. To get on and off the hayride, I literally had to pull myself up onto the trailer. (Imagine pulling yourself out of a swimming pool).The next morning, I woke up with chest soreness.I had pain in the upper left chest area, a few inches to the left of sternum.That was a radiating pain over the breast towards armpit.Pain worsened on bending over.Also, I could locate very tender spots when pressing on the area with fingers.I had no pain during regular breathing, but very deep breaths caused pain to worsen (from the left of sternum radiating across and to the left breast). Over the past two and a half weeks, pain has improved, but still not completely subsided.Most of the pain (while bending) is gone, but I still have tender areas across upper left chest when poking around with finger (trigger points?).I have some minor discomfort on taking deep breath, but greatly improved from what it was.And now pain is just in an area to the left of my left breast.Now, pain is mostly towards armpit area and may be slightly radiating to the upper, bottom side of arm.I do not have much pain as it was in the beginning, but more of soreness.It is not constant, it occurs mostly just when I move in a certain way or tense my chest.Also I am noticing upper left back discomfort, not really pain. Local FNP suspects strained muscle. No x-rays were done.I have no cough, no shortness of breath, no loss of appetite, no indigestion or heartburn.Otherwise I feel fine. My concern is that I still have some pain and discomfort after almost 3 weeks.Shouldn\\t a muscle strain be healed by now?I am a bit concerned as it may be something more serious than a strained muscle, perhaps pleurisy or costochondritis? ### Response: Hello, Welcome to Chat Doctor forum. You are right, muscular pain will not last so long. Pleurisy

Hello doctor,I am a 36 year old, otherwise healthy (as far as I know) female.I was a smoker earlier. No history of heart disease.My mother has COPD, but has been a long time smoker. Two and a half weeks ago, I went on a hayride with my sons.I have a short stature. To get on and off the hayride, I literally had to pull myself up onto the trailer. (Imagine pulling yourself out of a swimming pool).The next morning, I woke up with chest soreness.I had pain in the upper left chest area, a few inches to the left of sternum.That was a radiating pain over the breast towards armpit.Pain worsened on bending over.Also, I could locate very tender spots when pressing on the area with fingers.I had no pain during regular breathing, but very deep breaths caused pain to worsen (from the left of sternum radiating across and to the left breast). Over the past two and a half weeks, pain has improved, but still not completely subsided.Most of the pain (while bending) is gone, but I still have tender areas across upper left chest when poking around with finger (trigger points?).I have some minor discomfort on taking deep breath, but greatly improved from what it was.And now pain is just in an area to the left of my left breast.Now, pain is mostly towards armpit area and may be slightly radiating to the upper, bottom side of arm.I do not have much pain as it was in the beginning, but more of soreness.It is not constant, it occurs mostly just when I move in a certain way or tense my chest.Also I am noticing upper left back discomfort, not really pain. Local FNP suspects strained muscle. No x-rays were done.I have no cough, no shortness of breath, no loss of appetite, no indigestion or heartburn.Otherwise I feel fine. My concern is that I still have some pain and discomfort after almost 3 weeks.Shouldn\\t a muscle strain be healed by now?I am a bit concerned as it may be something more serious than a strained muscle, perhaps pleurisy or costochondritis?

Hello, Welcome to Chat Doctor forum. You are right, muscular pain will not last so long. Pleurisy

### Instruction: Answer this question truthfully ###Input: Hello doctor,My father is 65 years old. He has bipolar disorder for 40 years. He also has diabetes. He is taking medicine for high blood pressure.For a very long time, he took lithium 1000 mg and oxcarbazepine 900 mg. 2-3 episodes used to happen, normally of long manic spell followed by gloomy/not so active spell. He stopped lithium due to toxicity, as even low dose was toxic. He started 200 mg quetiapine at night. In manic spell, he used to take up to 30 mg aripiprazole for 2-3 months.Considering his age and other medical conditions, what should be the right combination of medicine? Is aripiprazole safe? (it is very effective in mania for him) Now he has stopped aripiprazole, and he is fine. But he is complaining of restlessness sometimes. He feels like not wanting to sit in a place. What should be given to him in this post mania phase? Please ask for any more details if you require. ### Response: Hi, Welcome to Chat Doctor forum. I have read through your query in detail. Please find my observations below. Medicines for mental health conditions should be taken under the strict supervision of the psychiatrist. As mentioned above, lithium toxicity is a serious concern and it is good that you have stopped lithium due to toxicity. Quetiapine is an atypical antipsychotic medication and studies have shown that it is a safe and effective medication for the elderly. The side effects are less when the patient takes Quetiapine. Transient hypotension, dizziness, and somnolence are the only side effects in patients and is seen rarely. Long term use of Quetiapine has shown no serious side effects in the elderly. Aripiprazole is good medicine but might cause agitation and activation in about 8 percent of elderly people who take it. Studies show that in most patients Aripiprazole can be continued at a dose of 10 to 15 mg/day. Aripiprazole has less metabolic side effects than other medicines. Side effects of Aripiprazole include dizziness, weakness, lightheadedness, nausea, vomiting, stomach upset, tiredness, excess saliva or ChatDoctor.

Hello doctor,My father is 65 years old. He has bipolar disorder for 40 years. He also has diabetes. He is taking medicine for high blood pressure.For a very long time, he took lithium 1000 mg and oxcarbazepine 900 mg. 2-3 episodes used to happen, normally of long manic spell followed by gloomy/not so active spell. He stopped lithium due to toxicity, as even low dose was toxic. He started 200 mg quetiapine at night. In manic spell, he used to take up to 30 mg aripiprazole for 2-3 months.Considering his age and other medical conditions, what should be the right combination of medicine? Is aripiprazole safe? (it is very effective in mania for him) Now he has stopped aripiprazole, and he is fine. But he is complaining of restlessness sometimes. He feels like not wanting to sit in a place. What should be given to him in this post mania phase? Please ask for any more details if you require.

Hi, Welcome to Chat Doctor forum. I have read through your query in detail. Please find my observations below. Medicines for mental health conditions should be taken under the strict supervision of the psychiatrist. As mentioned above, lithium toxicity is a serious concern and it is good that you have stopped lithium due to toxicity. Quetiapine is an atypical antipsychotic medication and studies have shown that it is a safe and effective medication for the elderly. The side effects are less when the patient takes Quetiapine. Transient hypotension, dizziness, and somnolence are the only side effects in patients and is seen rarely. Long term use of Quetiapine has shown no serious side effects in the elderly. Aripiprazole is good medicine but might cause agitation and activation in about 8 percent of elderly people who take it. Studies show that in most patients Aripiprazole can be continued at a dose of 10 to 15 mg/day. Aripiprazole has less metabolic side effects than other medicines. Side effects of Aripiprazole include dizziness, weakness, lightheadedness, nausea, vomiting, stomach upset, tiredness, excess saliva or ChatDoctor.